From Childhoods Hour I Have Not Been As Others Were: 10 Risk Factors of BPD

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  1. Anxious-Ambivalent Attachment — A failure of mother-baby bonding leads to clingy children. Clingy children are at risk of a developing BPD. Communication errors, abound on both sides, and the result is an anxious-ambivalent attachment, where children will be terrified of new situations, extremely inhibited, and preoccupied with danger. When this pattern carries into adult life it can lead to interpersonal chaos, emotional dysregulation and poor sense of self. These can easily become personality traits, which have the psychiatrists reaching for the textbook.
  2. Bad parenting — A cliche is a cliche because it’s true. It goes without saying bad parenting can cause all sorts of mental health problems for children and adolescents. But what constitutes a bad parent? Besides abuse and neglect there are more subtle forms of mistreatment. A pushy, self-orientated parent who is over-involved in their son or daughters life, makes the latter vulnerable to BPD. Why? Because, when a child’s individuality is stifled, and their freedom of expression censored, it naturally leads to more extreme acts of self-autonomy and self-expression — including self-harm and suicide attempts.
  3. Chronic Stress — Let’s face it, life’s stressful. Whether it’s abuse, neglect, poverty, or bereavement, such events leave a mark. Chronic stress, however is particularly dangerous, because it literally changes the body’s chemistry. Children and adolescents, will have abnormally high levels of cortisol and adrenaline coursing through their bloodstream, and this leads to anxiety. Paradoxically in extreme states of agitation, a person can shut down completely — like the tonic immobility displayed by animals. If the environment is stressful the body responds accordingly, and from here all sorts of health problems follow.
  4. Impulsivity — A child with emerging borderline personality disorder, could be labelled as suffering ADHD or Oppositional Defiant Disorder. In fact, many labels speak of one condition. This isn’t simply misdiagnosis, because the core symptom of behavioural impulsivity remains the same. In other words, a child who acts out, seeks instant gratification, and demonstrates poor executive functioning, is at risk of developing a whole raft of mental health problems. However it is the environment, which determines whether a genotype of impulsivity, become the phenotype of Borderline Personality.
  5. Identity Disturbance. — The ‘Storied self’ as it sometimes called, is the narrative we spin about our lives in order to construct our identity. The tales we tell, leave a lasting impression on our psyche and create a sense of who we are as individuals in our community. Individuals with BPD often have complicated and convoluted autobiographies, In a story that’s all to familiar, if a person has material to make a book about their life, but gets unbalanced in the first chapter, it may point to a single acronym.
  6. Social Exclusion — A common mantra totes out: ‘What we think we become.’ It may be more accurate to say: ‘What others think is what we become.’ From the earliest days of infancy, we are socialised by the reactions of those around us. If a child or adolescent is unable to function, due to mental health problems, they may become withdrawn and isolated. Stigma and exclusion are killers. Without a network of trustworthy friends or family, a child or adolescent find’s their personality broken into fragments of conflicting feelings, which are impossible to make sense of. In order to get better, we must befriend the broken pieces of our personality, including the jagged bits, without which we’d remain alone.
  7. Misdiagnosis — ‘Iatrogenesis’ is a Greek word, meaning “brought forth by the healer,” and means therapy which makes a person more unwell than they were to begin with. BPD in the old days, used to be considered a ‘wastepaper basket diagnosis.’ Because of the lingering stigma, clinicians still tend to rubbish the label in favour of others: Autism, Schizophrenia, Bipolar, take your pick — Misdiagnosis leads to mistreatment. Even if we disagree with the name of the condition its important to know what we’re up against, and not just paper over the cracks.
  8. Self-harm — 60% of adolescents who repeatedly self-harm will go on to develop Borderline Personality Disorder. Whats the difference between a chance encounter with a blade, and a cut that goes deeper? The answer may simply be the reason for doing it. Individuals with BPD who self-harm, often report feeling extremely agitated, or completely numb, immediately prior to cutting. Attacking the body is, either the desire to escape pain, or affirm it. It really is blood sweat and tears from here on out, but in truth we don’t need them, with time even deep wounds heal over.
  9. Suicidal preoccupation — Trauma psychiatrist Bessel Van Der Kolk, wonders of his borderline patients, whether, ‘their suicidal ruminations had started when they were very young’ as a way to find ‘comfort in plotting their escape by hoping to die.’ If life is so bad, death becomes a refuge. A child who is helpless and afraid will fantasise of escape, but an adolescent who is angry and depressed, will simply want to die. Suicidal preoccupation is a defence against overwhelming distress, but it can lead to acting out. The only way to get better is by ripping up the escape plan, and drafting a plan of radical acceptance instead.
  10. No help — How many times does a person with Borderline Personality Disorder, have to present at A&E or the ER, before they are given any help? While too much intervention can reinforce the condition, too little can create it. Teaching a young person skills in emotional regulation, distress tolerance, interpersonal effectiveness, should be the responsibility of every adult. A timely intervention, can stop a troubled phase of youth, turning into a serious adult mental illness. In the absence of services, self-education, may be a sure way to rewrite the script. If you help yourself, one day at a time, your self will thank you for it later on.

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Freelance journalist writing on mental health and disability. Words have the power to shine a light on realities otherwise missed.

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