Thanks for your great comment. I think unfortunately BPD is becoming a catch-all diagnosis for patients who can’t fit into any standard diagnostic pattern. This means the net is cast so wide, some people diagnosed do have BPD, others have similiar conditions like PTSD, others have something completely different. The problem with this lazy institutionalised thinking is it creates poor treatment plans. It’s much easier to evaluate a person’s symptoms as self-contained descriptions, rather than examine the context in which they’re happening. I don’t think mental health services have the time, resources or even basic commitment to really explore this. I wasn’t told anything — I had to learn it all myself.
As for the HPA axis being unregulated at birth I haven’t heard that — sounds interesting! I haven’t done any reading yet, but I do know Mentalisation Treatment is based on the work of Peter Fonagy who studied mother-infant bonding. He discovered empirically via clinical trials, that a failure in ‘mirroring’ (the baby smiles = the mother smiles etc) leads to a wider failure in ‘mentalisation’ (difficulty in reading the thoughts, beliefs, motives of self and other) that in turn creates a risk of getting BPD. According to Fonagy, children who become fearful of their parents/caregivers, will deliberately inhibit their capacity to mentalise to avoid thinking about their parents unconscious wish to harm them.