The Beginnings of Borderline Personality Disorder

By: Garry Cooper, LCSW
 

 

How early do attachment disorders and borderline personality disorders (BPD) begin? Given the constant interplay between neurological development and attachment between parent and child, when and how can interventions begin to reverse the development of such disorders? These are important questions that can reveal much about which treatments may be more effective and what kind of prognosis we can expect for people with BPD. Observational studies of 2-month old and 12-month old infants and brain scans of adults with BPD provide several clues.

A longitudinal study of mothers with BPD and their 2-month old infants provides a snapshot of the earliest effects of BPD mothers on their babies and dramatically illustrates babies’ sensitivity to subtle, unreliable empathic connections. The study also suggests, says lead researcher and child development psychologist Lisa Crandell, that early mother-infant psychotherapy might help alleviate the transmission of BPD.

The first stage of the study, reported in the September, 2003 British Journal of Psychiatry, looks at eight baby-BPD mother pairs and 12 psychologically healthy mothers and their babies. Researchers directed mothers to play face-to-face with their infants for two minutes without toys or props. Then they told mothers to stay silent and keep a still face for 90 seconds, without reacting to their infants. Then they resumed face-to-face play for another two minutes. Coders, blind to which mothers had BPD, then rated the babies’ faces and reactions during the three phases of the experiment.

The still-face regimen is frequently used in infant studies to explore how babies react to primary relationship stress. During still-face time, babies typically show signs of distress, such as increased heart rates, crying, and looking away from their mothers’ faces. Crandell found that during still-face time, babies with BPD mothers cried and fussed more, looked away from their mothers’ faces more frequently, and had more dazed and avoidant looks than the control infants. They also showed more difficulty recovering during the subsequent play period.

Crandell thinks she’s seeing the early effects of maternal BPD on infants’ social development. The dazed and avoidant looks suggest that during the stress of emotional abandonment, babies with BPD mothers feel more lost and confused, and they may be already learning that they can’t depend on the presence of an emotionally reliable mother to help them contain their powerful negative emotions.

But Crandell finds some hope in the study. Despite their greater distress, the infants of the BPD mothers still tried to reconnect with their mothers as many times as the control babies. She thinks that this indicates babies’ resilience in the face of what seems a gradually overpowering experience of confusion and empathic abandonment. Here’s where early intervention may play a key role. Crandell hopes that if therapists can help BPD mothers recognize how and when they disconnect, the mothers might be able to repair the empathic breaks more quickly and more often.

She points to the research of British psychologist Lynne Murray, who works with depressed mothers and their babies. Murray’s studies of both cognitive and psychodynamic short-term therapies that focus on mother-baby interactions find some success in improving mother-baby relationships and holds hope that longer therapy may show longer-lasting results. People with BPD aren’t always the easiest clients when the focus is working on themselves, but Crandell believes that mothers would do much better of the focus were on helping their babies. “I’ve never seen a BPD mother who doesn’t love her child and wants to be the best mother she can,” she says.

But early intervention is vital. In two follow-up studies of these babies and mothers at 10 and 12 months, the babies show much more impairment in their social development and in relating to their mothers. In the study of 12-month old infants and their mothers, reported in the 2005 Development and Psychopathology, Crandell and other researchers studied infants in the still face and the strange situation (in which a stranger walks into the room, talks to the mother, and then the mother walks out and leaves the infant with the stranger). In the still face, compared with control infants, the infants of mothers with BPD showed lower levels of “availability for positive engagement,” lower ratings of “behavior organization and mood state,” and a lower proportion of interpersonally directed looks that were positive. In the strange situation, a higher proportion (8 out of 10) of infants of BPD mothers were categorized as disorganized. In other words, it looks like by the age of one year old, babies of mothers with BPD are already trying less often than when they were younger, to reach out and connect when they feel emotionally abandoned or confused.

An experiment on adults with BPD by neuropsychologist Michael Posner suggests a link between psychodynamic and neurological factors in causing BPD. Posner finds that people with BPD, when given a purely cognitive task, experience more disorientation and conflict but a higher state of alertness than the control group. And their reaction times are the same. In other words, when confronted with challenges, even ones that don’t carry an emotional charge for others, people with BPD react quickly, yet feel negative and out of control.

In a paper on the December 10, 2002 Proceedings of the National Academy of Science, Posner describes his study of 39 people with BPD and 52 controls. Subjects watched a computer monitor with arrows pointing left or right. Their instructions were simply to match the direction of the marker arrows on the screen by pressing the left arrow or right arrow on their keyboards. Other arrows surrounded the marker arrows, sometimes pointing in the same direction as the marker arrows, making everything perfectly congruent, and sometimes pointing in distracting patterns, creating a visual and cognitive conflict.

Posner’s experiments arise from his long-time research at Cornell University on how young children normally learn to pay attention to certain stimuli and to ignore other stimuli. This crucial cognitive stage, which occurs between the ages of two and seven, is accompanied by the development of the anterior cingulate, the part of the brain believed to regulate conflicts between emotion and reason. Research suggests that by age seven, the anterior cingulated is fully formed—except in abused children.

Although people with BPD were about as accurate as controls in Posner’s study, they felt more out of control. Other studies have found that a sense of control is strongly associated with children’s capacity to develop empathy. Posner speculates that abused children, lacking this sense of control, don’t develop the empathy that leads to successful relationships. Thus, he thinks, the impaired development of the anterior cingulate and the negative feelings around potentially distracting stimuli lock children into a pattern of social isolation and negatively charged responses to conflict that may lead to adult BPD. Like Crandell’s findings, his study suggests the importance of psychotherapy with children and their BPD parents.

 
References

Crandell, LE, Patrick, MPH, and Hobson, P (2003). “‘Still-face’ interactions between mothers with borderline personality disorder and their 2-month-old infants,” British Journal of Psychiatry, 183, 239-247

Hobson, PR, Patrick, M, Crandell, L and Garcia-Perez, R (2005). “Personal relatedness and attachment in infants of mothers with borderline personality disorder,” Development and Psychopathology, 17 (2), 329-47

Murray, L and Andrews, L (2007). The Social Baby, Fond du Lac, WI: CP Publishing

Posner, MI, Rothbart, MK, Vizueta, N, Levy, KN, Evans, DE, Thomas, KM, and Clarkin, JF (2002). “Attentional mechanisms of borderline personality disorder,” in Proceedings of National Academy of Science, November 27, 2002, 10.1073/pnas.252644699. Available online at: https://www.pnas.org/cgi/content/abstract/252644699v1

 
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