Final Research Paper

Olivia McMillan-Roczniak

1266972

PSYC*1500

March 31, 2024

Borderline personality disorder (BPD) is a psychological disorder marked by consistent

challenges in balancing emotions, controlling impulses, navigating relationships, and

maintaining a strong sense of self (Mendez-Miller et al., 2022). Borderline personality disorder,

affecting approximately 6.4% of adults, often emerges in adolescents and is linked to many

adverse outcomes including educational and occupational difficulties, unstable relationships, and

increased risk of suicide (Bohus et al., 2021). Up to 10% of BPD patients commit suicide, a rate

almost 50% higher in the general population (Lieb et al., 2004). Addressing the risks associated

with individuals with BPD is increasingly important for taking the necessary precautions due to

the severity of the symptoms that environmental factors can cause. Environmental factors

significantly impact the progression and severity of Borderline Personality Disorder symptoms in

adulthood, with a particular focus on family dynamics, high stress and social support. In the

context of this paper, environmental factors refers to external influences including family

dynamics, high stressors, and social supports that can impact the progression and severity of

BPD. Family dynamics include examining the quality of relationships with parents, how neglect

and abuse can worsen the progression and severity of BPD and the role of inconsistent or

invalidating parental practices. High stress refers to how stressful life events can exacerbate

symptoms such as emotional dysregulation and impulsive behaviors. Social support refers to the

network of relationships and resources that provide emotional support to the individual.

Background

Family Dynamics

Childhood trauma and adversity have been consistently linked to BPD (Ibrahim et al.,

2017). Traumatic experiences in childhood can lead to struggles in emotional regulation and
developing a supportive self-image of themselves which is vital in adolescence and later in

adulthood (Pohl et al., 2020). 71% of individuals diagnosed with BPD report a childhood of

severe maltreatment (Ibrahim et al., 2017). Early intervention of this is crucial due to its

prevalence. (Pohl et al., 2020). Having adequate levels of self esteem is important for developing

mental resilience and dealing with stressful life events. Patients with BPD are expected to report

lower levels of self esteem and self compassion compared to healthy controls(Pohl et al., 2020).

This study aimed to investigate the role of self compassion and self esteem in individuals with

BPD, specifically in relation to childhood trauma and BPD symptom severity. A sample of 35

patients with BPD and 35 patients reporting healthy controls of self esteem and self

compassion(Pohl et al., 2020). Participants completed various measures and assessments

including BPD symptom severity, self compassion, self esteem, and childhood trauma (Pohl et

al., 2020). The results concluded that individuals with childhood trauma have significantly lower

levels of self compassion and self esteem compared to normal levels. The lack of self

compassion combined with adverse childhood experiences increases the severity of symptoms

within BPD. Individuals who have higher levels of self compassion and esteem are better

equipped to cope with past trauma, resulting in less severity of BPD symptoms(Pohl et al.,

2020). This study primarily relied on self-reported data, which could result in response bias(Pohl

et al., 2020). This can be influenced by how they perceive or want to present themselves.

Moreover, answering questions about personal experiences requires a certain amount of self-

awareness, which not all individuals may equally have. This makes it harder to be confident in

the accuracy of the data collected during the study and becomes more challenging to draw

conclusions about environmental factors related to the development and severity of BPD. This

leads to the question of, “what particular environmental factors contribute to the progression and
severity of BPD”. Since the study used self-reported data, it is vital to delve deeper into specific

environmental factors that contribute to the progression and severity of BPD. By using

longitudinal studies or observational studies, these can more accurately identify environmental

influences on BPD individuals. Secondly, the quality of relationships of the parent and child is

very important in the progression and severity of borderline personality disorder in adulthood

(Boucher et al., 2017). Parents who invalidate their child's emotions or experiences, can

contribute to the development and progression of BPD (Boucher et al., 2017). Insecure

attachment is greatly related to BPD including the the preoccupied, unresolved and fearful types

were the most likely attachment styles found in BPD patients. These insecure attachment types

stem from inconsistent or neglectful caregiving, where the child's emotional needs are

inconsistently met, resulting in struggles regulating emotions and forming stable relationships

(Boucher et al., 2017). The study conducted was a systematic review aimed at investigating the

parent-child relationship in individuals with borderline personality disorder. The results of the

review show consistent findings across multiple studies (Boucher et al., 2017). Individuals with

BPD experience a more dysfunctional parent child relationship by lower parental care and higher

parental overprotection compared to normal levels (Boucher et al., 2017). Therefore, it is very

important for positive care-giving experiences in the development and progression of BPD in

adulthood.

High stress

Stressful events can impact the progression and severity of borderline personality

disorder (Bourvis et al., 2017). Stressful experiences often trigger acute features of BPD

including cognitive distortion, intense anger, uncontrollable impulsivity, and self harm

behaviours, including suicide attempts(Bourvis et al., 2017). Studies have shown that BPD is an
unstable diagnosis. When studied with a dimensional approach, the less stable dimensions were

anger, suicidal attempts and impulsivity all behaviours that are strongly associated with stressful

situations (Bourvis et al., 2017). Moreover, personality disorders have high levels of neuroticism

and widespread psychosocial dysfunction, particularly in interpersonal relationships(Pagano et

al., 2004). Individuals with personality traits such as neuroticism is a common trait in personality

disorders including BPD in which they see and react to the world as threatening, problematic,

and distressing (Pagano et al., 2004). In addition, Individuals with BPD are shown to experience

elevated rates of life events over time compared to individuals without BPD(Pagano et al., 2004).

This shows they are more likely to encounter stressful situations, which add to the severity of

symptoms and progression of the disorder. The study looks into the impact of recent life events

on psychosocial functioning in patients with BPD. Stressful life events play a significant role in

crises that accentuate the clinical course of BPD and determine the need for treatment (Pagano et

al., 2004). Moreover, Individuals with BPD are found to have increased depressive symptoms

and episodes in response to stressful life events affecting the severity and progression of the

symptoms(Pagano et al., 2004). The study's limitations are the generalizability by primarily

recruiting participants from treatment clinics associated with specific sites, the study may bias

towards individuals who have access to mental health treatment(Pagano et al., 2004). This leads

to the question of, how does this study's focus on people from treatment clinics and its exclusion

of certain conditions impact our understanding of how environmental factors affect borderline

personality disorder severity?

Social Supports

Supportive environments are vital specifically in times of stress, to promote healthy

psychological functioning and potentially mitigate the severity of BPD symptoms (Elzy, 2011).
Social support can serve as a protective factor against the severe symptoms. BPD impacts

interpersonal relationships so building and maintaining supportive relationships is important for

improved interpersonal functioning and overall wellbeing for individuals with BPD. Individuals

with BPD struggle to regulate their emotions, which can result in unstable and intense

relationships which is why many individuals with BPD do not have many social supports (Elzy,

2011). Having social support can provide help against the emotion regulation by offering

validation, empathy and understanding which is crucial. This can provide stability and

consistency and help individuals with BPD navigate struggles of maintaining relationships as

well as reducing feelings of loneliness and social isolation (Elzy, 2011). Moreover, many

individuals with BPD have experienced childhood trauma and neglect from caregivers (Elzy,

2011). Having reliable social support helps to cope with past trauma and its ongoing effects.

Supportive relationships give a place for individuals to talk about experiences, express their

feelings and seek validation and comfort. This is vital for BPD individuals as without this social

support their symptoms can get worse and turn to lashing out in negative ways without anyone to

talk to. Furthermore, individuals with BPD are at risk for self-harming behaviors (Elzy, 2011).

At times of distress individuals with BPD are at increased risk of self harming behaviors such as

self-cutting and suicide attempts (Elzy, 2011). Social support can provide a protective factor to

avoid this from happening and provide alternative coping strategies and assistance during crises

(Elzy, 2011). Social support ultimately improves the quality of life for individuals struggling

with this disease. Individuals with BPD often struggle with maintaining relationships and feel

less socially connected compared to others (Schulze et al., 2022). An international study of 1,692

participants aged 18 and 65 conducted, emphasizes that individuals with BPD have small social

networks, disrupted relationships and are less satisfied with their support than others. (Schulze et
al., 2022). BPD individuals experience emotional abuse which is important in both childhood

trauma and BPD. Identity disturbance is common in BPD symptoms in which forming and

maintaining a stable sense of self is difficult (Schulze et al., 2022). Social support is a crucial

factor in this study, with perceived social support from friends and family this can play a

protective role against the adverse effects of childhood trauma and BPD symptoms (Schulze et

al., 2022).

Summary & Future directions

This paper has explored the impact of environmental factors on the progression and

severity of Borderline Personality Disorder (BPD), focusing on family dynamics, high stress and

social support. It has highlighted how childhood trauma, invalidating parental practices, stressful

life events and lack of social support contribute to the severity of BPD symptoms. Moving

forward, researchers should address the following unanswered or partially unanswered questions

to advance knowledge about BPD. Conducting longitudinal or observational studies to better

understand how specific environmental factors contribute to the progression and severity of BPD

over time. This will provide stronger evidence compared to depending on self-reported data and

allow for a deeper understanding of the environmental factors. Secondly, the focus on

participants from treatment clinics and exclusion of certain aspects may bias the understanding

of how environmental factors affect the progression and severity of BPD. Researchers should

aim to provide a more diverse sample to enhance the generalizability of findings. Overall, these

future directions are crucial for expanding knowledge about BPD and ultimately contribute to

more effective interventions and strategies for individuals suffering with BPD.

References
Bohus , M., Scoffers-Winterling, J., Sharp , C., Krause-Utz, A., Schmahl, C., & Lieb , K. (2021,
October 23). Borderline personality disorder. Lancet (London, England).
https://pubmed.ncbi.nlm.nih.gov/34688371/

Boucher, M.-È., Pugliese, J., Allard-Chapais, C., Lecours, S., Ahoundova, L., Chouinard, R., &
Graham, S. (2017). Parent-child relationship associated with the development of borderline
personality disorder: A systematic review. Personality and Mental Health, 11(4), 229–255.
https://doi.org/10.1002/pmh.1385

Bourvis, N., Aouidad, A., Cabelguen, C., Cohen, D., & Xavier, J. (2017, November 13). How do
stress exposure and stress regulation relate to borderline personality disorder?. Frontiers.
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.02054/full

Elzy, M. B. (2011). Examining the relationship between childhood sexual abuse and borderline
personality disorder: Does social support matter? Journal of Child Sexual Abuse, 20(3),
284–304. https://doi.org/10.1080/10538712.2011.573526

Ibrahim, J., Cosgrave, N., & Woolgar, M. (2017). Childhood maltreatment and its link to
borderline personality disorder features in children: A systematic review approach.
Clinical Child Psychology and Psychiatry, 23(1), 57–76.
https://doi.org/10.1177/1359104517712778

Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline
personality disorder. The Lancet, 364(9432), 453–461. https://doi.org/10.1016/s0140-
6736(04)16770-6

Mendez-Miller, M., Naccarato , J., & Radico , J. A. (2022, February 1). Borderline personality
disorder. American family physician. https://pubmed.ncbi.nlm.nih.gov/35166488/

Pagano, M. E., Skodol, A. E., Stout, R. L., Shea, M. T., Yen, S., Grilo, C. M., Sanislow, C. A.,
Bender, D. S., McGlashan, T. H., Zanarini, M. C., & Gunderson, J. G. (2004). Stressful life
events as predictors of functioning: Findings from the Collaborative Longitudinal
Personality Disorders Study. Acta Psychiatrica Scandinavica, 110(6), 421–429.
https://doi.org/10.1111/j.1600-0447.2004.00398.x

Pohl, S., Steuwe, C., Mainz, V., Driessen, M., & Beblo, T. (2020). Borderline personality
disorder and childhood trauma: Exploring the buffering role of self‐compassion and self‐
esteem. Journal of Clinical Psychology, 77(3), 837–845.
https://doi.org/10.1002/jclp.23070

Schulze, A., Cloos, L., Zdravkovic, M., Lis, S., & Krause-Utz, A. (2022, December 19). On the
interplay of borderline personality features, childhood trauma severity, attachment types,
and social support - borderline personality disorder and emotion dysregulation.
SpringerLink. https://link.springer.com/article/10.1186/s40479-022-00206-9