Family dynamics and development of borderline personality disorder

Nature versus nurture is a huge debate that will likely continue for centuries to come. Nature advocates state, “just as a sunflower grows in an orderly way – unless flattened by an unfriendly environment – so does the human grow in an orderly way” (Santrock, 2010, p.22). This sentence alone completely negates the nature-nurture debate. Stating that orderly growth can be flattened by an unfriendly environment further implicates that nurture has more of an impact on development than nature does. An individual’s biological inheritance will always be his or her biological inheritance. It is the way that it is nurtured that largely influences who he or she becomes. It is my intention to provide the reader with information regarding adolescents with either symptoms or a diagnosis of Borderline Personality Disorder, apply the theoretical orientation of Erik Erikson to facilitate my beliefs regarding this subject, and present an intervention strategy that I believe would assist in this escalating problem. My hypothesis is that if the family and the adolescent with Borderline Personality Disorder learn how to establish a functional lifestyle, the adolescent will be less likely to develop the severe, life-shattering symptoms of this disorder.

Literature Review

Theoretical Orientation

“Don’t laugh at a youth for his affectations; he is only trying on one face after another to find his own.” This quote by Logan Pearsall Smith briefly summarizes the general outcome desired in Erik Erikson’s Eight Stages of Psychosocial Development. Corey (2007) explains Erikson’s model as holistic, addressing humans inclusively as biological, social, and psychological beings. Erikson’s developmental theory describes human development over the entire life span in terms of various stages. He suggests that each stage is marked by a particular crisis that needs to be resolved (p.86).

Erikson’s stages begin in infancy and go through the remainder of life. He developed eight separate stages that signify a certain level of achievement. For healthy development to occur, it is necessary to establish a clear sense of our unique selves in the context of our connection with others at each stage of life (Corey, 2007, p.86). Larsen (2008) states that each stage represents a conflict, also known as a developmental crisis which needs to be resolved. Erikson also sustained the belief that fixations, meaning if the crisis was not successfully and adaptively resolved, then personality development could become arrested and the person would continue to be preoccupied by that crisis in development (p.334).

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Each stage is specified by a specific age range; however, when the crisis in each stage is not successfully resolved, it makes it difficult to enter the next stage at the same age that is expected. Corey (2007) identifies the four stages before the adolescent stage: trust versus mistrust, autonomy versus shame and doubt, initiative versus guilt, and industry versus inferiority. In the first stage, trust versus mistrust, the developmental crisis is to develop a sense of trust with the child’s caregiver between the ages of birth and one. The developmental crisis in the second stage is to gain autonomy, or emotional competence, between the ages of one and three. The developmental crisis in the third stage, initiative versus guilt, is to gain initiative in social interactions between the ages of three and six. The fourth stage, industry versus inferiority, identifies the developmental crisis as gaining a sense of industry between the ages of six and 12 (p.86-88) Corey also identifies the fifth stage which is known as identity versus identity confusion and is specific to adolescents between ages 12 and 20. The developmental crisis that should be mastered is gaining an identity (p.89). If Erikson believes humans are inclusively biological, social, and psychological beings, then his theoretical orientation supports my hypothesis that if the family and the adolescent with borderline personality disorder learn how to establish a functional lifestyle, the adolescent will be less likely to develop the severe, life-shattering symptoms of this disorder.

Identity

Females are more prone to a borderline diagnosis than males. Kreger (2005a) states that in the general population, 75% of the individuals diagnosed with borderline personality disorder are female (Statistics about BPD section, para. 1). The important question here is why BPD is more prevalent in females than males. There are multiple theories to this phenomenon. One indicates that women are more likely to seek professional help than men. Another is that “women experience more inconsistent and invalidating messages in this society” (Kreger, “Myths and Realities about BPD, 2005b). Santrock (2010) states that “gender development is influenced by biological, social, and cognitive factors” (p.168). The biological factors are related to pubertal changes; social factors are primarily derived from social experiences; and cognitive factors result from the intermingling of the child and the social environment (p.168-173). The social cognitive theory of gender supports my hypothesis. This theory accentuates that “children’s and adolescent’s gender development is influenced by their observation and imitation of others’ gender behavior, as well as by the rewards and punishments they experience for gender-appropriate and gender-inappropriate behavior” (Santrock, 2010, p.173). Adolescents experience many, many mixed messages that are constantly thrown at them as they develop. These mixed messages have the potential to do a large amount of damage. One skill that is important to develop during adolescence is emotion regulation and behavior regulation. Santrock identifies low self-control as being an antecedent of behavioral problems. Low self-regulation has been linked with “greater aggression, teasing of others, overreaction to frustration, low cooperation, and inability to delay gratification” (p.180). These behaviors are consistent with common borderline behaviors. Teaching emotion regulation skills is a crucial component in a specific therapy that will be used in my intervention strategy. Though my intervention will not be specifically targeted for adolescent females, it appears as if a majority of the clients being served will be female. Regardless of the gender being served, emotion regulation is crucial in the success of my intervention.

Moral Development

Interpersonal effectiveness is another target area in my intervention. The goal is to become more interpersonally effective in relationships; however, this may be more difficult for some than others. Those with a BPD diagnosis typically have difficulty in maintaining stable relationships. This deficit can be related to dysfunction in moral development. Moral development involves two dimensions: interpersonal and intrapersonal. The intrapersonal dimension is specific to one’s individual values and sense of self whereas the interpersonal dimensions is specific to what is expected of someone in their interactions with others (Santrock, 2010, p.236). Santrock identifies Lawrence Kohlberg as developing a theory on adolescents and their perceptions of right and wrong. Kohlberg’s theory involves three levels with two stages in each level. The first level, preconventional reasoning, involves stages one and two. Stage one is identified as punishment and obedience orientation (p.238). Moral thought processes in this stage are frequently congruent with punishment. Obedience is expected because parents request it. Stage two is identified as individualism, instrumental purpose, and exchange (p.238). This stage involves pursuit of individual interests and reciprocating that freedom to others. One example would be the golden rule which involves an equal exchange. Kohlberg’s second level, conventional reasoning, involves stages three and four. Stage three is labeled mutual interpersonal expectations, relationships, and interpersonal conformity (p.238). This stage is characterized by basing moral judgments on demonstrating trust towards others, caring for others, and remaining loyal towards others. Stage four is labeled social systems morality (p.238). This stage is basing moral judgments on the comprehension of social order, law, justice and duty. Kohlberg’s third level is known as postconventional reasoning which involves stages five and six. Stage five is known as social contract or utility and individual rights. This stage involves reasoning one’s values, principles, and rights as exceeding the law. Stage six is known as universal and ethical principles. This stage involves developing a moral standard with a basis on universal human rights. Personal risk is involved in this stage and requires an individual to determine if he or she will follow the law or his or her conscience in regards to human rights (p.239).

Stage two, preconventional reasoning, of Kohlberg’s theory is likely where borderline individuals adapt distorted thought patterns. The concept of pursuing one’s own interests is understandable to the borderline; however, allowing others to pursue their own interests becomes difficult. I attribute this to emotional dysregulation. Allowing others to pursue their own interests is not always difficult for the borderline. It only becomes difficult when the borderline is experiencing intense emotions and feels abandoned by the other person’s desire to pursue other interests. Stage three is also a difficult stage for borderline individuals to master. Borderlines do value the other individual’s trust, caring, and loyalty; however, their value of these characteristics is often taken to the extreme. If the other individual shows any sign of providing care towards others, the borderline can fluctuate between extreme idealizations and devaluations. Those with BPD will go to extreme measures in order to avoid being abandoned by someone important to them. Borderline individuals also struggle with interpersonal relationships. The thought of “impending separation from an important other person has a destabilizing effect on the mood, sense of self, thought patterns, and behavior”, even if this separation is imagined (Gunderson & Hoffman, 2005, p. 5). The alternating of idealization and devaluation of others is known as splitting. Melanie Klein identifies this phenomenon in her Object Relations Theory (Wasdell, 1980). Gunderson and Hoffman (2005) say that people with BPD often find themselves drawn towards others that are caring and loving. They often put the other person’s virtues and capacities on a pedestal. It is when that other person disappoints or hurts them in some way that “there can be a rapid shift to devaluating the other person, who now does not give or care nearly enough” (p. 5). These drastic changes of mood are often caused by the borderline thinking that he or she is being abandoned or rejected. When stages two and three of Kohlberg’s theory are dominated by such intense emotions, typical moral development is less likely to occur. Emotion regulation and interpersonal effectiveness are target areas in a specific therapy I will use in my intervention.