# MHApps BPD – Understand The Contemporary Thinking About The Condition – BPD EUPD GP Health Care Professional Information

2 Condition
GP

- 2. Understand the contemporary thinking about the condition Our personality is the sum of our personality traits which are enduring patterns of perceiving, relating to and thinking about the environment and ourselves, and which are exhibited in a wide range of important social and personal contexts. Our personality traits describe the way we adapt to our world. When the personality traits are inflexible and maladaptive and cause the individual significant functional impairment or subjective distress, that individual can be said to have a Personality Disorder.
- BPD / EUPD has been closely linked with a history of childhood trauma – most have suffered pre-adolescent physical, emotional and/or sexual abuse; often perpetrated by someone close to them and who they trusted. For many, the coping with the trauma results in an arrest in the acquisition of normal emotional development, followed by idiosyncratic, often inappropriate, problem solving strategies in emotional situations. An individual with BPD / EUPD can be viewed, therefore, as someone whose environment did not afford them the normal opportunities to learn to live adaptively within our society. In extreme circumstances such as prolonged childhood sexual abuse, where secrecy was paramount, some individuals who later present with BPD / EUPD were deliberately taught the wrong things about their emotions and how to cope by the perpetrator; the lack of knowledge about the situation by other adults prevented corrective emotional training.
- What is known about the likely cause is that there seems to be a combination of:
  - 1. Biological irregularity resulting in an oversensitive, over-reactive emotional response system and problems with attention control. Causative factors are often indefinable but could be associated with trauma, inadequate parent/infant interactions or genetic components. Physically this group react to emotional stimuli more quickly and strongly, and are slower to return to baseline than normal individuals.
  - 2. An invalidating environment. Childhood abuse is the most extreme invalidating environment but the effects of an environment where a child’s natural responses are pervasively rejected as invalid should never be underestimated. For example, when they say, “I'm sad”, they might be dismissed and told, “No you're not”. Their environment doesn’t teach them to label or express emotions in a ‘normal’ manner and this results in them getting many emotions, including anger, depression, pleasure and sadness, confused.
  - 3. Problems in regulating emotions. In addition to a highly reactive emotional response system, individuals with BPD / EUPD have an inability to modulate the resulting strong emotions and action. That is, they can't soothe themselves. They are often unable to inhibit inappropriate behaviour related to strong negative or positive emotions, or to refocus attention in the presence of strong emotion. It is important to remember that both extreme excitement and extreme fear can feel the same to them and can trigger such reactions.
- The high reactivity of the arousal system and the individual’s inability to modulate their emotions causes the difficulties in interpersonal relationships, self-image and control of thoughts, impulses and behaviours that are characteristic of BPD / EUPD.
  The most difficult manifestations of their distress are expressed through self harm and suicidal behaviours. They might do this to feel heard, to communicate the intensity of their distress, to elicit behaviours from others which will decrease their pain or distress and to express anger to others. The internal process that results in self harm arises from their need to: gain control over their inner experiences; replace an emotional pain with a physical one; make the emotion tangible and concrete; maintain a sense of integration so they can feel alive, centred and grounded and not ‘falling to pieces’; express anger towards themself and punish themself; and express hate towards their body.
  Self harm and suicidal behaviours are serious problems for the GP and others involved but are not actually problems for the person with BPD / EUPD. In their worlds, they are solutions to the pain and distress they are experiencing. You have to work out what the real problem is, rather than try and treat what is, in effect, a ‘solution’.
  It is sometimes assumed that their behavioural expression is an expression of their feelings, however this is not necessarily so. They actually have not learned to adequately express or meet their needs. It is a learned pattern of behaviour and so it can be changed with the right therapeutic interventions.

2 Condition
GP