Borderline Personality Disorder: Who Burdens Who?

Parents of children with BPD who join two support groups are atypical.

Posted Jul 24, 2017

 Helicopter Wikiworld by I Greg Willaims, CC Attribute ShareAlike 2.0
Source: Wikimedia Commons: Helicopter Wikiworld by I Greg Willaims, CC Attribute ShareAlike 2.0

When families have members who exhibit signs and symptoms of borderline personality disorder, it naturally creates a lot of distress for everyone involved. So in such cases who has the bigger burden—the parents of the adult child with the disorder, or the adult child of such parents?

I had a telling experience while trying to get a paper published about how the parents of offspring with borderline personality disorder (BPD) give their adult children a lot of double messages (The instrument I used is described in a previous post). The experience indicated that the peer review process by which other practitioners review an article for scientific merit and accuracy may sometimes use, at least possibly, political considerations as much or more than scientific ones in deciding what should be published.

At the time, I belonged to, and was the treasurer for, a research group in psychiatry in the field of personality disorders that had editorial control of a journal, the Journal of Personality Disorders (JPD).

For the purposes of gaining more financial support for their organization and its research, this group of researchers had been cultivating very close relationships with two "support groups" for the parents of people diagnosed with BPD - Treatment and Research Advances National Association for Personality Disorders (TARA), and the National Education Alliance Borderline Personality Disorder (NEA-BPD). 

As readers of this blog must know by now, my take is that the disorder is produced and maintained by certain ongoing repetitive dysfunctional interpersonal interactions with patients' families-of-origin members, particularly with primary attachment figures like parents. My paper showed that adults with the disorder reported frequent ongoing double messages from their parents and other attachment figures. The results proved to be highly, highly significant: BPD patients reported significantly more contradictory responses than did both patients with other psychiatric disorders (p=.004) and "normals" (p=.003). And this was with a small sample size that makes the results even more impressive. 

Nonetheless, the JPD turned down it down. Flat out rejected it. Nonetheless, it was subsequently accepted for publication by a mainstream psychiatry journal with a broader readership, Comprehensive Psychiatry

I cannot prove it, of course, but I suspect that the reason the paper was rejected was because the group was cultivating the relationship with the parent support groups and did not want to take any chances on alienating them.

Further evidence for my suspicion took place a short time later, when I was one of the peer reviewers for a paper for the JPD by some other authors. This paper detailed what was said when the authors interviewed the members of the parent support groups about their "burdens" in having to deal with an adult child with the disorder—as if the parents had nothing to do with the child's problems in the first place.

Research has consistently shown that a history of significant physical and/or sexual child abuse is one of the most frequently-seen risk factors for the disorder—although without a doubt not all parents of people with BPD had been physically or sexually abusive. A significant minority of them, in fact, exhibit a rather virulent but not technically "abusive" version of highly over-involved, so called "helicopter" parenting.

Not only are these parents over-involved with their offspring, but they also feel they are burdened by them. And according to this study, by their own admission! This is the source of a borderline-creating double message, "I'm obsessed with you, but I feel that you are big burden." If children believe that their parents need their children to be burdensome, then that is what the children will become. Far be it for a child to deprive a parent of a cherished role.

So the children begin to act like burdens. After a while, it becomes difficult to tell who is doing what to whom to cause burdens, because the adult children and the parents feed into one another's dysfunctional behavior simultaneously. I refer to this phenomenon as dialectic causality. In reality, everyone in the family becomes a burden for everyone else.

My review of this other paper pointed out that the members of the support group who had been interviewed most likely fell into the over-involved rather than the abusive category parents of offspring with BPD. After all, parents who had, for example, sexually abused their children were highly unlikely to join a parent support group (except perhaps the False Memory Syndrome Foundation, which would support them in their denial). To point out one obvious reason why not, the members of the group, if they found out, might turn them in to the authorities.

Therefore, I recommended that the authors should mention that the sample they interviewed was highly likely to be a rather biased sample of parents with offspring showing symptoms of BPD and not representative of all of them.

The paper was eventually accepted and published—with, despite my recommendation, almost no mention of this irony at all!