Etiology of BPD?

You might also want to take a look at my long list of psychological assessment tests used by clinicians to determine variables in individual personality.

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Models that Focus on the Interplay of Neurology/Environment

Because it is extremely hard to fully explain the development of human character (!), no single theory on the cause of personality disorders has been conclusively "proven."
Compare, for instance, these two recent articles:

1. Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study
by Yen S, Shea MT, Battle CL, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sanislow CA, Zanarini MC, Bender DS, Rettew JB, McGlashan TH., 2002
"Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events."

2. Nontraumatic Pathways to Borderline Personality Disorder
by Graybar, Steven R.; Boutilier, Lynn R., 2002
"Clinicians who treat borderline personality disorder (BPD) generally assume that this disorder is caused by childhood abuse. This assumption is strongly supported in the BPD literature, which indicates that the majority of individuals with BPD have suffered emotional, physical, and sexual abuse. What is often missed or simply ignored in discussions of BPD is that this same body of research also suggests that a significant minority of borderline individuals have not suffered childhood abuse. This article reviewed the literature on the prevalence of childhood abuse and BPD, offered a number of hypotheses about nontraumatic pathways to BPD, and briefly considered treatment implications for nontraumatized BPD individuals."

The models listed below emphasize the interplay between an inherited vulnerability, subsequent environmental experience and the corresponding development of neurobiogical changes that lead to cognitive distortions and perceptions. I find these to be the most satisfactory -- in particular models of BPD that read the symptoms of the mental disorder as the disorder itself. (For some provocative readings, see articles in this vein on Panic Disorder and Hallucinations).

"Young children, egocentric in their attributions, typically ascribe malevolent intentions to someone who hurts them regardless of actual intent ( Shantz, 1983 ); consequently, a child who cannot easily be soothed is likely to experience others as deliberately inducing distress. Such a child is likely, in turn, to respond with aggression, which leads to an escalating cycle of malevolent attributions, aggressive reactions, and angry or vengeful counterreactions. Similar difficulties could arise in children who are genetically or environmentally vulnerable to dysregulation of distress responses on separation from attachment figures. Separation, in that case, could lead to intense fear and rage and a belief that the other is leaving in order to hurt the child, not that hurting the child is an unwanted by-product of a separation motivated by other factors."
Lohr, Westen, Gold, & Silk, 199

An Equifinality Model of Borderline Personality Disorder
by Joseph Santoro, Ph.D., Michael Tisbe, M.D, Michael Katsarakes, 1997
Detailed and clearly written, one of the better articles I've seen on the causes of BPD. Describes a model in which biological "vulnerability" and childhood experience each play their part in the development of BPD. Santoro is the author of The Angry Heart and runs the Angry Heart Clinic for BPD in upstate NY.

What Causes Borderline Personality Disorder?
A great first essay to read on causality.
Compiled by Deb Martinson

Borderline Personality Disorder
by Anne Brown and Kristi Dodson 1999
Excellent overview of the way mental health professionals are thinking about BPD today. A NARSAD fact sheet.

The borderline diagnosis III: identifying endophenotypes for genetic studies
by Siever LJ, Torgersen S, Gunderson JG, Livesley WJ, Kendler KS., 2002
"Family aggregation studies suggest the heritability for BPD as a diagnosis, but the genetic basis for this disorder may be stronger for dimensions such as impulsivity/aggression and affective instability than for the diagnostic criteria itself."

A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena
by Russell Meares, Janine Stevenson, Evian Gordon
Excellent full-text article examining certain proposed theories. (PDF file, requires Adobe Acrobat or similar to read)

Researchers Discover Gene that Controls Learned Fear
Eric R. Kandel, MD, Dec. 13, 2002
(Read more on Kandel's important genetic research on the storage of memory here.)

Role of genotype in the cycle of violence in maltreated children
by Caspi A, McClay J, Moffitt TE, Mill J, Martin J, et al, 2002
"We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity to environmental insults."

Does childhood trauma cause personality disorders in adults?
by Joel Paris MD, 1998
From the abstract:

OBJECTIVE: To examine the relationship between trauma in childhood and personality disorders in adulthood. METHOD: A review of the literature was conducted. RESULTS: The reported associations between trauma and personality pathology are illuminated by the following research findings: 1) personality is heritable; 2) only a minority of patients with severe personality disorders report childhood trauma; and 3) children are generally resilient, and traumatic experiences do not consistently lead to psychopathology. CONCLUSIONS: The role of trauma in the personality disorders is best understood in the context of gene-environment interactions."

Pathways to the Development of Borderline Personality Disorder
Abstract of a study by Zanarini MC, Frankenburg FR., 1997
Research at MacLean Hospital, Mass, which runs a specialized BPD treatment program, produced a "tripartite model of the development of BPD [...] a traumatic childhood (broadly defined), a vulnerable (hyperbolic) temperament, and a triggering event or series of events."

The Biology of Borderline Personality Disorder
by Larry Siever, MD, 1997

The Neuropsychopharmacology of Personality Disorders
Excellent very detailed article by Emil F. Coccaro and Larry J. Siever.

Violence and Childhood: How Persisting Fear Can Alter the Developing Child's Brain
by Bruce D. Perry, M.D., Ph.D., 2001
Excellent article discussing the neurodevelopmental impact of childhood experience: fight-or-flight response, dissociation, etc.

PSYCHOTRAUMATOLOGY: A Two-Factor Formulation of Posttraumatic Stress
A really clear and excellent article detailing a model of the infinite "feedback loop" of neurological hypersensitivity and psychological hypersensitivity, by George S. Everey, Jr.
The site is in Portuguese, scroll down a bit to find the full-text Everey article in English.

Development of the Cerebral Cortex: Stress and Brain Development
by Paul J. Lombroso, M.D. and Robert Sapolsky, Ph.D, 1998
Excellent summary of the physiological damages of long-term stress on brain development (including the hippocampus/memory storage).

LeDoux Laboratory, New York University
Many research papers available on this site.
Worth the click just for the cool introductory amygdala visual alone -- move your mouse over the picture of the dude!

"According to the Public Health Service, about 50% of mental problems reported in the U.S. (other than those related to substance abuse) are accounted for by the anxiety disorders, including phobias, panic attacks, post-traumatic stress disorder, obsessive compulsive disorder, and generalized anxiety. Research into the brain mechanisms of fear help us understand why these emotional conditions are so hard to control. Neuroanatomists have shown that the pathways that connect the emotional processing system of fear, the amygdala, with the thinking brain, the neocortex, are not symmetrical - the connections from the cortex to the amygdala are considerably weaker than those from the amygdala to the cortex. This may explain why, once an emotion is aroused, it is so hard for us to turn it off at will. The asymmetry of these connections may also help us understand why psychotherapy is often such a difficult and prolonged process- it relies on imperfect channels of communication between brain systems involved in cognition and emotion."

Center for the Neuroscience of Fear and Anxiety, NYU

The Phelps Lab, Department of Psychology, NYU
This research group focuses on

"understanding how memory works in our lives and how this is represented in the brain, with a particular emphasis on emotion. Through our research we try to integrate what we know about human behavior with animal models of the neural basis of learning and memory. By combining traditional cognitive techniques with brain studies, we hope to get a better understanding of emotion's influence on human learning and memory from the behavioral and neuroanatomical perspectives."

Click on "Selected Papers" to read a host of relevant studies.

Can the Different Cerebral Hemispheres Have Distinct Personalities? Evidence and Its Implications for Theory and Treatment of PTSD and Other Disorders
This fascinating full-text article by Fredric Schiffer, M.D., 2000, works PTSD and related disorders into the 'two-brain' theory of the evolution of personality.

Introduction to Survival Strategies
A neo-Darwinian take on the evolution of certain bio-social stressors that determine personality dysfunction, by Paul Valent 1998

Integrated Defense System Overlaps as a Disease Model: With Examples for Multiple Chemical Sensitivity
by S.C. Rowat
This full-text article is very detailed, but if you scroll down a bit on this first page of it, it begins to make sense in the BPD/PTSD context: unique analysis of what role environmental pollutants might have in the development of brain disorders.

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Specific Studies of Brain Chemistry/Neurology/Genetics and Borderline Personality Disorder

A twin study of personality disorders
Abstract of a study of PDs in twins by Svenn Torgersen, Nov/Dec. 2000
which suggests that "Axis II personality disorders seem to be more strongly influenced by genetic effects than almost any Axis I disorder."

Neuropsychological Dysfunction In Borderline Children
A great full-text study of BPD and brain dysfunction by Julie A.C. Ellett
Explores and tests comorbidity with other neurological dysfunctions.

Familial transmission of DSM-III borderline personality disorder
Loranger AW, Oldham JM, Tulis EH., 1982
Older but interesting study:

"The relative of a borderline patient was about ten times more likely to have been treated for a borderline or borderlinelike personality disorder than was the relative of a schizophrenic or bipolar patient. The borderline patients' relatives were also treated for more unipolar depression than the schizophrenics' relatives. However, the relatives of the borderline patients did not have a higher morbid risk for treated mania or schizophrenia than that usually reported for the population at large."

Neural correlates of memories of abandonment in women with and without borderline personality disorder
Schmahl CG, Elzinga BM, et al, July 2003

THE BORDERLINE DIAGNOSIS II: BIOLOGY, GENETICS, AND CLINICAL COURSE
Skodol, Siever, Gundersen, et al, 1999
(pdf file; requires Adobe Acrobat to read)

Attentional mechanisms of borderline personality disorder
Posner MI, Rothbart MK, Vizueta N, Levy KN, Evans DE, Thomas KM, Clarkin JF., Dec 2002

"We consider whether disruption of a specific neural circuit related to self-regulation is an underlying biological deficit in borderline personality disorder (BPD).
Because patients with BPD exhibit a poor ability to regulate negative affect, we hypothesized that brain mechanisms thought to be involved in such self-regulation would function abnormally even in situations that seem remote from the symptoms exhibited by these patients. To test this idea, we compared the efficiency of attentional networks in BPD patients with controls who were matched to the patients in having very low self-reported effortful control and very high negative emotionality and controls who were average in these two temperamental dimensions.
We found that the patients exhibited significantly greater difficulty in their ability to resolve conflict among stimulus dimensions in a purely cognitive task than did average controls but displayed no deficit in overall reaction time, errors, or other attentional networks. The temperamentally matched group did not differ significantly from either group. A significant correlation was found between measures of the ability to control conflict in the reaction-time task and self-reported effortful control."

The role of the parietal lobe in borderline personality disorder
M. Swinton, 2002

"Many patients with a diagnosis of borderline personality disorder describe multi-modal hallucinations. A likely cortical origin for multi-modal hallucinations is the inferior parietal lobule. Neuropsychological testing of borderline personality disorder reveals deficits of visuospatial capacity; a function which is also localised to the inferior parietal lobule.
It is hypothesised that this brain area is likely to be dysfunctional in those patients with borderline personality disorder who have multi-modal hallucinations. A deficit in the inferior parietal lobe could plausibly explain a number of other clinical features; the gender dimorphism of this disorder, the lack of expressive gesture and the specific response to clozapine. More speculatively; the increased concern over this disorder over the past 40 years could result from the normal population showing an increase in functional ability in the parietal lobe, leaving patients with parietal deficits relatively more disabled."

Partial seizure-like symptoms in borderline personality disorder
by Catherine L. Harrisa, Wayne M. Dinn, and Jonathan A. Marcinkiewicz, Oct. 2002

Catechol O-methyltransferase genetic polymorphism in panic disorder
by Woo JM, Yoon KS, Yu BH., 2002
Suggests a specific genotype for panic disorder.

Enhanced intensity dependence as a marker of low serotonergic neurotransmission in borderline personality disorder
by Christine Norra, Monika Mrazek, et al, February 2003

Emotional processing in personality disorder
by Herpertz SC., Feb 2003

"In the field of personality disorders, borderline and antisocial types are associated with emotional dysfunctioning. In borderline personality disorder (BPD), the hypothesis of emotional hyperresponsiveness can be supported by several experimental studies that suggest highly intensive and slowly subsiding emotions to primed and non-primed stimuli, as well as by data showing biased information, which processes in the context of emotions. In addition, the first neuroimaging data suggest that limbic hypersensitivity is a neurofunctional correlate of emotional vulnerability in BPD. In antisocial psychopathic personality disorder, data confirm the theory of emotional detachment, subsuming fearlessness, and, beyond that, emotional indifference to appetitive stimuli. Because of a fundamental dysfunction in the amygdala, psychopathic individuals appear to use alternative cognitive operations of processing affective material to compensate for the absence of appropriate limbic input, which normally provides prompt information about the affective characteristics of stimuli."

5-HT1A dysfunction in borderline personality disorder
Hansenne M, Pitchot W, Pinto E, et al, July 2002

"The results show major involvement of serotonergic function in BPD and are consistent with previous studies linking lower serotonergic activity with impulsivity. More particularly, our data suggest that BPD is characterized by lower 5-HT1A receptor sensitivity. Moreover, the data support the involvement of 5-HT1A activity in suicidal behaviour."

Neuropsychological factors associated with borderline pathology in children
Full text article by Joel Paris, June 1999
From the article:

"Borderline pathology in children is a syndrome characterized by a combination of externalizing and internalizing symptoms, accompanied by cognitive deficits (Bemporad et al., 1987; Kernberg, 1997). Although these symptoms resemble adult borderline personality, it is not clear whether they represent a unique disorder or a heterogeneous group better described by other diagnoses (Petri and Vela, 1990). However, a long-term follow-up study (Lofgren et al., 1991) has shown that borderline pathology in children is a precursor of adult personality disorders."

Neuropsychological function in borderline personality disorder
by Swirsky-Sacchetti T, Gorton G, 1993

"The BPD group also was impaired significantly on motor skills, figural memory, complex visuomotor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients."

Pituitary-Adrenal and Autonomic Responses to Stress in Women After Sexual and Physical Abuse in Childhood
Full text of a study by by Christine Heim PhD, D. Jeffrey Newport MD, Stacey Heit MD, Yolanda P. Graham MD, et al, 1997-1999

"Severe stress early in life is associated with persistent sensitization of the pituitary-adrenal and autonomic stress response, which, in turn, is likely related to an increased risk for adulthood psychopathological conditions. This is the first human study to report persistent changes in stress reactivity in adult survivors of early trauma. The findings are remarkably consistent with findings from laboratory animal studies. There is evidence that central nervous system (CNS) corticotropin-releasing factor (CRF) systems are likely to mediate the association between early-life stress and the development of mood and anxiety disorders in adulthood. [...]
Women with a history of childhood abuse and a current major depression diagnosis exhibited a more than 6-fold greater ACTH response to stress than age-matched controls. [...] Future studies in survivors of childhood abuse should separate the effects of different kinds of abuse at different developmental stages and should explore potential reversibility of this biological stress vulnerability after psychotherapeutic and psychopharmacological intervention. Such findings may have important implications for the prevention and treatment of mood and anxiety disorders in survivors of early trauma. Much effort has recently been directed toward the development of CRF receptor antagonists for the treatment of depression and anxiety. The utility of CRF receptor antagonists in depression is currently being evaluated in an open-label clinical trial. Our findings suggest potential utility of such compounds for the prevention and treatment of psychopathological conditions related to early-life stress."

This article has a linked series of reference studies that might also be of great interest.

Serotonin transporter genetic variation and the response of the human amygdala
Hariri AR, Mattay VS, Tessitore A, et al, 2002
This intrigung study recently found that

individuals with one or two copies of the short allele of the serotonin transporter (5-HTT) promoter polymorphism, which has been associated with reduced 5-HTT expression and function and increased fear and anxiety-related behaviors, exhibit greater amygdala neuronal activity, as assessed by BOLD functional magnetic resonance imaging, in response to fearful stimuli compared with individuals homozygous for the long allele. These results demonstrate genetically driven variation in the response of brain regions underlying human emotional behavior and suggest that differential excitability of the amygdala to emotional stimuli may contribute to the increased fear and anxiety typically associated with the short SLC6A4 allele."

Depressive response to physostigmine challenge in borderline personality disorder patients
Steinberg BJ, Trestman R, Mitropoulou V, et al, 1997

A gender-specific association between the serotonin transporter gene and suicide attempts
Baca-Garcia E, Vaquero C, Diaz-Sastre C, et al, 2002

Subtle Prefrontal Neuropathology in a Pilot Magnetic Resonance Spectroscopy Study in Patients With Borderline Personality Disorder
Ludger Tebartz van Elst, M.D.,, et al, 2001

Serum cholesterol and leptin levels in patients with borderline personality disorder
Atmaca M, Kuloglu M, Tezcan E, Gecici O, Ustundag B., 2002

Biological nature of depressive symptoms in borderline personality disorder: endocrine comparison to recurrent brief and major depression
De la Fuente JM, Bobes J, Vizuete C, Mendlewicz J., 2002

Neurobehavioral study of borderline personality disorder
van Reekum R, Conway CA, Gansler D, White R, Bachman DL., 1993

"The existence of an "organic" subgroup of borderline personality disorder (BPD) has been postulated. This report is of a case-controlled, chart-review study of BPD. The control sample consisted of patients with a variety of psychiatric diagnoses. The study found that 81% of the patients with BPD and 22% of the control patients had a history of brain injury, either developmental (44%), acquired (58%) or both. Furthermore, there was a positive correlation between the summed number of developmental and acquired brain injuries and the score on the retro-Diagnostic Interview for Borderline. A pilot neuropsychological study showed that seven of nine subjects with BPD had evidence of frontal system dysfunction. These results help to support the hypothesized existence of an organic BPD subgroup."

Biologic markers in borderline personality disorder: a review
Abstract of a review by Lahmeyer HW, Reynolds CF 3rd, Kupfer DJ, King R., 1989

The role of dysregulated amygdalic emotion in borderline personality disorder
Abstract of research by F. M. Corrigan, A. Davidson, H. Heard, 1998-2000

"We hypothesize that the amygdaloid complex, and its connections with thalamus, cingulate cortex and insular cortex are critical in the development and maintenance of the disorder. If this is the case, peptides such as galanin, somatostatin and cholecystokinin will be the most important neurotransmitters, thus explaining the relative lack of efficacy of standard antipsychotic and antidepressant drugs."

The Chemistry of Personality
Web page. The nervous and endocrine system connection to personality.

Biological aspects of personality disorder
Nifty review of the correlation of BPD and epilepsy, among other disorders.

Decision Making and Neuropsychiatry
Shibley Rahman, Barbara J. Sahakia, et al. Trends in Cognitive Sciences , 2001, 5 :6:271-277
Abstract (full text requires paid registration):

"Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neuropsychiatric disorders such as mania, substance abuse and personality disorders. A neural network involving the orbitofrontal cortex, ventral striatum and modulatory ascending neurotransmitter systems has been identified as having a fundamental role in decision making and in the neural basis of neuropsychiatric diseases. This network accounts for the dissociations among decision-making deficits in different clinical populations. Ultimately, a more refined and sophisticated characterization of such deficits might guide the early diagnosis and cognitive and therapeutic rehabilitation of these patients."

Genetic Advances: Addition by Division
Report on research by Francis J. McMahon, M.D., 1997-2001
This is a very interesting study of the genetic heritability of affective disorders, and reports the discovery of differing genetic structures between Bipolar I (classic manic-depression) and Bipolar II (rapid cycling, with which BPD is often confused).
Here's an abstract of the research report itself.

Intrauterine and Birth Experiences: Birth, Drugs, and Violence. The Impacts and the Implications.
by Michael Odent MD., 1995

The Phenomenology of Social Withdrawal Following Brain Insult
Studies the relation between personality disorders and brain injury, by Roy Sugarman, 1999

Can Traumatic Brain Injury Cause Psychiatric Disorders?
Review of Robert van Reekum, M.D., F.R.C.P.C., Tammy Cohen, B.A.(H) and Jenny Wong, B.A.(H)

Suicide Prevention: Biochemistry offers some new clues
by Kristin Leutwyler, Scientific American 1999

The Physiology of Insight
by Elissa Ely, M.D., Psychiatric Times, September 1995
Frontal-lobe damage and lack of morality.

How do we put ourselves in someone else's shoes? : New brain mechanisms unveiled
Speculations on the neurochemical basis of empathy.

Cannabis (Marijuana) Use and Psychosis
by Louisa Degenhardt, PhD, and Wayne Hall, PhD, June 2002

Personality Disorder in Multiple Sclerosis Correlates With Cognitive Impairment

If applicable, you may also want to check out the articles on Traumatic Brain Injury & BPD.

FUNCTIONAL IMPAIRMENTS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDERS DEMONSTRATED BY NEUROSPECT HMPAO Tc 99 m IN BASAL CONDITIONS AND UNDER FRONTAL ACTIVATION
Cristi‡n Prado MD, Ismael Mena MD and Psych. Mar’a del Pilar Correa, 2000
A very interesting study that attempts to narrow down the specific locations in the brain contributing to BPD dysfunctionality.

COMPARATIVE FUNCTIONAL STUDY OF TWO PSYCHIATRIC PATHOLOGIES BY MEANS OF BRAINSPECT TC 99 HMPAO: MAJOR DEPRESSION AND BORDERLINE PERSONALITY DISORDER
Ismael Mena, Cristi‡n Prado Matte, Mar’a del Pilar Correa PS, 2001
Similar follow-up research.

Affective and impulsive personality disorder traits in the relatives of patients with borderline personality disorder
JM Silverman, L Pinkham, TB Horvath, 1991

Affective Responsiveness in Borderline Personality Disorder: A Psychophysiological Approach
Abstract of research by Sabine C. Herpertz, M.D., Hanns J. Kunert, Ph.D., Ulrich B. Schwenger, M.Eng., and Henning Sass, M.D., 1999
in which

"The results do not agree with the hypothesis that there is a fundamental, biologically based affective hyperresponsiveness in borderline personality disorder, as is suggested by current theories of affect dysregulation in the disorder. Autonomic underarousal may seriously interfere with a flexible adaptation to environmental stimuli."

Magnetic resonance imaging of hippocampal and amygdala volume in women with childhood abuse and borderline personality disorder
Abstract of a German study by Schmahl CG, Vermetten E, Elzinga BM, Douglas Bremner J., April 2003

Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study
Abstract of a first German study by Herpertz SC, Dietrich TM, Aug 2001

A brain MRI study in subjects with borderline personality disorder
Abstract of a study by Lyoo I.K.; Han M.H.; Cho D.Y., 1998

The Hippocampus Connection

Resonance Imaging of Women with BPD

Brain Regional -[11C]Methyl-L-Tryptophan Trapping in Impulsive Subjects With Borderline Personality Disorder
by Marco Leyton, Ph.D., Hidehiko Okazawa, M.D., Ph.D., Mirko Diksic, Ph.D., Joel Paris, M.D., et al. May 2001
Abstract of a study that suggests that the neurotransmission of serotonin is disturbed in BPD patients.

Temporal lobe volume in panic disorder--a quantitative magnetic resonance imaging study
by Marco Leyton, Ph.D., Hidehiko Okazawa, M.D., Ph.D., Mirko Vythilingam M, Anderson ER, Goddard A, et al., Aug 2000

"The mean volume of the left and right temporal lobes was significantly smaller in panic disorder compared to healthy subjects (16770+/-909 mm(3) vs. 18343+/-1740 mm(3)). This result was significant after controlling for differences in whole brain volume. There was no significant difference in volume of the hippocampus between patients and control subjects. These findings are consistent with smaller temporal lobe volume in panic disorder despite normal hippocampal volume."

Biological markers in borderline personality disorder: new perspectives
Abstract of research by Korzekwa M, Links P, Steiner M. 1993

Biology of Personality Disorders
Volume by Kenneth R. Silk, 1998.
A collection of essays summarizing the 'decade of the brain' in BPD research. Silk is a very well-known researcher on personality disorders at the University of Michigan, Ann Arbor.

Borderline and Beyond's Research Room
Laura Paxton also keeps files relating to recent research on BPD

A lengthy abbreviated summary of clinical research on BPD from 1991-1995

A nice little collection of summaries of 1999 BPD clinical research from various professional journals
compiled by Jason A. Rodgers

A dissenting view on the biological model:

Neuropsychological functioning in patients with borderline personality disorder
Abstract of research by June Sprock , Theresa J. Rader, Jeffrey P. Kendall, Carol Y. Yoder, Nov 2000
in which "little support was found for the neurobehavioral hypothesis of BPD."

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Childhood Sexual Abuse (CSA) and Borderline Personality Disorder

BPD has long been associated with a history of childhood sexual abuse. The psychological effects of surviving childhood sexual abuse have been extensively documented in psychological research and literature. Yet there is a sizeable percentage of those diagnosed with BPD (20-40%, depending on the source) who self-report no such personal history, but do report other forms of abuse or neglect.

Complicating matters, some studies questioning this data have emphasized the presence of faulty memory and a tendency to "rewrite" history slanted towards one's own victimization as key elements of the disorder's pathology itself.

Some studies have found (and many clinicians believe) that memories of childhood abuse are in fact more significant predictors of psychopathology than actual corroborated abuse itself. On the other hand, some researchers have focused on the tendency of those maltreated by familial caregivers to be more prone to traumatic amnesia regarding childhood abuse. Much more research will be necessary before this very tricky matter is resolved. For now, here are studies that examine the theory that childhood sexual (or other?) abuse is causal in BPD.

You may also want to take a look at my pages on
Dissociation & Traumatic Amnesia and Complex PTSD and Memory Loss.

If this is all new to you, this short essay Psychological Effects on Sexually Abused�Children by Michael S., is a great place to start for an overview in very clear language.
For a really top-notch collection of the latest research articles on the effects of childhood abuse on the developing brain and personality, see: Why Does Trauma Leave Such Lasting Effects? The Effect of Childhood Trauma on Brain Development

Here is an excellent chart of the results of recent studies on the 'Association between Childhood Sexual Abuse History and Adverse Psychosocial Outcomes'

If you don't see what you're seeking listed here, check out the very latest research catalogued in the National Institutes of Health PubMed database.

articles arranged by date

Implications of Childhood Sexual Abuse for Adult Borderline Personality Disorder and Complex Posttraumatic Stress Disorder
by Linda M. McLean, Ph.D., and Ruth Gallop, Ph.D., 2003

"This study examined whether women with a history of early-onset sexual abuse or those with late-onset sexual abuse were more likely to meet diagnostic criteria for both borderline personality disorder and complex posttraumatic stress disorder (PTSD). METHOD: The Revised Diagnostic Interview for Borderlines and the Trauma Assessment Package were administered to 65 women from three outpatient clinics in a metropolitan area. Thirty-eight subjects met criteria for early-onset abuse, while 27 subjects met criteria for late-onset abuse. RESULTS: The diagnoses of both borderline personality disorder and complex PTSD were significantly higher in women reporting early-onset abuse than in those with late-onset abuse. The trauma variables sexual abuse and paternal incest were significant predictors of both diagnoses. CONCLUSIONS: In contrast to those with comorbid diagnoses, some women with a history of childhood sexual abuse may be extricated from the diagnosis of borderline personality disorder and subsumed under that of complex PTSD."

Role of genotype in the cycle of violence in maltreated children
by Caspi A, McClay J, Moffitt TE, Mill J, Martin J, et al, 2002
"We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity to environmental insults."

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder
Soloff PH, Lynch KG, Kelly TM., June 2002

Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients
Zanarini MC, Yong L, Frankenburg FR, Hennen J, et al, June 2002

" It was found that more than 50% of sexually abused borderline patients reported being abused both in childhood and in adolescence, on at least a weekly basis, for a minimum of 1 year, by a parent or other person well known to the patient, and by two or more perpetrators. More than 50% also reported that their abuse involved at least one form of penetration and the use of force or violence. Using multiple regression modeling and controlling for age, gender, and race, it was found that the severity of reported childhood sexual abuse was significantly related to the severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment."

Sexual molestation of males: associations with psychological disturbance
by Michael King, PhD, 2002
This European study found that men who xperienced sexual abuse as children are 1.7 times more likely to exhibit self-injurious behavior than men who were not.

The contribution of temperament, childhood neglect, and abuse to the development of personality dysfunction: a comparison of three models
Carter JD, Joyce PR, Mulder RT, Luty SE, 2001

"We examined the contribution of temperament, childhood neglect, and abuse to the development of personality dysfunction as postulated in three different but correlated models of personality: the psychobiological, Vaillant's psychoanalytic, and DSM psychopathology models. Character, defense style, and personality disorder symptomatology (the dependent variables), and temperament, childhood neglect, and abuse (the independent variables) were assessed in 168 depressed outpatients. High harm avoidance (temperament) tended to be the strongest and most consistent risk factor across the three models. Deficient parental care predicted personality dysfunction, however low care was not consistently predictive across all three models. Emotional/psychological abuse and actual physical abuse were risk factors for increasing personality disorder symptomatology only. Childhood sexual abuse was not as predictive of personality dysfunction as might be expected, thereby raising questions as to the importance placed on child sexual abuse as a general risk factor for personality psychopathology."

The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners
Timmerman IG, Emmelkamp PM., 2001

"The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events."

Features of childhood sexual abuse and the development of psychiatric and substance use disorders
by Bulik CM, Prescott CA, Kendler KS., 2001

"In a population-based sample of adult female twins, we used logistic regression to explore the association between features of CSA (reported by the twin and her co-twin) and lifetime major depression, generalised anxiety disorder, bulimia nervosa, panic disorder and alcohol and drug dependence. RESULTS: In univariate and stepwise multiple regressions, patterns of predictors differed, although not significantly, across diagnoses. Greater risk was associated with attempted or completed intercourse, the use of force or threats, abuse by a relative, and a negative response by someone who was told about the abuse. Similar patterns were observed with co-twin reports. CONCLUSIONS: Specific features of CSA differentially increase risk of later psychopathology; however, there do not appear to be unique predictive relationships between features of CSA and the emergence of specific psychiatric disorders."

Unwanted Sexual Experiences and Sexual Risks in Gay and Bisexual Men: Associations Among Revictimization, Substance Use, and Psychiatric Symptoms
by Seth C. Kalichman, Feb 2001

"Explanations for the association between child sexual abuse and unwanted sexual events in adulthood have emphasized the roles of psychiatric symptoms such as dissociation, trauma-related anxiety, and borderline personality characteristics. Dissociation serves as a cognitive and emotional escape strategy that can be effective in coping with childhood trauma but becomes maladaptive in adulthood. Dissociation in response to fear producing events can translate to ignoring potential risks, including risks for HIV-AIDS. [...] Trauma, dissociation, and borderline characteristics may be important risk factors for substance abuse, unwanted sexual experiences, and sexual revictimization in women. However, to our knowledge sexual revictimization, dissociation, trauma-related anxiety, and borderline characteristics have not been investigated in relation to unwanted sexual experiences among gay and bisexual men. The purpose of the current study was, therefore, to extend findings reported in studies of women to men who have sex with men, and to examine revictimization as a risk factor for HIV and other sexually transmitted diseases (STDs) in men who have sex with men."

A comparison of posttraumatic stress disorder with and without borderline personality disorder among women with a history of childhood sexual abuse: etiological and clinical characteristics
Abstract of a study by Heffernan K, Cloitre M., 2000

The Altering of Reported Experiences
Abstract of a study by Daniel Offer, MD, Kenneth Howard, et al, 2000

"Objectives: The unreliability of human memory is well documented in the literature, yet psychiatrists and other mental health care professionals rely on patient self-report in history-taking. This study provides new evidence from a longitudinal study of autobiographical memory and discusses implications for the development and implementation of appropriate treatment plans and goals. Method: Seventy-three mentally healthy 14-year-old males were studied in 1962. Sixty-seven of these subjects were reinterviewed face-to-face at age 48. Questions concerning areas of family relationships, home environment, dating, sexuality, religion, parental discipline, and general activities were asked in both interviews. Results: Significant differences were found between adult memories of adolescence and what was actually reported during adolescence. Accurate memory was generally no better than expected by chance. Conclusions: If the accurate memory of one's past is not better than chance in the mentally healthy individual, even more care probably should be taken in obtaining accurate historical information in the medically, psychologically, or otherwise health-compromised individual. It would be more constructive to treat recollections as existential reconstructions."

Identity Disturbance in Borderline Personality Disorder: An Empirical Investigation
Tess Wilkinson-Ryan, A.B., and Drew Westen, Ph.D., 2000
Abstract:

"OBJECTIVE: Identity disturbance is one of the nine criteria for borderline personality disorder in DSM-IV, yet the precise nature of this disturbance has received little empirical attention. This study examines 1) the extent to which identity disturbance is a single construct, 2) the extent to which it distinguishes patients with borderline personality disorder, and 3)the role of sexual abuse in identity disturbance in patients with borderline personality disorder. METHOD: The authors constructed an instrument that consisted of 35 indicators of identity disturbance culled from relevant clinical and theoretical literature and asked clinicians to rate a patient on each of the items. The patient group consisted of 95 subjects diagnosed with borderline personality disorder (N=34), another personality disorder (N=20), or no personality disorder (N=41). Relevant diagnostic, demographic, and developmental history data were also collected. The authors used factor analysis to ascertain whether identity disturbance is a unitary construct and then examined the relation between dimensions of identity disturbance and borderline diagnosis after controlling for sexual abuse history. RESULTS: Four identity disturbance factors were identified: role absorption (in which patients tend to define themselves in terms of a single role or cause), painful incoherence (a subjective sense of lack of coherence), inconsistency (an objective incoherence in thought, feeling, and behavior), and lack of commitment (e.g., to jobs or values). All four factors, but particularly painful incoherence, distinguished patients with borderline personality disorder. Although sexual abuse was associated with some of the identity factors, particularly painful incoherence, borderline pathology contributed unique variance beyond abuse history to all four identity disturbance factors. The data also provided further evidence for an emerging empirical distinction between two borderline personality disorder types: one defined by emotional dysregulation and dysphoria, the other by histrionic characteristics. CONCLUSIONS: Identity disturbance is a multifaceted construct that distinguishes patients with borderline personality disorder from other patients. Some of its components are related to a history of sexual abuse, whereas others are not. Identity disturbance appears to be characteristic of borderline patients whether or not they have an abuse history."

False memories in women with self-reported childhood sexual abuse: an empirical study
Bremner JD, Shobe KK, Kihlstrom JF., 2000
This test found that "Abused women with PTSD had a higher frequency of false recognition memory."

Does childhood sexual abuse cause borderline personality disorder?
Abstract of an article by JM Bailey and A.Shriver 1999
The article suggests that the premise of childhood sexual abuse in the etiology of BPD may be misleading due to faulty reporting abilities of BPs.

Borderline Personality Disorder and childhood sexual abuse: a meta-analytic study
Fossati A, Madeddu F, Maffei C., 1999
Review of 21 studies "did not support the hypothesis that childhood sexual abuse (CSA) is a major psychological risk factor or a causal antecedent of BPD."

Childhood victimization and drug abuse: a comparison of prospective and retrospective findings
Widom CS, Weiler BL, Cottler LB., 1999
Another intriguing study suggesting that memory of abuse is a greater indicator of psychiatric symptomatology than actual experience of abuse.

"This study examined whether childhood victimization increases risk for drug abuse using prospective and retrospective victimization information. Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender, age, race, and approximate social class with nonabused/nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995, 1,196 participants (676 abused/neglected and 520 control) were administered a 2-hr interview, including measures of self-reported childhood victimization and drug use/abuse (the National Institute of Mental Health Diagnostic Interview Schedule--Version III--Revised). Prospectively, abused/neglected individuals were not at increased risk for drug abuse. In contrast, retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse. The relationship between childhood victimization and subsequent drug problems is more complex than originally anticipated."

Reported pathological childhood experiences associated with the development of borderline personality disorder
by Zanarini MC, Williams AA, Lewis RE,et al, 1997

"The results suggest that sexual abuse is neither necessary nor sufficient for the development of borderline personality disorder and that other childhood experiences, particularly neglect by caretakers of both genders, represent significant risk factors."

The Origins of Human Love and Violence
James W. Prescott, Ph.D., 1996

Trauma history and personal narratives: some clues to coping among survivors of child abuse
Ilene Kleina and Ronnie Janoff-Bulman, 1996
This interesting study

"focused on both the relative emphasis on the past versus present and future and on the self versus others in respondents' stories. The narratives of child abuse survivors differed from the comparison group on both of these features; their stories focused more on the past and de-emphasized the central role of the self.[...]the increased emphasis on others, with its maladaptive associations, was unique to child abuse survivors."

Neural Mechanisms in dissociative amnesia for childhood abuse: relevance to the current controversy surrounding the "false memory syndrome"
Bremner JD, Krystal JH, Charney DS, Southwick SM., 1996

"There is considerable controversy about delayed recall of childhood abuse. Some authors have claimed that there is a "false memory syndrome," in which therapists suggest to patients events that never actually occurred. These authors point to findings that suggest that memory traces are susceptible to modification. The purpose of this paper is to review the literature on the potential vulnerability of memory traces to modification and on the effects of stress on the neurobiology of memory. The authors review findings on mechanisms involved in normal memory function, effects of stress on memory in normal persons, children's memory of stressful events, and alterations of memory function in psychiatric disorders. The effects of stress on specific brain regions and brain chemistry are also examined. RESULTS: Neuropeptides and neurotransmitters released during stress can modulate memory function, acting at the level of the hippocampus, amygdala, and other brain regions involved in memory. Such release may interfere with the laying down of memory traces for incidents of childhood abuse. Also, childhood abuse may result in long-term alterations in the function of these neuromodulators. CONCLUSIONS: John Nemiah pointed out several years ago that alterations in memory in the form of dissociative amnesia are an important part of exposure to traumatic stressors, such as childhood abuse. The studies reviewed here show that extreme stress has long-term effects on memory. These findings may provide a model for understanding the mechanisms involved in dissociative amnesia, as well as a rationale for phenomena such as delayed recall of childhood abuse."

Borderline personality disorder symptoms and severity of sexual abuse
Abstract of a study by KR Silk, S Lee, EM Hill and NE Lohr, 1995

"Predictor variables were the most severe experience within each of three dimensions of sexual abuse: 1) perpetrator (sexual abuse by a parent), 2) duration (sexual abuse that was ongoing), and 3) type (sexual abuse that involved penetration). RESULTS: The severity dimension that was most frequently found to be a significant predictor of the sum of the six DIB items as well as the total scaled DIB score was the duration dimension."

Memories of abuse in borderline patients: true or false?
Dr. Joel Paris, 1995 (must purchase article for a fee)

"This review will examine issues related to the validity of memories of child abuse in patients with borderline personality disorder (BPD). Evidence will be examined suggesting that borderline patients have a distorted perception of interpersonal events."

Psychological sequelae in adult females reporting childhood ritualistic abuse
Abstract of a study by Lawrence KJ, Cozolino L, Foy DW., 1995

"The present study sought to increase current scientific knowledge about the controversial issue of subjectively reported childhood ritualistic abuse by addressing several key unresolved issues. In particular, the possibility that those reporting ritualistic abuse may be characterized primarily by the severity of their abuse histories or the severity of their present psychological symptoms, rather than the veridicality of the ritualistic events, was explored. Adult female outpatients reporting childhood sexual abuse with ritualistic features were compared with a second group of women who reported childhood sexual abuse without ritualism. Measures included characteristics of childhood sexual and physical abuse, current posttraumatic stress disorder (PTSD) diagnostic status and symptom severity, and severity of current dissociative experiences. Women reporting ritualistic features scored significantly higher on measures of childhood sexual and physical abuse. Neither PTSD diagnostic status nor severity for PTSD nor dissociative experiences were significantly different between the groups. While preliminary in nature, these results suggest that it may be helpful to conceptualize reported childhood ritualistic abuse as indicative of the need to assess carefully for severe abuse and its predictable sequelae within existing traumatic victimization conceptual frameworks."

Childhood experiences of borderline patients
Abstract of a study by Zanarini, Mary C; Gunderson, John G; Marino, Margaret F, et al, 1989

"The authors conclude that the development of Borderline Personality Disorder is more strongly associated with (1) exposure to chronically disturbed caretakers than prolonged separations from these same adults and (2) a history of abuse than a history of neglect."

SEXUAL ABUSE OF MALES: PREVALENCE, POSSIBLE LASTING EFFECTS, AND RESOURCES
from www.vix.com
Excellent comprehensive write-up by Jim Hopper, Ph.D.

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Borderline Personality Disorder as an Attachment Disorder

Much of the research done on BPD emphasizes the disorganization of attachment (attachment=bonding with a caretaker figure in the first few years of life) that may be found in those diagnosed with personality disorders. This may or may not be associated with childhood abuse (physical/sexual/emotional). It may or may not relate to an inherent biological "vulnerability" in the child to experience such attachment failure as more traumatic than other children.

Current attachment theory, based on the pioneering work of Dr. John Bowlby, proposes four major categories of infant attachment:
1. Securely attached infants initially seek their mother after separation, but then return to their play.
2. avoidant infants avoid and ignore the mother during reunion.
3. anxious/ambivalent infants seek contact with the mother on reunion, but also manifest anger and resistance toward her and are unable to be comforted.
4. disorganized/disoriented infants manifest a diverse array of behaviors indicating a temporary breakdown in strategy and a disorganized response in relation to the caregiver.
(Source: Greenberg et al, Attachment in the Preschool Years (pp. 121-160). Chicago, 1993).

According to attachment theory, the infant develops an internal "working model" of the world and people around them which endures into adulthood. In the case of disorganized-disoriented attachment, this model includes many world-views typical of BPD sufferers, such as that people are inherently cruel and unhelpful. (See this list of beliefs commonly held by those with BPD.)

The studies in this section represent more general models;
find specific studies on various aspects of parenting in the section below this one.

Bonding and Attachment in Maltreated Children
by Bruce D. Perry, M.D. Ph.D.
This is an excellent first essay to read; one of America's best-respected trauma experts describes in clear language the theory of attachment disorder and how it can be used to understand those with these dysfunctions, whether in children or adults.

Born Aliens
by Sam Vaknin
A great introductory essay on the development of the human psyche in the first three months of life, and speculation on what goes 'wrong' to create personality disorders.

Pathological Attachments and Therapeutic Action: A transgenerational model of personality disorder
by Peter Fonagy, PhD, FBA, 1999
An excellent full-text article (from the psychoanalytic perspective) detailing the relationship of early childhood to Borderline Personality Disorder, with an emphasis on the attachment model. Great descriptions of the etiology of the defense mechanisms in BPD.

ATTACHMENT AND BORDERLINE PERSONALITY DISORDER
by Peter Fonagy, PhD, 2000
A shorter, more readable summary of the principles in the above paper.

The Psychological Maltreatment of Children: Technical Report
Steven W. Kairys, MD, MPH, Charles F. Johnson, MD, and Committee on Child Abuse and Neglect, 4 April 2002

Developmental protective and risk factors in borderline personality disorder: A study using the Adult Attachment Interview
by Lavinia Barone, 2003

"Mental representations and attachment in a sample of adults with Borderline Personality Disorder were assessed using the George, Kaplan and Main (1985) Adult Attachment Interview (AAI). Eighty subjects participated in the study: 40 nonclinical and 40 with Borderline Personality Disorder (BPD). The results obtained showed a specific distribution of attachment patterns in the clinical sample: free/autonomous subjects (F) represented only 7%, dismissing classifications (Ds) reached about 20%, entangled/preoccupied (E) 23% and unresolved with traumatic experiences (U) 50%. The two samples differed in their attachment patterns distribution by two (secure vs. insecure status), three (F, Ds and E) and four-way (F, Ds, E and U) categories comparisons. [...] Results support the hypothesis that some developmental relational experiences seem to constitute pivotal risk factors underlying this disorder. Results demonstrated potential benefits in using AAI scales in addition to the traditional categories."

Social Cognitive Conceptualization of Attachment Working Models: Availability and Accessibility Effects
by Mark W. Baldwin, John Patrick Richard Keelan, et al.

Trauma and Terror in Childhood: The Neuropsychiatric Impact of Childhood Trauma
by Bruce D. Perry, M.D., Ph.D. 2000
Excellent overview of how the brain responds to trauma with mechanisms like hyperarousal, dissociation, etc.
A very good introduction to these "biochemical reaction" ideas.

Predictive factors for borderline personality disorder: patients' early traumatic experiences and losses suffered by the attachment figure
Very provocative study by G. Liotti, P. Pasquini, R. Cirrincione, 2000

Objective: To test the hypothesis that serious losses in the life of the attachment figure and patients' early traumatic experiences are risk factors for the development of borderline personality disorder.
Method: A multicentric hospitalbased case-control study of 66 cases and 146 controls.
Results: We estimated an odds ratio of 2.5 (95 CI 1.1-5.8) for mothers' serious losses experienced within 2 years of patients' birth and an odds ratio of 5.3 (95 CI 2.1-13) for patients' early traumatic experiences. Both of them are adjusted for the confounding effect of the other as well as for that of age, size of family and type of patient (in or outpatient), using a multiple logistic function.
Conclusion: Mourning process in the mother within 2 years of the patient's birth and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder."

The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health, Part 1
by Allan N. Schore, 2001
Part 1 offers "an overview of an interdisciplinary perspective of development, outline connections between attachment theory, stress regulation, and infant mental health, describe the neurobiology of a secure attachment, present models of right brain, early limbic system, and orbital frontolimbic development, and suggest links between continued orbitofrontal and right brain development and adaptive mental health."

The Effects of a Secure Attachment Relationship on Right Brain Development, Affect Regulation, and Infant Mental Health, Part 2
by Allan N. Schore, 2001
Part 2 presents "ideas on the effects of traumatic attachment experiences on the maturation of brain regulatory systems, the neurobiology of relational trauma, the neuropsychology of a disorganized/disoriented attachment pattern, the inhibitory effects of early trauma on the development of control systems involved in affect regulation, the links between early relational trauma and a predisposition to postraumatic stress disorder, a neurobiological model of dissociation, the connections between traumatic attachment and enduring right hemisphere dysfunction, and implications for early intervention."

The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism
Excellent full-text article by Bessel A. van der Kolk, 1989, examining Freud's old notion of "repetition compulsion" and why people with personality disorders seem to seek out re-enactments of their original traumatic experiences (such as abusive romantic relationships).

Attachment and metacognition in borderline patients
Full-text article by Giovanni Liotti, M.D. 1999
Excellent job detailing the relation of BPD to attachment dysfunctions in the first 2 years of life.

Unsolvable Fear, Trauma, and Psychopathology: Theory, Research, and Clinical Considerations Related to Disorganized Attachment Across the Life Span
by Jude Cassidy and Jonathan J. Mohr, 2001
Another excellent article on attachment theory and lifelong implications of inadequate parental bonding.

>Brain Development, Attachment and Impact on Psychic Vulnerability
by Deborah A. Lott 1998
This full-text article details the effect of faulty early bonding with caregivers on the brain development of children.

A longitudinal investigation of social causation and social selection processes involved in the association between socioeconomic status and psychiatric disorders.
Abstract of a study by Johnson JG, Cohen P, Dohrenwend BP, Link BG, Brook JS. 1999

"These findings indicate that low family socio-economic status is associated with risk for offspring anxiety, depressive, disruptive, and personality disorders."

Sex and ethnic distribution of borderline personality disorder in an inpatient sample
Results of a study by R Castaneda and H Franco, 1985
This research is a bit old, but it's the only study I've seen on the ethnic distribution of BPD.

"No significant differences in the prevalence of borderline personality disorder were found among whites, blacks, and Hispanics."

PHENOMENOLOGY AND PSYCHOBIOLOGY OF THE INTERGENERATIONAL RESPONSE TO TRAUMA
by Rachel Yehuda, Ph.D., Jim Schmeidler, Ph.D. Abbie Elkin, et al. 1997
Great detailed article and studies of the effects of the Holocaust on children of survivors

Please also check out: Related Disorders: Attachment Disorders for more research on this topic.

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"Will My Kid Turn Out BPD?" Specific Studies on Parenting Factors

ModOasis Support Group for Adult Children of BPs
and

'Kids of BPD' Support Group for Teens and Adult Children of BPs
I include these links here because I think it's VITAL that anyone co-parenting with an untreated Borderline spouse take a good hard look at the life-long effects this might have on the children.
For online support with your co-parenting, check out

WTOParenting

arranged by date

The Epigenesis of the Family System as a Context for Individual Development
Provocative article using BPD as a case example, by Herta A. Guttman, 2002

Maternal Borderline Personality Characteristics and Family Functioning
Ph.D. Thesis by Dr. Naomi Ruth Barends, 2002
(This is a full-text pdf file, requires Adobe Acrobat or similar to read.)
"ABSTRACT:

This study was designed to assess the relations among maternal borderline personality traits, perceived parenting self-efficacy, parenting quality, and the development of 2- and 3-year-old children. 75 mother and child dyads were observed in the laboratory and provided assessments of maternal personality traits, parenting self- efficacy, and child behavior problems. Mothers with higher borderline personality features were more flat and less positive with their children, felt less effective as parents, and had children with poorer adjustment. Mothers who felt less effective as parents tended to parent in less growth-promoting ways, and had children with more problematic behavior."

Maternal stress beginning in infancy may sensitize children to later stress exposure: effects on cortisol and behavior
Abstract of a study by Essex M, Klein M, Cho E, Kalin N., Oct 2002

Association of maladaptive parental behavior with psychiatric disorder among parents and their offspring
Abstract of a study by Johnson JG, Cohen P, Kasen S, Smailes E, Brook JS., May 2001
This study found that

"Most of the youths that experienced high levels of maladaptive parental behavior during childhood had psychiatric disorders during adolescence or early adulthood, whether or not their parents had psychiatric disorders. In contrast, the offspring of parents with psychiatric disorders were not at increased risk for psychiatric disorders unless there was a history of maladaptive parental behavior."

Relationships of Borderline Features to Parental Mental Illness, Childhood Abuse, Axis I Disorder, and Current Functioning
by T.J. Trull, Feb. 2001

"Multivariate models were tested and results indicated that parental mental illness and lifetime Axis I disorder were significant and unique predictors of borderline scores."

Childhood verbal abuse and risk for personality disorders during adolescence and early adulthood
Abstract of an article by Jeffrey G. Johnson , Patricia Cohen et al. Jan/Feb 2001
This study suggests that children who experienced maternal verbal abuse are 3 times as likely as other children to develop Personality Disorders, regardless of any other factors such as neurobiological history of the family.

Developmental Aspects of Borderline Personality Disorder
Abstract of research by Reich D.B.; Zanarini M.C., Nov. 2001
According to self-reports,

"Patients with borderline personality disorder remembered more difficulties with separation between ages 6 and 17 years, more mood reactivity and poorer frustration tolerance between ages 6 and 17, and the onset of more symptoms (most prominently sadness, depression, anxiety, and suicidality) before age 18 than did patients with other personality disorders."

Parental and infant factors in attachment and social development
Great online collection of ongoing research projects plus abstracts of the results. Lots of stuff on maternal/infant attchment.

Attachment and Affect Regulation
Online collection of abstracts of research. More stuff on maternal/infant attchment.

Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression
Abstract of a longitudinal study by Biederman J, Faraone SV, et al, Jan. 2001

"These findings confirm and extend previous results documenting significant associations between the presence of panic disorder and major depression in parents and patterns of psychopathology and dysfunction in their offspring."

Insight Into Mental Illness and Child Maltreatment Risk Among Mothers With Major Psychiatric Disorders
by Mrinal Mullick, et al, April 2001
Abstract of an article that suggests insight into one's own illness affects the ability to better parent children.
A kind of "well, duh!" study, but I include it for anyone needing the validation

Abusive relationships in families of women with borderline personality disorder, anorexia nervosa and a control group
Abstract of a comparison study by Laporte L, Guttman H., 2001

Predictive factors for borderline personality disorder: patients' early traumatic experiences and losses suffered by the attachment figure
by Liotti G, Pasquini P., The Italian Group for the Study of Dissociation, Oct. 2000
This fascinating study concluded that the

"Mourning process in the mother within 2 years of the patient's birth [serious losses in the life of the attachment figure] and patients' early traumatic experiences are predictive factors for the development of borderline personality disorder."

Disorganized infant, child, and adult attachment: collapse in behavioral and attentional strategies
by Erik Hesse and Mary Main, 2000

Biparental failure in the childhood experiences of borderline patients
Abstract of a survey by Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Lewis RE, Williams AA, Khera GS., Fall 2000

"Eighty-four percent of borderline patients reported having experienced some type of biparental abuse or neglect before the age of 18; 55% reported a childhood history of biparental abuse; 77% reported a childhood history of biparental neglect. These experiences were also reported by a substantial percentage of Axis II controls (biparental abuse or neglect [61%], biparental abuse [31%], and biparental neglect [55%]). However, borderline patients were significantly more likely than Axis II controls to report having been verbally, emotionally, and physically but not sexually abused by caretakers of both sexes. They were also significantly more likely than controls to report having caretakers of both sexes deny the validity of their thoughts and feelings, fail to provide them with needed protection, neglect their physical care, withdraw from them emotionally, and treat them inconsistently. "

Empathy in Families of Women with Borderline Personality Disorder, Anorexia Nervosa, and a Control Group
Full text of a study by Herta A. Guttman, Fall 2000
From the article:

"Women with BPD score highest of all daughters and parents on Empathic Concern and Personal Distress and lowest on Perspective Taking. [...] Because these scores reflect a disproportion between the affective and cognitive components of empathy, it is probably more accurate to use the term "borderline sensitivity" rather than "borderline empathy" to describe their way of relating, so as not to confuse it with a multidimensional capacity that includes both the cognitive and emotional components of empathy."

The Abused Child as Parent: The Structure and Content of Physically Abused Mothers' Perceptions of Their Babies
Abstract of a study by Gara MA, Allen LA, Herzog EP, Woolfolk RL., May 2000
This study suggests that mothers who reported being physically abused as children

"... lagged behind controls in how well-differentiated were their negative perceptions of their babies... On the other hand, abused mothers were comparable to controls with respect to differentiation of positive perceptions of babies." "The findings constitute a discovery about the structural organization of social cognition in mothers at-risk for child abuse."

Linking Childhood Sexual Abuse and Abusive Parenting: the Mediating Role of Maternal Anger
Abstract of a study by DiLillo D, Tremblay GC, Peterson L., June 2000
This study found that

"Even after controlling for mothers' childhood experience of physical abuse, CSA significantly predicted adult risk of physically abusing one's own children. Further, maternal anger was confirmed as a mediator of the relationship between having been sexually abused as a child and the potential for physically abusing one's own children."

Associations between four types of childhood neglect