Does Borderline Personality Disorder Always Involve Abuse in Childhood?

Every adult I have met who has borderline personality disorder had some kind of adverse childhood. Every one.

Does this mean that people who have borderline personality disorder were always abused in childhood? No, not necessarily. There are a couple of things that can happen to children that are not technically child abuse but are terrible things that can lead to borderline personality disorder. Let me give you a couple of examples:

If a child grows up in a situation that is scary all the time, their brain will suffer the same kind of damage that a child who is suffering abuse might suffer and they can end up having borderline personality disorder. For example, if they are growing up in an area where there is a war, a war that is raging all the time and causes everyone to be afraid all the time, their brain can be affected that way.

Here is another example: if a child suffers from neglect, their brain could suffer the same kind of damage that a child who is suffering physical or emotional abuse might suffer and they can end up having borderline personality disorder. However, I find it difficult to separate the idea of child neglect and child abuse. If a child is not given an adequate amount of food, the child is certainly being neglected, but is that not abusive? If a child’s diaper is not changed and she developed sores on her little bottom, is that not a kind of abuse? If a child does not have adequate supervision and she gets lost or finds herself in situations that are dangerous, how do we say it is neglect but not abuse? I’m not sure I understand the distinction between neglect and abuse.

When I am discussing these things with people, it is not unusual for someone to point out to me that every family has its problems. But families that cause the damage that produces one or more children with borderline personality disorder are families that go beyond having a problem or a couple of problems. They are families that are extensively troubled. Almost without exception, the difficulties and troubles of these families are emergent properties — that is, the difficulties emerged as a result of many factors, they were not planned by anybody.

The fact that a family develops very serious troubles through no one’s intention does not mean that it does not have very serious troubles. Even though there may be well-meaning parents who are trying hard to do the best things, very serious troubles may exist in a family. Children may be damaged. In a way, it is no one’s fault. The family structure has grown up in such a way that people are harmed.

I cannot say that every person with borderline personality disorder suffered from physical or emotional abuse in childhood. However, I can say that I have never met or spoken to someone who did not. A good-enough family is a family that does not inhibit children from becoming adults that can cope with the world. So, I guess, I would have to say that the families of persons with borderline personality disorder were, by my definition, not good enough.