The Biological Perspective

More than anything else, the intense moodiness and rapidly shifting emotions of the borderline personality have caused observers to wonder whether some biological abnormality might underlie the disorder or at least create a predisposition that favors its development. Some biological basis seems necessary to fuel the intense emotional reactivity of the borderline, as seen in Jenny and Georgia. After all, anger is an intensely arousing emotion, as Jenny shows us consistently throughout her case study. Alternatively, we might suppose that reactivity itself has some biological basis. Perhaps some people simply react more intensely than others given any negative stimulus, and borderlines fall at the extreme upper end of such a distribution.

Because borderlines not only act out frantically but also frequently feel depressed, the early history of the borderline construct is confounded with the history of manic-depressive illness. From the earliest times, writers recognized persons with intense and changeable moods. Homer, Hippocrates, and Aretaeus vividly described impulsive anger, intense activity, irritability, and depression, noting both the vacillation among these "spells" and the personalities in which they are embodied. As with most medical and scientific knowledge, these early writings were suppressed in medieval times, to be discovered again with the beginning of the Renaissance. During this time, some writers emphasized emotional instability as the essence of the syndrome; others focused on shifts from excitement to depression. The putative relationship between the borderline personality and the affective disorders remains controversial even today.

Famous for their descriptive acumen, Kraepelin (1921), Kretschmer (1925), and Schneider (1923/1950) all noted symptoms we would now recognize as borderline, though mainly in connection with manic-depressive illness. Kraepelin identified four associated temperaments, one of which, the excitable personality, resembles our contemporary borderline. Such individuals could display "great fluctuations in emotional equilibrium," "fall into outbursts of boundless fury," "shed tears without a cause, give expression to thoughts of suicide, [and] bring forward hypochondriacal complaints" (pp. 130-131). Kretschmer ascribed to such individuals a "hostile attitude toward the world," with "a sharpness, nervousness, and jerky restless moodiness" (p. 140). Closest to our contemporary conception of the borderline, however, is Schneider's labile personality, characterized by "abrupt and rapid changes of mood," so that "sometimes the small stimulus is sufficient to arouse a violent reaction" (p. 116). For Kraepelin, such symptoms were produced by a metabolic anomaly. For Kretschmer, they were an extreme manifestation of a temperamental continuum spanning the borderline and schizoid. For Schneider, the difficulty was primarily constitutional, an outgrowth of the subject's own organic matrix. Whatever their cause, the resemblance of the descriptions to Georgia and Jenny is striking.

The hypothesis that borderlines begin life with strong temperamental characteristics has great intuitive appeal. Certain cardinal characteristics of the borderline—namely, impulsivity, irritability, hypersensitivity to stimulation, emotional lability, reactivity, and intensity—have all been associated with a biological foundation. An individual, however, rarely begins life as a borderline personality though the presence of extreme characteristics early on is undoubtedly correlated with extreme outcomes. A predisposition to high emotional reactivity, for example, helps lay the foundation for intense relationships throughout life, beginning with intense, and possibly aversive, interactions between mother and child. Possession of any one of these characteristics would require careful parenting, but taken collectively in the context of the chaotic and often equally intense borderline family, future borderlines are not likely to internalize standards of behavior that might moderate their emotions or inhibit their expression, leaving biology to determine behavior.

The leading contemporary exponent of the temperament hypothesis is Akiskal (1981), who argues that borderlines and their family members frequently share characteristics of a cyclothymic temperament, a view reminiscent of Kraepelin. Such persons experience mood swings that resemble manic depression. To the outside observer, their emotions seem arbitrary and unstable, completely unconnected to external events. Viewed in this way, the emotional instability represents something of a trait, with the borderline as the beginning point of a continuum of instability running from Axis II to relatively less intense changes of cyclothymia and on to the exaggerated cycles of manic-depressive illness.

Other researchers have studied the link between the borderline personality and respective neurotransmitters. Siever and Davis (1991) associate the disorder with abnormalities in impulse action in which serotonin is diminished and norepinephrine is overactive, producing activation without behavioral inhibition. Serotonin has been linked to impulsive aggression, a cardinal trait of the syndrome, as well as to self-directed aggression such as suicide and suicide risk (Van Praag, 1991) and self-mutilation. In fact, personality disorder subjects with the greatest serotonergic abnormalities are at the highest risk for self-directed aggression (New, Trestman, Mitropoulou, & Benishay, 1997).

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