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Genetics plays a larger role in the development of BPD than previously thought.

The brains of people diagnosed with BPD are significantly different from normal brains.

Moderate to high functioning people with BPD rarely get diagnosed or included in research studies.

We do not yet know whether higher functioning people with BPD have an equally high genetic component.

I have been treating clients for borderline personality disorder for more than 45 years. When I first started studying the topic, most theorists emphasized the role early abandonment trauma played in its development. A great deal of research focused on 14 to 24 months as a critical window when normal personality development could be derailed, and borderline personality disorder could develop instead (Mahler, Pine, and Bergman, 1975).

However, that never seemed like the whole answer, as there were so many clients with different histories who developed borderline adaptations.

I am using the terms borderline adaptations and BPD as shorthand for someone who qualifies for a full diagnosis of borderline personality disorder.

The Genetic Component of BPD

Today, advances in neuroscience suggest that there is likely to be a much stronger genetic component involved than most theorists previously believed. Unfortunately, most current research on the genetic origins of BPD includes only people who are low-functioning. Most moderate-to-high-functioning people with BPD never get diagnosed or included in research studies.

Estimates Are Likely to Be Too High

Because most estimates of the genetic component of BPD are taken from brain scans or studies of the lowest-functioning group, they are unlikely to represent all people with BPD. We will not be able to get more accurate and inclusive data until we can study the brains and genetic history of the moderate- to high-functioning people with BPD who do well in individual psychotherapy and never need hospitalization or any form of emergency care.

35% Concordance Rate in Monozygotic Twins

Monozygotic twins are often called “identical twins” because they have identical genetic profiles. If only genetics mattered, we would expect both twins to develop BPD 100 percent of the time if one twin did so. However, the concordance rate for BPD is estimated to be about 35%, compared to an........

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