Question:
Hi,
I am looking for information, esp. original research on two
questions: -- BPD and pregnancy: I know that few careful
studies have been done on how BPD affects pregnancy.
But how
does pregnancy, e.g. pregnancy hormones, affect BPD? - I
have heard of some beneficial influences, but only in
anecdotal contexts... -- inheritable BPD: Aside from the
older observations of clustering of BPD (or really only BPD
symptoms) in families, are there any newer studies on
genetic components?-- BPD history: It is quite striking how
much more optimistic (and politically correct) the newer
literature is, from the NIMH, books and websites, compared
to that only a decade ago. One striking example is that it
is often observed that BPD gets better in the fourth decade of
life, but what is the latest on the reasons for this? It
appears that the older literature, (along with many
therapists in the trenches) seems to discount the phenomenon
as just the patients wearing themselves out...
Thank you for
any references, info or tips.
Dr. Heller's Answer:
1) There's very little in the literature on pregnancy in
the BPD. I've seen it go both ways. Some women with BPD do
great during pregnancy, better than usual. Many have a very,
very hard time. I've worked with some women who had to take
Tegretol during the pregnancy because the suicide risk was
so great. Most are very anxious to get back on medication
after the pregnancy (and/or breast-feeding) are over.
2) There have been some studies about heritability, but
like most topics pertaining to the BPD, scientific data is
sparse. The BPD clearly can run in families. Some of the
most fascinating cases I've seen are adoptions where the BPD
risk is high in the biological offspring that weren't raised
by the biological parents. I’ve rarely seen the other way
around. I think the ADHD genetic link is more important
than the BPD link as a cause of BPD.
3) The "improvement" over time is usually limited to the
ability to maintain a job. Most individuals with BPD during
adolescence still fit criteria and experience the medical
BPD symptoms throughout adult life - continuing to old age.
Interpersonal relationships generally remain a disaster.
Self-mutilation usually lessens or ceases after adolescence
is over. The worst symptoms are during adolescence when
the limbic system goes into hyperdrive. Maturity and
growing past adolescence make a huge difference, but don’t
make the core medical symptoms go away. Having successful
family and love relationships are to me far more important
than work success, and without treatment most people with
BPD have a difficult time throughout their lives with these
relationships.
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