What About Pregnancy, Genetics and Getting Older?

Written by Dr. Leland Heller

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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