BPD Distal Risk Factor Symptoms and Treatments Proximal vs. Distal Risk Factors in BPD By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Learn about our editorial process Updated on February 26, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Ian Nolan / Cultura / Getty Images Table of Contents View All Table of Contents Distal vs. Proximal Symptoms Treatments Prognosis A distal risk factor is a risk factor that represents an underlying vulnerability for a particular condition, such as borderline personality disorder (BPD). Having a distal risk factor does not mean you will get BPD. It simply means that you may be at risk for developing it at some time in the future. Some examples of distal risk factors include: Childhood trauma and adversities: Any sort of significant childhood stress can increase the risk of developing BPD. Trauma includes parental loss, parental alcohol or substance abuse, emotional and physical abuse and neglect, and sexual abuse.Family history and genetics: If you have a first-degree relative (a parent or sibling) with BPD or a similar disorder, you are more vulnerable to developing BPD.Temperament: If you were "wired" for traits such as emotionality and shyness, this could increase your risk for BPD. For instance, childhood trauma puts a person at a higher risk of later being diagnosed with BPD. However, not everyone who has BPD had a traumatic childhood. Similarly, not everyone who experienced trauma develops BPD. The Relationship Between Child Abuse and BPD Proximal vs. Distal Risk Factors In contrast to distal risk factors, proximal risk factors represent an immediate vulnerability for a particular condition or event. Some examples of proximal risk factors are ongoing abuse, having difficulties because of a physical impairment or injury, poor academic or work performance, and stressful life events. All of these risk factors, particularly when combined with distal risk factors, can lead to the development of a condition such as BPD. Distal factors indirectly influence health by acting on the more proximal factors. Symptoms Symptoms and patterns of BPD typically begin in the teenage years, and sometimes in young adulthood. Symptoms may be different for different people, but can include: Dissociative states Emotional instability Fear of abandonment Feelings of emptiness Impairment in identity Impulsivity Intense anger and aggressive behavior Self-harm or suicide Unstable relationships In order to be diagnosed with BPD, you must show at least five of these symptoms. If you or a loved one experiences any of these symptoms, make an appointment with your physician for an evaluation. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Treatments If you're diagnosed with BPD, the most helpful tool in your treatment plan will be psychotherapy. Specific types that have been shown to be particularly helpful for BPD include: Dialectical behavior therapy Mentalization-based therapy Schema-focused therapy Transference-focused psychotherapy Though the Food and Drug Administration (FDA) has not approved any particular medications for the treatment of BPD, your doctor may prescribe you medication to help treat your symptoms or other disorders you may have along with BPD, such as depression. Outlook Current research shows that if you have been diagnosed with BPD, the outlook for your future tends to be positive. A lot of the symptoms that can be so debilitating go away within the first few years of treatment, and most patients improve with time. Also, the sooner your BPD is diagnosed and treated, the more favorable your outcome, so early detection is vital. 6 Common Myths About BPD 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Hengartner MP, Ajdacic-Gross V, Rodgers S, Müller M, Rössler W. Childhood adversity in association with personality disorder dimensions: New findings in an old debate. Eur Psychiatry. 2013;28(8):476-482. doi:10.1016/j.eurpsy.2013.04.004 Stepp SD, Keenan K, Hipwell AE, Krueger RF. The impact of childhood temperament on the development of borderline personality disorder symptoms over the course of adolescence. Borderline Personal Disord Emot Dysregul. 2014;1(1). doi:10.1186/2051-6673-1-18 Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorder. Curr Behav Neurosci Rep. 2017;4(1):21-30. doi:10.1007/s40473-017-0103-z Additional Reading Biskin RS. The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60(7):303-308. doi:10.1177/070674371506000702 By Kristalyn Salters-Pedneault, PhD Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for BPD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.