Distal Risk Factor Symptoms and Treatments

Proximal vs. Distal Risk Factors in BPD

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A distal risk factor is a risk factor that represents an underlying vulnerability for a particular condition or event. This does not predict that the condition or event will definitely happen or that it will happen any time soon, but rather that a person may be at risk for the condition at some time in the future.


Some examples of distal risk factors include poverty, having endured abuse or trauma as a child, and genetic makeup. For instance, if you were sexually abused as a child, you may have distal risk factors for certain psychological disorders, including borderline personality disorder (BPD).

Borderline Personality Disorder

There are certain distal risk factors in developing a borderline personality disorder, including:

  • Genetics. If you have a first-degree relative, that means a parent or sibling, with BPD or a similar disorder, your risk is higher.
  • Temperament. If you were "wired" for traits such as emotionality, this could increase your risk for BPD.
  • Childhood abuse or trauma. Any sort of significant childhood stress can also increase your risk of developing BPD. Many sufferers say they were abused or neglected as children.

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 Risk Factors
  • Underlying risk in developing BPD

  • Examples include past abuse or trauma, genetic factors, and temperament

Proximal Risk Factors
  • Immediate risk in developing BPD

  • Examples include ongoing abuse, physical impairment or injury, and stressful life events


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:

  • Unstable mood, including mood swings, that can last for hours or days
  • Feeling chronically empty
  • Engaging in risky behaviors, such as shopping sprees or unprotected sex with multiple partners
  • Suicidal thoughts or attempts or purposely injuring yourself
  • Anger issues, including outbursts and difficulty controlling your temper
  • Excessive fear of abandonment, whether real or imagined
  • Intense relationships with others that are constantly up and down
  • Actively and often changing the way you view yourself, including your values and goals, and potentially seeing yourself as bad or as if you don't even exist

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 1-800-273-8255 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.


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 are dialectical behavior therapy (DBT), schema-focused therapy, transference-focused psychotherapy (TFP) and mentalization-based therapy (MBT).

Though the U.S. 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 for Patients

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. 

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Article Sources
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  1. MedlinePlus. Borderline personality disorder. Updated July 8, 2018.

  2. Cleveland Clinic. Borderline personality disorder. Updated December 8, 2017.

  3. Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorderCurr Behav Neurosci Rep. 2017;4(1):21–30. doi:10.1007/s40473-017-0103-z

Additional Reading
  • "Borderline Personality Disorder." Mayo Clinic, (2015). 
  • Biskin, R.S. "The Lifetime Course of Borderline Personality Disorder." The Canadian Journal of Psychiatry 60 (7), 2015.