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, 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.

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 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.


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:

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.


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.

3 Sources
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  1. 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

  2. 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

  3. 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

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.