Proximal Risk Factors in Borderline Personality

abused child siting on a staircase

princessdlaf / Getty Images

When talking about borderline personality disorder (BPD) and the possible causes of BPD, you may hear talk of both proximal risk factors and distal risk factors. What are proximal risk factors, and what do we know about their role in BPD? How are the causes of BPD, behaviors associated with BPD, and risk factors related?

What Causes Borderline Personality Disorder (BPD)?

Researchers are still uncertain about how or why borderline personality disorder (BPD) occurs. Many people with BPD have common backgrounds, but these are certainly not universal among people with BPD.

In addition to environmental factors like experiencing abuse as a child, scientists suggest that BPD could be linked to genetics or brain abnormalities. Some studies of people with BPD have shown that there are inherited traits that can predispose someone to developing BPD. People with BPD often have members of their family tree who also experienced BPD.

Other research has shown that people with BPD show different brain activity than other individuals, particularly in the areas that regulate impulsive behaviors and emotional responses. 

Along with these potential causes, certain risk factors can be linked to BPD, including both proximal risk factors and distal risk factors. These risk factors are very different in how they are connected to BPD.

What Is a Proximal Risk Factor?

A proximal risk factor is a risk factor that precipitates a disease, such as BPD. They represent an immediate vulnerability for a particular condition or event. Sometimes proximal risk factors cause or shape an event.

For example, an intensely stressful life experience, such as a divorce or loss of a job, is a proximal risk factor for a suicide attempt. This type of experience often occurs immediately prior to self-harm.

Proximal risk factors work directly, or almost directly, to cause a disease or symptom to take place. However, they do not act alone or come out of nowhere. Someone with a solid foundation is not likely to commit suicide after a divorce or job loss. But someone who has experienced years of abuse during his childhood or constant rejection may commit suicide after these setbacks.

A proximal risk factor might be "the last straw," for someone with BPD, but these factors might have been building upon distal risk factors for many years.

What Is a Distal Risk Factor?

In contrast to proximal risk factors, distal risk factors represent background characteristics that may put someone at risk for an event or condition at some point in his lifetime, but not immediately.

In the case of borderline personality disorder, this can include intense childhood trauma or abuse. This background of trauma puts a person at a higher risk of later being diagnosed with BPD. 

It is believed that distal risk factors are connected to BPD because of their link to learned behaviors. For example, someone who grew up in an abusive household may have been taught from an early age that violence and aggression are acceptable and useful tools. This learned behavior can stay with a person throughout their life and influence how they react to different situations or triggers. In addition, those early experiences can actually influence how one's brain reacts under stress.

Common Links Among People With BPD

While the exact cause of borderline personality disorder is still unknown, scientists and researchers have identified some common links among people with BPD. From early life traumas to emotional triggers, proximal and distal risk factors play a major role in how BPD reveals itself in a person's life.

Proximal Risk Factors for Suicide With BPD

Proximal risk factors are important in BPD, not just for their contribution to the development of the condition, but how they may play a role in some of the consequences of BPD, such as suicide.

For those who are living with BPD or have a loved one with the disease, learn more about the proximal risk factors for suicide in people with BPD. Be alert for factors such as stressful events, suicide in others ("contagion effect suicide"), a plan for suicide, and feelings of hopelessness.

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 or a Loved One May Have BPD

A diagnosis of BPD can only be made by an experienced mental health professional. Many people have some traits of the disorder, but with BPD these traits cause significant distress and marked impairment in one's life.

If you or a loved one have been diagnosed with BPD, learn as much as you can about the condition. Find a therapist you can trust. There are ways in which both the symptoms and potential risk factors can be managed.

Learn about the treatment options for BPD which are available and make sure to take the time to prepare a safety plan for yourself or your loved one.

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.

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