In my practice I have been seeing an increase in college students with borderline personality disorder. Almost all of the borderlines I have seen recently are children of “helicopter” parents. That is why I am asking does helicopter parenting contribute to borderline personality disorder?

I don’t know who originated the term “helicopter parent” but it is a great description. These parents hover over children and swoop in to rescue them at the first sign of trouble. This rescuing behavior prevents the child from developing autonomy and a sense of self.

In most cases helicopter parenting can cause severe anxiety, indecisiveness and perfectionism. But some of the college students have even more severe symptoms. These “helicoptered” students have borderline traits and a few have the full spectrum of borderline personality disorder.

Now, I am not a research scientist. I am just an Appalachian psychiatrist in a small college town. I write this only as a clinician who has noticed something interesting.

CHARACTERISTICS OF BORDERLINE PERSONALITY DISORDER

Borderline personality disorder (BPD) is a misnomer. The term “borderline” originated in the 1930s when psychiatrists thought that emotionally unstable patients dwelt on the border between neurosis and psychosis.

The classification, Emotional Instability Disorder, better describes those individuals who demonstrate 4-5 traits of the following symptoms:

• Ambivalent feelings about others—an “I hate you, don’t leave me” attitude. The borderline has intense love-hate relationships—thinking that a person is angel or a devil with no realization that all of us have “good” and “bad” traits. A few minutes or hours later, the borderline might idealize an individual and the next hour (or minute) the borderline will consider the individual worthless or evil.
• Chaotic relationships
•  Frantic efforts to avoid real or imagined abandonment
•  An unstable self-image
•  Self damaging impulsivity such as overspending, sexual indiscretion, substance abuse, reckless driving, binge eating
•  Recurrent suicidal behavior, gestures, or threats
•  Self-mutilating behavior—cutting or burning self
•  Rapid onset of intense and profound depression
•  Rejection sensitivity—considered the slightest inattention of an individual as a totally rejecting attitude
•  Chronic feelings of emptiness
•  Inappropriate, intense anger—screaming, yelling, throwing things
•  Transient paranoid thinking
•  Emotional instability that disrupts family and work life

People with BPD often have highly unstable patterns of social relationships.

While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). They may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all.

Individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans.

Suicide threats and attempts occur as a maladaptive attempt to prevent abandonment. Intense anger develops when the borderline feels rejected.

Self-mutilation results from an attempt to reduce emotional stress. For the borderline, physical pain is preferred over emotional distress.

People with BPD exhibit other impulsive behaviors, such as excessive spending and risky sexual activity.

CLASSICAL ORIGIN OF BORDERLINE BEHAVIOR

Anyone who has a child knows that around 18-months of age the youngster toddles out of the room plays alone for a few minutes and then toddles back in the room looking for mother. With a wide-eyed smile, mama picks up her toddler, gives a warm hug, and coos encouragement. Consistent maternal and paternal affection enables the child to develop a stable sense of self and, with dependable parental behavior, the child develops the ability to sooth the self—the ability to tolerate the vicissitudes of life.  

When the-soon-to-become borderline toddles back into the room, mama has disappeared or is drunk or is verbally, emotionally, physically, or sexually abusive. Inconsistent, negligent, and abusive parental behavior generates a fear of abandonment and retards the toddler’s emotional development. The toddler feels alone, lost, and worthless.

As the years pass, feelings of worthlessness, and a poor sense of self cause frequent changes in careers, jobs, friendships, and values.

Borderlines view themselves as fundamentally bad or unworthy. They feel unfairly misunderstood or mistreated, bored, and empty. These feelings result in frantic efforts to avoid being alone. The emotional clinging behavior exhibited by borderlines repulses others.

The fear of abandonment felt by the borderline generates hostile behavior that results in the very rejection that the borderline fears.

THE HELICOPTERING DYNAMIC

In the cases I have been seeing “helicopter” rescuing produces the same dynamic. Overprotecting the child interferes with the development of emotional maturity.

Some of the students I have seen have parents are constantly in touch with their college children. They call the dean to switch roommates for their child, attend classes with their college children or call college professors to argue over a grade. These kids never learn to fend for themselves.

Consequently, they have low frustration tolerance, an unstable sense of self and chronic feelings of emptiness. This emotional instability leads to unstable relationships, a chaotic lifestyle, sudden feelings of intense anger and transient profound depressive episodes.

These parents tend to “spoil” their children. (This is a non- psychiatric term used only by an Appalachian psychiatrist, but I like it better than “over gratification.”)

Parents who establish an atmosphere that the child is special and has uncommon talent puts pressure on the child to meet impossible expectations leading to self-doubt, fear of abandonment, anger, and intense frustration. Being treated as a “superchild”– leads to borderline behavior when the individual is confronted with challenges in the “real world.”

Yes, all of our children are special in their own way. We are all unique children of God. As a savorily cooked steak has a special taste, an under cooked ribeye has no piquancy. Likewise, an overprotected child never develops maturity. That’s why I’m asking does helicopter parenting contribute to borderline personality disorder?

MEDICAL TREATMENT

The chemical messenger serotonin helps regulate emotions, including sadness, anger, anxiety, and irritability. SSRIs and SNRIs that enhance brain serotonin function may improve emotional symptoms in borderline personality disorder.

Likewise, mood-stabilizing medication that stabilize the serotonin-norepinephrine-dopamine imbalance and are also known to enhance the activity of GABA, the brain’s major inhibitory neurotransmitter, may help people who experience BPD-like mood swings, rage, irritability, and impulsivity.

An imbalance of dopamine, the so-called pleasure neurotransmitter, may contribute to impulsivity and anger. Antipsychotic medications can help regulate dopamine balance.

Benzodiazepines should be avoided because their disinhibiting properties could increase explosive outbursts.

The serotonergic, non-addicting medication, trazodone, offers the best option for sleep disturbance.

PSYCHOTHERAPY

Dialectic behavior therapy, a beneficial treatment for borderline personality disorder consists of seven elements

1. Corrective Emotional Response: A trustworthy therapist acts in a way as a surrogate parent. The therapist demonstrates non-possessive warmth. This means the therapist shows emotional warmth without controlling the patient.
   1. A genuine respect for the patient enables the patient to learn self-soothing behavior that failed to develop due to childhood emotional abandonment and poor parent-child interactions.
   2. Through verbal and nonverbal behavior the therapist demonstrates emotional stability when the patient exhibits angry outbursts, intense depressive episodes, frustration, impulsivity, mutilation behavior, and excessive emotional dependency. In other words the therapist keeps cool when the patient explodes.
   3. The therapist models and teaches self-discipline by setting limits on emotional outbursts.
   4. The therapist avoids rescuing the patient from conflicts of daily living while remaining kind and understanding. 
2. Psychodynamic Emotional Connections: Explaining how childhood emotional experiences connect to present emotional distortions is extremely helping in building rapport. This explanation helps the patient feel understood.
3. Cognitive Behavior Therapy: The patient practices changing thoughts to have better feelings.
4. Improving Responses to Day-to-Day Events: The patient keeps a daily journal that records events, feelings and thoughts generated by daily events. The therapist asks a series of questions to enable the patient to learn better ways of handling conflict.
5. Developing Emotional Skills: Through a series of questions the therapist explores the what, where, when, why, and how of conflict and stress. The therapist teaches skills to deal with stress and interpersonal conflict in the following areas:
   1. Evaluation of distorted thinking: The patient is helped to see different viewpoints in a conflict.
   1. Dealing with stress: The patient learns to manage emotions that are triggered by distressing events, including those that cannot be immediately resolved.
   1. Dealing with interpersonal conflict: The therapist teaches the patient to maintain healthy relationships. The patient learns that certain rules of society must be followed to get along in the world and to break social, ethical, and moral rules leads to self-destruction. The therapist helps the patient find ways to fulfill emotional needs while allowing others to fulfill their needs.
   1. Developing emotional stability: The patient learns self-soothing behavior by changing distorted beliefs and inappropriate actions. For example, a series of questions can help improve the patient’s response to perceived rejection:
      • What are you thinking (or doing) right now?
      • Is what you are thinking (or doing) helping you?
      • What thoughts (or actions) can help you feel better about yourself? (Several options may be formulated until the best solution is discovered.)
      • Will you commit to changing your thoughts (or actions)?
      • How will you demonstrate that you have committed to change?

6. Family/Marital Therapy: The crux of family therapy involves educating family members regarding BPD. Improving communication will help resolve the two poles of inappropriate family response: over involvement (rescuing) and neglect.

7. Medication Education: The risk and benefits of medications, how medications work and medication side effects are explained to the patient.                                                           

HELICOPTER RESEARCH POSSIBILITIES

Does helicopter parenting contribute to borderline personality disorder? I don’t know. I’m just writing about what I have seen in a university town tucked away deep in the heart of the Appalachian hills.