Romantic Dysfunction, BPD, and Moral Responsibility

Posted on January 22, 2014 by

It is commonly argued that for one to be morally responsible, one must have control over one’s actions (see here for a run-down on arguments for that claim). Now, one does not generally concede that a person is moral pariah simply because the person is in the deepest stages of love, even if we do tend to lose our heads in moments of undeniable passion; but one might wonder whether some additional factor might play a role for when love nullifies moral responsibility. I want to entertain such a possibility by highlighting the fact that there are certain underlying disorders, such as Borderline Personality Disorder, or BPD, that can affect one’s capacity to form romantic relationships and sustain them. I suspect that in some cases, BPD might undo moral responsibility. Here is my reasoning.

The primary features of BPD are unstable interpersonal relationships, affective distress, marked impulsivity and unstable self image. The neurobiology of BPD suggests that there are specific dysfunctions to areas of the brain of persons with BPD that regulate emotions and actions. Therefore, if one were to peer into the brain of a person with BPD, it would appear to be  the brain of a person primed to lose control. Men or women with BPD typically have impairment in the anterior cingulate cortex (ACC), the frontal part of the cingulate cortex, a brain area associated with regulating emotions (Minzenberg, Fan, New, Tang, & Siever, 2008). In conjunction with dysfunction and decreased activation in the ACC, persons with BPD have also been attributed with an overactive amygdala, which is strongly associated with the processing of emotion (Herpertz et al., 2001). Dysfunction in the orbitofrontal cortex has also been associated with BPD. In a study by Heather Berlin and her colleagues, orbitalfrontal cortex lesions were correlated with disinhibition, socially inappropriate behavior and emotional irregularities; thus, the impulsive characteristics of BPD was associated with orbitofrontal cortex dysfunction (Berlin, Rolls, & Iverson, 2005). Furthermore, since dysfunction in the orbitofrontal cortex has also been linked to compulsive behavior, the orbitofrontal cortex dysfunction could reflect the compulsive features one often sees in impulsive disorders, like BPD (Torregrossa, Quinn, & Taylor, 2008). The brain abnormalities observed in borderlines are interpreted as corroborating the behavior and subjective experiences of persons with borderlines; firstly, borderlines typically report very intense and slowly subsiding emotions even in lower-level stress situations; secondly, borderlines often lack the cognitive tools to actually override their responses to emotions or appropriately deal with the intense emotions that they feel; and finally, borderlines tend to display behavior that is accompanied by little or no forethought, reflection or consideration of the consequences. It is with the aforementioned underlying brain abnormalities and dysfunctions that borderlines take into their romantic relationships.

Dysfunction within romantic relationships is a common characteristic of BPD. One study by John Gunderson notes that borderlines have a characteristic interpersonal style marked by abandonment fears and vacillation between idealization and devaluation (Gunderson, 2007). Another study on the relationship between attachment styles, BPD and romantic dysfunction indicates that BPD symptoms are specifically associated with romantic dysfunction (Hill et al., 2011). To be specific, BPD symptoms have an impact on several important aspects of couple functioning including: low levels of relationship satisfaction, higher degrees of intimate violence, attachment insecurity, and problematic sexual functioning (Bouchard & Sabourin, 2009). There are a number of explanations on offer for the problematic sexual behavior of persons with BPD. One explanation is that in cases of individuals with histories of childhood abuse, the BPD individuals find themselves re-enacting the abusive dynamic within a romantic relationship (Wiederman & Sansone, 2009, p. 279). In other cases, for some individuals with BPD, having sex may trigger post-traumatic anxiety because of past abuse, and therefore he or she is expected to avoid sexual activity when in a romantic relationship (Wiederman & Sansone, 2009, p. 279). Both explanations of the sexual dysfunctions of persons with BPD suggest that not only does BPD symptoms affect relationship dynamics, but also being in a romantic relationship is a significant factor that can exacerbate BPD symptoms.

Recent research on the effects of oxytocin on persons with BPD corroborates the hypothesis that romantic relationships, and perhaps love, is a factor that can exacerbate BPD symptoms. Oxytocin is a hormone that acts as a neuromodulator in the brain that has been specifically associated with sexual reproduction, pair bonding and romantic love. Not surprisingly, the neurochemical that we commonly associate with love has deleterious effects on persons with BPD. In one study by Jennifer Bartz and her colleagues, the effect of intranasal oxytocin on BPD was studied. Bratz concluded that oxytocin impedes trust and pro-social behavior on those with BPD and others who have chronic interpersonal insecurities (Bartz et al., 2011). Therefore, BPD is associated with relationship dysfunction in the sense that BPD symptoms affect the way that a person loves, and romantic love effects BPD symptoms. The romantic dysfunction characterized by BPD is, therefore, best understood as a reciprocal relationship between BPD symptoms and the dynamics of the romantic relationship. Therefore, when borderlines become out of control is frequently when they are in romantic relationships, and love can attenuate moral responsibility when the lover happens to be a person with BPD.

One final consideration is warranted regarding control and BPD: it is not the case that BPD individuals are equally disturbed, rather there is a continuum of borderline psychopathology which implies that those on the one end of the BPD continuum may be in more control than those on the other pole of the BPD continuum. Mary Zanarini, in “The Subsyndromal Phenomenology of Borderline Personality Disorder” suggests that on the one end of the spectrum, patients have mild cases of BPD have more control over their behavior, and on the other end of the BPD continuum patients have less control over their own behavior. Describing patients who have a mild case of BPD, Zanarini says, “These patients manifest the same dysphoria, and same cognitive disturbances, and the same interpersonal difficulties as more severely ill borderline patients. However what distinguishes them is their lack of impulsivity, particularly in the areas of self-mutilation and suicidal efforts, and their greater ability to use treatment relationship to enhance their functioning in the wider world.” (Zanarini, 2005)

Some worries arise about the accuracy and clarity of Zanarini’s characterization of less severe BPD patients. One item that remains unexplored and unmentioned by Zanarini is whether persons with less severe BPD actually have the exact same interpersonal difficulties as more severely ill borderline patients. I suspect that the BPD symptoms and relationship troubles would be more severe in more severely ill borderline patients. Furthermore, there is no indication that less severe borderline patients are impulsive in other areas like sex, reckless driving, spending of money or binge eating. It is my suspicion that persons with less severe symptoms may display some impulsivity, yet may be impulsive to a lesser degree. On the other end of the BPD spectrum, persons with BPD are described as being in less control.  As Zanarini writes, “(These) patients lead very chaotic lives, with areas of strength intermingled with wide-ranging and chronic pattern of self-defeating behaviors. These patients typically use a tremendous amount of psychiatric treatment and over the course of their disorder, may well give up both their determination and ability to function in the real world. More specifically, many of these patients abandon the structure of work or school and end up supporting themselves on disability. Many relinquish important relationships such as those with spouse or children and end up living lives of almost complete social isolation.”
(Zanarini, 2005)

Because of the plurality of degrees on the BPD continuum that appears to exist, my original thesis must be qualified to suggest that those with less severe conditions of BPD may experience more control over their behavior and hence may be more morally responsible. On the other hand, those with conditions on the other end of the BPD continuum may experience less control over their actions, and hence may be less morally responsible. While the BPD continuum may imply that persons with BPD can still be, to some degree, morally responsible, it can still be plausibly argued that BPD does have implications for whether one is more or less morally responsible.  When a person with BPD falls in love or is in a romantic relationship, he or she can experience a loss of control to such a degree, that one can plausibly assume that the person with BPD is not morally responsible for their own actions. So what do you think? Can love, in conjunction with conditions like BPD undo moral responsibility? What do you think?

-Ray Aldred

Ray is a doctoral student in Philosophy at the University of McGill. Follow him on twitter @Ray_Aldred


Works Cited and Consulted

Bartz, J., Simeon, D., Hamilton, H., Kim, S., Crystal, S., Braun, A., Hollander, E. (2011). Oxytocin can hinder trust and cooperation in borderline personality disorder. Social Cognition & Affective Neuroscience, 7(8).

Berlin, H. A., Rolls, E., & Iverson, S. (2005). Borderline Personality Disorder, Impulsivity and the Orbitofrontal Cortex. The American Journal of Psychiatry, 162(12).

Bouchard, S., & Sabourin, S. (2009). Borderline personality disorder and couple dysfunctions. Current Psychiatry Reports, 11(1), 55-62.

Bray, A. (2003). Moral responsibility and borderline personality disorder. Australian and New Zealand Journal of Psychiatry, 37, 270-276.

Cozolino, L. (2006). The Neuroscience of Human Relationships. New York: Norton & Company.

Gregorios-Pippas, L., Tobler, P. N., & Schultz, W. (2008). Short-Term Temporal Discounting of Reward Value in Human Ventral Striatum. Journal of Neurophysiology, 101, 1507-1523.

Griffin-Shelley, E. (1991). Sex and Love: Addiction, Treatment and Recovery. Westport: Praeger.

Gunderson, J. G. (2007). Disturbed Relationships as a Phenotype for Borderline Personality Disorder. The American Journal of Psychiatry, 164(11).

Hayden, B. Y., & Platt, M. L. (2010). Neurons in Anterior Cingulate Cortex Multiplex Information about Reward and Action. The Journal of Neuroscience, 30(9), 4874-4809.

Herpertz, S., Dietrich, T. M., Wenning, B., Krings, T., Erberich, S. G., Willmes, K. & Sass, H. (2001). Evidence of Abnormal amygdala functioing in borderline personality disorder: a functional MRI study. Biological Psychiatry, 50(4), 292-298.

Hill, J., Stepp, S. D., Wan, M. W., Hope, H., Morse, J. Q., Steele, M., & Pilkonis, P. A. (2011). Attachment, Borderline Personality and Romantic Relationship Dysfunction. Journal of Personality Disorders, 25(6), 789-805.

Minzenberg, M. J., Fan, J., New, A. S., Tang, C. Y., & Siever, L. J. (2008). Frontolimbic structural changes in borderline personality disorder. Journal of Psychiatric Research, 42(9), 727-733.

Nigg, J., Silk, K., Stavro, G., & Miller, T. (2005). Disinhibition and borderline personality disorder. Development and Psychopathology, 17(04), 1129-1149.

Torregrossa, M., Quinn, J., & Taylor, J. (2008). Impulsivity, Compulsivity, and Habit: The Role of Orbitofrontal Cortex Revisited. Biological Psychiatry, 63(3), 253-255.

Wiederman, M. W., & Sansone, R. A. (2009). Borderline Personality Disorder and Sexuality. The Family Journal, 17, 277-282.

Yang, Y., & Raine, A. (2009). Prefrontal Structural and Functional Brain Imaging findings in Antisocial, Violent, and Psychopathic Individuals: A Meta-Analysis. Psychiatry Research, 174(2), 81-88.

Zanarini, M. C. (2005). The Subsyndromal Phenomenology of Borderline Personality Disorder.In M. C. Zanarini (Ed.), Borderline Personality Disorder. New York: Taylor & Francis Group.