What Is a Proximal Risk Factor?

Proximal Risk Factors and Borderline Personality Disorder

abused child siting on a staircase
What is a proximal risk factor an what are their role in borderline personality disorder (BPD)?. 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 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 it could be an inherited trait. 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. While the proximal risk factor may be the final straw, they are usually built off of years of development, such as through distal risk factors.

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 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.

Someone who grew up in an abusive household may have learned from an early age that violence and aggression are an acceptable and useful tool to get what is desired. These learned behaviors can stay with that person throughout their lives and influence how they react to different situations or triggers. 

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 or a Loved One May Have BPD

A diagnosis of BPD can only be made by an experienced therapist. Many people have some traits of the disorder, but with BPD these traits cause significant distress and an inability to fully appreciate 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.

Sources:

Aaltonen, K., Naatanen, P., Heikkinen, M. et al. Differences and Similarities of Risk Factors for Suicidal Ideation and Attempts Among Patients with Depressive or Bipolar Disorders. Journal of Affective Disorders. 2016. 193:318-330.

Reed, L., Fitzmaurice, G., and M.Zanarini. The Course of Dysphoric Affective and Cognitive States in Borderline Personality Disorder: A 10-Year Follow-Up Study. Psychiatry

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