From the inside out : A Systematic Literature Review of the Etiology of Borderline Personality Disorder from a Social Work and Ecological Systems Perspective

Background and Purpose: According to data collected by the National Association of Social Workers (NASW), 60% of all mental health professionals in the United States are clinically trained social workers. Social workers often serve those who are marginalized and under serviced for example, individuals living with Borderline Personality Disorder (BPD). BPD is a highly gendered and stigmatized mental health disorder. People living with BPD experience intense and rapid changes in mood, and often engage in destructive and self-harming behaviour such as suicide attempts or non-suicidal self-injury such as cutting or burning. Approximately 10% of people diagnosed with BPD will die by suicide. Since 2000, research on BPD has increased significantly however, the etiology of BPD remains to be understood. For this reason, a systematic review of the literature was conducted from a social work lens and ecological systems perspective.

Methods: A systematic review was conducted utilizing the five-step framework outlined by Khan, Kunz, Kleijnen, and Antes (2011) in the book titled Systematic Reviews to Support Evidence-Based Medicine. The five steps are: (1) frame questions for the review, (2) identify relevant work, (3) assess the quality of the studies, (4) summarize the evidence and (5) interpret the findings.

Results: Findings from this study suggest that the etiology of BPD is complex and constructed of psychological, biological, and social factors. More specifically, this review found that: (1) the symptoms of BPD are well understood and the etiology is not, (2) the dominant discourse about the etiology of BPD is built almost entirely from the psychological literature with no social work critique and (3) the etiology of BPD has only been examined from the individual and microsystems levels, neglecting to consider macro levels, such as health and mental healthcare policies. 

Conclusions and Implications: Increasing awareness of the etiology of BPD within the social work literature has many potential positive implications to social work policy and practice. As social workers, we play a versatile role in the healthcare system and to be the most effective advocates, we must expand our understanding of BPD so that we can create more effective mental health services, enhanced health care policy, and better quality of life for individuals and families living with BPD. A novel framework for understanding the cause of BPD through a social work lens and ecological systems perspective will be presented with a focus on systemic and macro level implications. Treatment and policy implications for social workers will be discussed.