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Sexual orientation may also play a part in the borderline’s role confusion. In line with this theory, some researchers estimate a significantly increased rate of sexual perversions among borderlines. 10,11 Environmental factors that may theoretically contribute to the development of sexual identity include lack of role models, sexual assaults, an insatiable need for affection and attention, discomfort with one’s own body, and inconsistent sexual information.

Family and Child-Rearing Patterns

Since the end of World War II, our society has experienced striking changes in family and child-rearing patterns:

• The institution of the nuclear family has been in steady decline. Largely due to divorce, half of all American children born in the 1990s will spend some part of their childhood in a single-parent home.12

• Alternative family structures (such as “blended families,” in which a single parent with children combines with another one-parent household to form a new family unit) have led to situations in which many children are raised by persons other than their birth parents. According to one study, only 63 percent of American children grow up with both biological parents—the lowest percentage in the Western world.13 Due to increased geographical mobility, among other factors, the traditional extended family, with grandparents, siblings, cousins, and other family relations living in close proximity, is almost extinct, leaving the nuclear family virtually unsupported.

• The number of women working outside the home has increased dramatically. Forty percent of working women are mothers of children under age eighteen; 71 percent of all single mothers are employed.14

• As a result of women working outside the home, more children than ever before are being placed in various forms of day care—and at a much earlier age. The number of infants in day care increased 45 percent during the 1980s.15

• The evidence clearly suggests that the incidence of child physical and sexual abuse has increased significantly over the past twenty-five years.16

What are the psychological effects of these child-rearing changes—on both children and parents? Though many of these changes (such as blended families,) are too new to be the subject of intensive long-term studies, psychiatrists and developmental experts generally agree that children growing up in settings marked by turmoil, instability, or abuse are at much greater risk for emotional and mental problems in adolescence and adulthood. Moreover, parents in such environments are much more likely to develop stress, guilt, depression, lower self-esteem—all characteristics associated with BPD.

Child Abuse and Neglect: Destroyer of Trust

Child abuse and neglect have become significant health problems. In 2007, about 5.8 million children were involved in an estimated 3.2 million child abuse reports and allegations in the United States.17 Some studies estimate that 25 percent of girls experience some form of sexual abuse (from parents or others) by the time they reach adulthood.18

Characteristics of physically abused preschool-age children include inhibition, depression, attachment difficulties, behavior problems (such as hyperactivity and severe tantrums), poor impulse control, aggressiveness, and peer-relation problems.

“Violence begets violence,” said John Lennon, and this is particularly true in the case of battered children. Because those who are abused often become abusers themselves, this problem can self-perpetuate over many decades and generations. In fact, about 30 percent of abused and neglected children will later abuse their own children, continuing the vicious cycle.19

The incidence of abuse or neglect among borderlines is high enough to be a factor that separates BPD from other personality disorders. Verbal or psychological abuse is the most common form, followed by physical and then sexual abuse. Physical and sexual abuse may be more dramatic in nature, but the emotionally abused child can suffer total loss of self-esteem.

Emotional