Attachment in Adolescence and Borderline Personality Disorder

Borderline personality disorder (BPD) has been conceptualized as a constellation of symptoms related to problems in self-functioning, emotion regulation, and interpersonal relationships. Its etiology has been connected to individuals’ early childhood environment, caregiving relationships, and traumatic life events. Recent literature has noted the potential presence of BPD beginning in adolescence, or even earlier in childhood. Attachment theory offers a lens for understanding the symptoms of borderline personality disorder and identifying potential aspects of treatment that may be specifically valuable for adolescent patients. Adolescence marks a time when the attachment system has increased relevance due to the importance of identity formation, peer relationships, body representations and the development of autonomy at this time, in the face of physical changes and academic challenges. This article will summarize research on attachment, body representations, personality disorders, and features of development in adolescence, in order to enhance clinical understanding of patients who presenting with these types of difficulties.     

Personality Characteristics and Development of Psychopathology in Bipolar I and Borderline Personality Disorder Patients

The debate whether Bipolar Affective Disorder and Borderline Personality Disorder fall under the same spectrum or they represent separate categories has received much research attention. However, the question of their underlying psychological aetiology as well as their personality correlates has remained largely un-explored. The present study aims at gaining knowledge about and insights into these questions. The sample studied consists of 10 Bipolar I patients and 10 patients with Borderline Personality Disorder. Following a cross-sectional design, after determining the remitted phase of Bipolar I patients using Hamilton Depression Rating Scale and Young’s Mania Rating Scale, the Temperament and Character Inventory, Attachment Style Questionnaire, Defense Style Questionnaire and Rorschach Inkblot Test were administered individually by the researcher. Both group of patients showed features of immaturity and instability. A correlational analysis indicated the probable pathway of development of psychopathology. The parallels of the findings to Kernberg’s concept of borderline personality organization have been discussed.     

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.     

Hypermentalizing in Borderline Personality Disorder: A Model and Data

Interpersonal difficulties are a widely accepted characteristic of borderline personality disorder (BPD). However, the results of empirical findings of deficits in social-cognitive abilities that may underlie interpersonal difficulties in this population have been mixed. In this paper, we review the literature on social-cognitive impairment in BPD by organizing studies based on patterns of positive and negative of findings. We provide a new model of mentalizing impairment in BPD by integrating findings into one framework that suggests hypermentalizing as the core feature of social-cognitive impairment in BPD. We review data in support of a hypermentalizing model of BPD and situate this data in the broader context of current work on hypermentalizing.     

Development of Borderline Personality Disorder in Adolescence and Young Adulthood: Introduction to the Special Section

Recognizable symptoms and features of borderline personality disorder (BPD) appear during adolescence. However, there has been resistance to diagnose or research this disorder prior to adulthood because of clinical lore that BPD is a long-standing illness and that personality traits are not stable until adulthood. This has resulted in little information regarding the development of and risk factors for BPD in youth. The goal of this special section is to examine the development of BPD in adolescence and young adulthood using a broad collection of approaches, including a theoretical review paper, two prospective studies, and a multi-method cross-sectional study. This body of work provides new insights into vulnerabilities that may transact with early attachment relationships and experiences to predict the emergence of BPD in adolescence and young adulthood. These papers also point to future research that is needed to better understand the etiology, development, and course of BPD.     

Borderline Personality Disorder in Adolescence Through the Lens of the Interview of Personality Organization Processes in Adolescence (IPOP-A): Clinical Use and Implications

Borderline personality disorder can be assessed in adolescence mainly through a dimensional approach that takes into account strengths and weaknesses of emerging personality patterns. Clinical interviews could help clinicians to gather information about adolescent’s functioning, fostering therapeutic alliance and promoting a mentalizing stance during the assessment of borderline adolescents. In this article, the Interview of Personality Organization Processes in Adolescence (IPOP-A) is presented through clinical case material to show its usefulness in clinical and research settings. The IPOP-A assesses an adolescent’s emerging personality along three dimensions: identity, quality of object relations and affect regulation. These dimensions are the core of borderline personality in adolescence.     

The Developmental Roots of Borderline Personality Disorder in Early Attachment Relationships: A Theory and Some Evidence

The paper suggests a way of understanding borderline personality disorder in terms of the failure of a secure base. We begin with an account of optimal self-development in a secure attachment context, highlighting the importance of the caregiver's ability to help the small child think about his own and others' minds. This optimal self-development is crucial in developing the child's capacity for mentalization, which can enhance his resilience in the face of later trauma. We discuss the impact of attachment trauma in later development, arguing that the extent of this impact depends on how well early attachment relationships facilitated the capacity for mentalization. We identify some of the consequences for the representations of the internal world of a failure of mentalization that may follow trauma in individuals made vulnerable by genetic predisposition or disorganized early attachment. We link these features to the clinical presentation associated with borderline personality organization. Finally, some of the necessary characteristics of successful psychotherapeutic treatment of borderline personality disorder are briefly considered.     

Children At-Risk for Borderline Personality Disorder

Adult patients who have been diagnosed with borderline personality disorder (BPD) have provided valuable information about events and family dynamics that are frequently associated with BPD. Clinicians who work with children are frequently aware of family or individual characteristics that may put a child at risk for developing BPD. Such situations frequently involve attachment issues with the child's caregivers and can include sexual abuse, divorce, alcoholism/substance use, illness/ death, and neglect. Child characteristics such as learning difficulties and temperament may also predict BPD. Yet, many children are resilient and seemingly unaffected by these events or situations, especially when early intervention may prevent development of BPD.     

Dysfunctional beliefs and psychopathology in Borderline Personality Disorder

This study examined the factor structure of the Borderline Personality Disorder subscale of the Personality Beliefs Questionnaire (PBQ-BPD; Butler, Brown, Beck, & Grisham, 2002), and the relationships between the emergent factors and psychopathology. The sample comprised 184 patients diagnosed with borderline personality disorder (BPD). Exploratory factor analysis yielded three factors relating respectively to dependency, distrust, and the belief that one should act preemptively to avoid threat. Although the three factors were significantly associated with depression, only dependency and distrust significantly correlated with hopelessness. Distrust was the sole factor that correlated significantly with suicide ideation. These findings support the dimensional structure of the PBQ-BPD. Given its multidimensional structure, the scale can be used as a measure of belief profiles associated with BPD and as an aid to conceptualizing beliefs underlying a range of psychopathology associated with patients with BPD.     

Impulsivity and emotion dysregulation in Borderline Personality Disorder

This study examined the association of borderline personality disorder (BPD) and negative emotional states with impulsivity in the laboratory. Undergraduate participants who were high in BPD features (high-BPD; n = 39) and controls who were low in BPD features (low-BPD; n = 56) completed measures of negative emotional state before a laboratory measure of impulsivity--a passive avoidance learning task. Controlling for psychopathology, high-BPD participants committed a greater number of impulsive responses than did low-BPD participants. Negative emotional state moderated the effect of BPD on impulsive responses. High-BPD participants who were in a negative emotional state committed fewer impulsive responses than high-BPD participants who were low in negative emotional state. Fear, nervousness, and shame negatively correlated with impulsivity among high-BPD participants but not among low-BPD participants. In addition, high-BPD participants reported greater emotion dysregulation in a variety of domains, compared with low-BPD participants.     

Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.     

The Role of Incest in Developmental Theory and Treatment of Women Diagnosed with Borderline Personality Disorder

The incidence of incest in the histories of women diagnosed with borderline personality disorder (BPD) has been noted recently by a number of clinicians (e.g., Barnard & Hirsch, 1985; Herman, Perry, & van der Kolk, 1989). However, the experience of child sexual abuse is virtually ignored in the developmental theory of the borderline syndrome. This paper presents a critical review of theoretical and clinical literature on child sexual abuse and BPD to explore three major goals: to describe the overlapping clinical picture of adult female survivors of incest and of women diagnosed with BPD, to examine the ways in which mother-blaming in psychoanalytic thought has contributed to the neglect of this experience in borderline clients, and to integrate treatment strategies from the child sexual abuse literature, traditional object relations theory, and feminist clinical theory.     

Autonomic impairment in Borderline Personality Disorder: A laboratory investigation

Recent research suggests that emotional dysfunction in psychiatric disorders can be reflected in autonomic abnormalities. The present study examines sympathetic and parasympathetic autonomic nervous system activity in individuals with Borderline Personality Disorder (BPD) before, during, and following a social stressor task. Data were obtained from an analogue sample of participants screening positive for BPD (n = 12) and healthy controls (n = 28). In general, BPD participants exhibited increased sympathetic activity (indexed by Cardiac Sympathetic Index, CSI; Toichi et al., 1997) and decreased parasympathetic activity (indexed by Respiratory Sinus Arrhythmia, RSA) compared to controls. During the stressful task, BPD and control participants exhibited different trajectories of sympathetic activation: estimates of sympathetic activity increased for BPD participants and decreased for controls. Furthermore, BPD participants reported the task (but not baseline or recovery phases) to be more frustrating than controls. Findings are interpreted in the context of Polyvagal theory.     

Recognition of facial affect in Borderline Personality Disorder

Patients with Borderline Personality Disorder (BPD) have been described as emotionally hyperresponsive, especially to anger and fear in social contexts. The aim was to investigate whether BPD patients are more sensitive but less accurate in terms of basic emotion recognition, and show a bias towards perceiving anger and fear when evaluating ambiguous facial expressions. Twenty-five women with BPD were compared with healthy controls on two different facial emotion recognition tasks. The first task allowed the assessment of the subjective detection threshold as well as the number of evaluation errors on six basic emotions. The second task assessed a response bias to blends of basic emotions. BPD patients showed no general deficit on the affect recognition task, but did show enhanced learning over the course of the experiment. For ambiguous emotional stimuli, we found a bias towards the perception of anger in the BPD patients but not towards fear. BPD patients are accurate in perceiving facial emotions, and are probably more sensitive to familiar facial expressions. They show a bias towards perceiving anger, when socio-affective cues are ambiguous. Interpersonal training should focus on the differentiation of ambiguous emotion in order to reduce a biased appraisal of others.     

Experiential Avoidance and Emotion Regulation in Borderline Personality Disorder

Many of the severe behavioral difficulties observed among persons with BPD (e.g., self-harm, suicidal behaviors) have been conceptualized as attempts to avoid or escape unwanted emotional experiences. As such, experiential avoidance likely plays a prominent role in the difficulties faced by persons with BPD. Individuals with BPD have demonstrated heightened levels of experiential avoidance in several studies. Several key features of BPD may contribute to experiential avoidance among persons with BPD, including a vulnerability to negative or distressing emotions, difficulty regulating emotions, and distress intolerance. Some research also suggests that a vulnerability to negative emotions among persons with BPD may be partly due to the use of experiential avoidance strategies to cope with emotional experiences. Within this paper, we review the literature on experiential avoidance and possible mechanisms underlying experiential avoidance among persons with BPD, and discuss the research and clinical implications of this literature.     

对边缘性人格障碍亚型的研究

边缘性人格障碍是一种最常见的人格障碍。描述性精神病学、心理测验和精神分析的研究发现,边缘性人格障碍可能是由若干个异质性的亚群体组成,不同的亚群在症状表现、病因、心理病理机制、对治疗干预的反应和预后等方面可能都存在着很大的差异,可以根据不同的维度将其进行亚型分类,而使同一个亚群中的个体差异小于不同亚群之间的个体差异。