A Developmental Psychopathology and Neurobiological Model of Borderline Personality Disorder in Adolescence

The antecedents and risk factors and for developing borderline personality disorder (BPD) are now well documented, but there is a paucity of developmental models to understand the key processes through which they impact on the development of BPD in adolescents. In this article, we present a developmental psychopathology model of BPD in adolescence and link the difficulties adolescents with BPD have with impulsivity and self regulation, with risk factors such as genetic vulnerability, parenting and trauma. We propose a number of psychological processes through which these risk factors undermine personal and interpersonal functioning, and makes it particularly difficult to engage with the challenges of adolescence. These key psychological processes undermine the integration of the self, with extreme unintegrated affects and extreme representations of self and others, undermining the capacity to mentalize. We then make links to possible neurobiological underpinnings of the disturbances in affect, Theory of Mind and interpersonal difficulties in adolescents with BPD.     

What we say we do: results of the 1997 UK Association of Family Therapy Members Survey

This study represents the first UK national survey of family therapists and systemic practitioners. The aim was to provide demographic information of systemic practitioners/family therapists and also to describe their clinical practice. The sampling frame used was the UK Association of Family Therapy membership list and all members were sent a postal questionnaire. The response rate was 33% with 495 out of 1500 questionnaires returned. Among the major findings were: systemic practitioners/family therapists are most likely to work for an NHS trust, to use family therapy techniques/systemic ideas predominantly, and to treat a broad range of client issues. They are also most likely to work with families, and therapy is relatively short term (five to eight sessions) regardless of whether they treat families, couples or individuals. Most family therapists/systemic practitioners use some measure of outcome, although frequently this will be feedback from clients. Supervision is sought by the majority of AFT members. In spite of some methodological limitations, the study provides interesting insights into the training and practice of UK family therapists and systemic practitioners which appears to differ in some respects from our American colleagues. It also provides a baseline for future surveys, making it possible to describe the developments of family therapy and systemic practice in this country.     

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.     

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.     

Borderline personality disorder in an intermediate psychological therapies service

The intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n?=?63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.     

An Investigation of the Relationships among Negative Affect, Difficulties in Emotion Regulation, and Features of Borderline Personality Disorder

This study investigated the indirect effects of problematic emotion regulation on features of Borderline Personality Disorder (BPD) when accounting for negative affect in 456 participants from two distinct geographic regions. Participants completed the Affect Intensity Measure (AIM), Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Questionnaire (ERQ), and the Borderline Symptom List (BSL). Results from this study supported a model in which there were significant indirect effects of both a lack of emotional clarity and limited access to emotion regulation strategies on features of BPD when accounting for negative affective intensity. Results also supported a second model in which there were significant indirect effects of both limited access to emotion regulation strategies and difficulties engaging in goal-directed behavior on features of BPD when accounting for negative affective reactivity. The results highlight important inter-relationships among features of BPD, difficulties regulating emotions, and negative affective intensity and reactivity.     

Characteristics of Repetitive Thought Associated with Borderline Personality Features: A Multimodal Investigation of Ruminative Content and Style

Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of self-focused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.     

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.     

An experimental investigation of emotion dysregulation in borderline personality disorder

Despite the prominent role of emotion dysregulation in theoretical accounts of borderline personality disorder (BPD), few studies have examined emotion dysregulation in BPD. This study extends extant research by providing an experimental investigation of emotion dysregulation among outpatients with BPD. Specifically, this study modified an experimental measure of distress tolerance to examine differences between outpatients with BPD (n = 17) and those without a personality disorder (n = 18) in 2 aspects of emotion dysregulation: (a) the unwillingness to experience emotional distress in order to pursue goal-directed behavior and (b) the inability to engage in goal-directed behavior when distressed. As hypothesized, BPD participants were less willing to experience distress in order to pursue goal-directed behavior. However, BPD participants did not evidence greater difficulties engaging in goal-directed behavior when distressed. Results highlight directions for future research and suggest that particular aspects of emotion dysregulation may be more or less relevant to BPD.     

Nonjudgment as a moderator of the relationship between present-centered awareness and borderline features: Synergistic interactions in mindfulness assessment

The symptoms of borderline personality disorder (BPD) have been characterized as deficits in mindfulness. Mindfulness can be defined as nonjudgmental, present-centered awareness. The present study investigates the theory that, consistent with this conceptualization, the extent to which acting with awareness predicts reduced BPD features and related dysfunction depends upon levels of nonjudgment. In a sample of 223 undergraduates, we calculated the interaction between awareness-based and nonjudging-based mindfulness skills using subscales of the Five Facet Mindfulness Questionnaire. Regression analyses demonstrated a significant effect of the interaction on several difficulties that are common in BPD: problems with relationships, emotion-related impulsivity, and anger rumination. For acting with awareness to benefit individuals with these difficulties, a less judgmental stance toward internal experiences may be necessary. These findings have significant treatment implications and demonstrate the importance of assessing mindfulness as a multifaceted, synergistic construct.     

Do deficits in mindfulness underlie borderline personality features and core difficulties?

The current study investigated whether deficits in mindfulness (the awareness, attention, and acceptance of the present moment) can account for variability in borderline personality (BPD) features and characteristic difficulties in emotion regulation, interpersonal effectiveness, and impulsivity. Structural equation modeling and hierarchical regressions were utilized to examine the associations of trait mindfulness with BPD features, interpersonal problem-solving, impulsive and passive emotion-regulation strategies, and neuroticism in a sample of young adults (N = 342). As hypothesized, mindfulness was related inversely to BPD features and core areas of difficulty, and these associations continued even when controlling for neuroticism. Additionally, mindfulness deficits continued to predict borderline features even when interpersonal effectiveness, passive and impulsive emotion-regulation, and neuroticism were controlled. It is concluded that deficits in mindfulness may be integral to BPD features. Difficulties with attention, awareness, and acceptance of internal and external experience appear to explain borderline pathology even when controlling for problems with negative affectivity, behavioral dyscontrol, and emotional and interpersonal dysfunction--which have been described as definitional of this disorder. Thus, attention to mindfulness deficits may enhance clinical formulation of BPD symptomatology, as well as provide a vital component of effective BPD treatment.     

Borderline Personality Disorder in 3-D: Dimensions,Symptoms, and Measurement Challenges

Borderline personality disorder (BPD) is a pervasive pattern of psychopathology characterized by unstable affect, suicidal behaviors, and identity problems (Diagnostic and statistical manual of mental disorders. Washington, DC: Author; 2000). BPD is heterogeneous in nature, highly prevalent in clinical settings, and increasingly studied by clinical and social psychologists. This review highlights affective instability, impulsivity, and interpersonal hypersensitivity, the interaction of which we believe accounts for the symptoms of BPD, the BPD criteria most associated with these features, and the interrelationships among these underlying dimensions. We also discuss difficulties in measurement of these dimensions. Real-world assessment methods will assist in the measurement of time-dependent processes and identify causes, covariates, or consequences of these processes to determine how these features manifest themselves in real life.     

The Influence of Attachment Style,Self-protective Beliefs,and Feelings of Rejection on the Decline and Growth of Trust as a Function of Borderline Personality Disorder Trait Count

Borderline personality disorder (BPD) is associated with paradoxical trust behaviours, specifically a faster rate of trust growth in the face of trust violations. The current study set out to understand whether attachment style, self-protective beliefs, and feelings of rejection underpin this pattern. Young adults (N=234) played a 15-round trust game in which partner cooperation was varied to create three phases of trust: formation, dissolution, and restoration. Discontinuous growth modelling was employed to observe whether the effect of BPD trait count on trust levels and growth is moderated by fearful or preoccupied attachment style, self-protective beliefs, and feelings of rejection. Results suggest that the slower rate of trust formation associated with BPD trait count was accounted for by feelings of rejection or self-protective beliefs, both of which predicted a slower rate of trust growth. The faster rate of trust growth in response to trust violations associated with BPD trait count was no longer significant after self-protective beliefs were accounted for. Interventions targeting self-protective beliefs and feelings of rejection may address the trust-based interpersonal difficulties associated with BPD.

     

Clinical,neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) symptoms overlap with Borderline Personality Disorder (BPD). Since ADHD presents earlier than BPD, ADHD might be either a risk factor or a prodromal stage in the development of BPD or in the reinforcement of its symptoms. However, despite the similar phenomenological origin of the two disorders, ADHD and BPD patients often present discrete profiles. The present study reviews literature data of the clinical, neuropsychological and structural convergences and divergences of ADHD and BPD. A total of 185 studies were identified that address the association of ADHD and BPD and relate to clinical, neuropsychological and structural parameters. The total number of articles included was 45. ADHD exhibits a more outwardly expressed symptomatology, with difficulties in inhibition control and dysfunction in ventrolateral prefrontal regions. BPD presents a more mixed picture of externalizing and interrelating clinical features with emotionally conditioned cognitive disturbances and dysfunction in the orbitofrontal and dorsolateral prefrontal regions. When considering the three abovementioned parameters there is no unique clear-cut point that can differentiate the two disorders in a definitive way. Both disorders share impulsivity, emotional dysregulation, deficits in attention and decision making, brain volume reductions and connectivity impairments in prefrontal and limbic areas.     

Social perspective coordination in youth with borderline personality pathology

This study investigated social perspective coordination (SPC) in youth (15-24-year-olds) with first-presentation borderline personality disorder (BPD). SPC is defined as the capacity to differentiate and integrate the perspective of the self with the perspectives of others (Selman, Beardslee, Schultz, Krupa, & Podorefsky, 1986). Two groups: patients with full or sub-syndromal BPD (n = 30) and patients with major depressive disorder (MDD; n = 30) completed measures of SPC derived from the interpersonal negotiation strategies (INS) model (Selman et al., 1986). Compared with the MDD group, the BPD group responded to all vignettes with significantly lower SPC scores and SPC was a significant predictor of BPD status over and above self-reported, personality factors (Neuroticism and Agreeableness), attachment disturbance and functional impairment. These findings suggest that disturbances in social cognition are an important characteristic of individuals with BPD pathology. These difficulties extended beyond attachment contexts and were not limited to situations involving BPD-related themes of abandonment, deprivations or mistrust/abuse.     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients

To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.     

‘Seeing beyond the battled body’ – An insight into selfhood and identity from women's accounts who self‐harm with a diagnosis of borderline personality disorder

Background: Self‐harm (self poisoning and self‐injury) is broadly characterised as any act intended to harm one's own body, without a conscious intent to die. Research indicates that when practitioners encounter self‐harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self‐harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self‐harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self‐harm with a diagnosis of BPD. Participants: Four women who had a history of self‐harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face‐to‐face, in‐depth narrative interviews were undertaken and were analysed within a framework which drew upon aspects of the ‘performance’ (Langellier, 1989; 2001) and ‘narrative thematic’ approaches (Reissman, 1993). Findings: Two of the participant's accounts illustrate how their self‐harming appeared to have affected their selfhood and sense of agency. They discuss how the external signs of self‐harm may take over their identity and how others communicate and interact with them. Despite the problematic nature of self‐harm implications for practice are highlighted which practitioners may draw upon in their work around self‐harm.     

The Mediator Role of Negative Cognitive Emotion Regulation Strategies Between Interpersonal Problems and Borderline Personality Beliefs

Journal of Rational-Emotive & Cognitive-Behavior Therapy - Interpersonal difficulties and emotion regulation are the core characteristics of borderline personality disorders (BPD). However, how...     

Dialectical Behavior Therapy for Managing Interpersonal Relationships

Dialectical Behavior Therapy (DBT) is a treatment designed for individuals having borderline personality disorder (BPD), patients having binge eating disorder, co-morbid substance dependence and BPD, and depressed older adults. This paper aims to explore the use of DBT and to ascertain the status of DBT education in treating difficulties in handling interpersonal relationships among clients seeking counseling and psychotherapy. The skills training mode can be employed for teaching skills to solve relationship problems. Validation and acceptance strategies can lessen rejection sensitivity and negative feelings that make interpersonal situations chaotic. Black and white thinking can be resolved by finding a middle path through acceptance and change. This paper suggests the possible utility of DBT for enhancing psychological well-being in clients.