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.     

The self-image in borderline personality disorder: an in-depth qualitative research study

Patients with borderline personality disorder (BPD) suffer from affective instability, impulsivity, and identity disturbance which particularly manifest in an unstable or insecure self-image. One main problem for studies of core psychopathology in BPD is the complex subject of identity disturbance and self-image. The purpose of this study was to investigate the self-image of BPD patients with a qualitative research approach. Twelve patients with BPD were compared to 12 patients with remitted major depressive disorder (MDD) without personality disorder, using the Structured Interview of Personality Organization (STIPO). The transcribed interviews were analyzed using a combination of content analysis and grounded theory. BPD patients described themselves predominantly as helpful and sensitive; reported typical emotions were sadness, anger, and anxiety. MDD patients on the other hand reported numerous and various characteristics and emotions, including happiness, as well as sadness and anxiety. Other persons were characterized by the BPD group as egoistic and satisfied, while the MDD group described others as being balanced and secretive. BPD patients displayed an altruistic, superficial, and suffering self-image. Aggressive tendencies were only seen in other persons. Our findings support the concept of a self and relationship disturbance in BPD which is highly relevant for psychotherapy treatment.     

Deconstruction and Reconstruction

The authors present and elaborate their thesis that psychoanalysis is a hermeneutic science concerned with the causal nature of meaning. They contend that psychoanalysis is concerned primarily with uncovering the meaning of experience as unconsciously determined, that is, caused, by fantasy and as revealed by symptomatic effects. The cause-and-effect interrelationship that exists among fantasy, meaning, and symptom derives from certain abnormal experiences of self relative to selfobject that occur during early development. The authors draw upon their clinical studies of patients diagnosed with panic disorder, OCD, and OCPD and present two clinical vignettes for illustrative purposes. Using a combined method of "analytic deconstruction" and reconstruction, the authors demonstrate how various psychopathological states are reflective of failures to transform archaic narcissistic fantasies that unconsciously determine the meaning of the symptoms suffered by those diagnosed with these specific self-disorders.     

Some comments on masochism and the delusion of omnipotence from a developmental perspective.

This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother-child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patient's need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.     

Personal and parents’ life stories in patients with borderline personality disorder

Patients with borderline personality disorder (BPD) display disturbances in understanding self and others. We examined whether these disturbances extended to how patients described their personal and parents’ life stories and to measures of identity, alexithymia, empathy, and emotional intelligence. Thirty BPD patients and 30 matched control participants described personal and parents’ life stories and completed measures of identity disturbance, alexithymia, empathy, and emotional intelligence. Compared to the controls, patients with BPD described their personal and their parents’ life stories more negatively and with fewer themes of agency and communion fulfillment. Patients and controls showed equally complex reasoning about their personal life stories, but patients displayed less complexity and more self‐other confusion, when reasoning about their parents’ stories. Patients also differed from controls on identity disturbance, alexithymia, and empathy. The results suggest that patients’ storied understanding of themselves and others are disturbed and should be taken into account to better understand BPD.     

On knowing oneself directly and through others

For certain patients, the experience of self lacks solidity and conviction. These patients appear to be unable to know themselves directly and turn to others in their environment and in fantasy in order to discover or confirm a vision of themselves. The author argues that we can come to understand these patients' shadowy sense of self by looking at direct self-knowledge and knowledge of the self that is acquired through others as two storylines. Detailed clinical material from the analysis of a woman who came to analysis feeling shadowy and insubstantial illustrates the value of attention to both storylines and to the changing relationship between them.     

儿童区分幻想和现实的发展特点及作用机制

幻想(Fantasy)是指向未来, 与个人愿望相联系的想象, 且不一定以客观规律为依据。现实(Reality)是存在于日常生活中, 或者与我们生活法则相一致的事物或现象。准确地区分幻想和现实有利于在保护儿童想象力的同时, 确保他们的人身安全。国内外研究发现, 儿童区分幻想和现实的能力随着年龄的增长而提高; 受外部(实验材料的情感色彩、人物和主题类型)和内部(个体情绪感知强度、经验)因素的影响; 语言、元认知、心理理论和认知神经等可能是儿童区分幻想和现实的作用机制。未来研究需探索各种作用机制在儿童年龄与区分幻想和现实能力之间可能的调节效应, 以及儿童混淆幻想和现实的认知神经。在此基础上, 进一步明确既保护儿童想象力又确保其人身安全的有效措施。     

Psychotic withdrawal and the overthrow of psychic reality1

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to ‘dream’) from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self‐suffi ciency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or ‘dreamed’ in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and ‘deconstructed’ in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re‐emerge into a psychic reality.     

Fantasy proneness, mental imagery and reality monitoring

Individual differences in fantasy proneness and vividness of mental imagery have been suggested to be related to source memory confusions. To test this hypothesis, two groups scoring either high or low on a measure of fantasy proneness (selected from a group of 231 subjects) were compared on measures of self report vividness of mental imagery, objective imagery ability and reality monitoring performance. The two groups differed significantly on ratings of imagery vividness (p<0.01), but not on the imagery performance tasks, nor on reality monitoring performance. Our results indicate that, although fantasy proneness is associated with experiences of vivid mental imagery, it does not necessarily lead to reality monitoring errors.     

CHEMISTRY AND CONTAINING: THE ANALYST'S USE OF UNAVOIDABLE FAILURES

Certain patients overwhelm the analyst's capacity to contain both the patient and the analyst's own unbearable feelings. Though some such failures of containing may lead fairly quickly to self‐correction and others to clinical impasse, our focus is on an in‐between state in which the analyst's ability to tolerate his inevitable failures and gradually to (re)establish his containing capacities through difficult self‐analytic work can lead to significant change that might not otherwise be possible. The authors argue that this internal psychological work on the analyst's part, which may require considerable time, effort, and suffering, is an important aspect of “good enough” containing. The unique chemistry generated between patient and analyst plays an important role in both establishing and maintaining this kind of productive analytic process.     

Caregiver models of self and others, coping, and depression: predictors of depression in children with chronic pain.

In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.     

Exploring the Online Communicative Themes of Child Sex Offenders

This exploratory study aimed to examine online communications between contact reality and non‐contact fantasy child sex offenders (CSOs). This research wanted to ascertain whether it was possible to differentiate between these offenders based on the content of their online communications, something which has not previously been examined. The sample consisted of five contact reality and seven non‐contact fantasy offenders, all convicted of a Child Sex Offence. Content analysis revealed 26 them. Results showed that non‐contact fantasy offenders discussed Adult sexual relationships significantly more than contact reality offenders. All other comparisons were non‐significant. The themes were then grouped into five higher order themes: (i) Adult relationships, (ii) Child sexual interest, (iii) Media, (iv) Sexual self, and (v) Rapport. The average largest proportion of the online communication related to Child sexual interest (34%) followed by Rapport (28%). There were no significant differences between the two types of offenders in relation to these five higher order themes. Explanations for the findings are discussed with implications for police investigations. Copyright © 2015 John Wiley & Sons, Ltd.     

Egocentrism versus protocentrism: the status of self in social prediction

In this article, the author discusses the limitations of the egocentric view of self in which self serves as an automatic filter, inhibiting access to alternative representations of others' thoughts and feelings. The author then outlines a protocentric model, the self-as-distinct (SAD) model, in which generic representations of prototypic others serve as the default; representations of self, specific others, or categories encode only distinctiveness from generic knowledge about prototypic others. Thus, self-knowledge is distributed both in generic representations in which self and prototypic others are undifferentiated and in a self-representation that encodes distinctiveness. The self-representation does not serve to make predictions about others because it encodes how self differs from the generic representation of others. Predictions that are the same about self and others are protocentric, based on generic knowledge that serves as the default. The SAD model parsimoniously accounts for many inconsistent findings across various domains in social cognition.     

The day the earth stood still: The presence of trauma in time experience

The experience of time is commonly perceived as developing within the context of the early relationship between mother and infant. The beginning of life occurs in an adapted environment, aimed to protect the child from internal and external disruptions. Through healthy development, the mind acquires a feeling of continuity that gradually becomes a cohesive sense of personal identity. However, in cases of traumatic interruptions to the primary environment, the defensive shield of the self is penetrated and the individual becomes prematurely aware and adapted to the external reality. This forced acknowledgement of time and reality could be manifested in various types of time disturbances, such as disorientation about time or difficulties in following a schedule. In therapeutic relationships, this drama would be enacted in a struggle against the psychoanalytic setting, which disrupts the continuity of being with the therapist. Importantly, these patients express a deep conscious or unconscious fantasy to live in a timeless world, in which they would not be forced to adapt themselves to others’ expectations or needs. Clinical examples are used to illustrate how traumatic history is evident in the patient’s time experience and in the psychoanalytic dialogue.     

The relational self: an interpersonal social-cognitive theory

The authors propose an interpersonal social-cognitive theory of the self and personality, the relational self, in which knowledge about the self is linked with knowledge about significant others, and each linkage embodies a self-other relationship. Mental representations of significant others are activated and used in interpersonal encounters in the social-cognitive phenomenon of transference (S. M. Andersen & N. S. Glassman, 1996), and this evokes the relational self. Variability in relational selves depends on interpersonal contextual cues, whereas stability derives from the chronic accessibility of significant-other representations. Relational selves function in if-then terms (W. Mischel & Y. Shoda, 1995), in which ifs are situations triggering transference, and thens are relational selves. An individual's repertoire of relational selves is a source of interpersonal patterns involving affect, motivation, self-evaluation, and self-regulation.     

Seeing yourself helps you see others

It has been proposed that self-face representations are involved in interpreting facial emotions of others. We experimentally primed participants' self-face representations. In Study 1, we assessed eye tracking patterns and performance on a facial emotion discrimination task, and in Study 2, we assessed emotion ratings between self and nonself groups. Results show that experimental priming of self-face representations increases visual exploration of faces, facilitates the speed of facial expression processing, and increases the emotional distance between expressions. These findings suggest that the ability to interpret facial expressions of others is intimately associated with the representations we have of our own faces.     

Shared representations between self and other: a social cognitive neuroscience view

The abilities to identify with others and to distinguish between self and other play a pivotal role in intersubjective transactions. Here, we marshall evidence from developmental science, social psychology and neuroscience (including clinical neuropsychology) that support the view of a common representation network (both at the computational and neural levels) between self and other. However, sharedness does not mean identicality, otherwise representations of self and others would completely overlap, and lead to confusion. We argue that self-awareness and agency are integral components for navigating within these shared representations. We suggest that within this shared neural network the inferior parietal cortex and the prefrontal cortex in the right hemisphere play a special role in interpersonal awareness.     

Dissociation and self-awareness in directed daydreaming

Self-awareness, as the ability to be the observer of one's own cognitive. affective, and volitional states, was explored in directed daydreaming. Self-awareness of varying complexity and depth was found in the dissociated ego states, which were experienced as relatively discontinuous with each other in space and time, and discontinuous with the subjects' usual experience of a cohesive self. An extreme expression of shallow self-awareness was found for a few subjects who reported a fantasy with no experience of a self. The most elaborate form of self-awareness, coconsciousness , was found for the majority of subjects in the two-ego state group, where both of their ego states were associated with an identity feeling, and where one ego state evidenced full awareness of the thoughts and feelings of the other state. Coconsciousness was found to be a prerequisite for deep self-awareness in directed daydreaming.     

Preschool Fantasy-Reality Discrimination: Influences of Trait and Primed Fearfulness

Distinguishing between fantasy and reality is an important developmental milestone, achieved in the preschool years, that has been linked to children's cognitive capabilities and emotional knowledge. The authors examined the influence of both trait and prime fearfulness on preschoolers' ability to differentiate between fantastic and real situations. Forty 3–5-year-old preschoolers were administered a fearfulness assessment, a standard theory-of-mind task, and a fantasy-reality discrimination task (with or without a fear prime). When primed to experience fear, participants who were high in trait fearfulness made more mistakes distinguishing between fantastic and real events than did participants who were low in trait fearfulness. In the absence of a fear prime there was no difference in performance between these two groups. These findings were independent of participants' age, gender, and theory of mind abilities and suggest that preschoolers who are high in trait fearfulness are more prone to difficulty in discriminating between fantasy and reality when actively experiencing fear. This study illuminates important factors that contribute to the errors in fantasy-reality judgments frequently seen in preschoolers.