An Attachment Perspective on Borderline Personality Disorder: Advances in Gene–Environment Considerations

Abstract

Accumulating evidence points to severe relationship dysfunction as the core epigenetic expression of borderline personality disorder (BPD). In adulthood, BPD is typified by disorganization within and across interpersonal domains of functioning. When interacting with their infants, mothers with BPD show marked withdrawal and frightening or frightened behavior, leading to disorganized infant-mother attachments. Linked to both infant disorganization and BPD is a maternal state of mind typified by unresolved mourning regarding past loss or trauma. Early risk factors for BPD in adulthood include maternal withdrawal in infancy and separation of 1 month or more from mother in the first 5 years of life. Likely contributing biological factors include genes linked to dopamine, serotonin, the hypothalamic-pituitary-adrenal axis, and neuropeptides. The complex gene-environment picture emerging confers risk or protection against BPD pathology in ways consistent with infants varying biological sensitivity to context. This line of research may refine early risk assessment and preventive mental health services.

Empathy and Alexithymia in Borderline Personality Disorder: Clinical and Laboratory Measures

“…Instead, diagnostic associations between intrapsychic pain, interpersonal sensitivity, alexithymia, and dissociation over the course of the borderline patient's development are likely related to a complex interplay between largely genetic, temperamental factors and chronic, repeated, or less discrete attachment stressors such as neglect, rejection, or abandonment (Fonagy & Luyten, 2009;Gunderson & Lyons-Ruth, 2008;Steele & Siever, 2010;Stiglmayr et al, 2008).…”

Dysregulation between emotion and theory of mind networks in borderline personality disorder

“…Current theories of borderline personality disorder (BPD) propose that the experience of early life trauma (e.g., childhood abuse or maternal separation), genetics, neurobiological alterations, or a combination of the above may play crucial roles in the development of the disorder (Goodman et al, 2004;Steele and Siever, 2010). In recent years, the spotlight has increasingly been focused on neurobiological abnormalities revealed using in vivo neuroimaging techniques.…”

Personality Disorders, Attachment and Psychodynamic Psychotherapy

“…Depending on which of these two modes of assessment are used, one might be tapping more into generalized trait-like characteristics more likely to be manifest in AAIs, while more situational/relational factors are more apparent on the Experiences in Close Relationships. Self-report inventories, organized around dimensions of avoidance or anxiety, tap into factors that map onto personality traits that are, in part, heritable [26], while studies using the AAI have tended to highlight the effects of the early caretaking environment [for reviews, see [6], [27]].…”