Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder.

Abstract

We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.

Grandiose and Vulnerable Narcissism in Borderline Personality Disorder

“…The quality of coping or defense styles could potentially be seen as a distinguishing factor underlying the phenomenological appearance of narcissism. Concerning this matter, other factors have also been proposed, e.g., neuroticism [29], attachment representations [14], and rejection sensitivity [10, 11, 35]. In line with the latter [74], BPD patients with vulnerable but not grandiose traits were more sensitive to rejection in our study.…”

“…Emotional vulnerability and interpersonal dysfunction are considered as key factors of both [10, 11], and co-occurrence of BPD and narcissistic personality disorder (NPD) is frequent [12, 13]. Although it is considered as particularly difficult to treat, studies of this comorbidity are limited [14, 15]. Even less research has been done on subthreshold narcissistic traits in BPD [16, 17].…”

Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind

“…In contrast to the insecure/organized categories of attachment, the U/d category showed a significant association with childhood adversity, PD diagnoses and severity variables, which indicates that a lack of resolution of these experiences may be an important factor in shaping the developmental pathway in the direction of long‐term negative effects that continue into adulthood (Bakermans‐Kranenburg & van IJzendoorn, ; Barone, ; Sroufe, ). These findings are consistent with previous research that highlights that U/d attachment category tends to be overrepresented in clinical populations, including PD (Diamond et al, ; Holmes, ; Hughes et al, ).…”

The parental reflective functioning questionnaire: Development and preliminary validation

“…The capacity for reflective functioning is therefore key in our ability to navigate the social world [5]. Unsurprisingly, therefore, impairments in mentalizing, and particularly an absent or compromised capacity to understand oneself and others in terms of mental states, have been shown to play an important role in the development of various psychiatric disorders, most specifically borderline personality disorder [6–11], antisocial personality disorder [12], eating disorders [13–17], and depression [18–20]. Over the past decades, a number of prevention and treatment programs for a variety of disorders and problem behaviors have been developed based on these ideas [6, 21–23] and have been evaluated in randomized controlled trials [24–26].…”