Borderline personality disorder, mentalization, and the neurobiology of attachment

Abstract

We discuss the neural and neurobiological underpinnings of the core features of borderline personality disorder (BPD), including emotion dysregulation, impulsivity, disturbed interpersonal functioning, identity diffusion, and feelings of inner pain. We review neurobiological research that supports a developmental, biobehavioral switch-model of the relationship between mentalization, stress, and attachment. Although it is likely that there are different developmental pathways to BPD, involving complex interactions between environmental, biological, and psychosocial factors, the final common outcome of these pathways is a low threshold for the activation of the attachment system and for deactivation of controlled mentalization, coupled with impairments in the ability to differentiate mental states of self and other. This leads to hypersensitivity and increased susceptibility to contagion from other people's mental states, poor integration of cognitive and affective aspects of mentalization, and dysfunctions in stress-regulation systems. The treatment implications of this neurobiologically informed model of BPD are discussed.

The Borderline Empathy Paradox: Evidence and Conceptual Models for Empathic Enhancements in Borderline Personality Disorder

“…Such enhanced attention and perception may become pathological if they interact with deficits in other domains such as attentional control, emotion regulation, and regulation of the attachment system, such that the inferences drawn from social information become amplified and distorted toward negative, self-referential emotional states. This model is consistent with previous evidence of hypersensitivity to the social environment in BPD (Goodman & Siever, 2011;Gunderson & Lyons-Ruth, 2008;Lynch et al, 2006), which involves constant vigilance to anticipated rejection (Fertuck et al, 2009) and difficulties in regulating emotion due to low thresholds for stress-related activation of the attachment system and deactivation of controlled mentalization (Fonagy, Luyten, & Strathearn, 2011). Such stress-and emotion-mediated deactivation of controlled mentalization should be unlikely to reduce performance on the laboratory-based empathic-skill tests analyzed here, which could help to explain preservation of empathic abilities in individuals with BPD but cannot explain enhancements.…”

“…The dissociation between cognitive and affective empathy observed by Harari et al (2010) and Guttman and Laporte (2000) may also be concordant with the model, in that affective empathy may be more closely linked to the automatic and immediate perception of social-emotional cues and accompanying physiological responses, whereas cognitive empathy involves higher order cognitive functions (Shamay-Tsoory, 2011). Borderline empathy may thus involve dysregulation to the integrated social cognitive-affective system, resulting in a characteristic asymmetry or splintering of empathic skills (Fonagy et al, 2011). Gaining an understanding of the specific pattern of cognitive-affective enhancements and reductions in individuals with BPD, and their interactions with social attention and perception, attentional control, and emotion regulation, should clarify the relationship between borderline and normal social cognition, as well as elucidate the role of enhanced empathy in BPD etiology and symptoms.…”

Relationships: Empirical Contribution: Understanding Personality Pathology in Adolescents: The Five Factor Model of Personality and Social Information Processing

“…Moreover, these findings reinforce the growing consensus that problems in social functioning are a central key to personality pathology (Fonagy, Luyten, & Strathearn, 2011). The importance of addressing problems in social functioning from a developmental perspective is also noted by Chanen and Kaess (2012), who state that in contrast to the relatively unstable nature of the diagnosis of borderline personality disorder, both in adolescents and in adults, problems in social functioning are much more stable.…”

The Specific Role of Childhood Abuse, Parental Bonding, and Family Functioning in Female Adolescents With Borderline Personality Disorder

“…According to Fonagy and Bateman (2008), an invalidating and rejecting caregiving environment marked by parental criticism likely impairs a child's reflective capacities and sense of self which may in turn lead to BPD development (Fonagy, Luyten, & Strathearn, 2011). However, despite the high occurrence of antipathy from fathers in the BPD sample, this variable did not predict BPD symptoms in the final model over and above the influence of sexual abuse, family functioning, and low maternal care.…”