Brain activity to transitional objects in patients with borderline personality disorder

Abstract

Adult patients with borderline personality disorders (BPD) frequently have attachments to inanimate transitional objects (TOs) such as stuffed animals. Using event-related potential (ERP) recordings, we determined in patients with BPD the neural correlates of the processing of these attachment-relevant objects and their functional significance. Sixteen female patients with BPD viewed pictures of their TOs, other familiar stuffed toys (familiar objects, FOs), and unfamiliar objects (UOs). ERPs in the patients were compared to those in 16 matched healthy controls who possessed a stuffed animal of comparably high familiarity. Here, we found a specific increase of frontal P3/LPP amplitude in patients with BPD, which was related to attachment anxiety and depression scores. Attachment-related TO stimuli in patients with BPD specifically modulated stages of emotional stimulus evaluation reflecting processing of self-relevance. The relation of the frontal ERP effect to patients’ attachment anxiety and depression highlights the function of TOs for coping with anxiety about being abandoned by significant others and for dealing with depressive symptoms.

Evidence for Altered Neural Processing in Patients With Borderline Personality Disorder

“…Another facet of self-relevance concerns so-called transitional objects, a term used in psychodynamic therapy describing the projection of attachment to inanimate objects (Kiefer et al, 2017). Kiefer et al (2017) examined whether patients with BPD exhibited altered processing of attachment-relevant transitional objects during a 1-back task, compared to less emotionally salient, but familiar objects.…”

“…Another facet of self-relevance concerns so-called transitional objects, a term used in psychodynamic therapy describing the projection of attachment to inanimate objects (Kiefer et al, 2017). Kiefer et al (2017) examined whether patients with BPD exhibited altered processing of attachment-relevant transitional objects during a 1-back task, compared to less emotionally salient, but familiar objects. During the task, pictures of transitional objects, familiar and high familiar objects and unfamiliar objects were presented to the participants, who had to indicate whether the object was presented in the trial before.…”

“…In contrast to healthy controls, significant findings with regard to frontal P3/LPP (320–520 ms after stimulus onset) occurred in the patient group, with transitional objects eliciting larger P3/LPP amplitudes compared to unfamiliar and familiar objects. Interestingly, increased attachment anxiety and depression correlated positively with the “frontal transitional object effect.” This could reflect the function of transitional objects as supplementary attachment figures in individuals with BPD (Kiefer et al, 2017).…”

The Compassionate Kitbag: A creative and integrative approach to compassion‐focused therapy

“…Bateman and Fonagy (2004) have identified the specific difficulties that patients with a diagnosis of borderline personality disorder experience in mentalizing, that is, holding mind in mind, and therefore having a concrete symbol of the positive regard of the therapist can be helpful to mediate the often‐overwhelming feelings. This is supported by recent neuroscientific data showing that transitional object usage in a group of female patients with a diagnosis of borderline personality disorder activated attachment‐related neural circuitry in the right prefrontal and orbito‐frontal cortex, which was not the case when compared to using other familiar or unfamiliar objects (Kiefer et al ., 2017). The functions of these were to cope with feelings of anxiety about abandonment by significant others and for emotion regulation (Kiefer et al ., 2017).…”

“…This is supported by recent neuroscientific data showing that transitional object usage in a group of female patients with a diagnosis of borderline personality disorder activated attachment‐related neural circuitry in the right prefrontal and orbito‐frontal cortex, which was not the case when compared to using other familiar or unfamiliar objects (Kiefer et al ., 2017). The functions of these were to cope with feelings of anxiety about abandonment by significant others and for emotion regulation (Kiefer et al ., 2017). The transitional object can also serve the function of the secure base to mediate the impact of threat‐based stimuli which could be the material that the patient brings to the therapy space (Keefer, Landau, & Sullivan, 2014).…”