The implications of attachment theory and research for understanding borderline personality disorder

Abstract

Borderline personality disorder~BPD! is a highly prevalent, chronic, and debilitating psychiatric problem characterized by a pattern of chaotic and self-defeating interpersonal relationships, emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation. Recently, psychopathology researchers and theorists have begun to understand fundamental aspects of BPD such as unstable, intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment and intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. These investigators have noted that the impulsivity, affective lability, and self-damaging actions that are the hallmark of borderline personality occur in an interpersonal context and are often precipitated by real or imagined events in relationships. This article reviews attachment theory and research as a means of providing a developmental psychopathology perspective on BPD. Following a brief review of Bowlby's theory of attachment, and an overview of the evidence with respect to the major claims of attachment theory, I discuss individual differences, the evidence that these differences are rooted in patterns of interaction with caregivers, and how these patterns have important implications for evolving adaptations and development. Following this discussion, I present recent work linking attachment theory and BPD, focusing on the implications for understanding the etiology and treatment of BPD. In conclusion, I address some of the salient issues that point to the direction for future research efforts.

Inconsistency and social decision making in patients with Borderline Personality Disorder

“…BPD symptoms have frequently been attributed to an impairment in the underlying attachment organization (Levy, 2005). According to the attachment theory (Ainswort et al, 1978;Bowlby, 1969;1973;1977;1980), the affective bond between a child and a caregiver has an influence on the emerging self-concept of the child (for overview see Levy, 2005).…”

“…Mentalizing includes the capacity to generalize other's intentions to new social situations and to adjust evaluations in repeated social interactions. Securely attached individuals with BPD are very rare (Levy, 2005). The childhood and youth of BPD patients are typically characterized through conditions that impairs mentalizing (Ball & Links, 2009).…”

Enhanced sensitivity and response bias for male anger in women with borderline personality disorder

“…Although the etiological pathway of BPD is not well understood, negative experiences with caretakers are implicated in many theoretical models of the disorder (e.g., Bateman and Fonagy, 2003;Clarkin et al, 2007;Linehan, 1993). Adverse experiences in childhood may help explain why, compared to healthy controls, people with BPD have problems with attachment, are fearful of abandonment, and are less trusting of others (Hooley and Wilson Murphy, 2012;King-Casas et al, 2008;Levy, 2005;Unoka et al, 2009). …”

Betrayal trauma and borderline personality characteristics: Gender differences.

“…One consistent finding regarding BPD and attachment is the association between BPD and insecure attachment styles (Levy, 2005). In fact, some have suggested a disorganization of the attachment system is a key contributor of BPD features (Gunderson & Lyons-Ruth, 2008).…”