Developmental protective and risk factors in borderline personality disorder: a study using the Adult Attachment Interview

Mental representations and attachment in a sample of adults with Borderline Personality Disorder were assessed using the George, Kaplan and Main (1985) Adult Attachment Interview (AAI). Eighty subjects participated in the study: 40 nonclinical and 40 with Borderline Personality Disorder (BPD). The results obtained showed a specific distribution of attachment patterns in the clinical sample: free/autonomous subjects (F) represented only 7%, dismissing classifications (Ds) reached about 20%, entangled/preoccupied (E) 23% and unresolved with traumatic experiences (U) 50%. The two samples differed in their attachment patterns distribution by two (secure vs. insecure status), three (F, Ds and E) and four-way (F, Ds, E and U) categories comparisons. In order to identify more specific protective or risk factors of BPD, 25 one-way ANOVAs with clinical status as variable (clinical vs. nonclinical) were conducted on each scale of the coding system of the interview. Results support the hypothesis that some developmental relational experiences seem to constitute pivotal risk factors underlying this disorder. Results demonstrated potential benefits in using AAI scales in addition to the traditional categories. Implications for research and treatment are discussed.     

Mental representations of attachment in Eating Disorders: a pilot study using the Adult Attachment Interview

Mental representations of attachment in a sample of adults with Eating Disorders (ED) were assessed using the Adult Attachment Interview (AAI). Sixty subjects participated in the study: 30 non-clinical and 30 clinical. The results obtained showed a specific distribution of attachment patterns in the clinical sample: 10% Free/Autonomous (F), 47% Insecure-Dismissing (Ds), 17% Insecure-Entangled/Preoccupied (E) and about 26% disorganized (CC/U). The two samples differed in their attachment pattern distribution and were significantly different on some coding system scales. Further information was obtained by analyzing differences between the three ED subtypes considered (i.e. Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder) and by investigating the differential role of the two parental figures in the definition of attachment representations. Results showed potential benefits in using the AAI coding system scales in addition to the main classifications in order to understand better the developmental issues involved in these disorders. Implications for developmental research and clinical nosology are discussed.     

3140例一、二年级大学生B群人格障碍患病率调查

目的:调查我国大学生B群人格障碍患病现状.方法:用PDQ 4问卷从3140名一、二年级大学生中筛选出DSM-IV的B群人格障碍划界分阳性者,再以PDI-Ⅳ定式晤谈法进一步确定大学生群体的患病率.结果:3140名大学生样本中有38例符合B群人格障碍PDI-Ⅳ半定式晤谈的评定标准,总患病率为1.21%,符合反社会型人格障碍评定标准的大学生1例;边缘型21例,患病率0.67%;自恋型20例,患病率0.64%;表演型8例,患病率0.25%.其中10例符合一种以上的诊断标准,共病率为26.3%.结论:B群大学生B群人格障碍患病率低于国外报道的普通人群患病率,但略高于国内以往的调查结果,B群人格障碍各型之间有较高的共病率.     

Association between Low-Activity Allele of Cathecolamine-O-Methyl-Transferase (COMT) and Borderline Personality Disorder in an Italian Population

The objective of the present study was to test the association between Borderline Personality Disorder (BPD) and the cathecolamine-O-methyl-transferase (COMT) low-activity (Met158) single nucleotide polymorphism (SNP). In this case-control study, DNA was obtained from venous blood of 19 BPD patients and 36 healthy subjects. COMT-Val158Met single-nucleotide polymorphism was genotyped by predesigned SNP assay. The COMT Met158 allele was over-represented in patients with BPD in comparison to normal subjects (68.4% vs 44.4%, respectively; Fisher exact test, p = .02). In terms of genotype, the Met158Met subjects were more frequent in patients versus controls (47.4% vs 22.2%, respectively), whereas the high-activity genotype Val158Val was under-represented (10.5% vs 33.3%, respectively). The allele encoding for the COMT with low enzymatic efficiency was found to be over-represented in BPD, possibly resulting in excessive synaptic dopaminergic activity and ultimately affecting externalizing behaviours, such as impulsivity and aggressiveness.     

Attachment mental states and inferred pathways of development in borderline personality disorder: a study using the Adult Attachment Interview

We report the outcome of an investigation on how specific attachment states of mind and corresponding risk factors related to different DSM Axis I comorbidities in subjects with BPD. Mental representations of attachment in four BPD sub-groups (BPD and Anxiety/Mood Disorders, BPD and Substance Use and Abuse Disorders, BPD and Alcohol Use and Abuse Disorders, and BPD and Eating Disorders) were assessed in 140 BPD subjects using the Adult Attachment Interview (AAI). In addition to the global attachment picture in which Insecure organized (Dismissing 51% and Enmeshed 35%) and Insecure disorganized categories (40%) were overrepresented, significant differences in attachment category were found between the four BPD sub-groups. Axis I comorbidities corresponded with attachment features on the internalizing/externalizing functioning dimension of the disorder. Furthermore, specific constellations of inferred developmental antecedents and attachment states of mind corresponded differentially with the BPD sub-groups. Implications for developmental research and clinical nosology are discussed.     

Attachment mental states and inferred pathways of development in borderline personality disorder: a study using the Adult Attachment Interview

We report the outcome of an investigation on how specific attachment states of mind and corresponding risk factors related to different DSM Axis I comorbidities in subjects with BPD. Mental representations of attachment in four BPD sub-groups (BPD and Anxiety/Mood Disorders, BPD and Substance Use and Abuse Disorders, BPD and Alcohol Use and Abuse Disorders, and BPD and Eating Disorders) were assessed in 140 BPD subjects using the Adult Attachment Interview (AAI). In addition to the global attachment picture in which Insecure organized (Dismissing 51% and Enmeshed 35%) and Insecure disorganized categories (40%) were overrepresented, significant differences in attachment category were found between the four BPD sub-groups. Axis I comorbidities corresponded with attachment features on the internalizing/externalizing functioning dimension of the disorder. Furthermore, specific constellations of inferred developmental antecedents and attachment states of mind corresponded differentially with the BPD sub-groups. Implications for developmental research and clinical nosology are discussed.     

Absence of Attachment Representations (AAR) in the adult years: The emergence of a new AAI classification in catastrophically traumatized Holocaust child survivors

In the present study we present a new and rare type of discourse in the AAI which is characterized by absence of attachment representations during adulthood. Forty-eight women, who as children lost both parents as a result of the Holocaust, were administered the AAI in their late adulthood. Two cases in this sample could not be assigned to any of the traditional AAI classification system (F, Ds, E, CC), mainly because they were unable to associate themselves with any significant attachment figure throughout their life. We raise the possibility that some devastating experiences during childhood might cause an unrecoverable crash in already established patterns of attachment to an extent that adulthood will be characterized by state of mind that bears no emotional tie to even a single attachment figure. We illustrate this state of mind by presenting the life history as well as quotations from the AAI of two women, and we discuss the possibility of a new AAI classification, namely Absence of Attachment Representations – AAR. The possible effects of the AAR classification on parental caregiving behaviors are discussed.     

Absence of Attachment Representations (AAR) in the adult years: the emergence of a new AAI classification in catastrophically traumatized Holocaust child survivors

In the present study we present a new and rare type of discourse in the AAI which is characterized by absence of attachment representations during adulthood. Forty-eight women, who as children lost both parents as a result of the Holocaust, were administered the AAI in their late adulthood. Two cases in this sample could not be assigned to any of the traditional AAI classification system (F, Ds, E, CC), mainly because they were unable to associate themselves with any significant attachment figure throughout their life. We raise the possibility that some devastating experiences during childhood might cause an unrecoverable crash in already established patterns of attachment to an extent that adulthood will be characterized by state of mind that bears no emotional tie to even a single attachment figure. We illustrate this state of mind by presenting the life history as well as quotations from the AAI of two women, and we discuss the possibility of a new AAI classification, namely Absence of Attachment Representations--AAR. The possible effects of the AAR classification on parental caregiving behaviors are discussed.     

边缘型人格障碍大学生的童年期创伤经历特征

目的:探讨边缘型人格障碍(borderline personality disorder,BPD)大学生的童年期创伤经历特征。方法:用人格诊断问卷第四版(Personality Diagnosis Questionnaire-4+,PDQ-4+)从3227名二、三年级本科生中筛选出边缘型阳性者293例,用个性障碍晤谈手册第四版(Personality Disorder Interview,PDI-IV)半定式晤谈法进一步筛选出BPD患者(得分5分)31例。从PDQ-4+划界分阴性的大学生中按年龄和性别比随机选取114例为对照组。用童年期创伤经历问卷(Childhood Trauma Questionnaire,CTQ-SF)对两组进行测评。结果:①在PDQ-4+筛查中,总体的边缘型分量表分为(2.62±1.70);31例BPD患者中女18例,男13例,女性CTQ-SF不良环境因子得分高于男性[(13.63±4.54)vs.(9.83±1.95),P0.01]。②BPD组的CTQ-SF各因子分均高于对照组[如,情感虐待(2.11±0.77)vs.(1.66±0.49),P0.01]。结论:大学生边缘型人格障碍者均有不同程度的童年期创伤经历,而且这种创伤经历存在性别差异。     

边缘性人格障碍的研究进展

目的 对边缘性人格障碍的流行病学、临床表现、诊断问题、药物治疗情况作一综述,有助于临床工作者提高对边缘性人格障碍的认识.方法 对近年来国内外有关边缘性人格障碍的研究和文献进行整理和回顾.结果 发现迄今国内对边缘性人格障碍的研究还很少,国外则有较多和较深入的研究. 结论 对边缘性人格障碍的研究应予以重视.     

Disorganized attachment and borderline personality disorder: a clinical perspective

The aim of this paper is to explore the links between the attachment-theory derived concept of disorganized attachment, and the psychiatric diagnosis of Borderline Personality Disorder (BPD). Disorganized attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatized/traumatizing caregivers are simultaneously a source of threat and a secure base. Interpersonal relationships in BPD including those with care givers is similarly seen in terms of approach-avoidance dilemmas, which manifests themselves in disturbed transference/countertransference interactions between therapists and BPD sufferers. Possible ways of handling these phenomena are suggested, based on notion of 'meta-cognitive monitoring', in the hope of re-instating meaning and more stable self-structures, in these patients' lives.     

Disorganized attachment and Borderline Personality Disorder: A clinical perspective

The aim of this paper is to explore the links between the attachment-theory derived concept of disorganized attachment, and the psychiatric diagnosis of Borderline Personality Disorder (BPD). Disorganized attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatized/traumatizing caregivers are simultaneously a source of threat and a secure base. Interpersonal relationships in BPD including those with care givers is similarly seen in terms of approach-avoidance dilemmas, which manifests themselves in disturbed transference/countertransference interactions between therapists and BPD sufferers. Possible ways of handling these phenomena are suggested, based on Main's () notion of ‘meta-cognitive monitoring’, in the hope of re-instating meaning and more stable self-structures, in these patients' lives.     

Does mindfulness mediate the association between attachment dimensions and Borderline Personality Disorder features? A study of Italian non-clinical adolescents

The aim of this study was to assess whether mindfulness mediates the association between attachment dimensions and features of Borderline Personality Disorder (BPD) in a sample of 501 Italian high-school students. Low scores on Confidence and high scores on Need for Approval and Preoccupation with Relationships attachment scales was significantly related to the number of BPD features (adjusted R(2) = .2, p < .001). Further, mindfulness scores were negatively associated with Need for Approval and Relationships as Secondary attachment scales (adjusted R(2) = .14, p < .001). Finally, mindfulness scores were negatively associated with the number of BPD features (adjusted R(2) = .15, p < .001). Mediation analyses showed that the relationship between Need for Approval and BPD was completely mediated by the mindfulness effects. Our results in non-clinical adolescents are consistent with Bateman and Fonagy's (2004) hypothesis that the link between attachment disturbances and BPD features may be mediated by deficits in mentalization, at least as these are operationalized by low mindfulness.     

Effects of borderline personality disorder features and a family history of alcohol or drug dependence on P300 in adolescents.

Decrements in P300 amplitude have been associated with familial risk for alcoholism as well as several other psychiatric disorders characterized by disinhibited behavior. The present study examined the P300 in relation to Borderline Personality Disorder (BPD) features in adolescents with a paternal history of alcohol or drug dependence. One hundred and seventy-five males and females, aged 14-20, were assigned to groups based on BPD features (BPD+ vs. BPD-), family history of substance dependence (negative FH-, alcohol FHA, drug FHD) and gender. BPD features were assessed using the Structured Clinical Interview for the DSM-III-R questionnaire. P300 ERPs were recorded while each subject performed the Stroop color-word compatibility test. Repeated measures analyses, which included Conduct Disorder and Depression symptoms as covariates, indicated a significant reduction in P300 amplitude in the BPD+ group. There were no significant effects of FH or gender on P300 amplitude. These results document the presence of neurophysiological abnormalities associated with BPD features in an adolescent sample. This effect appeared to be independent of a family history of alcohol or substance dependence. These findings suggest that BPD symptoms during adolescence are relevant to the examination of the physiological antecedents of those forms of adult psychopathology characterized by behavioral disinhibition, including alcohol and drug dependence.     

Possible selves and borderline personality disorder

Although clinical theories suggest that people with Borderline Personality Disorder (BPD) experience a confused sense of self, little empirical research has directly examined the self in BPD (Heard & Linehan, 1993; Westen & Cohen, 1993). In this study, 43 female participants, 15 with BPD and 28 without BPD, completed the closed-ended version of Markus and Wurf's (1987) Possible Selves Questionnaire (PSQ). Participants with BPD were less likely than controls to endorse positive possible selves as current, but more likely to endorse negative possible selves as current, probable, desired, and important. Participants with BPD linked negative and positive selves to their desired selves, which is consistent with the unstable sense of self characteristic of BPD.     

A Rorschach exploration of the DSM-IV Borderline Personality Disorder.

Rorschach data has been useful in identifying the DSM Borderline Personality Disorder (BPD) and has potential for improving our understanding of this disorder. Recently, the DSM-IV BPD has been shown to be composed of 3 primary or core factors: Factor I-unstable self-other images. Factor II-deficits in affect and thought modulation, and Factor III-impulsive self-damaging actions. In a sample of outpatients with personality disorders. we explored the relationships among 6 psychoanalytically derived Rorschach scales (primitive aggression, oral dependency, self-other differentiation, splitting, devaluation, and projective identification), and the core BPD features. Significant correlations were found between 5 of the Rorschach variables and BPD total scores. Correlations between these 5 variables and the BPD core features showed that oral dependency needs were negatively associated with all 3 BPD core features, whereas the defenses of devaluation and splitting were positively associated with these core features. The clinical implications of these findings are reviewed.     

Borderline personality traits and adult attention‐deficit hyperactivity disorder symptoms: A genetic analysis of comorbidity

Previous research has established the comorbidity of adult Attention‐Deficit Hyperactivity Disorder (ADHD) with different personality disorders including Borderline Personality Disorder (BPD). The association between adult ADHD and BPD has primarily been investigated at the phenotypic level and not yet at the genetic level. The present study investigates the genetic and environmental contributions to the association between borderline personality traits (BPT) and ADHD symptoms in a sample of 7,233 twins and siblings (aged 18–90 years) registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey (EFPTS) . Participants completed the Conners' Adult ADHD Rating Scales (CAARS‐S:SV) and the Personality Assessment Inventory‐Borderline Features Scale (PAI‐BOR). A bivariate genetic analysis was performed to determine the extent to which genetic and environmental factors influence variation in BPT and ADHD symptoms and the covariance between them. The heritability of BPT and ADHD symptoms was estimated at 45 and 36%, respectively. The remaining variance in BPT and ADHD symptoms was explained by unique environmental influences. The phenotypic correlation between BPT and ADHD symptoms was estimated at r = 0.59, and could be explained for 49% by genetic factors and 51% by environmental factors. The genetic and environmental correlations between BPT and ADHD symptoms were 0.72 and 0.51, respectively. The shared etiology between BPT and ADHD symptoms is thus a likely cause for the comorbidity of the two disorders. © 2011 Wiley‐Liss, Inc.     

Fact or fiction: diagnosing borderline personality disorder in adolescents

Borderline Personality Disorder (BPD) has long been considered a mental health problem that results in considerable costs in terms of human suffering and psychiatric expenses among adult patients. Although the diagnosis of BPD for adolescents is frequently used in clinical settings, the field of mental health has questioned whether one should diagnose BPD among adolescents. This paper reviews the recent empirical literature (identified through PsycINFO 1980 to present) to evaluate prevalence, reliability, and validity of a BPD diagnosis in adolescents. It is concluded that the features BPD diagnoses in adolescents are comparable to those in adults. Furthermore, there appears to be a legitimate subgroup of adolescents for whom the diagnosis remains stable over time as well as a less severe subgroup that moves in and out of the diagnosis. While caution is warranted, formal assessment of BPD in adolescents may yield more accurate and effective treatment for adolescents experiencing BPD symptomatology. More longitudinal research is necessary to further explicate the issues of diagnosing BPD in adolescents.     

大学生B群人格障碍患者童年期创伤性经历的研究

目的：了解大学生B群人格障碍被试童年期创伤性经历的特点。方法：先用PDQ＋4问卷筛查，冉以PDI—IV对筛查的阳性被试进行半定式查询确诊B群人格障碍患者，然后用童年期创伤性经历问卷（CTQ）测查所有被试的章年负性经历。结果：除情感忽视因子外，B群人格障碍组CTQ各因子和总分均显著高于正常对照组。进一步将边缘型人格障碍（Borderline Personality Disordel ，BPD）组和自恋型人格障碍（Narcissistic Personality Disorder．NPD）组分别与正常对照组比较．发现BPD组情感虐待和情感忽视的因子分和总分屁著高于正常对照组。NPD组与对照组比较无鼎著性差异。结论：大学生B群人格障碍被试的童年期创伤较正常组严重。BPD在情感方面的创伤性经历尤其明显，提示情感虐待和忽视是大学生BPD发病的特征性因素。