Defining the mechanisms of Borderline Personality Disorder

J. Clarkin and M. Posner (2005)

Introduction

Prevalence 0.3-0.7% Suicidal and self-injurious behaviour Prevalent, chronic, debilitating No clear organic markers

Symptoms

At least 5 out of 9 (DSM-IV) Identity diffusion Impulsivity Affect disregulation But: symptoms are unstable

Temperament

„Individual differences in motor and emotional reactivity and self-regulation”

Influenced by genes and environment

Relates to negative affect, self-control, and the internal sense of self and others

Negative affect

Invades information processing Influences individual and

interpersonal experience

Poor self-regulation

Manifested in impulsive behaviour Impulsive self-destructive

behaviours and aggression More heritable than BPD itself Involvement of serotonergic activity

(biological component) Dysregulation of negative affect Developmental course

Identity diffusion

Lack of integration of the concept of self and others

Pathology of object relations Difficulties in commitment to work Disturbances in sexual and love life Anatomically connected to problems

with self-regulation (midfrontal cortex)

Attachment

Early developmental experience influences the representations of self and others later on

BPD: early abuse, separation from parents, neglect

Insecure attachment style: dismissive or preoccupied

Working model

Focus on the information-processing system

Temperamental dispositions + environmental factors BPD

Research plan

Borderline Personality Disorder patients compated to 2 groups Controls matched for temperament

(rather difficult people) Controls with average temperament

Attention

Alerting Orienting Conflict resolution

Here BPD patients are poorer than both control groups

Temperament isn’t sufficient for the development of BPD

What may influence treatment?

Patient-therapist interaction Neurocognitive factors Emotional dysregulation Sense of self and others

Treatment study

Random assignment to one of 3 groups Manualized psychoanalytic treatment Cognitive behavioural treatment Pharmacological treatment and counselling

Measurements: Self-reported temperament Activation of the amygdala Executive attention

Conclusions

Relating symptoms to enduring temperamental characteristics

Focus on the developmental aspect Interaction between genes,

temperament, and experience