A Qualitative Examination of Borderline Personality Disordered (BPD) Patients: Interpersonal Dynamics and Underlying Paradoxes (original) (raw)
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Cognitive Conflict in Borderline Personality Disorder: A Study Protocol
Behavioral Sciences
Borderline personality disorder (BPD) represents a severe mental condition that is usually characterized by distressing identity disturbances. Although most prevailing explanatory models and psychotherapy approaches consider and intervene on self-concept, they seem not to recognize or explore idiosyncratic cognitive conflicts that patients may experience. These conflicts, which have been conceptualized as “implicative dilemmas” and “dilemmatic constructs” by personal construct theorists, could be considered as key elements of the explanatory model for BPD to provide a better understanding of this disorder and possibly enhance the effectiveness of contemporary psychotherapeutic approaches. The current study (Identifier: NCT04498104) aims to examine the characteristics of the interpersonal cognitive system of a group of patients diagnosed with BPD, using the repertory grid technique, and to compare them with those of a community sample. We will test if BPD participants are more affect...
A Preliminary Report on Defenses and Conflicts Associated with Borderline Personality Disorder
Journal of the American Psychoanalytic Association, 1986
The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed. FOR THE PAST SEVERAL YEARS we have been conducting a study of the psychopathology and course of borderline personality disorder to determine whether this diagnosis is valid and can be discriminated from other disorders. We selected two near neighbor disorders for this comparison on which there has been systematic research. We chose antisocial personality disorder because of a possible overlap in impulse pathology, and bipolar type II affective disorder because recurrent depression and hypomania represent disturbances in affect regulation which may overlap with borderline personality disorder. To determine the discriminate validity of borderline personality disorder from these two comparison disorders, we have examined descriptive features, and the prevalence of accompanying syndromes such as depression, alcohol, and drug abuse. We are following their course for patterns of impulse problems, social role dysfunction, and response to life events (Perry 1985); (Perry and Cooper 1985). In addition to this descriptive work, we are systematically examining the psychodynamics of these disorders using a framework of defense mechanisms and psychodynamic conflicts, ascertained outside of psychoanalytic or other treatment contexts. This preliminary report addresses the question of whether the borderline personality disorder is associated with psychodynamics that differentiate it from these two comparison disorders. The psychodynamic literature has generally viewed the antisocial and borderline personality disorders as strongly related or even identical regarding their underlying psychodynamics. Kernberg (1975) stated that most cases of antisocial personality disorder have an underlying borderline personality organization. This concept is defined by the presence of intact reality testing, identity diffusion, and the use of certain primitive defenses revolving around splitting, which defend against the activation of pathological internalized object relations (Kernberg, 1981). Kernberg has suggested that the major deficit in borderline psychopathology is the inability to integrate positive and negative identifications and introjects. The reliance
Diagnosis and treatment of borderline personality organization
Clinical Social Work Journal, 1978
This paper describes the diagnostic and therapeutic approach to borderline personality organization proposed by Otto Kernberg. Diagnosis is based primarily on the characteristic ego pathology which includes the mechanism of splitting, defined as the defensive separation of '~good" and ~%ad" self and object representations. The therapeutic strategy emphasizes systematic exploration of the negative transference and the pathological defenses. A case is presented to illustrate the applicability of Kernberg's concepts to the therapy of a borderline client treated by a clinical social worker on a once-a-week outpatient basis.
Understanding and treating borderline personality organization
Psychotherapy, 1983
For many years clinicians have been ceptualizations of these borderlines states puzzled by those nonpsychotic but severely dis-reflects the sense of urgency that many cliturbedpatients referred to as "borderline." Recent n i c i a n s feei abOut this puzzling, seemingly work in object relations theory has suggested that f o r m l e s S j b u t v i r u i e n t disorder. Unfortuborderhne conditions are the result of a failure ^ {{ ^ r e f l e c t § c o n f u s i o n a n d l a c k o f of integration of the basic personality, leading to J / T. .. *nr<,\ IT a major distortion in the patient's sense of self. consensus (Knight, 1953). However, recent Because most of this investigative work is relatively investigations by object relations theorists, recent, many clinicians are unfamiliar with current most notably Kernberg (1967, 1968, 1972, theory and clinical observations on the subject. 1975a,fr, 1976), have stimulated the emer-Failure to comprehend these patients' dynamics gence of a greater understanding of the nature can lead to treatment catastrophes, whereas un-of borderline conditions. Kernberg redirects derstanding of these phenomena may be helpful Our attention away from patterns of sympin dealing with a wide variety of borderline and tomatology and toward an examination of the other clinical problems. Here we present an overs t r u c t u r e a n d organization of personality.
Psychodynamic Formulation in Borderline Personality Disorder: Case Study
Journal of Psychiatric Nursing
Psychodynamic case formulation examines how symptoms of the patient appeared and constitutes a useful guideline for clinicians because it examines the level of object relations, ego strength, mental capacity, and core conflict, plans the treatment, and predicts prognosis. Borderline personality disorder (BPD) cases display symptoms characterized by dramatic life history, impulsivity, relationship problems, and unstable moods and behaviors. These unstable and multiple symptoms affect the clinical appearance and treatment response of the disorder. People with BPD build up intense transference and countertransference responses and are often perceived as "difficult patients" by healthcare professionals and nurses who spend the most time with these patients in inpatient services. Therefore, psychodynamic formulation is particularly necessary and useful in BPD cases to understand the patient better and manage the treatment processes. The case presented here reported complaints including mood swings, feelings of emptiness, inability to go to school, bursts of rage, self-injurious behaviors, and suicidal thoughts and attempts. Her expectations from treatment were to control her anger, express herself, be strong in bilateral relationships, and be a normal person. A psychodynamic formulation was done in company with the supervision and the case was diagnosed with BPD. Formulating BPD cases in terms of a psychodynamic perspective may provide more information on thoughts, emotions, and behaviors of the patients. In this study, through the information obtained using psychodynamic interview techniques, impulse, affectivity, mood characteristics, defense mechanisms, selfdom, object relations, and superego of the BPD diagnosed case are discussed.
British Journal of Medical Psychology, 2001
Recent ndings suggest that personality fragmentation may be a core component of borderline personality disorder (BPD) and that successful treatment of BPD may depend on the extent to which this is addressed. Cognitive analytic therapy (CAT) can increase integration by strengthening awareness, and hence control, of the dissociative processes maintaining fragmentation. This pilot study aimed to conduct a systematic evaluation of the impact of CAT on BPD severity and personality integration. A patient series within-subject design was used. Five BPD participants completed a series of assessments to evaluate the impact of therapy on BPD severity, fragmentation, dissociation, symptomatology and interpersonal adjustment before, during and following 16-session CAT. By follow-up, CAT had produced reductions in the severity of BPD for all ve participants, and three participants showed signi cant changes in their levels of personality fragmentation. Improvements in comorbid disturbance were less consistent, however. Although the small number of participants involved limits these ndings, they have theoretical and clinical interest. They generally support the suggestion that integration should be enhanced with BPD patients, and suggest that CAT may be a useful method to achieve this goal. Interest in borderline personality disorder (BPD) has increased dramatically during the past 15 years. Individuals meeting DSM-IV (American Psychiatric Association, 1994) BPD criteria present themselves to mental health services with increasing frequency (Widiger & Frances, 1989), and receive longer periods of hospital treatment (Stone, Hurt, & Stone, 1987) and more contact from psychiatric outpatient services (Seivewright & Tyrer, 1988) than other groups. Their interpersonal dif culties, impulsivity and parasuicidal behaviour render them a high-risk patient group (Paris, 1993; Stone, 1990) that 47
Journal of Social and Clinical Psychology, 2007
Interpersonal theory conceptualizes variants of personality pathology as describable by two dimensions: affiliation and control. Inconsistent results in placing borderline personality along these dimensions have been interpreted by some as representing internal conflict or ambivalence on these dimensions, as opposed to a lack of relevance of these dimensions. This hypothesis was tested in a large clinical sample using inconsistency in self-report item responding on scales measuring affiliation and control to operationalize psychological conflict. Individuals with borderline personality features were more inconsistent in item responding to both scales than were individuals without borderline features. Item response inconsistency did not differentiate antisocial from non-antisocial participants. Results support the view that variability, as well as mean scores, on the interpersonal dimensions may be important for the conceptualizing some disorders, such as borderline, and offers a novel approach for representing such conflict.