Cognitive Conflict in Borderline Personality Disorder: A Study Protocol (original) (raw)
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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.
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
Archives of Psychiatry and Psychotherapy
Dysfunctional interpersonal patterns are a defining feature of Borderline Personality Disorder (BPD). A number of studies have aimed to determine if there are specific patterns in the interpersonal functioning of patients with BPD. The vast majority of these studies have used a widely-used rating system called the Core Conflictual Relationship Theme method [1]. To date, three main models of interpersonal functioning of patients with BPD have been developed using the CCRT [2, 3] including one model developed by our team . The aim of this study was to examine to what extent these three empirically-derived models of interpersonal functioning in patients with BPD overlap. borderline personality disorder / core conflictual relationship theme / CCrT / BPd / personality disorders / Interpersonal Functioning
Journal of Behavior Therapy and Experimental Psychiatry, 2005
Based on cognitive concepts of personality disorders as well as on the bio-social model of borderline personality disorder (BPD), a 34-item instrument, the questionnaire of thoughts and feelings (QTF) was developed for the assessment of feelings, strategic cognitions, and assumptions characteristic for BPD. In different studies, item-and factor analyses were conducted with a dataset of N ¼ 646 clinical and non-clinical participants. Cross-sectional data as well as longitudinal data are available including several other measures on personality and personality disorders: DSM-IV SCID II dimensional score, a personality inventory (PSSI), the German version of the personality disorder beliefs questionnaire (PBQ), as well as overall severity of symptoms (GSI) of the SCL-90-R.
Psychopathology, 2022
Borderline personality disorder (BPD) is a complex condition marked by heterogeneity. People with BPD have a profusion of symptoms spread across various levels of lived experience, such as identity, affectivity, and interpersonal relationships. Researchers and clinicians have often resorted to the structuring concept of Self to organize the fragmentation of their experience at the identity level. Notably, using the concept of the narrative self, Fuchs proposed to interpret BPD as a fragmentation of narrative identity. This interpretation of BPD, widely shared, has been challenged by Gold and Kyratsous, who have proposed a complementary understanding of the self through the idea of agency, and to which Schmidt and Fuchs in turn have countered. This article proposes to contribute to this discussion from a phenomenological perspective. First, we will briefly review the discussions around narrative interpretation of BPD. From the problems left unresolved by the discussion, we will then justify the necessity to proceed with a stratification of the self from a phenomenology method. Third, from the thought of the Hungarian phenomenologist László Tengelyi, we will continue with an archaeology of the self, in three layers-self-institution, selfformation, and minimal self-integrating Schmidt and Fuchs' concepts of self, in addition to those of Gold and Kyratsous, but also, to a lesser extent, those of Dan Zahavi. Finally, we will proceed with a phenomenological reconfiguration of the experiences and manifestations associated with the identity axis of BPD.
Hypothesized Mechanisms of Change in Cognitive Therapy for Borderline Personality Disorder
Preliminary evidence suggests that cognitive therapy (CT) is effective in treating borderline personality disorder (BPD). According to cognitive theory, BPD patients are characterized by dysfunctional beliefs that are relatively enduring and inflexible and that lead to cognitive distortions such as dichotomous thinking. When these beliefs are activated, they lead to extreme emotional and behavioral reactions, which provide additional confirmation for the beliefs. It is hypothesized that a change in dysfunctional beliefs is the primary mechanism of change associated with CT. However , additional mechanisms of change are likely also at work in CT, including enhancement of skills, reduction in hopelessness, and improvement in attitude toward treatment. Each of these mechanisms is discussed in light of cognitive theory, data from an open clinical CT trial, relevant literature , and therapeutic interventions. Findings from the CT trial support the role of cognitive change during therapy and its continuation after termination. A salient feature of patients who have borderline personality disorder (BPD) is their tendency to engage in dichotomous thinking, as they often evaluate themselves, other people, and their environment in extreme terms and demonstrate little flexibility in assimilating new information to modify their rigid beliefs (e.g., Arntz, 1994; Veen & Arntz, 2000). This pattern of distorted perception often results in angry outbursts, impulsive behavior, and/or severe and sudden symptoms of anxiety and depression. One purpose of cognitive therapy (CT) is to help patients develop tools to identify and evaluate such cognitive distortions, given that a realistic appraisal of one's circumstances will reduce