Defining the mechanisms of Borderline Personality Disorder J. Clarkin and M. Posner (2005)

Introduction  Prevalence %  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