Attachment and its vicissitudes in borderline personality disorder

Current Psychiatry Reports

Volumn 13, Issue 1, 2011, Pages 50-59

  Levy, Kenneth N ^a   Beeney, Joseph E ^a   Temes, Christina M ^a  

^a PENNSYLVANIA STATE UNIVERSITY   (United States)

Author keywords

Attachment; Borderline personality disorder; Developmental psychopathology; Interpersonal relationships; Neurobiology; Psychotherapy; Reflective processes

Indexed keywords

OXYTOCIN; PLACEBO; SEROTONIN TRANSPORTER;

AGGRESSION; ANXIETY; ARTICLE; BEHAVIOR THERAPY; BORDERLINE STATE; CHILD ABUSE; COGNITIVE DEFECT; COGNITIVE THERAPY; DRUG MECHANISM; EMOTIONAL ATTACHMENT; ENVIRONMENTAL FACTOR; FAMILY STRESS; GENE EXPRESSION; GENETIC POLYMORPHISM; GENETIC PREDISPOSITION; HETEROZYGOSITY; HOMOZYGOSITY; HUMAN; MATERNAL DEPRIVATION; MENTAL DISEASE; NEUROBIOLOGY; NEUROSCIENCE; PSYCHODYNAMICS; PSYCHOTHERAPY; SYMPTOMATOLOGY;

BORDERLINE PERSONALITY DISORDER; HUMANS; INTERPERSONAL RELATIONS; OBJECT ATTACHMENT; PERSONALITY DEVELOPMENT;

EID: 79551573853     PISSN: 15233812     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11920-010-0169-8     Document Type: Article

References (83)

1. SJ Blatt JS Auerbach KN Levy 1997 Mental representations in personality development, psychopathology, and the therapeutic process Review of General Psychology. 1 4 351 374 10.1037/1089-2680.1.4.351
2. Fonagy P, Target M, Gergely G. Attachment and borderline personality disorder. A theory and some evidence. Psychiatric Clinics of North America. 2000;23(1):103-22, vii-viii.
3. P Fonagy T Leigh M Steele H Steele R Kennedy G Mattoon M Target A Gerber 1996 The relation of attachment status, psychiatric classification, and response to psychotherapy Journal of Consulting and Clinical Psychology. 64 1 22 31 1:STN:280:DyaK2s%2FmtlaisQ%3D%3D 10.1037/0022-006X.64.1.22 8907081 (Pubitemid 26076062)
4. JG Gunderson 1996 The borderline patient's intolerance of aloneness: insecure attachments and therapist availability American Journal of Psychiatry. 153 6 752 8 1:STN:280:DyaK283jtlCktg%3D%3D 8633685
5. KN Levy SJ Blatt 1999 Attachment theory and psychoanalysis: Further differentiation within insecure attachment patterns Psychoanalytic Inquiry. 19 4 541 575 10.1080/07351699909534266
6. D Westen N Lohr KR Silk L Gold 1990 Object relations and social cognition in borderlines, major depressives, and normals: A Thematic Apperception Test analysis Psychological Assessment 2 4 355 10.1037/1040-3590.2.4.355
7. FE Yeomans KN Levy 2002 An object relations perspective on borderline personality Acta Neuropsychiatrica. 14 4 10.1034/j.1601-5215.2002.140205.x (Pubitemid 34785619)
8. A Bateman P Fonagy 2001 Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up American Journal of Psychiatry. 158 1 36 42 1:STN:280:DC%2BD3M7isVCntw%3D%3D 10.1176/appi.ajp.158.1.36 11136631 (Pubitemid 32047244)
9. Pilkonis P. Indentification of Risk Factors in Borderline Personality Disorder: The Example of Interpersonal Functioning. New Directions in Personality Disorder: Minneapolis Nationa Institute of Mental Health 2002.
10. IG Gurvits HW Koenigsberg LJ Siever 2000 Neurotransmitter dysfunction in patients with borderline personality disorder Psychiatric Clinics of North America 23 1 27 40 1:STN:280:DC%2BD3c7psVWhsA%3D%3D 10.1016/S0193-953X(05)70141- 6 10729929 vi
11. KR Silk 2000 Borderline personality disorder. Overview of biologic factors Psychiatric Clinics of North America. 23 1 61 75 1:STN:280: DC%2BD3c7psVWhtg%3D%3D 10.1016/S0193-953X(05)70143-X 10729931
12. KN Levy JF Clarkin FE Yeomans LN Scott RH Wasserman OF Kernberg 2006 The mechanisms of change in the treatment of borderline personality disorder with Transference Focused Psychotherapy Journal of Clinical Psychology. 62 4 481 501 10.1002/jclp.20239 16470612
13. K Levy 2005 The Implications of Attachment Theory and Research for Understanding Borderline Personality Disorder Development and Psychopathology. 17 959 986 10.1017/S0954579405050455 16613426 (Pubitemid 43362199)
14. Bowlby J. A secure base: Parent-child attachment and healthy human development. New York, NY, US: Basic Books, Inc; 1988.
15. SJ Blatt KN Levy 2003 Attachment theory, psychoanalysis, personality development, and psychopathology Psychoanalytic Inquiry. 23 1 102 150 10.1080/07351692309349028
16. D Diamond J Clarkin H Levine K Levy P Foelsch F Yeomans 1999 Borderline conditions and attachment: A preliminary report Psychoanalytic Inquiry. 19 5 831 884 10.1080/07351699909534278
17. BA Farber RA Lippert DB Nevas 1995 The therapist as attachment figure Psychotherapy: Theory, Research, Practice, Training. 32 2 204 212 10.1037/0033-3204.32.2.204
18. Fonagy P, Gergely G, Jurist EL, Target M. Affect regulation, mentalization, and the development of the self. New York, NY, US: Other Press; 2002.
19. Holmes J. "Something there is that doesn't love a wall": John Bowlby, attachment theory, and psychoanalysis. In: Goldberg SM, Muir R, ed. Attachment theory: Social, developmental, and clinical perspectives. Hillsdale, NJ, England: Analytic Press, Inc; 1995:19-43.
20. Holmes J. Attachment, intimacy, autonomy: Using attachment theory in adult psychotherapy. Northvale, N.J.: J. Aronson; 1996.
21. AJ Mackie 1981 Attachment theory: Its relevance to the therapeutic alliance British Journal of Medical Psychology. 54 3 203 212 1:STN:280:DyaL38%2FgtVCitQ%3D%3D 7272247
22. P Sable 1992 Attachment theory: Application to clinical practice with adults Clinical Social Work Journal. 20 3 271 283 10.1007/BF00754639
23. NM Szajnberg PM Crittenden 1997 The transference refracted through the lens of attachment Journal of the American Academy of Psychoanalysis. 25 3 409 438 1:STN:280:DyaK1c7nsVejuw%3D%3D 9513124
24. L Barone 2003 Developmental protective and risk factors in borderline personality disorder: a study using the Adult Attachment Interview Attachment and Human Development. 5 1 64 77 10.1080/1461673031000078634 12745829 (Pubitemid 36410401)
25. M Dozier 1990 Attachment organization and treatment use for adults with serious psychopathological disorders Development and Psychopathology. 2 1 47 60 10.1017/S0954579400000584
26. C Tyrell M Dozier GB Teague RD Fallot 1999 Effective treatment relationships for persons wtih serious pscyhiatric disorders: The importance of attachment states of mind Journal of Consulting & Clinical Psychology. 67 725 733 10.1037/0022-006X.67.5.725 (Pubitemid 29491684)
27. M Dozier KL Cue L Barnett 1994 Clinicians as caregivers: Role of attachment organization in treatment Journal of Consulting and Clinical Psychology. 62 4 793 800 1:STN:280:DyaK2M%2FltF2isA%3D%3D 10.1037/0022-006X.62. 4.793 7962883
28. B Mallinckrodt DL Gantt HM Coble 1995 Attachment patterns in the psychotherapy relationship: Development of the Client Attachment to Therapist Scale Journal of Counseling Psychology. 42 3 307 317 10.1037/0022-0167.42.3.307
29. M Dozier L Lomax CL Tyrell SW Lee 2001 The challenge of treatment for clients with dismissing states of mind Attachment and Human Development. 3 1 62 76 1:STN:280:DC%2BD3MnmtlSnsA%3D%3D 11708384
30. KN Levy KB Meehan KM Kelly J Reynoso JF Clarkin OF Kernberg 2006 Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder Journal of Consulting & Clinical Psychology 74 1027 1040 10.1037/0022-006X.74.6.1027 (Pubitemid 44950827)
31. EA Carlson B Egeland LA Sroufe 2009 A prospective investigation of the development of borderline personality symptoms Development and Psychopathology 21 1311 1334 10.1017/S0954579409990174 19825270 The authors of this study used a prospective, longitudinal design to examine potential antecedents of BPD from infancy to adulthood. The findings suggest that temperament in addition to early relational factors in early childhood (e.g., attachment) are predictive of BPD symptoms in adulthood. Other disruptions in relationships, behavior, emotion, and self-representation in adolescence were also predictive of adult BPD, with self-representation acting as a mediator between early, disorganized attachment and adult BPD symptoms. These findings highlight the importance of early attachment and subsequent representations in the development of BPD, and add to our understanding of the trajectory of BPD symptomatology over time.
32. TN Crawford PR Cohen H Chen, et al. 2009 Early maternal separation and the trajectory of borderline personality disorder symptoms Development and Psychopathology 21 1013 1030 10.1017/S0954579409000546 19583895
33. P Fonagy P Luyten 2009 A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder Development and Psychopathology 21 1355 1381 10.1017/S0954579409990198 19825272
34. Kernberg OF. Severe personality disorders: Psychotherapeutic strategies. New Haven, CT: Yale University Press; 1984.
35. R Kobak K Zajac C Smith 2009 Adolescent attachment and trajectories of hostile-impulsive behavior: Implications for the development of personality disorders Development and Psychopathology. 21 839 851 10.1017/S0954579409000455 19583886
36. M Patrick RP Hobson D Castle R Howard 1994 Personality disorder and the mental representation of early social experience Development and Psychopathology. 6 2 375 388 10.1017/S0954579400004648
37. Levy KN, Meehan KB, Weber M, Reynoso J, Clarkin JF. Attachment and borderline personality disorder: implications for psychotherapy. Psychopathology; 2005:64-74.
38. LW Choi-Kain GM Fitzmaurice MC Zanarini, et al. 2009 The relationship between self-reported attachment styles, interpersonal dysfunction, and borderline personality disorder Journal of Nervous and Mental Disease 197 816 821 10.1097/NMD.0b013e3181bea56e 19996719
39. LN Scott KN Levy AL Pincus 2009 Adult attachment, personality traits, and borderline personality disorder features in young adults Journal of Personality Disorders. 23 3 258 290 10.1521/pedi.2009.23.3.258 19538081
40. M Goodman R Yehuda 2002 The relationship between psychological trauma and Borderline Personality Disorder Psychiatric Annals 32 6 337
41. LA Kaehler JJ Freyd 2009 Borderline personality characteristics: A betrayal trauma approach Psychological Trauma: Theory, Research, Practice, and Policy 1 216 268 10.1037/a0017833
42. CS Widom SJ Czaja J Paris 2009 A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood Journal of Personality Disorders 23 433 446 10.1521/pedi.2009.23.5.433 19817626
43. LM Bierer R Yehuda J Schmeidler V Mitropoulou AS New JM Silverman LJ Siever 2003 Abuse and neglect in childhood: relationship to personality disorder diagnoses CNS Spectrums. 8 10 737 754 14712172
44. L Dutra J Bureau B Holmes, et al. 2009 Quality of early care and childhood trauma: A prospective study of developmental pathways to dissociation Journal of Nervous and Mental Disease 197 383 390 10.1097/NMD.0b013e3181a653b7 19525736
45. EA Selby SR Braithwaite TE Joiner, et al. 2009 Features of borderline personality disorder, perceived childhood emotional invalidation, and dysfunction within current romantic relationships Journal of Family Psychology. 22 885 893 10.1037/a0013673
46. G Kochanska RA Philibert RA Barry 2009 Interplay of genes and early mother-child relationship in the development of self-regulation from toddler to preschool age Journal of Child Psychology and Psychiatry 50 1331 1338 10.1111/j.1469-7610.2008.02050.x 19207629
47. P Zimmerman C Mohr G Spangler 2009 Genetic and attachment influences on adolescents' regulation of autonomy and aggressiveness Journal of Child Psychology and Psychiatry 50 1339 1347 10.1111/j.1469-7610.2009.02158.x
48. MH van IJzendoorn K Caspers MJ Bakermans-Kranenburga SRH Beach R Philibert 2010 Methylation Matters: interaction between methylation density and serotonin transporter genotype predicts unresolved loss or trauma Biol Psychiatry. 68 5 405 407 10.1016/j.biopsych.2010.05.008 20591416
49. RP Hobson MPH Patrick JA Hobson, et al. 2009 How mothers with borderline personality disorder relate to their year-old infants British Journal of Psychiatry. 195 325 330 10.1192/bjp.bp.108.060624 19794201
50. J Macfie SA Swan 2009 Representations of the caregiver-child relationship and of the self, and emotion regulation in the narratives of young children whose mothers have borderline personality disorder Development and Psychopathology 21 993 1011 10.1017/S0954579409000534 19583894
51. NR Herr C Hammen PA Brennan 2008 Maternal borderline personality disorder symptoms and adolescent psychosocial functioning Journal of Personality Disorders 22 451 465 10.1521/pedi.2008.22.5.451 18834294
52. T Baumgartner M Heinrichs A Volanthen U Fischbacher E Fehr 2008 Oxytocin Shapes the Neural Circuitry of Trust and Trust Adaptations in Humans Neuron. 58 639 650 1:CAS:528:DC%2BD1cXmsVOqtb4%3D 10.1016/j.neuron.2008.04.009 18498743 (Pubitemid 351672358)
53. B King-Casas C Sharp L Lomax-Bream T Lohrenz P Fonagy PR Montague 2008 The rupture and repair of cooperation in borderline personality disorder Science 321 5890 806 810 1:CAS:528:DC%2BD1cXptlyhsLo%3D 10.1126/science.1156902 18687957 This article seems to capture an aspect of the core disturbance that leads to painful and chaotic experiences in the lives of individuals experiencing BPD. Using an ecologically valid paradigm in which two individuals interact, it is clear that individuals with BPD face great difficulties in seeking harmony in interpersonal relationships. In addition, the study shines a light on the nature of difficulties individuals with BPD have in psychotherapy relationships-prone to lapses in collaboration, frequent ruptures, and potential difficulty with repair.
54. B Ditzen M Schaer B Gabriel G Bodenmann U Ehlert M Heinrichs 2009 Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict Biological Psychiatry. 65 728 731 1:CAS:528: DC%2BD1MXktV2qsbw%3D 10.1016/j.biopsych.2008.10.011 19027101
55. A Buchheim M Heinrichs C George D Pokorny E Koops P Henningsen M-F O' Connor H Gundel 2009 Oxytocin enhances the experience of attachment security Psychoneuroendocrinology. 34 9 1417 1422 1:CAS:528:DC%2BD1MXhtFWqtbfF 10.1016/j.psyneuen.2009.04.002 19457618
56. G Domes M Heinrichs A Michel C Berger SC Herpertz 2007 Oxytocin improves "mind reading" in humans Biological Psychiatry. 61 6 731 733 1:CAS:528:DC%2BD2sXisVWhtb8%3D 10.1016/j.biopsych.2006.07.015 17137561 (Pubitemid 46330242)
57. P Fonagy M Target 1997 Attachment and reflective function: their role in self-organization Development and Psychopathology. 9 4 679 700 1:STN:280:DyaK1c7htVCruw%3D%3D 10.1017/S0954579497001399 9449001
58. A Theodoridou AC Rowe IS Penton-Voak PJ Rogers 2009 Oxytocin and social perception: Oxytocin increases perceived facial trustworthiness and attractiveness Hormones and Behavior. 56 128 132 1:CAS:528:DC%2BD1MXmsFygu7s%3D 10.1016/j.yhbeh.2009.03.019 19344725
59. G Domes D Czieschnek F Weidler C Berger K Fast SC Herpertz 2008 Recognition of facial affect in borderline personality disorder Journal of Personality Disorders. 22 2 135 147 10.1521/pedi.2008.22.2.135 18419234 (Pubitemid 351556177)
60. D Simeon JA Bartz S Ketay A Braun H Hamilton S Crystal V Vicens E Hollander 2009 Impact of oxytocin on stress-related dysphoria in borderline personality disorder (abstract) Biological Psychiatry 65 suppl 8 2445
61. JA Bartz D Simeon RK Hamilton S Crystal V Vicens E Holander 2009 Effects of oxytocin in adults with borderline personality disorder and healthy controls (abstract) Biological Psychiatry 65 suppl 8 2445
62. B Stanley LJ Siever 2010 The interpersonal dimension of borderline personality disorder: Toward a neuropeptide model The American Journal of Psychiatry. 167 1 24 39 10.1176/appi.ajp.2009.09050744 19952075
63. MI Posner MK Rothbart 2000 Developing mechanisms of self-regulation Development and Psychopathology. 12 3 427 441 10.1017/S0954579400003096
64. MJ Minzenberg JH Poole S Vinogradov 2008 A neurocognitive model of borderline personality disorder: Effects of childhood sexual abuse and relationship to adult social attachment disturbance Development and Psychopathology. 20 341 368 10.1017/S0954579408000163 18211741 (Pubitemid 351166719)
65. HW Koenigsberg LJ Siever H Lee S Pizzarello AS New M Goodman H Cheng J Flory I Prohovnik 2009 Neural correlates of emotion processing in borderline personality disorder Psychiatry Research 172 192 199 10.1016/j.pscychresns.2008. 07.010 19394205 This is an important research report in that it signals the possibility that individuals with BPD may tend to use a fear circuit when confronted with emotional stimuli. This possibility should promote research that might bridge current foci of the nature of the disorder-emotion regulation dysfunction and mentalization deficit. Emotion regulation deficits may be the result of difficulty engaging in more reflective processes, particularly in emotional contexts.
66. MA Austin T Riniolo SW Porges 2007 Borderline personality disorder and emotion regulation: Insights from the Polyvagal Theory Brain and Cognition. 65 69 76 10.1016/j.bandc.2006.05.007 17659821 (Pubitemid 47391119)
67. KN Levy KB Meehan JS Reynoso MF Lenzenweger JF Clarkin OF Kernberg 2005 The relation of reflective function to neurocognitive functioning in patients with borderline personality disorder Journal of the American Psychoanalytic Association. 53 4 1305 1309
68. KN Levy JF Clarkin OF Kernberg 2006 Change in attachment and reflective function in the treatment of borderline personality disorder with transference focused psychotherapy Journal of Consulting and Clinical Psychology. 74 481 501 10.1037/0022-006X.74.6.1027 (Pubitemid 44950827)
69. Slade A. Attachment theory and research: Implications for theory and practice of individual psychotherapy. In: Cassidy J, Shaver P, eds. Handbook of Attachment Theory and Research. New York: Guilford Press; 1999.
70. H Steele M Steele A Murphy 2009 Use of the Adult Attachment Interview to measure process and change in psychotherapy Psychotherapy Research. 19 6 633 643 10.1080/10503300802609698 19544185
71. Levy KN, Kelly KM. Using interviews to assess adult attachment. In: Obegi JH, Berant E, eds. Attachment Theory and Research in Clinical Work with Adults. New York: Guilford; 2009:121-151.
72. JG Gunderson 2007 Disturbed relationships as a phenotype for borderline personality disorder American Journal of Psychiatry. 164 11 1637 1640 10.1176/appi.ajp.2007.07071125 17974925 (Pubitemid 350205336)
73. A Bateman P Fonagy 1999 Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial American Journal of Psychiatry. 156 10 1563 9 1:STN:280:DyaK1Mvks1Cgtw%3D%3D 10518167
74. Bateman A, & Fonagy, P. Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder. American Journal of Psychiatry. 2009.
75. KN Levy KB Meehan KM Kelly JS Reynoso M Weber JF Clarkin OF Kernberg 2006 Change in Attachment Patterns and Reflective Function in a Randomized Control Trial of Transference-Focused Psychotherapy for Borderline Personality Disorder Journal of Counseling & Clinical Psychology. 74 6 1027 1040 10.1037/0022-006X.74.6.1027 (Pubitemid 44950827)
76. C McBride L Atkinson LC Quilty RM Bagby 2006 Attachment as moderator of treatment outcome in major depression: A randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy Journal of Consulting and Clinical Psychology. 74 6 1041 1054 10.1037/0022-006X.74.6.1041 17154734 (Pubitemid 44950828)
77. JF Clarkin K Levy 2007 N., Lenzenweger, M. F., and Kernberg, O. F. Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study American Journal of Psychiatry. 164 6 922 928 10.1176/appi.ajp.164.6.922 17541052 (Pubitemid 46972908)
78. S Doering S Horz M Rentrop M Fischer-Kern P Schuster C Benecke A Buchheim P Martius P Buchheim 2010 Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial The British Journal of Psychiatry. 196 389 395 10.1192/bjp.bp.109.070177 20435966
79. S Kellogg J Young 2006 Schema Therapy for Borderline Personality Disorder Journal of Clinical Psychology. 62 445 458 10.1002/jclp.20240 16470629
80. MM Linehan HI Schmidt LA Dimeff JC Craft J Kanter KA Comtois 1999 Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence American Journal on Addictions. 8 4 279 292 1:STN:280:DC%2BD3c%2Fms1Wmug%3D%3D 10.1080/105504999305686 10598211
81. Cortina M, Marrone M. Patient-therapist attachment: Impact on the therapeutic process and outcome. Attachment theory and the psychoanalytic process. London, England: Whurr Publishers, Ltd.; 2003:127.
82. KN Levy WS Edell TH McGlashan 2007 Depressive Experiences in Inpatients with Borderline Personality Disorder Psychiatric Quarterly. 78 129 143 10.1007/s11126-006-9033-8 17347875 (Pubitemid 46525470)
83. P Fonagy M Tallandini-Shallice 1993 On Some Problems of Psychoanalytic Research in Practice Bulletin of the Anna Freud Centre. 16 5 22