Attachment, detachment and borderline personality disorder.

Abstract

In an attempt to expand understanding of more severe pathology, attachment theory, developed by John Bowlby, is applied to borderline personality disorder in adults. Conceptualized as a condition of profound insecure attachment, with extreme vacillations between a desire for proximity and attachment and a dread and avoidance of engagement, borderline pathology reflects traumatic attachment experiences, beginning early in life. Besides the importance of trauma, disturbances in affect regulation and cognitive distortions are emphasized. The secure base of a therapeutic bond provides consistency, reliability, and affirmation while encouraging exploration of separation and loss experiences, both current and past, in order to modify inner working models of oneself and relationships with others. Implications for prevention are discussed.

Clinical Supervision of Nurses Working With Patients With Borderline Personality Disorder

“…BPD manifests in severe problems in sustaining close interpersonal relationships, with dramatic shifts from idealization to devaluation; self-destructive behaviors associated with impulsiveness, including sexual promiscuity, self-mutilation, and suicide attempts; intense volatile feelings and moods; and identity disturbance. Patients' thinking can be grandiose, with distorted versions of reality; and communications of these patients can be vague, tangential, and over personalized (APA, 2000;Bland, 2003;Sable, 1997).…”

Treatment of Depressive Symptoms in Adult Survivors of Childhood Trauma

“…There is much research suggesting that individuals with borderline PD are very difficult to treat in group therapy, particularly of such a brief, intensive nature (Sable, 1997). In treatment, individuals with borderline PD may present affective instability and desire constant attention and special recognition from therapists and other group members (Sable, 1997).…”

Evaluations of emotional noninterpersonal situations by patients with borderline personality disorder

“…This focus was probably chosen because having unstable interpersonal relationships is a salient feature of borderline patients. Another reason is that objectrelation and attachment theories conceptualize extreme evaluations of borderline patients as direct or indirect reiterations of adverse interpersonal childhood experiences (e.g., Fonagy, Target, & Gergely, 2000;Kernberg, 1996;Sable, 1997). It is however not clear whether DT in BPD is a general characteristic which is applied in frustrating or rewarding interpersonal as well as noninterpersonal situations.…”