BPD's Interpersonal Hypersensitivity Phenotype: A Gene-Environment-Developmental Model

Abstract

This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…It is readily apparent than an individual's sensitivity to emotion will likely impact their potential for emotion dysregulation, which certainly impacts their interpersonal relationships and their behavioral constraint. As has been highlighted, evidence suggests that emotion dysregulation may underlie behavioral impulsivity and interpersonal sensitivity [141,134], yet we also find suggestive evidence that interpersonal sensitivity (and rejection sensitivity) may underlie many of the other BPD symptoms [38,184]. The goal of this project, therefore, was not to determine, what is, once and for all the chicken and what is the egg in the BPD diagnosis, because that is a futile endeavor.…”

“…Disturbances in interpersonal relationships in BPD have been documented broadly and are suggested to be core to the pathology [38][39][40]. Many clinicians find that the interpersonal style characteristic of BPD is qualitatively different, and particularly challenging to treat, relative to other psychiatric disorders [41].…”

“…Some researchers view disturbed interpersonal relationships as central to borderline pathology, more so than other symptom domains, arguing that affective instability and behavioral impulsivity may be non-specific features of psychopathology [47]. Furthermore, disturbed interpersonal relationships may be the best discriminator of a BPD diagnosis, relative to the other symptom domains [38,39]. Beyond the importance of this criteria to assessment, diagnosis, and treatment of BPD, problematic interpersonal relationships serve to exacerbate certain of the other dimensions of the disorder (e.g., high interpersonal reactivity during childhood and adolescence might influence parenting that in turn aggravates borderline symptoms related to emotion dysregulation or behavioral impulsivity).…”

Petrificación epistémica y la restauración de la confiabilidad epistémica: Una nueva conceptualización del trastorno límite de la personalidad y su tratamiento psicosocial

“…Una explicación alternativa, que surge en la segunda mitad del siglo pasado, ubica los orígenes de los trastornos de la personalidad en las distorsiones del instinto por el apego. Originado en el trabajo de John Bowlby y en la investigación de Mary Ainsworth, una generación de académicos estuvo dedicada a la identificación de patrones relacionales tempranos entre la madre (cuidador) y el infante que probablemente pudieran ser asociados con un trastorno de la personalidad (Gunderson, 1996;Gunderson & Lyons-Ruth, 2008). Aun así, la complejidad de la evidencia que vinculara más adelante el ambiente educativo temprano del niño con la adaptación, el poder limitado de predicciones a largo plazo que la calidad de la observación del apego temprano ofrece (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010;Groh, Roisman, van IJzendoorn, BakermansKranenburg, & Fearon, 2012;van IJzendoorn & Bakermans-Kranenburg, 2008;van IJzendoorn, Scheungel, & Backermans-Kranenburg, 1999), y la nueva evidencia sobre el papel potencial de la genética en las predicciones hechas a partir de la clasificación del apego (Fearon, Shmueli-Goetz, Viding, Fonagy, & Plomin, 2014;Fearon et al, 2010;Groh et al, 2012) todos han llevado a los comentaristas a anunciar más escepticismo sobre los modelos del desarrollos anómalo de la personalidad y el constructo del apego (Harris, 2013).…”

Aberrant link between empathy and social attribution style in borderline personality disorder

“…Patients with BPD suffer from rapid alternations of intense attachment and intense detachment in interpersonal situations, extreme devaluation or idealization of others, and impairments in mentalizing, the capacity to understand other people's behavior in terms of their likely feelings, desires and goals (Gunderson, 1996;Gunderson and Lyons-Ruth, 2008;Koenigsberg et al, 2009;Fonagy and Bateman, 2008;American Psychiatric Association, 2013). BPD is a severe condition, present in an estimated 2.7% of the population (Tomko et al, 2013), and characterized by emotional instability and impulsive aggression (Skodol et al, 2002).…”