Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment

Abstract

A new developmental model of borderline personality disorder (BPD) and its treatment is advanced based on evolutionary considerations concerning the role of attachment, mentalizing, and epistemic trust in the development of psychopathology. We propose that vulnerability to psychopathology in general is related to impairments in epistemic trust, leading to disruptions in the process of salutogenesis, the positive effects associated with the capacity to benefit from the social environment. BPD is perhaps the disorder par excellence that illustrates this view. We argue that this conceptualization makes sense of the presence of both marked rigidity and instability in BPD, and has far-reaching implications for intervention.

Processes of change in school-based art therapy with children: A systematic qualitative study

“…Mentalizing (Allen, Fonagy, & Bateman, 2008;Fonagy et al, 2015) may also be involved within the 'relationship', 'doing/making', and 'talking' categories of Model 2. Assessing the child's mentalizing abilities over the course of therapy, for example using the Test of Emotional Comprehension (Pons & Harris, 2000, 2005, may thus be beneficial.…”

Child psychotherapy with looked after and adopted children: a UK national survey of the profession

“…This finding perhaps indicates the way in which actual practice seems to have adapted to the nature of these children"s problems, and furthermore supports the growing recognition amongst therapeutic interventions of the importance of network working, particularly in complex cases. Fonagy et al (2015) have argued that the extent to which the person benefits from therapy may depend on what they encounter outside the therapeutic environment, in their social world. Despite the importance that respondents in this survey placed on these aspects of their work, particularly work with carers and consultations, there was a sense that these areas were under-resourced and sometimes under-valued by services and commissioners, compared to their direct work with children.…”

“…the capacity to trust others as source of knowledge concerning the (interpersonal) world, with survey respondents" comments highlighting the perceived levels of epistemic mistrust and epistemic hypervigilance amongst this group of traumatised children (see Fonagy et al, 2015;Fonagy et al, 2016). Hence, the very children that many benefit the most from establishing such a relationship, seem to have marked problems in this area.…”

Mentalizing, Attachment, and Epistemic Trust in Group Therapy

“…The theory of mentalization has recently developed to consider another important function of attachment relationships, namely their role in the development of epistemic trustthat is, trust in the authenticity and personal relevance of interpersonally transmitted knowledge about how the social environment works and how best to navigate it (Fonagy & Allison, 2014) (Fonagy, Luyten, & Allison, 2015). Given the complexity of the human social and cultural environment, much of the information that juveniles are presented with is complicated and needs to be explained by an experienced elder.…”

“…Secure attachment relationships -with their characteristic of contingent reactivity -by their very nature work to open epistemic trust. Accurate mentalizing, generally and powerfully, achieves the same end as, for example, looking at someone in the eye or calling them by name: it is an indicator of a recognition of agency and forms a powerful underpinning ostensive cue for the relaxation of epistemic vigilance within that relationship (Fonagy et al, 2015).…”