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Attachment was believed by Bowlby to be a critical aspect of the normal development of human behavior. Attachment is inclusive of the following characteristics:
1) Proximity Seeking - the infant seeks to be near the maternal figure;
2) Separation distress or protests - when separated or distant from the material figure the infant becomes distressed and signals this by vocalizing these feelings and changes in affect.
3) a secure base - when the infant develops a healthy attachment, the mother becomes a 'secure base' from which the child can venture forth into the world and securely explore their surroundings.
Ainsworth is noted as the first to conduct empirical research assessing patterns of attachment behaviors in infant attachment relating to the mother being under stress. Infant attachment behavior was categorized as: (1) secure; (2) avoidant; and (3) ambivalent. Since then the behavioral patterns of infants has undergone intensive assessment and study with a core body of empirical findings replicating extensively the earlier research. The work of Bowlby (1973) acknowledged anger as being a natural response when the child, with the expectation of safety, when in close proximity to the attachment figure was jeopardized. It is believed by Bowlby that the root of anxious attachment is "dysfunctional anger." (Fonagy, 1999) Anxious attachment has been linked to behavior including violent behavior. Broussard (1995) found that anxious attachment is present in the majority of working class children.
Levy states in the 2005 Development and Psychopathology journal article: "The Implications of Attachment Theory and Research for Understanding Personality Disorder" that psychopathology researchers and theorists have now began to: "understand fundamental implications of BPD. Behaviors within the realm of those with this disorder include "...unstable, intense interpersonal relationships, feelings of emptiness, bursts rage, chronic fears of abandonment and intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization." (Levy, 2005) it is related by Levy (2005) that it has been noted among researchers that the characteristics of "Impulsivity, affective lability and self-damaging actions that are the hallmark of borderline personality occur in an interpersonal context." These are often known to occur after events in relationships whether they are real or imagined events. Levy (2005) holds that the individual difference is shown by evidence of research to be "rooted in interaction with caregivers" and have implications of importance in the individual's adaptations and development." (Ibid)
The work of Agrawal, Gunderson, Holmes, and Lyons-Ruth entitled: "Attachment Studies with Borderline Patients: A Review" states that it has been suggested by clinical theorists that disturbed attachments are central to borderline personality disorder (BPD) psychopathology. In this work thirteen empirical studies are reviewed in the attempt to examine the types of attachment of these studies. The types of attachments at these authors state are "most characteristic" of individuals with BPD are "unresolved, preoccupied and fearful." (Agrawal, Gunderson, Holmes, and Ruth-Lyons, 2004) in the BPD individual there exists a desire for intimacy while at the same time these individuals have a deep concern of dependency and rejection. It has been a suggestion since the inception of BPD diagnosis among clinical theorists that BPD is a disorder in which the core psychopathology arises: "within the domain of interpersonal relations." (Ibid) it has been as postulated by John Bowlby that all humans, just as primates, "are under pressures of natural selection to evolve behavioral patterns, such as proximity seeking, smiling, and clinging, that evoke caretaking behavior in adults, such as touching, holding and soothing." (Ibid) This is considered an affective tie between the infant and its caregiver thereby constituting an attachment. From these responses of the parents which are of a natural nature the infants development of internal models of both self and other form and function in the future as templates for relationships.
Bowlby holds that "the content of the internal working model of self is related to how acceptable or lovable one is in the eyes of primary attachment figures." It is through this model that the individual's perception of 'other' is related to "how responsive and available attachment figures are expected to be" (Ibid) if the child develops a 'secure' attachment then a positive self-image and a sense of being loved and this in combination with an expectations that is positive concerning the 'significant other' in their lives are usually receptive and respond positively to caring. Alternatively, the individual who does not develop a secure attachment: "contrasts dramatically with the malevolent or split representations of self and others, as well with the needy, manipulative, and angry relationships that characterize persons with BPD." (Ibid) Furthermore the models developed persist throughout the life of the individual forming their beliefs in regards to past, present and future interactions with the 'other' in their life. The individual with a secure attachment frees the child in their exploration of the world in confidence knowing that the availability of the caregiver is assured. A secure attachment is more likely to develop if the child has capacity in perceiving the thoughts of others. The core symptoms of BPD in 'Fonagy's theory to be inclusive of a diminished capacity to mentally represent other's feelings and thoughts as well as the individual having a lack of sense of their own self, impulsivity, and feelings of emptiness that are of a chronic nature. Individuals with BPD do not have the ability to bring about a "soothing introject" (Ibid) in situations of distress due to early attachments to caregivers that are "inconsistent and unstable" due to lack of a secure early attachment. Gunderson made the observation that insecure patterns of attachment."..specifically, please for attention and help, clinging, and checking for proximity that often alternate with a denial of, and fearfulness about, dependency needs 'closely parallel the behavior of borderline patients." (Ibid)
The work of Winston (2000) states the diagnostic criteria for borderline personality disorder to include at least five of the following:
1. Intense and unstable personal relationships;
2. Frantic efforts to avoid real or imagined abandonment;
3. Identity disturbance or problems with sense of self;
4. Impulsivity that is potentially self-damaging;
5. Recurrent suicidal or parasuicidal behavior;
6. Recurrent suicidal or parasuicidal behavior.
7. Affective instability;
8. Chronic feelings of emptiness;
9. Inappropriate intense or uncontrollable anger;
10. Transient stress-related paranoiac ideation or severe disassociate symptoms. (Winston, 2000)
The prevalence of BPD in the community was estimated by Widiger & Weissman (1991) to be 2% and among psychiatric patients to be 15%. (Winston, 2000) the following chart labeled Figure 1 is an 'aetiological model of borderline personality disorder.
Borderline Personality Disorder [aietiological Model]
Winston states that the "lack of a sense of self is a core feature of the psychopathology of BPD" which has been linked by psychoanalysts to "pathological splitting of the ego and object." (2000) This splitting is often noted in patients with BPD. This is believed to be due to childhood abuse and neglect as these are both common in borderline patients. In fact the following have been stated in findings:
1) 87% of BPD individuals have undergone some type of childhood trauma;
2) 40-71% have been sexually abused; and 3) 25-71% have been physically abused. (Winston, 2000)
The effect of abuse on the individual is greatly dependent upon the stage of psychological development that the abuse occurs within. Winston holds that the earlier the abuse then the more damaging to the individual because "the young child's cognitive immaturity and consequent inability of make sense of traumatic experiences." (Winston, 2000)
Effects that are a Possible from Childhood Trauma in BPD are those of:
Defective affect regulation
Lack of reflective capacity
Disturbed Interpersonal relationships. (Winston, 2000)
Treatments for BPD
Treatments for BPD include:
1) Dialectical behavior therapy;
2) Psychoanalytic psychotherapy;
3) Therapeutic Communities;
4) Cognitive-analytic therapy;
5) Interpersonal therapies;
6) Schema-Focused cognitive therapy.
Description of Treatment Models for BPD
Dialectical behavior therapy:
This therapy claims as its basis the principle that "BPD is essentially the results of deficits in interpersonal and self-regulatory skills and that these skills can be taught in therapy. Defective affect regulation is seen as particularly important. Treatment consists of weekly individual and group therapy sessions based on skills-training model, together without-of-hours telephone contact with the therapist." (Winston, 2000) One study did show Dialectical behavior therapy to be "superior to 'treatment as usual' in reducing self-harm and time spent in hospital, but not subjective experiences such as depression and hopelessness (Linehan, et al., 1991; as cited in Winston, 2000) Noted as well were improved functioning, both global and social and improved levels of anger however, only one year following the treatment end the rates of self inflicted harm were not able to be differentiated in the DBT and the treatment-as-usual groups in the study although there was improvement in both groups.
This therapy has…[continue]
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