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      Attachment and Reflective Functioning in Women With Borderline Personality Disorder

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          Abstract

          Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients pre- dominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status.

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          Most cited references26

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          Models of the self and other: Fundamental dimensions underlying measures of adult attachment.

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            Attachment Stability From Infancy to Adulthood: Meta-Analysis and Dynamic Modeling of Developmental Mechanisms

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              Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study.

              Borderline personality disorder (BPD) is traditionally considered chronic and intractable. To compare the course of BPD's psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning. Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities. Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder. The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders-Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function. Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P < .001) and minimally slower than for other personality disorders (P < .03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P < .001) and other personality disorders (P = .008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P < .001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P < .001). The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.
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                Author and article information

                Journal
                Journal of Personality Disorders
                Journal of Personality Disorders
                Guilford Publications
                0885-579X
                February 2018
                February 2018
                : 32
                : 1
                : 17-30
                Affiliations
                [1 ] Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland, and Office Médico-Pédagogique Research Unit, Department of Psychiatry, University of Geneva School of Medicine.
                [2 ] Program TRE, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva.
                [3 ] Department of Clinical, Educational and Health Psychology, University College London.
                [4 ] Faculty of Psychology and Educational Sciences, KU Leuven, Belgium.
                [5 ] Department of Psychiatry, University of Geneva.
                Article
                10.1521/pedi_2017_31_283
                28263091
                50756851-8be6-433e-93b7-08752c9465ed
                © 2018
                History

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