Term Paper: Bpd Is Related to Secure Attachment

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¶ … Bpd Is Related to Secure Attachment

HOW BORDERLINE PERSONALITY DISORDER IS RELATED to EARLY INSECURE ATTACHMENT

Overview of Borderline Personality Disorder

Diagnostic Criteria of BPD

Overview of Attachment Theory

Summary of Literature Reviewed

HOW BORDERLINE PERSONALITY DISORDER IS RELATED to EARLY INSECURE ATTACHMENT

The objective of this work is to write a critical review of the literature about borderline personality disorder (BPD) from an attachment theories perspective. This work will contain references from Bowbly, Ainsworth, and Main in the discussion of secure vs. insecure attachment. Insecure attachment will then be researched regarding insecure attachment as a contributor to BPD. It should also discuss the potential benefits of viewing BPD from an attachment perspective in terms of prevention and treatment of the BPD.

Introduction

Borderline personality disorder (BPD) is a psychiatric problem that is highly prevalent and chronic in nature. This debilitating problem is characterized by self-defeating patterns of a chaotic nature in their interpersonal relationships. Other characteristics of this problem include."..emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation." (Levy, 2005)

Overview of Borderline Personality Disorder (BPD)

In the view of Dr. William Sears: "the concept of attachment is a literal one." (Kendall, 2003) in fact Kendall relates the fact that Dr. Sears states that in order to "immunize" your child against "the social and emotional diseases that plague our society" that the parent should carry the child strapped close to their body. Kendall states the fact that "attachment theory is undergoing a renaissance of sorts, in both the lab and clinic. As a wealth of long-term studies now show, children who develop strong bonds with their parents are likely to form similar bonds with peers, partners, and eventually their own children." (2003)

In the year 2000 an entire issue of the Journal of the American Psychoanalytic Association" was devoted to attachment theory stating that a recent study conducting was reporting that: "mother rats who groomed their infants more than usual triggered the expression of a gene that enabled the babies to grow into less anxious adults with lower levels of stress hormones." (Kendall, 2003) Kendall relates that the work of Bowlby is receiving a "second look." (2003) Bowlby's attachment theory was not accepted by science and in fact got him into trouble after completion his medical studies and started his psychoanalytic training. (Kendall, 2003) Psychoanalysis mainstream belief at the time was that problems in the emotional area "stemmed primarily from internally generated conflicts or fantasies." (Kendall, 2003) the external realities (activities and events in the environment) were considered irrelevant insofar as the emotions of the child.

The argument of Bowlby in his 1958 paper entitled: "The Nature of a Child's Tie to his Mother" was that the primary need that the infant required was the mother's attention even above receiving nourishment. Bowlby never swayed from this belief. During the 1960s and 70s Mary Ainsworth, who conducted a study that identified three attachment styles or categories of the response of an infant upon reunion with the mother after a brief separation. Those attachment styles are: (1) secure; (2) avoidant; and (3) ambivalent. The secure infant protested when the mother departed yet sought close proximity upon her return. Avoidant infants did not express much emotion to begin with showed little acknowledgement of the mother's return. Finally, the ambivalent infant, protested at the mother's department provide to be difficult to comfort upon the mother's return. During the decade of the 1980s, a third attachment style was added by Mary Main, UC-Berkeley psychologist which is the "disorganized" attachment style. The 'disorganized' individual is one who has a history of neglect or abuse and exhibit chaotic behavior upon the return of the mother after a brief separation. In spite of empirical findings the attachment theory has "generated a blistering barrage of criticism from the very start." (Kendall, 2003) Bowlby's attachment theory was attacked furiously by feminists groups however, "the most rigorous challenge to Bowlby's ideas has come from a group of developmental psychologists, led by Harvard's Jerome Kagan." (Kendall, 2003) According to Kagan: "Infant experience is very critical only if your mother goes after you with a frying pan. But extremely adverse circumstances are rare." (as cited in Kendall, 2003) Kagan's belief is that the 'strange situation' measures of Ainsworth are not useful although studies have remained consistent over time upholding the validity of Ainsworth' three styles of attachment.

The study conducted by Jay Belsky in 1996 states findings that only 50% of the infants were categorized the same when retesting was conducted three months following. Thomas Insel, director of the National Institute of mental Health and others are "charting new directions for both the mental-health practice and policy" in the area of neurobiology and bonding which has "put the theory on ever-strong empirical footing." (Kendall, 2003) Insel's work has been exploratory in the role of "brain chemicals called neuropeptides in pair-bonding the discovery of these so-called "attachment hormones," such as oxytocin and vasopressin, has highlighted the physiological basis of various attachment behaviors, such as the infant's desire to be soothed." (Kendall, 2003) Recently Allan Schore released two books revealing neurobiological research that upholds that the "ultimate architecture of the child's brain" is determined by the mother or caregiver. Schore holds that "therapists can facilitate emotional growth, even treat serious mental illness such as borderline personality disorder, by serving as protective attachment figures. Not just drugs but a strong therapeutic relationship itself, regardless of the specific style of therapy, can alter faulty brain chemistry for the better." (Kendall, 2003) landmark study conducted by Harvard Medical school's Karlen Lyons-Ruth that involved 72 families that tracked the long-effects of home visits aimed at helping mother improve their communication style-by" through the expression of emotions that are more positive. By the age of five years the children of mothers receiving the support were found to be "less hostile and aggressive toward peers" than children whose mother's did not receive the support.

Diagnostic Criteria of Borderline Personality Disorder (BPD)

I. DIB-R

Stated as the diagnostic interview to be used for borderline personality diagnosis by Gunderson and Kolb is the DIB-R (revised 1989) in assessing borderline characteristics in patients. The DIB categorizes symptoms into four major groups as follows:

The Diagnostic Interview for Borderlines, Revised

Affect

Chronic/major depression

Helplessness

Hopelessness

Worthlessness

Guilt

Anger (frequent expression of anger)

Anxiety

Loneliness

Boredom

Emptiness

Cognition

Odd thinking

Unusual perceptions

Nondelusional paranoia

Quasipsychosis

Impulse action patterns

Substance abuse/dependence

Sexual deviance

Manipulative suicide gestures

Other impulse behaviors

Interpersonal relationships

Intolerance of alones

Abandonment, engulfment, annihilation fears

Counterdependency

Stormy relationships

Manipulativeness

Dependency

Devaluation

Masochism/sadism

Demandingness

Entitlement

The DIB-R is stated to be the most well-known method of testing for and diagnosing BPD and as well use of this specific test has allowed researchers to make identification of four behavior patterns specific to BPD which are those of:

Abandonment;

Engulfment;

Annihilation fears

Demandingness and entitlement,

Treatment regressions

Ability to arouse inappropriately close or hostile treatment relationships.

II. DSM-IV

The DSM-IV states nine criteria and requires that the individual have at least five of these evident. Traits are those as follows:

Traits involving emotions: Individuals with BPD have a very hard time controlling their emotions. According to one researcher: "People with BPD are like people with third degree burns over 90% of their bodies. Lacking emotional skin, they feel agony at the slightest touch or movement." (Linehan, nd) These traits are those of: (1) Shifts in mood lasting only a few hours; and (2) Anger that is inappropriate, intense or uncontrollable.

Traits involving behavior - Includes (1) Self-destructive acts, such as self-mutilation or suicidal threats and gestures that happen more than once; and (2)Two potentially self-damaging impulsive behaviors. These could include alcohol and other drug abuse, compulsive spending, gambling, eating disorders, shoplifting, reckless driving, compulsive sexual behavior.

Traits involving identity - Inclusive of:

1) marked, persistent identity disturbance shown by uncertainty in at least two areas. These areas can include self-image, sexual orientation, career choice or other long-term goals, friendships, values. People with BPD may not feel like they know who they are, or what they think, or what their opinions are, or what religion they should be. Instead, they may try to be what they think other people want them to be. Someone with BPD said, "I have a hard time figuring out my personality. I tend to be whomever I'm with."

2) Chronic feelings of emptiness or boredom. Someone with BPD said, "I remember describing the feeling of having a deep hole in my stomach. An emptiness that I didn't know how to fill. My therapist told me that was from almost a "lack of a life." The more things you get into your life, the more relationships you get involved in, all of that fills that hole. As a borderline, I had no life. There were times when I couldn't stay in the same room with other people. It almost felt like what I think a panic attack would feel like."

Overview of Attachment Theory

John Bowlby first developed the… [END OF PREVIEW]

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