Mental Representations, Social Exclusion, And Neurobiological Processes In Borderline Personality Disorder: A Multi-Level Study

Borderline Personality Disorder (BPD) is an ongoing public health crisis. Poor developmental quality of differentiation-relatedness of object representations and attachment insecurity have been clinically and empirically demonstrated as core patterns of intrapsychic and interpersonal dysfunction in this particular form of personality pathology. Differentiation-relatedness (D-R), which involves a complementary relationship between intrapsychic autonomy and interpersonal relatedness, has been shown to be a significant aspect of internal psychic experience that relates directly to external relationship patterns, including characteristic response to interpersonal interactions and has been a specific target for treatment of BPD. Specifically, individuals with BPD have shown lower developmental quality of differentiation-relatedness than non-clinical controls. Similarly, attachment insecurity, stemming from repetitive, conflicted exchanges with caregivers beginning from early development, is a hallmark of borderline personality. Although differentiation-relatedness and attachment organization have been extensively studied in this clinical population, few studies have investigated the relationship between such measures of historically relevant intrapsychic functioning, behavioral and neural responses to social interaction in the here and now. Through narrative responses to a clinical v interview, self-reports and a measure of social cognition during fMRI that operationalize borderline pathology in distinct ways, this study investigated differences between individuals diagnosed with BPD and non-clinical controls, as well as the relationship among measures of developmental quality of differentiation-relatedness of object representations, attachment style, and behavioral and neural response patterns in a laboratory-based design. Results: Independent samples t-tests showed significant differences between borderline patients and controls for D-R mean, father, and self scores, attachment anxiety and avoidance, and anger response patterns to experiences of social exclusion. Simple linear regression analyses demonstrated that D-R mean, father, and self scores also significantly predicted anger response in Cyberball. Non-significant positive trends for attachment anxiety, scored from the self-report Experience in Close Relationships (ECR) measure, predicting rejection and anger were also evident; however the ECR was less sensitive at predicting rejection and anger in response to social exclusion than D-R scores. The D-R mean score also modulated neural activity associated with social inclusion in Cyberball in the left inferior frontal cortex. Thus, this study provides further evidence of the multidimensional nature of borderline personality disorder and the intricate complexity of the relationship among different levels of the pathology (i.e., intrapsychic, attachment, behavioral, and neural). These results, in conjunction with further studies on the relationship among these components, have the potential to offer crucial insights for the treatment of this disorder.