Cognitive Conflict in Borderline Personality Disorder
Condition: Borderline Personality Disorder
MeSH terms: Personality Disorders; Borderline Personality Disorder
Study type: Observational

Summary: 
      Background: Borderline personality disorder (BPD) is a severe psychological condition
      characterized by emotional, interpersonal and self-image instability in addition to impulsive
      behaviour. Although there have been several explanatory models and psychotherapy approaches
      that have been designed to comprehend and intervene on BPD, most seem not to recognize
      idiosyncratic cognitive conflict as an important feature on this disorder. Adding personal
      dilemmas, such as those conceptualized in personal construct theory, as a key element to
      BPD's explanatory model could provide a better picture to understand this disorder and
      possibly to enhance effectiveness of current psychotherapy approaches. Despite the fact that
      constructivist explanatory models have been used and tested in several clinical populations,
      there is little work done studying the relevance of inner conflicts in BPD. According to the
      prototypical symptomatology manifested by these patients, psychological instability can be
      assumed as a transversal feature present in this disorder; therefore, a larger amount of
      cognitive conflict can be expected in BPD patients.

      Method and Analysis: In order to test this assumption, this study aims to examine the
      characteristics of the interpersonal cognitive system of patients diagnosed with BPD and note
      their potential differences with the general population using the repertory grid technique, a
      complex assessment tool derived from personal construct theory. Statistical analyses will be
      performed to examine whether the clinical sample tends to present with more cases and with
      higher number of cognitive conflicts than the control group. Likewise, the association
      between cognitive conflict and symptom severity will be explored. Results will be a first
      step to determine if cognitive conflicts have an important role in the explanation of BPD.
      This will also help to value the convenience to further investigate the efficacy of conflict
      resolution psychotherapy interventions with these patients. This research work is undertaken
      in the context of a funded predoctoral research program.
    

Detailed description: 
      Out of all personality disorders, BPD is one of the most life-threatening and psychological
      distressful due the symptomatic manifestation of impulsive behavior along with emotional,
      interpersonal and self-image instability. Suicidality and Non-Suicidal Self-Injury (NSSI)
      rates in this population are extremely high, and worrying for the families and mental health
      professionals. Over the last decades, BPD has obtained broad attention and many psychological
      treatments have been proposed to deal with its main symptoms. Although some treatments have
      been proven to be empirically effective in some domains, clearly not all experienced symptoms
      are successfully targeted, and some cases seem not to be helped even when treated by the more
      efficacious approaches. Perhaps, the explanatory models from which these psychotherapies
      emerge could have underestimated important aspects such as personal dilemmas.

      Cognitive conflict has been defined and conceptualized by different psychological
      orientations, but only a few have included this phenomenon as an influential factor in the
      understanding of the origin and nature of psychological disorders and their psychotherapy
      proposals. Those that have considered inner conflicts have mainly focused on theoretical
      based dilemmas the academics would perceive relevant or common instead of exploring potential
      ideographic conflicts patients may have.

      Being a disorder that is noticeably characterized by identity disturbances, finding relevant
      unresolved cognitive conflicts regarding self and others in these patients is expected.
      Addressing these issues could be potentially useful to further develop an explanatory model
      for this disorder as well as to increase therapeutic resources to help with these unattended
      potential necessities.

      The central aim of this research is to assess cognitive conflicts in BPD diagnosed
      individuals to determine their role in the explanatory model of this disorder. These findings
      would permit the consideration of adapting a dilemma-focused intervention module which could
      complement existing treatments for these patients. In addition, exploring other
      characteristics of self-construction and the construction of others that are assessed with
      the RGT would be of interest. The specific objectives of this study are:

        1. To test the hypothesis that patients with BPD present more cognitive conflicts (i.e.,
           implicative dilemmas and dilemmatic constructs) than a general population sample.

        2. To explore the content of cognitive conflicts in patients with BPD.

        3. To examine whether presence and/or frequency of cognitive conflicts is associated with
           severity of emotional symptoms in BPD patients.

        4. To explore whether the presence and number of cognitive conflicts has any capacity to
           predict treatment outcome.

        5. To examine the relevance of other aspects of the construction of the self and others to
           explain the psychological functioning of patients with a BPD diagnosis.

      The hypothesis of this study are:

        1. The percentage of participants with implicative dilemmas and/or dilemmatic constructs
           will be superior in the group of patients diagnosed with BPD compared to a control group
           (community sample).

        2. The number of implicative dilemmas and/or dilemmatic constructs will be higher in the
           BPD group than in the control group.

        3. Presence and higher number of cognitive conflicts will be associated with greater levels
           of general clinical symptomatology (such as depression, anxiety, etc.).

        4. Presence and higher number of individual cognitive conflicts will predict poor treatment
           outcome one year after the initial assessment.

      For exploratory purposes, the content of implicative dilemmas and dilemmatic constructs will
      be studied, as well as the differences with the control group regarding self-construction
      measures (self-ideal discrepancy, self-others discrepancy, ideal-others discrepancy) and
      other characteristics of the construction system (interpersonal cognitive differentiation and
      polarization) and its association with other clinical and sociodemographic variables.
    

Intervention name(s): Psychological assessment
Intervention type(s): Other
Intervention description(s): Psychological assessment with the repertory grid technique (RGT) in order to quantify cognitive conflicts.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Study Population: The borderline personality group will be formed by participants diagnosed
        with BPD that receive treatment from outpatient or inpatient public and private mental
        health facilities in the local area of Barcelona, Spain (CSMA Benito Menni, ITA -
        especialistas en salud mental and ITLímit).

        The control group will be formed by healthy volunteers of a student sample from the
        University of Barcelona and a nonstudent community sample who were not receiving
        psychotherapy when evaluated. These participants will be matched by age, gender and
        educational level with the clinical sample.
      
Keywords: Repertory grid technique; Predictors of outcome; Implicative dilemma; Dilemmatic construct; Personal Construct Theory