Attachment and Borderline Personality Disorder: Implications for Psychotherapy

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Abstract
Background: Psychopathology researchers and theorists have begun to understand fundamental aspects of borderline personality disorder (BPD) such as unstable and intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment, intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. In the present study, we will examine self-reported attachment in a study group of well-characterized patients reliably diagnosed with BPD. Sampling and Methods: Ninety-nine outpatients reliably diagnosed with BPD using the International Personality Disorders Examination, completed a number of attachment measures including the Relationship Questionnaire, Relationship Style Questionnaire, and Experiences in Close Relationships inventory. Results: Factor analysis revealed six factors that clustered into three groups corresponding to an avoidant attachment pattern, a preoccupied attachment pattern, and a fearfully preoccupied pattern. The preoccupied pattern showed more concern and behavioral reaction to real or imagined abandonments, whereas the avoidant group had higher ratings of inappropriate anger. The fearfully preoccupied group had higher ratings on identity disturbance, although only at the trend level. Conclusions: The psychometric properties and response characteristics of the ECR items suggest that the scales, keying, and domains are appropriate for assessment of attachment in BPD samples. The scales generally retain their factor structure and show a similar pattern of correlations and inter-relationships. Nevertheless, consistent with a developmental psychopathology model, there are some important differences in factor structure, indicating the need to look at both typical and atypical samples when constructing models of attachment. Further research is needed to delineate the prognostic and prescriptive significance of attachment patterns for treating patients with BPD.