Is It Time To Rethink Borderline Personality?

Is it Time to Rethink Borderline Personality?

Borderline personality disorder (BPD) is a chronic condition that influences how individuals think and feel about themselves and the world around them.

When someone experiences BPD it is common to have issues with anger management, and self-harm is a potential danger.

In particular, those with BPD struggle to maintain a stable sense of identity and often feel empty inside.  It is common for these feelings to lead to a heightened sense of abandonment which can result in extreme rage if the individual feels neglected.

To date researchers have theorized that BPD is a result of a number of factors including early childhood experiences, genetic predisposition, hypersensitivity and hyperreactivity and trouble deciphering how others feel. However, new data questions the essential core of borderline personality disorder.

But recently two Italian researchers have offered a different perspective on the development of BPD. Cesare Maffei and Marco Cavicchioli assert that BPD can be better understood and diagnosed when using a, “cognitive-affective personality system,” as a framework, rather than relying on biological explanations.

In laying out their ideas, the scientists argue that current BPD theories which consider the disorder to be radically different from a normal personality state are incorrect.

According to them, “all these theories are not based on a theory of normal personality, such as trait-based or sociocognitive approaches, which are necessary to explain the continuum existing between adaptive and maladaptive personality.”

In other words, the researchers believe that BPD falls somewhere on a continuum of personality which ranges from normal to abnormal, versus being a distinct form of personality.

This is a different view from that taken by most psychologists (Diagnostic and Statistical Manual of Mental Disorders, 2013).

Maffei and Cavicchioli argue that it would be more useful and ultimately efficacious to view BPD as one point on a personality spectrum which ranges from adaptive to maladaptive and not as a discrete disorder. In their world view, each of us have personality traits which range from moderate to extreme, with BPD characterized by an ongoing struggle to function.

To this end, they propose that BPD be seen through the lens of cognitive-affective personality system (CAPS).

CAPS views personality not as a biological construct, but as an end result of the ways in which we react to situations. Thus, personality is not considered to be a bundle of developed or inherited traits, but rather the outcome of ongoing interaction between the individual and her environment.

To give you an example, a CAPS theorist views introversion not as a fixed trait, but as a response that will vary depending on the situation one is in.

Specifically, Maffei and Cavicchioli believe that there exists a single core feature of personality that illuminates why those with BPD tend to react in maladaptive ways. They have termed this one element, “rejection sensitivity.”

Those with rejection sensitivity, “anxiously expect, readily perceive, and intensely react (emotionally or behaviorally) to signals of interpersonal rejection,” leading individuals to expect that people will reject them, even if others have no such intention.

Not content to merely speculate about the ability of CAPS to explain BPD, Maffei and Cavicchioli conducted an extensive study of previously published findings to determine if CAPS has merit in explaining BPD.

They sought to test the idea that individuals with BPD would have, “a pervasive and inflexible disposition to expect rejection,” and would perceive rejection even when they were included in social activities, leading them to feel anger about their perceived rejection.

Ultimately, the researchers found nearly 40 studies that fit their parameters. The studies used varied procedures to test for perceptions of inclusion and exclusion but all studies compared individuals who reported high BPD scores, those with a BPD diagnosis, and healthy controls.

What did Maffei and Cavicchioli discover after undertaking their project? Overall, they found data to support their idea that CAPS can accurately explain BPD.

After studying the results of prior research, they concluded that individuals with BPD did indeed display “pervasive and inflexible expectancies of rejection across several situations,” leading to the assumption that rejection expectancies are core elements of BPD.

Based on these findings, they predict that individuals with BPD are so certain of rejection that this belief clouds their judgement in individual situations, leading to the anger that is so pervasive in BPD. In addition, such individuals have difficulty adapting to situations in which they actually are included.

Interestingly enough, the data indicates that younger individuals more often expect rejection and once this pattern is established, it continues through the lifespan. For example, even when older these individuals continue to adjust their behavior to avoid situations where they may encounter rejection, thereby maintaining BPD over time.

What do Maffei and Cavicchioli’s findings mean in terms of future treatment and diagnosis of BPD? For one thing, using CAPS to describe the origin and process of BPD provides an alternate understanding of the disorder which could help sufferers through the use of a different set of set of therapeutic techniques. For example, those with BPD would learn to better understand their hypersensitivity to rejection, thus adding a beneficial intervention to their skill set.

The findings also serve to underscore that the current perception of BPD as a discrete clinical category may call for adjustment. If Maffei and Cavicchioli’s findings are replicated and shown to have efficacious treatment results, our understanding of BPD will increase, potentially leading to greater life satisfaction for those with BPD who currently struggle to understand the social context of situations thus impacting life in negative ways.

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