Providing a Causal Model for Explaining the Development of Borderline Personality Disorder

Document Type : Research Paper

Authors

• Farideh Gholami ¹
• Hossein Baghouli ²
• m barzegar ³
• Maryam Koroshnia ⁴

¹ Departement of psychology

² Faculty member

³ 0

⁴ Department of psychology, Marvdasht Branch, Islamic Azad university, marvdasht, Iran

Abstract

The aim of present study was to provide a causal model to explain Borderline personality disorder(BPD). To do this one hundred and sixty patients with BPD (58 men& 102 women) between 18 and 45 years old, who attended private clinics in Shiraz were assessed, using six scales: BPD inventory (Leichsenring), pathologic Narcissism inventory (Pincus), The Rosenberg self esteem inventory, The Other As Shamer scale (Goss& et al), Aggression inventory (Buss& Perry) &Object relation inventory (Bell). Data were analyzed by Structural equation modeling and confirmatory factor analysis using AMOS software . Finding showed that the research model had sufficient goodness of fit and all research hypotheses were confirmed. There was a significant relationship between predicator variable, Object relation and mediator variables, such as Aggression, Shame, self esteem and pathological narcissism with BPD. Also the result indicated that mediator variables had direct effect on predicting of BPD. They can provide a right framework to diagnose this disorder.

Keywords

• Object relation
• Borderline personality disorder
• Aggression
• Shame
• Pathological Narcissism

20.1001.1.22285516.1399.11.41.7.1

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References

American psychiatric Assosiation. (2016). Diagnoitic and statistical manual of meatal disorder (DSM-5), Fifth Edition.washington:APA 593-623.

Baumann, E., Schmidt, F.,  Lena, J., Cord, B., Spitzer, C. (2020).  Implicitly measured aggressiveness self-concepts in women with borderline personality disorder as assessed by an Implicit Association Test . Journal of Behavior Therapy and Experimental Psychiatry,66, 101513.

Bell, M. D., Billington, R.J., Becker, B.R,. (1986). A scale for the assessment of object relations: Reliability, validity, and factorial invariance. Journal of Clinical Psychology. 42(5):733-41.

Boesky, D. (1983). Representation in self and object theory.Psychoanalytic Quarterly, 52, 564-583.

Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Clinical Psychology, 63, 452-459.

Clarkin, F. J., Lenzenweger, F. M., Yeomans, F., Levy, N. K., Kernberg, F. O. (2007). An Object relations model of borderline pathology.Journal of Personality Disorders,21(5), 474.

Crocker, J., & Wolfe, C. T. (2001). Contingencies of self-worth. Psychological Review, 108 (3), 593–623.

Dhaliwal, K.,  Danzig, A., Fineberg, Sarah, K. (2020). Improving Research Practice for Studying Borderline Personality Disorder.chronic stress,(4), 1-10.

Dickinson, K. A., & Pincus, A. L. (2003). Interpersonal analysis of grandiose and vulnerable narcissism. Journal of Personality Disorders, 17(3), 188–207.

Drake, W. (2019). How Object Relations Therapy Can Help Your Relationship. Retrieved from  https://www.betterhelp.com.

Einy, S., Narimani, M., Atadokht, A., Basharpoor, S., Sadeghi Movahhed, F. (2018). Effectiveness of cognitive analytical therapy on ego strength and object relations of persons with borderline personality disorder.The Journal of Urmia University of Medical Sciences, 29(1).

Emmons, R. A. (1987). Narcissism: Theory and measurement. Journal of Personality and Social Psychology, 52(1), 11–17.

Esbati, M., Khodabakhsh,R., Mehrinejad,A.,Khosravi,Z. (2017). Psychometric Properties of Other As Shamer inventory,  Contemporary Psychology, 12, (Suppl.), 63-68.

Etemadi, M., Aghebati, A., Ayatmehr, F., & Ashoori, A. (2020). Predicting borderline personality traits in adoles-cents based on parenting styles and emotion regulation strategies. Journal of Practice in Clinical Psychology, 8(2), 133-142.

Etherington, L. (2020). Melanie Klein and Object Relations Theory . Simply Psychology. https://www.simplypsychology.org/Melanie-Klein.html

Euler, S.,  Stöbi, D., Sowislo, J., Franziska Ritzler, F., Huber, G. C.,  Lang, E. U., Wrege, J.,  Walter, M. (2018). Grandiose and Vulnerable Narcissism in Borderline Personality Disorder.Psychopathology, 51(2), 110-121.

 Eveleth, C. M., Bassir Nia, A. & et al. (2018).  Past, present, and future of genetic research in borderline personality disorder. Current Opinion in Psychology,( 21), 60-68.

Fossati, A., Novella, L., Donati, D., Donini, M.,Maffei, C.(2004). History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: A controlled study. Comprehensive Psychiatry, 43 (5), 369-377.

Gagnon, J., Leblanc, S., Amand, J., Julie, St .(2015). Relationship between Two Dimensions of Object Relations and GroupPsychotherapy Attendance Rate in Borderline Personality Disorder Individuals. Journal of Psychology & Psychotherapy, 5 (2).

Goss, K., Gilbert, P. & Allan, S. (1994).An exploration of shame measures: I: The ‘other as shamer’s scale. Personality and Individual Differences, 17, 713-717.

Gottlich, M., Westermair, A., Beyer, F., Bußmann, L. M., Schweiger, U., Krämer, M.U. (2020). Neural basis of shame and guilt experience in women with borderline personality disorder. European Archives of Psychiatry and Clinical Neuroscience,13.

Grambal, A., Prasko, J.,  Kamaradova, D.,  Latalova, K., Holubova, M.,  Marackova, M.,  Ociskova, M.,  Milos Slepecky, M. (2016).Self-stigma in borderline personality disorder – cross-sectional comparison with schizophrenia spectrum disorder, major depressive disorder, and anxiety disorders.Neuropsychiatric Disease and Treatment, 12, 2439-2448.

Greenacre, M. J. (1984).Theory and Applications of Correspondence Analysis.New York: Academic Press

Gunderson, G. J., Kolb, E. J. (1979).  Drs. Gunderson and Kolb Reply.American Journal of Psychiatry, 136(2), 239-240.

Hadinezhad, H., Tabatabaeian, M., Dehghani, M. (2014). A preliminary study for validity and reliability of Bell object relations and reality testing inventory. Iranian Journal of Psychiatry and Clinical Psychology, 20(2), 162-169.

Hedrick, , N. A., Brelin, A.H. (2012). Implicit Self-Esteem in Borderline Personality and Depersonalization Disorder. Frontiers in Psychology, 3, 91.

Hoerman, S., Clarkin, J. F., Hull, J. W., & Levy, K. N. (2013). The construct of effortful control: An approach to borderline personality disorder eterogeneity. Psychopathology, 38, 82- 86

Hook, L. T. (2007). The role of self concept and narcissism in aggression.Unpublished PHD’s thesis,university of Saskatchewan.

Jeung, H., Vollmann, M., Herpertz, C. S., Schwieren, C. (2020). Consider others better than yourself: Social decision-making and partner preference in Borderline Personality Disorder.Journal of Behavior Therapy and Experimental Psychiatry, 67, 101436.

Karan, E., Niesten, I. J., Frankenburg, F. R., Fitzmaurice, G. M., Zanarini, M. C.(2014). The 16-year course of shame and its risk factors in patients with borderline personality disorder. Personal Mental Health, 8(3), 169-77.

Kernberg, O. F. (1976).  Borderline conditions and pathological narcissism.  New York.Jason Aronson.

Kernberg, O. F.Yeomans, E. F. (2013). Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: Practical differential diagnosis. Bulletin of the Menninger Clinic, 77(1), 1-22.

Kim, K., Talbot, N. L., Cicchetti, D. (2015).  Childhood abuse and current family conflict: The role of shame. Child Abuse & Neglect, 33(6), 362–71.

Klein, M., &Tribich, D. (1981). kernberg’s object relations theory;a critical evaluation.International Journal of Psychoanalysis,62, 27-43.

Kockler, D.T., Santangelo, S. P., Limberger, F. M., Bohus, M., Ebner-Priemer, W. U. ( 2020).  Specific or transdiagnostic? The occurrence of emotions and their association with distress in the daily life of patients with borderline personality disorder compared to clinical and healthy controls.Psychiatry Research,248, 112692.

Kohut, H. (1977) .The Restoration of the Self. New York: Int. Univ. Press

Latalova, K.,  Prasko, P. (2010). Aggression in Borderline Personality Disorder.Psychiatric Quarterly, 81(3), 239-251.

Lynum, L. I., Wilberg, T. & Karterud, S. (2008). Self-esteem in patients with borderline and avoidant personality disorders. Scandinavian Journalof Psychology, 49, 469–477.

Mancke, F., Herpertz, C. S., Bertsch, K. (2015). Aggression in Borderline Personality Disorder: A Multidimensional Model.Personality Disorders: Theory, Research, and Treatment. American Psychological Association, 6(3), 278-291.

Martino, F., Caselli, G., Berardi,D., Fiore, F., Marino, E., Menchetti, M., Prunetti, E., Ruggiero,M. G., Sasdelli, A., Selby, E.,  Sandra Sassaroli, S. (2015).  Anger rumination and aggressive behaviour in borderline personality disorder,Personality and Mental Health 9(4,  277-287.

Masterson, J.F. (1981). Narcissistic and Borderline disorders. An integrated developmental approach. New York: Brunner/Mazel.

Miller, J.D., Campbell, W. K. (2008). Comparing clinical and social personality conceptualizations of narcissism. Journal of Personality,76,450-476.

Mohammadzadeh, A., Rezaee, A. (2011).Validitation of borderline personality inventory iniranian population, Journal of Behavioral Science,5(3),23-34.

Morse, J. ,Q. H. J., Pilkonis, P ., A.&et all .(2009).Anger Preoccupied attachment,and disorganization in borderline personality disorder. Journal of Personality Disorders, 23(3), 240–257.

Newman-Morris, V., Simpson, K., Gray, M. K., Perry, N., Dunlop, A., Newman, K. L. (2020). Evaluation  of Early relational Disturbenc in high-risk  population:Borderline personality disorder features.maternal mental state and observed interaction. Infant Mental Health.1-18.

Nevels, M. R.,  Dehon, E. E., Alexander, K., Gontkovsky,T. S. (2010). Psychopharmacology of aggression in children andadolescents with primary neuropsychiatric disorders: a review of current and potentially promisingtreatmentoptions.Journal ofExpect Clinical Psychopharmacol,18(2), 184-201.

Oldham, M. J., & et al. (2015). The alternative DSM‐5 model for personality disorders. World Psychiatry, 14 (2), 234-236.

Pedneault,  S. K. (2020).  Coping With Borderline Disorder Embarrassment and Shame. Mental Health.

Peters, R. J., Geiger, J.P. (2016). Borderline Personality Disorder and Self-Conscious Affect: Too Much Shame But Not Enough Guilt? Personal Disorders:Theory,Research and Treatment , 7(3), 303–308.

Pincus, L.A., Ansell, B.E., Pi.mentel,A. C., Cain, M.N., Wright,GC. A., Levy, N. K.( 2009). Initial construction andvalidation of the Pathological Narcissism Inventory.Psychological Assessment, 21, 365–79.

Porr,V. (2020). Shame: An Overlooked Factor in Conceptualizing and Treating Borderline Personality Disorder: Its’ Powerful Role in the Lives and Suicides of People with BPD. European Psychiatry, 41 (1), 715-716.

Potegal, M., Stemmler , G., Spielberger, C. et al. (2010). Anger and Psychopathology. International Handbook of Anger . Springer New York Dordrecht Heidelberg London. 465-497 .

Pullmann, H., & Allik, J. (2000). The Rosenberg Self­Esteem Scale: Its  dimensionality,  stability  and  personality  correlates  in  Estonian. Personality and Individual Differences, 28, 701-715.  

Roepke, S., Schröder-Abé, M., Schütz,A., Jacob, G., Dams, A.,  Vater, A., Rüter, A.,  Merkl, A., Heuser, I., Lammers, H. C.(2011). Dialectic behavioural therapy has an impact on self-concept clarity and facets of self-esteem in women with borderline personality disorder.Clinical Psychology & Psychotherapy,18(2), 148-158.

Ronningstam E. 2009. Narcissistic personality disorder: facing DSM-V.Psychiatr. Ann, 39, 111–21.

Rozenberg,M.(1965).Rozenberg self steem scale.Prinston university press.

Rüsch, N., Corrigan, P.W., Bohus, M.,  Kühler, T.,  Jacob, G. A. Lieb, K. (2007). The Impact of Posttraumatic Stress Disorder on Dysfunctional Implicit and Explicit Emotions Among Women With Borderline Personality Disorder. The Journal of Nervous and Mental Disease,  195(6), 537-539.

Rüsch, N., Corrigan, P.W., Bohus, M., Jacob, G.A., Brueck, R., Lieb, K. (2007). Measuring shame and guilt by self-report questionnaires: a validation study. Psychiatry Research,  150(3), 313–325.

Rüsch, N., Lieb, K.,  Göttler, I., Hermann, ., Schramm, E., &  Bohus, M. .(2007). Shame and Implicit Self-Concept in Women With Borderline Personality Disorder.The American journal of psychiatry, 164(3), 500-508.

Samani, S. (2007). Assessing the reliability and validity of the Buss and Perry Aggression Questionnaire. Iranian Journal of Psychiatry and Clinical Psychology. 13 (4), 359-365.

Sarkar, J. (2019). Borderline personality disorder and violence,Australasian Psychiatry, 27 (6), 578-580.

Schupert, H. Marieke. &et al. (2014). Severity of Borderline personality.Symptoms in adolescence:Relationship with mathernal parenting:Matenal psychopathology and rearing style.Journal of Personality Disorder, 28, 155.

 Sharp, C., Vanwoerden, S., Jouriles, E., Godfrey,A. D., Babcock, J., McLaren, V., McFarlane, J., Brashear, B., Quenette Walton, Q., Temple, R. J.(2020).  Exposure to interparental intimate partner violence and the development to borderline features in adolescents.Child abuse and Neglect, 103.

Soleimani, M., et al. (2015). Psychometric properties of the Pathological Narcissism Inventory. Contemporary Psychology, 10(1), 95-110.

Tangney, J. P. , & Dearing, R. l. (2004). Shame & guilt. The Guilford Press: New York, London.

Timothy, J. T., Stephanie, D. S., Christine, A. D. (2003). Research on borderline personality disorder.Current Opinion in Psychiatry, 16(1),  77-82.

Tunc, P., Eren, N.(2019).  Psychodynamic formulation in borderline personality disorder: A case study. Journal of psychiatric nursing, 10(4), 309-316.

Vermeiren, R., Bogaerts, J., Ruchkin, V., Deboutte, D. & Schwab-Stone, M. (2004).  Subtypes of self-esteem and self-concept in adolescent violent and property offenders.  Journal of Child Psychology and Psychiatry, 45, 405-411

 

Wink, P.(1991).Two faces of narcissisim.Journal of Personality and Social Psychology,61(4), 590-597.

Zanarini, C. M., Frankenburg,F. R., Reich,D. B., Silk,K. R., Hudson, J.I., McSweeney, L. B.(2007).  The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. American Journal of Psychiatry ,164(6),929–35.

Zanarini, M. C., Frankenburg, F.,   Bradford, R. D., Fitzmaurice, G. (2010). The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects.Acta Psychiatrica Scandinavica, 122 (2), 103-109.

  Zeigler, H.V., & Jennifer, A.(2006). Borderline Personality Features:Instability of Self steem and Affect . Journal of Social and Clinical Psychology, 25) 6(,668-687.