Duncan GILL1, Wayne WARBURTON1, Naomi SWELLER1
1 Department of Psychology, Macquarie University, NSW, 2109, Australia
Introduction: The biosocial model of borderline personality disorder (BPD) underpins dialectical behaviour therapy (DBT). This study sought to examine several untested aspects of the model. These included the significance of invalidating parenting, the importance of the interaction between this parenting style and childhood emotional vulnerability, whether the model is equally applicable to clinical and nonclinical populations, and whether the difficulties in establishing a therapeutic alliance observed in clients with BPD are also associated with the childhood antecedents of the disorder. Method: 291 students (239 females, 52 males; mean age of 20.33 years) and 148 (135 females, 13 males; mean age of 34.10 years) individuals with a history of borderline traits were administered questionnaires assessing their current levels of borderline traits and emotional dysregulation, in addition to retrospective measures of invalidating parenting, other forms of poor parenting, childhood emotional vulnerability, and a measure of the quality of their most significant therapeutic relationship. Results: Some differences emerged regarding the applicability of the model to the clinical and nonclinical samples. In neither sample was the interaction between childhood emotional vulnerability and a history of invalidating parenting critically important in relation to the aetiology of borderline traits. In the clinical sample, difficulties with establishing therapeutic alliances were associated with current borderline traits, but not with the childhood antecedents of the condition.
Keywords: borderline personality disorder, biosocial theory, emotional dysregulation, invalidating parenting, emotional vulnerability
Published online: 2018/09/01
Published print: 2018/09/01
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14, 249-256. doi: 10.1080/10673220600975121
Barnicot, K., Katsakou, C., Bhatti, N., Savill, M., Fearns, N., & Priebe, S. (2012). Factors predicting the outcome of psychotherapy for borderline personality disorder: A systematic review. Clinical Psychology Review, 32, 400-412. doi: 10.1016/j.cpr. 2012.04.004
Battle, C. L., Shea, M. T., Johnson, D. M., Yen, S., Zlotnick, C., Zanarini, M. C., . . . Morey, L. C. (2004). Childhood maltreatment associated with adult personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Personality Disorders, 18, 193-211. doi: 10.1521/pedi.188.8.131.52777
Bender, D. S. (2005). The therapeutic alliance in the treatment of personality disorders. Journal of Psychiatric Practice, 11, 73-87. doi: 10.1097/00131746-200503000-00002
Bryant, F. B., Yarnold, P. R., & Grimm, L. M. (1996). Toward a measurement model of the Affect Intensity Measure: A three factor structure. Journal of Research in Personality, 30, 223-247. doi: 10.1006/jrpe.1996.0015
Chanen, A. M., Jovev, M., Djaja, D., McDougall, E., Yuen, H. P., Rawlings, D., & Jackson, H. J. (2008). Screening for borderline personality disorder in outpatient youth. Journal of Personality Disorders, 22, 353-364. doi: 10.1521/pedi.2008.22.4.353 Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135, 495-510. doi: 10.1037/a0015616
Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28, 1167-1187. doi: 10.1016/j.cpr.2008.04.002
Fonseca-Pedrero, E., Paino, M., Lemos-Giráldez, S., Sierra-Baigrie, S., González, M. P., Bobes, J., & Muniz, J. (2011). Borderline personality traits in nonclinical young adults. Journal of Personality Disorders, 25, 542-556. doi: 10.1521/pedi.2011.25. 4.542
Gill, D. J., & Warburton, W. A. (2014). An investigation of the biosocial model of borderline personality disorder. Journal of Clinical Psychology, 70, 866-873. doi: 10.1002/jclp.22074
Gill, D. J., Warburton, W. A., & Beath, K. (2018). The specificity of the biosocial model to borderline traits. Clinical Psychologist, 22, 27-36. doi: 10.1111/cp.12104
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41-54. doi: 10.1023/B:JOBA.0000007455.08539.94
Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37, 14-25. doi: 10.1080/16506070701819524
Gratz, K. L., Tull, M. T., Baruch, D. E., Bornovalova, M. A., & Lejuez, C. W. (2008). Factors associated with co-occurring borderline personality disorder among inner-city substance users: The roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Comprehensive Psychiatry, 49, 603-615. doi: 10.1016/j.comppsych.2008.04.005
Hong, P. Y., & Lishner, D. A. (2016). General invalidation and trauma-specific invalidation as predictors of personality and subclinical psychopathology. Personality and Individual Differences, 89, 211-216. doi: 10.1016/j.paid.2015.10.016
Igarashi, H., Hasui, C., Uji, M., Shono, M., Nagata, T., & Kitamura, T. (2010). Effects of child abuse history on borderline personality traits, negative life events, and depression: A study among a university student population in Japan. Psychiatry Research, 180, 120-125. doi: 10.1016/j.psychres.2010.04.029
Krause, E. D., Mendelson, T., & Lynch, T. (2003). Childhood emotional invalidation and adult psychological distress: The mediating role of emotional inhibition. Child Abuse & Neglect, 27, 199-213. doi: 10.1016/S0145-2134(02)00536-7
Lawrence, K. A., Allen, J. S., & Chanen, A. M. (2011). A study of maladaptive schemas and borderline personality disorder in young people. Cognitive Therapy and Research, 35, 30-39. doi: 10.1007/s10608-009-9292-4
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the national comorbidity survey replication. Biological Psychiatry, 62, 553-564. doi: 10.1016/j.biopsych.2006.09.019 Levy, K. N., Beeney, J. E., Wasserman, R. H., & Clarkin, J. F. (2010). Conflict begets conflict: Executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder. Psychotherapy Research, 20, 413-422. doi: 10.1080/10503301003636696
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy. New York: Basic Books. Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450. doi: 10.1037/0022-006X.68.3.438
Nilsson, A. K. K., Jørgensen, C. R., Straarup, K. N., & Licht, R. W. (2010). Severity of affective temperament and maladaptive self-schemas differentiate borderline patients, bipolar patients, and controls. Comprehensive Psychiatry, 51, 486-491. doi: 10.1016/j.comppsych.2010.02.006
Poreh, A. M., Rawlings, D., Claridge, G., Freeman, J. L., Faulkner, C., & Shelton, C. (2006). The BPQ: A scale for the assessment of borderline personality based on DSM-IV criteria. Journal of Personality Disorders, 20, 247-260. doi: 10.1521/pedi.2006.20.3.247
Reeves, M. D. (2007). The effect of invalidation on emotion regulation: An empirical investigation of Linehan’s biosocial theory (Doctoral dissertation). Retrieved from http://diginole.lib.fsu.edu/islandora/object/fsu:176376/ datastream/PDF/view.
Sauer, S. E., & Baer, R. A. (2010). Validation of measures of biosocial precursors to borderline personality disorder: Childhood emotional vulnerability and environmental invalidation. Assessment, 17, 454-466. doi: 10.1177/1073191110373226
Sharf, J., Primavera, L. H., & Diener, M. J. (2010). Droupout and theraputic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47, 637-645. doi: 10.1037/a0021175
Sheffield, A., Waller, G., Emanuelli, F., Murray, J., & Meyer, C. (2005). Links between parenting and core beliefs: Preliminary psychometric validation of the Young Parenting Inventory. Cognitive Therapy and Research, 29, 787-802. doi: 10.1007/s10608-005-4291-6
Specht, M. W., Chapman, A. L., & Cellucci, T. (2009). Schemas and borderline personality disorder symptoms in incarcerated women. Journal of Behavior Therapy and Experimental Psychiatry, 40, 256-264. doi: 10.1016/j.jbtep.2008.12.005
Thimm, J. C. (2011). Incremental validity of maladaptive schemas over five-factor model facets in the prediction of personality disorder symptoms. Personality and Individual Differences, 50, 777-782. doi: 10.1016/j.paid.2010.12.030
Thomas, R., DiLillo, D., Walsh, K., & Polusny, M. A. (2011). Pathways from child sexual abuse to adult depression: The role of parental socialization of emotions and alexithymia. Psychology of Violence, 1, 121-135. doi: 10.1037/a0022469
van Asselt, A. D. I., Dirksen, C. D., Arntz, A., & Severens, J. L. (2007). The cost of borderline personality disorder: Societal cost of illness in BPD-patients. European Psychiatry, 22, 354-361. doi: 10.1016/j.eurpsy.2007.04.001 Warburton, W. A. (2007). Control-related aggression: Evidence for a mechanism, its origins and personality correlates (Unpublished doctoral dissertation). Macquarie University, Sydney, Australia.
Young, J. E. (1999). Young Parenting Inventory (YPI). New York: Cognitive Therapy Center of New York. Available from: http://www.schematherapy.com.
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Marino, M. F., Lewis, R. E., Williams, A. A., & Khera, G. S. (2000). Biparental failure in the childhood experiences of borderline patients. Journal of Personality Disorders, 14, 264-273. doi: 10.1521/pedi. 2000.14.3.264
Zanarini, M. C., Gunderson, J. G., Marino, M. F., Schwartz, E. O., & Frankenburg, F. R. (1989). Childhood experiences of borderline patients. Comprehensive Psychiatry, 30, 18-25. doi: 10.1016/0010-440X(89)90114-4
Zhang, T. H., Chow, A., Wang, L. L., Dai, Y. F., & Xiao, Z. P. (2012). Role of childhood traumatic experience in personality disorders in China. Comprehensive Psychiatry, 53, 829-836. doi: 10.1016/j.comppsych.2011.10.004
Zweig-Frank, H., & Paris, J. (1991). Parents’ emotional neglect and overprotection according to the recollections of patients with borderline personality disorder. American Journal of Psychiatry, 148, 648-651. doi: 10.1176/ajp.148.5.648