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Introduction to special feature on borderline personality disorder: Part II.

This issue contains the second part of the Special Feature on theoretical models of borderline personality disorder. The first part was in issue Volume 21 Number 5 published in October 2007. In first of the three articles in Part II, Peter Fonagy and Anthony Bateman offer an additional psychoanalytically-based model of the disorder. Unlike previous models emphasizing structural problems primarily centered on object relationships, they suggest that impaired mentalizing capacity–the ability to make sense of the mental states of self and others–is the core feature of the disorder. Their model postulates that disturbances in early attachment due to the interplay between constitutional and environmental factors leads to hyperresponsiveness of the attachment system. A disturbed attachment relationship hinders the acquisition of mentalizing capacity because the skills involved are acquired in interaction with care-givers who convey sensitive understanding. Impaired mentalizing leads to problematic interpersonal relationships and hinders the development of the self system. Subsequently, hyper-responsiveness of the attachment system makes mentalizing unstable when emotions are strongly aroused. As Fonagy and Bateman note, the formulation has direct implications for treatment. It suggests that important goals in treating BPD are to improve mentalizing capacity and ensure that patients are able to maintain these functions when the attachment system is activated. In the second paper, John Gunderson and Karlen Lyons-Ruth hypothesize that the psychobiological disposition to BPD involves a “constitutional diathesis” involving hypersensitivity to interpersonal stressors. Early in development, this interpersonal hypersensitivity along with other heritable characteristics interacts with problems in the attachment relationship leading to a disorganized pattern of attachment. Gunderson and LyonsRuth note that the developmental pathways linking early disorganized attachment and the subsequent development of BPD are complex and as yet poorly understood. However, they hypothesize that an important factor is the emergence of controlling strategies that may be either controlling and punitive or controlling and care-giving. The model extends Gunderson’s earlier descriptions of the unstable interpersonal relationships of individuals with BPD that involve conflict between needs for closeness and attention with intense fears of rejection or abandonment by proposing that this pattern is not simply acquired in the context of adversity but also has a heritable component.