A Cognitive-Developmental Formulation of BPD

This chapter presents a cognitive-developmental model for understanding borderline personality disorder (BPD) and describes how it may be used in conceptualizing and treating this disorder. The model represents an extension of standard cognitive and schema-focused models. It is developmental in that it postulates that BPD stems from (1) biological and genetic propensities toward affect dysregulation, (2) deficits in the acquisition of affect regulation skills, and (3) the establishment of maladaptive tacit beliefs about oneself and relationships with others. The cognitive-developmental model is similar, in many respects, to traditional cognitive and schema-focused approaches for understanding and treating personality disorders in that it emphasizes the central role of cognitive and perceptual processes in the development and maintenance of clinical disorders. It differs from them in that it incorporates insights from the developmental psychopathology literature (Cicchetti, 1989, 1990; Garber & Dodge, 1992; Rutter & Garmezy, 1983; Sroufe, 1990) and postulates that personality disorders may usefully be understood from a developmental-systems perspective (Geiger & Crick, 2001). Variations in symptom patterns over time and across settings can complicate both the diagnostic and treatment process. With this in mind, the cognitive-developmental model focuses upon commonly occurring features of the disorder and directs our attention toward factors associated with their development and maintenance. Borderline personality disorder is characterized by (1) intense and unstable emotions, (2) behavioral impulsivity, (3) a tendency to view others as uncaring