Mental Representations, Social Exclusion, And Neurobiological Processes In Borderline Personality Disorder: A Multi-Level Study

MENTAL REPRESENTATIONS, SOCIAL EXCLUSION, AND NEUROBIOLOGICAL PROCESSES IN BORDERLINE PERSONALITY DISORDER: A MULTI-LEVEL STUDY By Jeffrey Kendall Erbe, M.Sc., M.Phil. Advisers: Eric Fertuck, Ph.D. and Diana Diamond, Ph.D. Borderline Personality Disorder (BPD) is an ongoing public health crisis. Poor developmental quality of differentiation-relatedness of object representations and attachment insecurity have been clinically and empirically demonstrated as core patterns of intrapsychic and interpersonal dysfunction in this particular form of personality pathology. Differentiationrelatedness (D-R), which involves complementary relationship between psychic autonomy and object-relatedness, has been shown to be a significant aspect of internal psychic experience that relates directly to external relationship patterns, including characteristic response to interpersonal interactions and has been a specific target for treatment of BPD. Specifically, individuals with BPD have shown lower developmental quality of differentiation-relatedness than healthy controls. Similarly, attachment insecurity, stemming from repetitive, conflicted exchanges with caregivers beginning from early development, is a hallmark of borderline personality. Although differentiation-relatedness and attachment organization have been extensively studied in this clinical population, few studies have investigated the relationship between such measures of historically relevant intrapsychic functioning and behavioral and neural responses to social interaction in the here and now. Through narrative responses to a clinical interview, self-reports 1 This study was supported by grants from the International Psychoanalytic Association to the author and NIMH (K23 MH077044), the American Psychoanalytic Foundation, and the Neuropsychoanalysis Foundation to Dr. Eric Fertuck. and a measure of social cognition during fMRI, that operationalize borderline pathology in distinct ways, this study investigated differences between individuals diagnosed with BPD and healthy controls, as well as the relationship among measures of developmental quality of object representations, attachment style, and behavioral and neural response patterns in a laboratorybased design. Results: Independent samples t-tests showed significant differences between borderline patients and controls in some D-R scores, but not others, attachment style, and anger response patterns to experiences of social exclusion. Simple linear regression analyses demonstrated that certain D-R scores significantly predicted anger response in Cyberall. Non-significant positive trends for attachment anxiety, scored from a self-report measure, predicting rejection and anger were also evident, however this self-report measure was less sensitive at predicting rejection and anger in response to social exclusion than D-R scores. Altogether, this study further evidenced the multidimensional nature of borderline personality disorder and the intricate complexity of the relationship among different levels of the pathology (i.e., intrapsychic, attachment, behavioral, and neural). These results, in conjunction with further studies on the relationship among these components, have the potential to offer crucial insights for the treatment of this disorder.