Kenneth R. Silk

Object relations and social cognition in borderlines, major depressives, and normals : a thematic apperception test analysis

This study compared reliably diagnosed borderline personality disorder patients (n = 35) with major depressives (n = 25) and normals (n = 30) on 4 dimensions of object relations and social cognition coded from Thematic Apperception Test (TAT) responses: Complexity of Representations of People, Affect-Tone of Relationship Paradigms (malevolent to benevolent), Capacity for Emotional Investment in Relationships, and Understanding of Social Causality. As predicted, borderlines scored significantly lower on all 4 scales than did normals and lower on Affect-Tone and Capacity for Emotional Investment than did nonborderline major depressives. Borderlines also produced more pathological responses than did both groups on every scale, indicating more poorly differentiated representations, grossly illogical attributions, malevolent expectations, and need-gratifying relationship paradigms. The results suggest the importance of distinguishing several interdependent but distinct cognitive-affective dimensions of object relations and the potential utility of assessing object relations and social cognition from TAT responses. The psychological processes underlying the interpersonal pathology of patients with borderline personality disorder (BPD), that is, their distorted object relations, have been conceptualized in various ways by different theorists. Most argue that a disturbance in the first 3 years of life leads to the continued use of developmentally primitive modes of relating in adulthood (Kernberg, 1975; Masterson, 1976). Although theorists and clinicians (see Greenberg & Mitchell, 1983) often speak of levels of object relations as unitary phenomena, from developmentally immature to mature, the term object relations refers to a congeries of cognitive and affective functions and structures, including ways of representing people and relationships, rules of inference for interpreting the causes of peoples feelings, behaviors, interpersonal wishes, conflicts, and so forth. The concept of general levels of object relations is clinically an indispensable heuristic, but these levels should be understood as being composed of several interdependent but distinct developmental lines that differ in their maturity and quality among individuals as well as within a single individual at any given time (Westen, 1989, 1990, in press-b). The aim of the present study is to explore the nature of different dimensions of the cognitive-af

Emotion dysregulation and the development of borderline personality disorder

We review the role of emotion regulation in borderline personality disorder (BPD). We briefly discuss the historical development of BPD as a disorder where emotional regulation plays a key role. We review the concept of emotion regulation in general and explore both one-factor and two-factor models of emotion regulation. We discuss cognitive and attentional aspects of emotion regulation, and explore these regulatory controls as operating as both voluntary as well as automatic processes. We then turn to other neurophysiological models of emotion regulation in general and examine how those models, both neurophysiologically and neuroanatomically, are expressed in individuals with BPD. We examine how neuroimaging, both anatomical and functional, reveals the roles that various neuroanatomical structures play in the regulation of emotion in BPD. We conclude by creating a neurodevelopmental model that describes how a complex matrix involving the interplay of constitutional/biological predispositions with environmental stressors as well as with parental effectiveness in response to the childs emotion expression can impact key aspects of adult cognitive, affective, interpersonal, and behavioral functioning that culminate in a diagnosis of BPD.

Dysregulation of Regional Endogenous Opioid Function in Borderline Personality Disorder

OBJECTIVE Borderline personality disorder is characterized by a lack of effective regulation of emotional responses. The authors investigated the role of the endogenous opioid system and mu-opioid receptors in emotion regulation in borderline personality disorder. METHOD Mu-opioid receptor availability in vivo (nondisplaceable binding potential, or BP(ND)) was measured with positron emission tomography and the selective radiotracer [(11)C]carfentanil during neutral and sustained sadness states in 18 unmedicated female patients with borderline personality disorder and 14 healthy female comparison subjects. RESULTS Patients showed greater regional mu-opioid BP(ND) than did comparison subjects at baseline (neutral state) bilaterally in the orbitofrontal cortex, caudate, and nucleus accumbens and in the left amygdala, but lower BP(ND) in the posterior thalamus. Sadness induction was associated with greater reductions in BP(ND) (endogenous opioid system activation) in the patient group than in the comparison group in the pregenual anterior cingulate, left orbitofrontal cortex, left ventral pallidum, left amygdala, and left inferior temporal cortex. Patients showed evidence of endogenous opioid system deactivation in the left nucleus accumbens, the hypothalamus, and the right hippocampus/parahippocampus relative to comparison subjects. Correlations of baseline measures with the Dissociative Experiences Scale and endogenous opioid system activation with the Barratt Impulsiveness Scale did not remain significant after correction for multiple comparisons. CONCLUSIONS Differences exist between patients with borderline personality disorder and comparison subjects in baseline in vivo mu-opioid receptor concentrations and in the endogenous opioid system response to a negative emotional challenge that can be related to some of the clinical characteristics of patients with borderline personality disorder. The regional network involved is implicated in the representation and regulation of emotion and stress responses.

Axis II comorbidity of borderline personality disorder: description of 6‐year course and prediction to time‐to‐remission

Objective:  The purpose of this study was to compare the axis II comorbidity of 202 patients whose borderline personality disorder (BPD) remitted over 6 years of prospective follow‐up to that of 88 whose BPD never remitted.

Disinhibition and borderline personality disorder

We review different conceptions of inhibitory control that may be relevant to the regulatory problems featured in borderline personality disorder (BPD). These conceptions have often been framed with regard to personality traits of inhibitory control, but can also be related to cognitive measures of response suppression as well as affect regulation. Reactive behavioral inhibition is relatively unstudied in relation to BPD. A substantial amount of literature links executive function problems with BPD, but that literature has not isolated executive response inhibition nor been controlled for other personality disorder symptoms of antisociality, attention-deficit/hyperactivity disorder (ADHD), or depression, anxiety, or posttraumatic symptoms. We therefore conducted a study of this question looking at BPD symptoms in an adult sample with a small number of BPD subjects and other disorders. Results indicated that symptoms of BPD were correlated with response inhibition (measured by stop signal reaction time) even after controlling for the overlap of stop inhibition with ADHD, antisociality, and other Axis II disorder symptoms. We conclude by hypothesizing discrete developmental routes to BPD, based on different mechanism breakdowns, which would be amenable to empirical investigation at the cognitive or trait level of analysis.

Malevolent Object Representations in Borderline Personality Disorder and Major Depression

To study malevolent representations, earliest memories were reliably coded on scales of affect tone. Ss were diagnosed with borderline personality disorder: 31 without and 30 with concurrent major depression. Nonborderline comparison subjects had either major depressive disorder (n = 26) or no psychiatric diagnosis (n = 30). Borderline subjects were discriminated from comparison subjects by their more malevolent representations; they more frequently produced memories involving deliberate injury; and they portrayed potential helpers as less helpful. Results suggest the diagnostic significance of malevolent representations, which need to be explained by any theory of borderline personality disorder.

The impact of sexual and physical abuse on eating disordered and psychiatric symptoms: a comparison of eating disordered and psychiatric inpatients

The authors compared rates of physical and sexual abuse in women with eating disorders (N = 102) and general psychiatric disorders (N = 49). Relationships between sexual abuse and severity of eating disordered and psychiatric symptoms were also examined. While high rates of sexual abuse were found in the eating disordered sample, these rates were not significantly higher than those found in the general psychiatric population. No relationship between a history of sexual abuse and severity of eating disordered symptoms was found. However, within the eating disordered group, sexually abuse subjects reported more severe psychiatric disturbances of an obsessive and phobic nature than nonabused subjects. These findings suggest that while sexually abusive experiences may be related to increased psychological distress, they do not serve to increase eating disordered symptomatology.

Adult Experiences of Abuse Reported by Borderline Patients and Axis Ii Comparison Subjects Over Six Years of Prospective Follow-up

The main objective of this study was to assess the rates of adult experiences of verbal, emotional, physical, and sexual abuse reported by borderline patients and Axis II comparison subjects during 6 years of prospective follow-up. A semistructured interview was administered to 290 borderline patients and 72 Axis II comparison subjects during their index admission. A follow-up analogue to this interview was administered at three contiguous 2-year follow-up periods. Over 94% of surviving patients were reinterviewed at all three follow-up waves. The rates of all four forms of reported abuse declined significantly over time for all subjects considered together. However, each of these types of abuse was reported by a significantly higher percentage of borderline patients than Axis II comparison subjects. When the presence of these forms of abuse was used to predict time to remission, all but sexual abuse were strongly associated with the failure to achieve symptomatic remission from borderline personality disorder. Taken together, the results of this study suggest that the rates of adult abuse reported by borderline patients decline significantly with time but remain relatively high. They also suggest that adult experiences of abuse are strongly associated with a failure to remit from borderline personality disorder.

Malevolence, splitting, and parental ratings by borderlines

Malevolent object relations as well as splitting have long been considered by psychodynamic theorists as central features of borderline personality disorder. We tested the hypotheses that borderlines would a) perceive their parents more negatively than both nonborderline major depressive patients and nonpatient normal controls, and b) split their representations of their parents into opposites more than the comparison subjects. Borderlines (N=31), who were identified by the Diagnostic Interview for Borderlines, Research Diagnostic Criteria major depressives (N=15), and nonpatient controls (N=14) were asked to rate each parent on the Adjective Check List (ACL; Gough and Heilbrun, 1983). Seven ACL scales were studied: Favorable, Unfavorable, Critical Parent, Nurturing Parent, Nurturance, Aggression, and Dominance. Correlations were performed between scores for mother and father on the various scales for each of the three cohorts. Analysis of variance and one-way Wests with Bonferroni correction were used to test group differences. Borderlines rated their parents, especially their fathers, not only as more unfavorable on negative scales than depressives or normals, but as less favorable on positive scales than the comparison groups. Analysis of covariance revealed that a significant portion of the variance in father scores, but not in mother scores, was related to age of respondent and history of sexual abuse. While borderlines did not appear to split their parents into one good and one bad parent, they did show significantly less correlation between parents on the Favorable scale when compared with either depressives or normal subjects. The results imply that borderlines have a greater tendency to view the world in negative, malevolent ways than to split their object representations.

Object Relations in Borderlines, Depressives, and Normals: An Examination of Human Responses on the Rorschach

Recently, researchers and clinicians have become increasingly interested in diagnostic distinctions between borderline and mood disorders. Object relations theory provides a useful framework for the comparison of these two overlapping diagnostic categories. In our study, a measure of object relations as represented on the Rorschach, developed by Blatt, Brenneis, Schimeck, and Glick (1976), was applied to data produced by borderline and depressive inpatients and by normal comparison subjects. Portions of the Blatt measure that tap the subjects experience of human action and interaction distinguish among the three diagnostic groups. Specifically, borderlines tend to understand human action as more highly motivated and human interaction as more malevolent in nature than do either depressive or normals. The data indicate that borderlines experience the object-relational world in a way that is fundamentally different from the way normals and depressives perceive it. Implications are discussed for theories of borderline object relations.