Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-23T12:42:40.128Z Has data issue: false hasContentIssue false
  • English
  • Français

Social domain dysfunction and disorganization in borderline personality disorder

Published online by Cambridge University Press:  25 September 2007

J. Hill ,
P. Pilkonis ,
J. Morse ,
U. Feske ,
S. Reynolds ,
H. Hope ,
C. Charest  and
N. Broyden
J. Hill*
Affiliation:
University of Manchester, Manchester, UK
P. Pilkonis
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
J. Morse
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
U. Feske
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
S. Reynolds
Affiliation:
University of Pittsburgh, Pittsburgh, PA, USA
H. Hope
Affiliation:
University of Liverpool, Liverpool, UK
C. Charest
Affiliation:
University of Liverpool, Liverpool, UK
N. Broyden
Affiliation:
University of Liverpool, Liverpool, UK
*
*Address for correspondence: Professor J. Hill, Education and Research, New Rawnsley Building, MRI, Oxford Road, ManchesterM13 9WL, UK. (Email: jonathan.hill@manchester.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Social dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD.

Method

Patients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of ‘domain disorganization’ (DD).

Results

Pervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count.

Conclusions

A focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.

Keywords

Borderline personality disordersocial domain disorganization
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 1 , January 2008 , pp. 135 - 146
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agrawal, HR, Gunderson, J, Holmes, BM, Lyons-Ruth, K (2004). Attachment studies with borderline patients: a review. Harvard Review of Psychiatry 12, 94–104.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn.American Psychiatric Association: Washington, DC.Google Scholar
Arntz, A, Appels, C, Sieswerda, S (2000). Hypervigilance in borderline disorder: a test with the emotional Stroop paradigm. Journal of Personality Disorders 14, 366–373.CrossRefGoogle ScholarPubMed
Bradley, R, Westen, D (2005). The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Development and Psychopathology 17, 927–956.CrossRefGoogle ScholarPubMed
Bugental, DB (2000). Acquisition of the algorithms of social life: a domain-based approach. Psychological Bulletin 126, 187–219.CrossRefGoogle ScholarPubMed
Chisholm, K (1998). A three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages. Child Development 69, 1092–1106.Google ScholarPubMed
Crick, NR, Murray-Close, D, Woods, K (2005). Borderline personality features in childhood: a short-term longitudinal study. Development and Psychopathology 17, 1051–1070.CrossRefGoogle ScholarPubMed
Daley, SE, Burge, D, Hammen, C (2000). Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity. Journal of Abnormal Psychology 109, 451–460.CrossRefGoogle ScholarPubMed
Dodge, KA, Pettit, GS, Bates, JE, Valente, E (1995). Social information-processing patterns partially mediate the effect of early physical abuse on later conduct problems. Journal of Abnormal Psychology 104, 632–643.CrossRefGoogle ScholarPubMed
First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS (1997 a). Structured Clinical Interview for DSM-IV Axis II Personality Disorders. American Psychiatric Press: Washington, DC.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997 b). Structured Clinical Interview for DSM-IV Axis I Disorders. American Psychiatric Press: Washington, DC.Google Scholar
Heape, CL, Pilkonis, PA, Lambert, J, Proietti, JM (1989). Interpersonal Relations Assessment. Department of Psychiatry, University of Pittsburgh: Pittsburgh, PA.Google Scholar
Herpertz, SC, Kunert, HJ, Schwenger, UB, Sass, H (1999). Affective responsiveness in borderline personality disorder: a psychophysiological approach. American Journal of Psychiatry 156, 1550–1556.CrossRefGoogle ScholarPubMed
Hill, J, Fudge, H, Harrington, R, Pickles, A, Rutter, M (1995). The Adult Personality Functioning Assessment (APFA): factors influencing agreement between subject and informant. Psychological Medicine 25, 263–275.CrossRefGoogle ScholarPubMed
Hill, J, Fudge, H, Harrington, R, Pickles, A, Rutter, M (2000). Complementary approaches to the assessment of personality disorder: the Personality Assessment Schedule and Adult Personality Functioning Assessment compared. British Journal of Psychiatry 176, 434–439.CrossRefGoogle Scholar
Hill, J, Harrington, R, Fudge, H, Rutter, M, Pickles, A (1989). Adult Personality Functioning Assessment (APFA); an investigator-based standardised interview. British Journal of Psychiatry 155, 24–35.CrossRefGoogle ScholarPubMed
Hill, J, Stein, H (2002). Revised Adult Personality Functioning Assessment (Technical Report No. 02-0052). The Menninger Clinic, Research Department: Topeka, KS.Google Scholar
Johnson, MH, Griffin, R, Csibra, G, Halit, H, Farroni, T, de Haan, M, Tucker, LA, Baron-Cohen, S, Richards, J (2005). The emergence of the social brain network: evidence from typical and atypical development. Development and Psychopathology 17, 599–619.CrossRefGoogle ScholarPubMed
Levy, KN (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology 17, 959–986.CrossRefGoogle ScholarPubMed
Linehan, MM (1993). Cognitive-behavioural Treatment of Borderline Personality Disorder. Guilford Press: New York.Google Scholar
O'Connor, TG, Marvin, RS, Rutter, M, Olrick, JT, Britner, PA; English and Romanian Adoptees Study Team (2003). Child–parent attachment following early institutional deprivation. Development and Psychopathology 15, 19–38.CrossRefGoogle ScholarPubMed
Pickles, A, Angold, A (2003). Natural categories or fundamental dimensions: on carving nature at the joints and the re-articulation of psychopathology. Development and Psychopathology 15, 529–551.CrossRefGoogle ScholarPubMed
Pilkonis, PA, Meyer, B (2001). Which personality disorders are best understood as disorders of attachment? Paper presented at the meeting of the Association for Clinical Psychosocial Research, Portland, ME, October 2001.Google Scholar
Rutter, M (1987). Temperament, personality and personality disorder. British Journal of Psychiatry 150, 443–458.CrossRefGoogle ScholarPubMed
Seivewright, H, Tyrer, P, Johnson, T (2004). Persistent social dysfunction in anxious and depressed patients with personality disorder. Acta Psychiatrica Scandanavica 109, 104–109.CrossRefGoogle ScholarPubMed
Skodol, AE, Gunderson, JG, McGlashan, TH, Dyck, IR, Stout, RL, Bender, DS, Grilo, CM, Shea, MT, Zanarini, MC, Morey, LC, Sanislow, CA, Oldham, JM (2002). Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. American Journal of Psychiatry 159, 276–283.CrossRefGoogle ScholarPubMed
Skodol, AE, Pagano, ME, Bender, DS, Shea, MT, Gunderson, JG, Yen, S, Stout, RL, Morey, LC, Sanislow, CA, Grilo, CM, Zanarini, MC, McGlashan, TH (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychological Medicine 35, 443–451.CrossRefGoogle ScholarPubMed
Sroufe, LA (2005). Attachment and development: a prospective longitudinal study from birth to adulthood. Attachment and Human Development 7, 349–367.CrossRefGoogle ScholarPubMed
Sroufe, LA, Waters, E (1977). Attachment as an organizational construct. Child Development 48, 1184–1199.CrossRefGoogle Scholar
Stein, H, Allen, JG, Hill, J (2003). Roles and relationships: a psychoeducational approach to reviewing strengths and difficulties in adulthood functioning. Bulletin of the Menninger Clinic 67, 281–313.CrossRefGoogle ScholarPubMed
Trevarthen, C, Aitken, KJ (2001). Infant intersubjectivity: research, theory, and clinical applications. Journal of Child Psychology and Psychiatry 42, 3–48.CrossRefGoogle ScholarPubMed
Widiger, TA, Frances, AJ (2002). Toward a dimensional model for the personality disorders. In Personality Disorders and the Five-factor Model of Personality, 2nd edn (ed. Costa, P. T. and Widiger, T. A.), pp. 23–44. American Psychiatric Press: Washington, DC.CrossRefGoogle Scholar
Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR (2005). Psychosocial functioning of borderline patients and Axis II comparison subjects followed prospectively for six years. Journal of Personality Disorders 19, 19–29.CrossRefGoogle ScholarPubMed