Borderline personality disorders: from the developmental theory of the "self" and mentalizing to "systems"

Abstract

In the last fifty years the thinking around borderline personality disorder (BPD) shifted from an intra-psychic to a psychoanalytically oriented relational model. The latter described the difficulties associated with this presentation as arising from a disorganisation of the "self" structure in the context of an early caregiving relationship. The concept of inaccurate, or inconsistent "social biofeedback parental affect mirroring" has been pivotal to explain the characteristic failure to mentalize and the interpersonal difficulties associated with a diagnosis of BPD. Nevertheless, far from being the result of a sole linear relationship, these difficulties appear linked to communicative and emotional feedback loops that are reminiscent of cybernetic principles. Furthermore, recent claims have suggested that the communication feedback loops characteristic of the carer–child attachment style represent nothing less that the communication styles of the wider social environment in which the dyad is located. These claims have recently prompted a further shift from mentalizing to epistemic trust and epistemic vigilance, hence departing from a relational model towards a more systemic one. The difficulties associated with BPD are now suggested to be linked to a disorder of social learning, impacted by the rigid nature of the person's information-processing systems. This article reviews this journey.