The developmental line of autonomy in the etiology, dynamics, and treatment of borderline personality disorders

Abstract

Borderline personality disorder (BPD) is considered as a disorder of autonomy, and is related to both predisposing vulnerabilities and social relationships that fail to support basic psychological needs. Autonomy, which is defined within the self-determination theory as the capacity for self-endorsed action based on integrative, reflective awareness, is discussed as a developmental line that is dependent on specific supports from caregivers. Unresponsiveness, invalidation, or abuse by caregivers is argued to impair the capacity for autonomy and to catalyze an array of processes, both biological and psychological, which impact subsequent development and, in vulnerable individuals, can lead to BPD. Aspects of treatment, including the emphases on validation and acceptance of the patient's experience, and the cultivation of more reflective or mindful regulation of behavior, can be deduced, from this analysis of autonomy disturbance, and these in turn have appeared as the cornerstones of effective treatments for BPD.