Borderline Personality Organization Research Articles

Psychometric properties of the Greek Inventory of Personality Organization – Brief (IPO-Brief-GR) in a community sample of emerging adults

Several studies have evaluated different versions of the Inventory of Personality Organization (IPO) around the world and some shortened versions of the instrument have also been constructed. The aim of this study was to develop the first brief Greek-language version of the IPO (IPO-Brief-GR) to be used for clinical screening and research purposes regarding personality pathology defined according to Kernberg's object relations model of personality organization. Data were collected from a community sample of 543 Greek emerging adults aged 18–29 years (M = 21.45, SD = 2.51) with the 83-item IPO, from which a 30-item version was constructed, based on confirmatory factor analysis of the full measure. The psychometric properties of the IPO-Brief-GR were then examined. Confirmatory factor analyses indicated that a four-factor structure best fitted the data, that is, primitive defenses/identity diffusion, reality testing, aggression, and moral values. Criterion validity and internal consistency reliability were also supported. Measurement invariance across gender using an exact protocol approach (i.e., configural, metric, scalar) was found allowing latent mean comparisons. These preliminary findings support the reliability and validity of the IPO-Brief-GR for the assessment of borderline personality organization and indicate the need for further research into the psychometric properties and clinical utility of this measure.

The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18–29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0–6, 7–12, 13–18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

Association between dimensions of borderline personality organization and pathological narcissism.

Association between dimensions of borderline personality organization and pathological narcissism.

Supplemental Material for Association Between Dimensions of Borderline Personality Organization and Pathological Narcissism

Supplemental Material for Association Between Dimensions of Borderline Personality Organization and Pathological Narcissism

The borderline personality organization in Otto F. Kernberg’s psychodynamic perspective

ABSTRACT In this article, we examine the concept of borderline personality organization as it was conceptualized by Otto F. Kernberg. We highlight the diagnostic criteria so that it is possible to recognize a borderline organization, namely primitive defensive mechanisms associated with an examination of reality generally uncompromised. We point out that, for Kernberg, dysfunctional management of the primitive feelings of anger would prevent the psychic integration, in early childhood of the borderline subject, of the ‘good’ and ‘bad’ dyads in which Self and object are related. The patient, growing up, would then discover herself as dominated by tearing and opposing experiential and affective ‘states’. Kernberg describes borderline personality organization as a pathological condition of internalized object relations.

Edited Pictures in Social Network and Borderline Personality Organization: Focusing on Shame, Guilt, Social Comparison, and Body Image

The habit to share edited pictures through social networks have been reported in young people and associated to psychological vulnerabilities. The research addresses the effects of the exposure to edited pictures on guilt, shame, social comparison tendencies, body image dissatisfaction. Moreover, the study assesses the mediating role of borderline organization on perceived identification and attractiveness in edited and original personal pictures.
 We asked seventy young women to rate perceived identification and attractiveness in their original and edited pictures. Subjects report higher identification in the original picture compared to the edited ones; attractiveness does not change between original and edited pictures, but high identification in edited ones negatively affects the score of attractiveness in original versions. They report negative associations between the level of identification and attractiveness in the original picture and dysphoria, guilt and body image. Identification and attractiveness in personal pictures are influenced by psychological vulnerabilities. Eventually, borderline organization features mediate the association between guilt and body image satisfaction with identification and attractiveness respectively. Furthermore, psychopathological features might affect individual self-perception and behavior in social network.

Borderline Personality Organization as an Aid in Differential Diagnosis.

There are subsets of patients whose presentations elude a precise diagnosis. All diagnoses are asymptotic to nature as they are constructs imposed on the world. Nonetheless, a greater degree of accuracy and precision is possible and beneficial for most patients. This is particularly true for patients with borderline personality organization (BPO) who present with psychotic symptoms. For the purposes of avoiding a misconstrual of the meaning of psychotic experiences in these patients, a brief synopsis of borderline personality organization, in contradistinction to borderline personality disorder, may prove to be of some clinical utility. The BPO construct presciently anticipates the trend toward a dimensional model of personality disorders and has the potential to enrich and inform these developments.

One Year of Outpatient Dialectical Behavioral Therapy and Its Impact on Neuronal Correlates of Attachment Representation in Patients with Borderline Personality Disorder Using a Personalized fMRI Task.

(1) Background: BPD is characterized by affect dysregulation, interpersonal problems, and disturbances in attachment, but neuroimaging studies investigating attachment representations in BPD are rare. No study has examined longitudinal neural changes associated with interventions targeting these impairments. (2) Methods: We aimed to address this gap by performing a longitudinal neuroimaging study on n = 26 patients with BPD treated with Dialectic Behavioral Therapy (DBT) and n = 26 matched healthy controls (HCs; post intervention point: n = 18 BPD and n = 23 HCs). For functional imaging, we applied an attachment paradigm presenting attachment related scenes represented in drawings paired with related neutral or personalized sentences from one's own attachment narratives. In a prior cross-sectional investigation, we identified increased fMRI-activation in the human attachment network, in areas related to fear response and the conflict monitoring network in BPD patients. These were especially evident for scenes from the context of loneliness (monadic pictures paired with individual narrative sentences). Here, we tested whether these correlates of attachment representation show a near-to-normal development over one year of DBT intervention. In addition, we were interested in possible associations between fMRI-activation in these regions-of-interest (ROI) and clinical scores. (3) Results: Patients improved clinically, showing decreased symptoms of borderline personality organization (BPI) and increased self-directedness (Temperament and Character Inventory, TCI) over treatment. fMRI-activation was increased in the anterior medial cingulate cortex (aMCC) and left amygdala in BPD patients at baseline which was absent after intervention. When investigating associations between scores (BPI, TCI) and functional activation, we found significant effects in the bilateral amygdala. In contrast, aMCC activation at baseline was negatively associated with treatment outcome, indicating less effective treatment effects for those with higher aMCC activation at baseline. (4) Conclusions: Monadic attachment scenes with personalized sentences presented in an fMRI setup are capable of identifying increased activation magnitude in BPD. After successful DBT treatment, these increased activations tend to normalize which could be interpreted as signs of a better capability to regulate intensive emotions in the context of "social pain" towards a more organized/secure attachment representation. Amygdala activation, however, indicates high correlations with pre-treatment scores; activation in the aMCC is predictive for treatment gain. Functional activation of the amygdala and the aMCC as a response to attachment scenes representing loneness at baseline might be relevant influencing factors for DBT-intervention outcomes.

Treating Narcissistic Personality Disorders: a case illustration of key clinical contributions from Transference Focused Psychotherapy for psychoanalytic practitioners

Narcissistic Personality Disorder (NPD) is complex and difficult to treat. Whilst there is no research based evidence for the specific treatment of NPD, there is an evidence base for psychotherapeutic approaches to Borderline Personality Disorder (BPD) which includes Transference Focused Psychotherapy (TFP). TFP is a contemporary object relations approach which has been developed to treat patients with a Borderline Personality Organization, which includes narcissistic personality structures. TFP therefore stands to contribute to the treatment of NPD. We introduce main tenets of TFP, and how TFP views narcissism. We then present a case illustration to illustrate aspects of TFP which are key clinical contributions in treating NPD. These include assessment of personality organization, the treatment contract, transference, countertransference, use of clarification and interpretation, technical neutrality, therapist centered interpretations, the treatment frame and consideration of the stage of treatment

Metacognition and defensive activity in response to relational–emotional stimuli in borderline personality organization.

Metacognition and defensive activity in response to relational–emotional stimuli in borderline personality organization.

Conversion to Transference-Focused Psychotherapy from Other Treatments by the Same Therapist: Pitfalls and Benefits.

Borderline personality disorder and broadly speaking, borderline personality organization, including narcissistic personality disorder, can be effectively treated by transference-focused psychotherapy (TFP), which is a modern object relations-based structured psychoanalytic psychotherapy. TFP can be taught successfully to therapists from a wide array of backgrounds, not only to psychoanalysts, provided they have a basic grasp of psychodynamic concepts, including object relations theory. We initially thought that starting with a new patient would always be easier than conversion to TFP from a different method. Our supervisory experience supported this only partially. To learn more, we distributed a survey among therapists who completed formal TFP training or participated in supervision for at least 1 year. Only four of the 36 respondents felt that starting with a new case was easier. Conversion was a lot more common than we had expected (in fact, it seemed to be an almost inevitable part of training), and it often took place without appropriate supervision of the process. Moving from supportive therapy to TFP was the most difficult for the therapist, and often for the patient. All respondents felt that they would treat all new patients with borderline personality organization with TFP from the outset or, if indicated or necessary, begin with a preliminary treatment using TFP elements. Our findings strongly suggest that conversion needs to be taught in training seminars, and should not be left to be dealt with entirely in supervision.

Investigating the Lived Experience of Religion in People with Neurotic and Borderline Personality Organization: A Phenomenological Study

Investigating the Lived Experience of Religion in People with Neurotic and Borderline Personality Organization: A Phenomenological Study

Empirical Developments in Transference-Focused Psychotherapy.

Transference-focused psychotherapy (TFP) is an empirically supported individualized psychotherapy for patients with borderline personality disorder. This review highlights its development and current status. A review of the theoretical background underpinning TFP and empirical advances in the development of TFP provide perspective. Otto Kernberg's object relations model of personality and its implications for assessment and diagnosis of personality disorders are described. The authors review the programmatic research that has been developed and has demonstrated the efficacy of TFP. In view of the empirical studies that have demonstrated the successful outcomes and processes of TFP for patients with borderline personality disorder, compared with other approaches, TFP has been applied to a broader range of difficulties related to patients' self-functioning and interpersonal functioning across the range of severities in personality pathology, consistent with the Alternative DSM-5 Model for Personality Disorders. The authors discuss borderline personality organization in the context of interpersonal, neurocognitive, and self-regulatory dysfunction, including preliminary findings. The theoretical and empirical advances in TFP lead to future directions for research evaluating personality disorder and its treatment.

Histrionical Blurriness. A God Image Without Features

RESEARCH OBJECTIVE: Exploring the specificity of God Image in histrionic personality organization.
 THE RESEARCH PROBLEM AND METHODS: The main research question is: God Image in histrionic subtype of Personality Organization is similar or different from the God Image in Borderline Personality Organization? Methodological strategy of Qualitative Secondary Analysis with the use of CAQDAS of material gathered in a project concerning God Image in Borderline personality organization (Krzysztof-Świderska, 2017) was performed.
 THE PROCESS OF ARGUMENTATION: The influence of the pre-oedipal roots of histrionic personality organization on the development of the specific God Image was argued.
 RESEARCH RESULTS: Outcomes shed light on certain characteristics of the histrionic God image: idealization and blurriness. The main conclusion is that characteristics of God Image in histrionical patients correspond with Bollas’s theoretical approach.
 CONCLUSIONS, INNOVATIONS, AND RECOMMENDATIONS: From a methodological point of view in future research, it is recommended to standardize groups in terms of the phase of therapy. It is also indicated that acting out experienced problems in a religious space could be potentially dangerous to those patients.

Sibling relationship quality and parental rearing style influence the development of Dark Triad traits

Currently our understanding of environmental factors that influence the development of dark personality traits (DT) is limited. Therefore, we conducted three studies using online questionnaires, each examining a different aspect of the relation between dark personality traits and family environment. In Study 1, 117 adults (mean age: 30.36 years, SD = 10.19) filled out questionnaires regarding their childhood relationship with siblings and their own DT traits. We found that the amount of conflicts with siblings during adolescence correlated positively with Machiavellianism and psychopathy. The feeling of closeness towards the siblings showed negative correlation with Machiavellianism. Parental partiality towards the other sibling was positively correlated with narcissism. In Study 2, 111 adolescents (mean age: 15.92, SD = 1.24) reported their perceptions of the rearing style of their parents, in addition to their sibling relationships and DT traits. Perceived parental emotional warmth was negatively associated, whereas both rejection and overprotection were positively correlated with psychopathy. Parental warmth was positively, while rejection negatively associated with narcissism. Machiavellianism was positively associated with the amount of conflicts with siblings, but negatively with closeness to siblings. In Study 3, 110 adults (mean age: 32.62 years, SD = 12.25) reported their levels of the Vulnerable Dark Triad that included measures of primary and secondary psychopathy, maladaptive covert narcissism, and borderline personality organization. Results indicated that sibling relation quality had a significant effect on primary psychopathy and borderline traits. Parental rejection and overprotection correlated with borderline traits and vulnerable narcissism. The results of these studies shed some light on how environmental impulses, particularly the quality of relationships between family members, affect the development of personality.

Impact of Object Relations Couple Therapy on Marital Intimacy of Divorce Applicant Couples With High-leveL Borderline Personality Organization: A Pilot Study Considering the Moderating Role of Executive Functions

Objective: Recently, the stability of marriages and the proper communication between couples has become more difficult. Therefore, exploring the impacts of relevant clinical interventions in resolving marital conflicts seems crucial. This study investigates the effectiveness of object relations couple therapy on marital intimacy of divorce applicant couples with high-level borderline personality organization while considering the moderating role of executive functioning. Methods: Using a quasi-experimental design, a sample of 90 volunteers was selected from all couples seeking a divorce and referred to counseling centers in Tehran City, Iran. All participants were screened by Structured Interview of Personality Organization (STIPO). A final sample of 38 individuals with high-level personality organization was randomly divided into control and experimental groups. After dropping the sample, 11 couples remained in the experimental group and 8 in the control group. Participants in the experimental group received 14 sessions of object relations couple therapy, while the control group remained on the waiting list. The Wisconsin Card Classification Test (WCST) and Thompson and Walker’s marital intimacy scale were administered on pre- and post-intervention occasions as well. The data were analyzed by a multivariate analysis of covariance. Results: Significant positive effects were found on marital intimacy in the post-intervention stage (P<0.001). Significantly, better results were also evident for couples with higher executive function scores (P<0.001). Conclusion: It could be concluded that object relation couple therapy could promote the marital intimacy of couples with high-level borderline personality organization, and executive functioning could moderate the therapeutic effects.

The specifics of discourse, mentalization and conceptualization of reality in the formation of a borderline personality

The subject of the study is the mutual influence of discourse deformations and cognitive mechanisms of mentalization and conceptualization of the world in a borderline personality. The aim of the work is to prove the decisive role of the deficits and defects of the "theory of mind" in the development and structuring of the borderline personal organization. The research methodology is represented by interdisciplinary categorical-genetic analysis and synthesis of theories and ideas of phenomenology, cognitive psychology, clinical psychology, psychotherapy, discourse analysis. The author examines the interaction of discursive and cognitive mechanisms of personality in the construction and personalization of the conceptual sphere and "theory of mind". The role of splitting in the conceptualization of reality and the connection of violations of mentalization with changes in the concept of Self are shown. A special contribution of the author to the study of the problem is the systematization of violations of mentalization as predictors of the development of borderline personal organization. The novelty of the research lies in determining the double determination of distortions of the conceptual sphere in the borderline personality by its discourse. Violations of conceptualization processes are described. The systematic organization of the operational units of the mental lexicon, memory and the conceptual sphere in their connection with discourse is determined. The main conclusion is the proof of the relationship between stereotypical discursive formulas, mental vocabulary, methods and abilities of the subject to process information and construct the conceptual sphere. The range of the subject's capabilities in this area is manifested in his discursive formulas of interpretations, assessments, self-regulation. The deformations of these phenomena and the deep rooting of discourse in the structures of thinking correlate with the formation of a pathological "theory of mind" and personal organization. The "borderline" conceptual sphere and the discourse "speaking" by the subject hinder reflection, honest internal dialogue, criticism of representations of reality and support the status quo of the pathology of cognition of reality and orientation in it. The study of the subject's speech models and the understanding of the cognitive-discursive mechanisms of his orientation in his Self and relationships has practical significance in the diagnosis of borderline personality organization and psychocorrective effects on it.

The Physical Dynamics of Primitive States

Primitive mental states, such as used by people suffering from psychosis, psychogenic autism, and severe borderline personality organization, may also be manifest in ‘ordinary’ people who are impacted by the ‘emotional plague’ of existential anxiety sweeping the planet. The implicit supposition within Bioenergetic Analysis is that our patients have a self and a sensory base to their experience that gives rise to the capacity to feel and to think. There is a radical need to reconsider this presupposition if we are to help many of our patients. There is a need to recover Lowen’s insistence on the «physical dynamics” that underlie psychic phenomena, and to do this with theoretical frameworks, models of practice, and therapeutic principles that are adequate to the task. This article is an invitation to participate in that important process.

Structural relationship between borderline personality organization and thematic relationships: the mediating role of resistibility in young boys and girls

Aim: The aim of this study was to explain the organization of border personality based on the initial thematic relationships and resilience. Methods: This descriptive study was performed by correlation method. The statistical population included all undergraduate and graduate students of Tehran universities in the academic year 1401-1400, of which 412 were selected using the available sampling method. Participants completed the Bell et al. (1985) Thematic Relationships Questionnaire, the Kernberg Borderline Personality Organization (2002), and the Ashourpour et al. (2010) Resilience Scale. Structural equation modeling was performed using the data obtained from the questionnaires. Results: The results showed that thematic relationships directly explain 0.29% and due to resilience 0.19% of the borderline personality structure. Overall, the estimation of the structural model in which the thematic relations of the predictor variable and resilience were entered as mediating variables, showed that this model explains 0.19% of the borderline personality structure (P<0.01). Conclusion: Therefore, it can be concluded that borderline personality organization is only indirectly and negatively explained by thematic relationships through resistance.

Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A

This study examines whether transference-focused psychotherapy for adolescents (TFP-A) in a dayclinic setting increases the capability to regulate affects and decreases self-destructive behavior in adolescents with borderline personality organization in comparison to treatment as usual (TAU). A total of 120 adolescents consecutively presenting to the dayclinic were allocated to either TFP-A or TAU. They were assessed for aggression, irritability, depression, self-harm, internalizing behavior and pathological personality traits at baseline and after twelve weeks. TFP-A was more effective than TAU in reducing self-harm. Aggression and irritability was improved within the treatment group. These results can be explained by an improvement in affect regulation through a treatment with TFP-A in a dayclinic setting. Further research is necessary in order to assess whether TFP-A reduces self-harm, aggressive behavior and irritability from a long-term perspective and whether these exploratory results can be replicated in independent samples.