Personality Disorders

Borderline Personality Disorder's Links to Early Attachment

New research examines attachment style in borderline personality disorder.

Posted Feb 25, 2020

Among the symptoms of borderline personality disorder (BPD), insecurity in one's sense of self and relationships can be seen as a fundamental feature. Fearing abandonment, alternating between idealizing and devaluing others, and having wide variations in their moods, people with BPD seem to share some of the basic elements of individuals with what’s known as insecure attachment style.

Providing a perspective on the development of disorders in self and relationships, attachment theory proposes that early caregiving experiences set the stage for how individuals think about themselves and others. If you were made to feel that the world is a safe and reliable place through the nurturing you received as an infant, you’ll enter into your adult relationships with what attachment theory calls a “secure” attachment style. However, if you were raised by neglectful caregivers, your sense of self and your adult romantic relationships, based on an unstable early foundation, can lead you to develop an “insecure” attachment style in which you either avoid relationships or become too heavily enmeshed with your partner.

Perhaps you dated, or are in a relationship with, an individual who you think fits the description of the insecure attachment style. This individual may even have a BPD diagnosis. You know how difficult it can be to reassure such individuals that you are “there” for them. If you inadvertently cause them to feel that you’re not, it’s only a matter of time until you become the target of their wrath or- alternatively- their desperate and clingy attempts to regain your attention and affection. You can see from this example how insecure attachment and BPD features seem to feed into each other.

According to Purdue University’s Madison Smith and Susan South (2020), “BPD criteria… are frequently described when discussing insecure attachment” (p. 1). Apart from the diagnostic features themselves that define BPD are descriptions of the traits that characterize this disorder which include disordered patterns of identity and intimacy. Furthermore, among the many ways that BPD affects people’s lives, “one of the most consistent impairments… is dysfunction in romantic relationships” (p. 2). Your own experiences might confirm this observation. Previous researchers investigating attachment style and BPD, as the Purdue researchers note, don’t always narrow their approaches to studying attachment style with respect to people’s romantic partners. Existing attachment style measures may refer to “others” in general rather than the current partner vs. parents vs. other people in the individual's life.

An additional complication in previous research on attachment style is the fact that measures of attachment style don’t always take the same approach to defining its variations. Researchers are beginning to come to an agreement of sorts that attachment styles can be defined along the two dimensions of anxiety and avoidance. However, as Smith and South point out, this dimensional approach may not be the best way to capture the attachment style features most like BPD. In their words, “the dissociation and fragmented sense of self in BPD is theoretically consistent with disorganized attachment, and neither anxiety nor avoidance fully explains the range of symptomatology commonly observed in BPD” (p. 3). The disorganized attachment style, the authors explain, is “chaotic and characterized by rapid vacillations between extreme closeness and extreme distance, which creates and sustains unstable and chaotic relationships” (p. 2).

With this background, Smith and South sought to answer the question of which form of romantic attachment is most likely to be associated with BPD by conducting a meta-analysis, or empirically-based review, of relevant previous literature. They began by identifying 318 potential studies which they then narrowed down to 26, including four unpublished papers. The articles needed to be published in English, conducted after 1980, and had to define BPD in terms of its personality dimensions rather than the diagnostic criteria. The studies also needed to have, as measures of attachment style, ones focused on specifically on romantic partners. The Purdue researchers also took into account a number of other potentially relevant factors in their analysis including age, gender, sample type, relationship status, and whether participants were from the U.S. Other controls included the quality of the measurement instruments and whether those instruments were self-rated or scored by an interviewer.  

Having established these parameters for their analysis, the authors then went on to calculate whether the correlation between attachment style and BPD traits would support their predictions and whether those moderators made a difference in the overall relationship. Taking the dimensions of attachment anxiety and avoidance into account separately, Smith and South observed that BPD traits were more strongly associated with anxiety than with avoidance. However, the strongest association was with the combination of anxiety and avoidance represented by disorganized attachment, with its dissociative features and “breakdown of coping strategies" as well as the “chaotic instability” of their inner lives (p. 9).

Fearful attachment, they go on to note, may be related to the tendency of people with BPD traits to want to be close to others but to be reluctant to do so. The anger of people with BPD can, furthermore, be understood as reflecting a “behavioral script” that these individuals use to keep their partners close. Finally, the feelings of emptiness that people with BPD experience can be understood as a result of disorganized attachment, where they feel they cannot have close and loving relationships.

Returning to an understanding of how the BPD-attachment style link may develop, the authors propose a novel approach in which they suggest that, as infants, the individuals who go on to develop BPD traits had difficult temperaments. Their caregivers, in response, may have responded inconsistently or even inappropriately to their distress. In other words, “In essence, BPD may not be ‘caused’ by attachment, but at least in childhood, the developmental antecedents of BPD may be indistinguishable from insecure attachment” (p. 11). Later relationships with romantic partners continue this pattern, strengthening the extreme emotional reactions BPD individuals show until their psychopathology becomes “calcified.”

To sum up, perhaps the individuals you know with BPD traits have experienced lifelong struggles in feeling that they cannot count on the important people in their lives. By examining the early life course of BPD’s connection to attachment style, the Purdue study provides unique insights into seeing BPD not just as a diagnosis, but as a developmental process.

References

Smith, M., & South, S. (2020). Romantic attachment style and borderline personality pathology: A meta-analysis. Clinical Psychology Review, 75. doi:10.1016/j.cpr.2019.101781