Pathways From Early Maladaptive Experiences to the Development of Borderline Pathology in Adults: A Retrospective Study

Abstract Borderline Personality Disorder (BPD) is a disorder that is stigmatised and largely misunderstood. Undoubtedly, it is a disorder that has required and continues to require extensive investigation due to its severity, pervasiveness, and widespread adverse outcomes. BPD is becoming increasingly prevalent in Western countries and is associated with exorbitant use of mental health resources and emergency services. As a society, we are becoming more aware of this condition and many other major mental health afflictions. However, significant gaps around pathogenic pathways and preventative mechanisms remain. As the BPD condition creates huge financial burden for medical, mental health, and hospital services, there has been increasingly greater efforts to identify the factors that mediate, moderate, minimise, and/or prevent the emergence and/or severity of BPD to understand, promote and protect these vulnerable individuals. It has been well established that BPD has a strong genetic component in first-degree relatives (siblings, children, or parents) of people treated for the condition. Relatives are four times more likely to develop BPD than those without BPD-affected relatives. It is also well-established that the four aggregates of instability – affective, interpersonal, behavioural, cognitive - are particularly heritable trait pathologies across families. This has advanced earlier conceptual models that essentially almost always attributed BPD to early trauma and highlights the importance of investigating other factors that are symbolic in the manifestation of in this condition. Aims: The current study addresses some of the gaps in knowledge, including the identification of demographic differences between community and clinical samples, and the variables that most significantly contribute to, predict, and may protect from, the development of BPD. This is an important distinction that can inform the mental health community of alternative pathogenic pathways, in addition to the risk-factors already established such as childhood trauma, genetic vulnerability, and poor attachments. Research Design: Using a cross-sectional design, this study explored differences and 1 similarities between community and clinical samples, focusing on a vast array of variables and their interrelationships, including early maladaptive experiences such as poor attachment and parental bonding, (actual or perceived) rejection and abandonment, other major life stressors (e.g., poverty, trouble with the law) as well as past and present psychological health. It also explored external support systems and their contribution to the developing child and examined the six key protective attributes in psychologically-well people that are believed to be lacking in those diagnosed with BPD. Structure of thesis: The themes presented in Chapters 1 – 4 are relevant to both studies comprising this paper. Chapter 1 introduces the BPD and the importance of further research in this field, emphasising the complexities of this condition. A literature review is presented across chapters 2 and 3. Chapter 2 provides an overview of BPD in the context of the broader category of personality disorders and their systems of diagnosis and classification, using the most recent Diagnostic and Statistical Manual and briefly presents the international classification system (International Classification of Diseases [ICD-10], primarily adopted in other countries. Chapter 3 presents specific information about BPD symptomatology, current prevalence, aetiology, comorbidities, and theoretical frameworks used to operationalize and conceptualize this condition. Chapter 4, the Methodology, describes the participant sample, instruments, and procedures used in the present thesis. The next two chapters present Study 1 and Study 2 respectively. Chapter 5, based on the study of differences between the community and clinical samples across all variable domains (i.e., demographic, early adversities, mental health, resilience and psychological wellbeing), provides an introduction, brief methodology, the statistical findings pertaining to Study 1, and discusses the importance of these findings as well as comparing them to the outcomes of previous literature. Similarly, Chapter 6 covers Study 2, which explores the significant correlates and predictors in the pathogenesis of BPD, and presents a brief introduction, methodology, findings, and a discussion of the Study 2 results. 2 Study 1 focus and findings: As Study 1 aimed to identify group differences in the data obtained from both samples, descriptive statistics and independent samples t-tests were employed. Findings included significant differences in gender, country of origin, parental marital relationship (greater ‘intact’ families in clinical sample), and relationships with extended family through childhood. As expected, differences in mental health indicators were evident in self-rated general mental health, current depression, anxiety and stress levels, borderline pathology indices, the degree of impact from adverse life events between 0-16 years, and physical abuse during childhood; all of which were greater in the clinical cohort. The quality of parental bonding with both mother and father in both the care and protection domains were more favourable for the community sample. Further, schemas of emotional deprivation, abandonment, social isolation, high degrees of self-shame, failure, and unrelenting standards were also significantly more prevalent in the clinical sample. In line with Ryff’s research on psychological wellbeing (PWB), levels of autonomy, personal growth, personal relations, and involvement in community activities throughout childhood, demonstrated positive correlations with the construct of resilience. This finding endorses the notion that both constructs, resilience and psychological wellbeing, have similar constituents and are alike in the personality traits and strengths they are measuring. Study 2 focus and findings: Study 2 utilised the clinical sample to explore the demographic, childhood trauma and adversities variables, as well as the inherent/person-centred traits that significantly correlate with SCID-BPD. Of these correlates, it was imperative to identify the factors that significantly contributed to the variance in self-rated borderline scores. In doing so, the factors that performed the role of protecting against borderline traits through their inverse relationship with SCID scores will also be revealed, which in this study, were anticipated to include some of the resilience traits as well as reporting healthy and positive involvement in one’s community through their upbringing. relationship status, life stressors experienced in the past 12-months, current depression a Study 2 findings demonstrated significant relationships between BPD, current relationship, and stress levels, and schemas reflecting emotional deprivation, abandonment, mistrust/abuse, social isolation, failure, and defectiveness/shame; of which, only current stress levels, singledom, and defectiveness/shame schemas significantly contributed to the variance in the borderline scores. Unexpectedly, it appeared that factors reflecting current personal circumstances and experiences were more predictive than historical/childhood factors. Despite the mixed findings regarding the main contributors to BPD – historical or recent; the current study attempted to identify the least number of variables that can be utilised to identify BPD traits in members of the community. This can eliminate burdens such as using excessive resources to eventually diagnose BPD, which usually occurs after months to years of assessment and treatment. It is more valuable to easily identify the main indicators of BPD in their early onset and initiate treatment at this time. If the disorder does not proceed to develop in certain individuals and instead, only some BPD traits are identified, they will still benefit through their engagement with a clinician that can provide psychoeducation and preliminary strategies to manage their BPD traits Discussion and conclusions: Chapter 7, the final chapter, comprises a general discussion of all findings and highlights the key themes that emerged amongst both studies, which were deduced through comprehensive evaluation of all research outcomes and selecting the most frequently recurring topics, as well as those that opposed the wealth of prior literature. The themes were reviewed with my supervisors and agreed upon. Discussion of the reasons for the unexpected outcomes and gaps in the literature is presented, indicating directions for future research. These include the importance of certain demographic variables in the making of this disorder, as well as the presence of a key set of BPD-consistent schemas that is different to the larger 15-schema subset identified in the past; the relevance of childhood physical assault; and the importance of recognising present-day factors that played a pivotal role in the maintenance and severity of BPD pathology in this cohort. These factors include current depression and stress scores, physical health ratings, stressors and adversities experienced in the 12-months prior to assessment, current relationship status, and the well-embedded maladaptive schemas that continue to be endorsed in adulthood. The discussion also presents future research implications, methodological limitations, summary and conclusions and final comments. Explanations are provided for the lack of significant contributions from other key variables, such as childhood abuse, and positive influences of resilience traits, as well as the influence of ecological systems that surround the individual. The lack of significance of these variables emphasises their importance as theme<p></p>