Skip to main content
SpringerLink
Log in

Psychodynamic Treatment for Borderline Personality Disorder and Mood Disorders: A Mentalizing Perspective

  • Chapter
  • First Online:
Borderline Personality and Mood Disorders

Abstract

Borderline personality disorder (BPD) and mood disorders are highly comorbid, and both disorders share important developmental pathways and underlying neurobiological features. This chapter reviews evidence for the overlap between BPD and mood disorders and presents an attachment and mentalizing approach to the conceptualization and treatment of depressed patients and without marked BPD features. We propose that patients with BPD and mood disorders can be situated on a continuum, with four related features distinguishing individuals with depression with, versus without, marked BPD features: (a) the nature of their depressive experiences; (b) the nature of their mentalizing impairments; (c) the presence of insecure, but organized, attachment in response to stress and arousal versus disorganized attachment; and (d) problems with epistemic trust versus epistemic hypervigilance. We outline the therapeutic implications of these views, arguing that treatments that combine a mental representation and mental process (i.e., mentalizing) focus may be most appropriate for patients with mood problems without marked BPD features. Yet, for patients with more marked BPD features, these treatments may be iatrogenic, as these patients may have serious problems in establishing a therapeutic alliance and lack the reflective capacities needed for such treatments. For these patients, a mental process approach that focuses on restoring the capacity for mentalizing might be more appropriate. Preliminary empirical evidence supporting these assumptions is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Stringer B, van Meijel B, Eikelenboom M, Koekkoek B, Licht CM, Kerkhof AJ, et al. Recurrent suicide attempts in patients with depressive and anxiety disorders: the role of borderline personality traits. J Affect Disord. 2013;151(1):23–30. doi:10.1016/j.jad.2013.02.038.

    PubMed  Google Scholar 

  2. Levenson JC, Wallace ML, Fournier JC, Rucci P, Frank E. The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy. J Consult Clin Psychol. 2012;80(5):719–29. doi:10.1037/a0029396.

    PubMed  PubMed Central  Google Scholar 

  3. Westen D, Moses MJ, Silk KR, Lohr NE, Cohen R, Segal H. Quality of depressive experience in borderline personality disorder and major depression: when depression is not just depression. J Pers Disord. 1992;6(4):382–93.

    Google Scholar 

  4. Levy KN, Edell WS, McGlashan TH. Depressive experiences in inpatients with borderline personality disorder. Psychiatr Q. 2007;78(2):129–43. doi:10.1007/s11126-006-9033-8.

    PubMed  Google Scholar 

  5. Lemma A, Target M, Fonagy P. Brief dynamic interpersonal therapy. A clinician’s guide. Oxford: Oxford University Press; 2011.

    Google Scholar 

  6. Luyten P, Fonagy P, Lemma A, Target M. Depression. In: Bateman A, Fonagy P, editors. Handbook of Mentalizing in mental health practice. Washington, DC: American Psychiatric Association; 2012. p. 385–417.

    Google Scholar 

  7. Sperber D, Clément F, Heintz C, Mascaro O, Mercier H, Origgi G, et al. Epistemic vigilance. Mind Lang. 2010;25:359–93.

    Google Scholar 

  8. Zuroff DC, Kelly AC, Leybman MJ, Blatt SJ, Wampold BE. Between-therapist and within-therapist differences in the quality of the therapeutic relationship: effects on maladjustment and self-critical perfectionism. J Clin Psychol. 2010;66(7):681–97. doi:10.1002/jclp.20683.

    PubMed  Google Scholar 

  9. Fonagy P, Luyten P, Allison E. Teaching to learn from experience: epistemic mistrust, personality, and psychotherapy. Manuscript submitted for publication. 2014.

    Google Scholar 

  10. Fonagy P, Edgcumbe R, Moran GS, Kennedy H, Target M. The roles of mental representations and mental processes in therapeutic action. Psychoanal Study Child. 1993;48:9–48.

    PubMed  CAS  Google Scholar 

  11. Luyten P, Blatt SJ, Fonagy P. Impairments in self structures in depression and suicide in psychodynamic and cognitive behavioral approaches: implications for clinical practice and research. Int J Cogn Ther. 2013;6(3):265–79. doi:10.1521/ijct.2013.6.3.265.

    Google Scholar 

  12. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand. 2004;109(s420):21–7.

    Google Scholar 

  13. Blazer D, Kessler R, McGonagle K, Swartz M. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry. 1994;151(7):979–86.

    PubMed  CAS  Google Scholar 

  14. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–105. doi:10.1001/jama.289.23.3095.

    PubMed  Google Scholar 

  15. Murray CJL, Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press; 1996.

    Google Scholar 

  16. Segal ZV, Pearson JL, Thase ME. Challenges in preventing relapse in major depression. Report of a National Institute of Mental Health Workshop on state of the science of relapse prevention in major depression. J Affect Disord. 2003;77(2):97–108.

    PubMed  Google Scholar 

  17. Kupfer DJ, Frank E. The interaction of drug- and psychotherapy in the long-term treatment of depression. J Affect Disord. 2001;62(1–2):131–7.

    PubMed  CAS  Google Scholar 

  18. Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry. 1997;54(11):989–91. doi:10.1001/archpsyc.1997.01830230015002.

    PubMed  CAS  Google Scholar 

  19. Gibb BE, Uhrlass DJ, Grassia M, Benas JS, McGeary J. Children’s inferential styles, 5-HTTLPR genotype, and maternal expressed emotion-criticism: an integrated model for the intergenerational transmission of depression. J Abnorm Psychol. 2009;118(4):734–45. doi:10.1037/a0016765.

    PubMed  PubMed Central  Google Scholar 

  20. Alloy LB, Abramson LY, Smith JM, Gibb BE, Neeren AM. Role of parenting and maltreatment histories in unipolar and bipolar mood disorders: mediation by cognitive vulnerability to depression. Clin Child Fam Psychol Rev. 2006;9(1):23–64. doi:10.1007/s10567-006-0002-4.

    PubMed  Google Scholar 

  21. Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med. 2010;40(2):211–23. doi:10.1017/S0033291709006114.

    PubMed  CAS  Google Scholar 

  22. Luyten P, Blatt SJ, Van Houdenhove B, Corveleyn J. Depression research and treatment: are we skating to where the puck is going to be? Clin Psychol Rev. 2006;26(8):985–99. doi:10.1016/j.cpr.2005.12.003.

    PubMed  Google Scholar 

  23. Luyten P, Blatt SJ. Looking back towards the future: is it time to change the DSM approach to psychiatric disorders? The case of depression. Psychiatry. 2007;70(2):85–99. doi:10.1521/psyc.2007.70.2.85.

    PubMed  Google Scholar 

  24. Driessen E, Van HL, Don FJ, Peen J, Kool S, Westra D, et al. The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. Am J Psychiatry. 2013;170(9):1041–50. doi:10.1176/appi.ajp.2013.12070899.

    PubMed  Google Scholar 

  25. Kool S, Dekker J, Duijsens IJ, de Jonghe F, Puite B. Efficacy of combined therapy and pharmacotherapy for depressed patients with or without personality disorders. Harv Rev Psychiatry. 2003;11(3):133–41.

    PubMed  Google Scholar 

  26. Zanarini MC, Reichman CA, Frankenburg FR, Reich DB, Fitzmaurice G. The course of eating disorders in patients with borderline personality disorder: a 10-year follow-up study. Int J Eat Disord. 2009. doi:10.1002/eat.20689.

    Google Scholar 

  27. Zanarini MC, Barison LK, Frankenburg FR, Reich DB, Hudson JI. Family history study of the familial coaggregation of borderline personality disorder with axis I and nonborderline dramatic cluster axis II disorders. J Pers Disord. 2009;23(4):357–69. doi:10.1521/pedi.2009.23.4.357.

    PubMed  PubMed Central  Google Scholar 

  28. Grilo CM, Sanislow CA, Shea MT, Skodol AE, Stout RL, Gunderson JG, et al. Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder comorbidity. J Consult Clin Psychol. 2005;73(1):78–85. doi:10.1037/0022-006X.73.1.78.

    PubMed  PubMed Central  Google Scholar 

  29. Hilsenroth MJ, Defife JA, Blake MM, Cromer TD. The effects of borderline pathology on short-term psychodynamic psychotherapy for depression. Psychother Res. 2007;17(2):175–88. doi:10.1080/10503300600786748.

    Google Scholar 

  30. Mulder RT. Personality pathology and treatment outcome in major depression: a review. Am J Psychiatry. 2002;159(3):359–71.

    PubMed  Google Scholar 

  31. Westen D, Novotny CM, Thompson-Brenner H. The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull. 2004;130(4):631–63. doi:10.1037/0033-2909.130.4.631.

    PubMed  Google Scholar 

  32. Fonagy P, Bateman A. Progress in the treatment of borderline personality disorder. Br J Psychiatry. 2006;188:1–3. doi:10.1192/bjp.bp.105.012088.

    PubMed  Google Scholar 

  33. Akiskal HS. Borderline: a adjective still in search of a noun. In: Silver D, Rosenbluth M, editors. Handbook of borderline disorders. Madison: International Universities Press; 1992.

    Google Scholar 

  34. Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders. In: Lenzenweger MF, Clarkin JF, editors. Major theories of personality disorder. 2nd ed. New York: Guilford Press; 2005. p. 114–56.

    Google Scholar 

  35. Bradley R, Westen D. The psychodynamics of borderline personality disorder: a view from developmental psychopathology. Dev Psychopathol. 2005;17(4):927–57.

    PubMed  Google Scholar 

  36. Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biol Psychiatry. 2002;51(12):936–50. doi:10.1016/S0006-3223(02)01324-0.

    PubMed  Google Scholar 

  37. Skodol AE, Siever LJ, Livesley WJ, Gunderson JG, Pfohl B, Widiger TA. The borderline diagnosis II: biology, genetics, and clinical course. Biol Psychiatry. 2002;51(12):951–63. doi:10.1016/S0006-3223(02)01325-2.

    PubMed  Google Scholar 

  38. Akiskal HS. Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatr Scand. 2004;110(6):401–7.

    PubMed  Google Scholar 

  39. Linehan MM. Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.

    Google Scholar 

  40. Barnow S, Arens EA, Sieswerda S, Dinu-Biringer R, Spitzer C, Lang S. Borderline personality disorder and psychosis: a review. Curr Psychiatry Rep. 2010;12(3):186–95. doi:10.1007/s11920-010-0107-9.

    PubMed  Google Scholar 

  41. Heim C, Newport DJ, Mletzko T, Miller AH, Hemeroff CB. The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology. 2008;33(6):693–710. doi:10.1016/j.psyneuen.2008.03.008.

    PubMed  CAS  Google Scholar 

  42. Blatt SJ, Luyten P. Reactivating the psychodynamic approach to classify psychopathology. In: Millon T, Krueger RF, Simonsen E, editors. Contemporary directions in psychopathology. Scientific foundations of the DSM-V and ICD-11. New York: Guilford Press; 2010. p. 483–514.

    Google Scholar 

  43. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748–51. doi:10.1176/appi.ajp.2010.09091379.

    PubMed  Google Scholar 

  44. Luyten P, Blatt SJ. Psychodynamic treatment of depression. Psychiatr Clin North Am. 2012;35(1):111–29. doi:10.1016/j.psc.2012.01.001.

    PubMed  Google Scholar 

  45. Fonagy P, Bateman A. The development of borderline personality disorder–a mentalizing model. J Pers Disord. 2008;22(1):4–21. doi:10.1521/pedi.2008.22.1.4.

    PubMed  Google Scholar 

  46. Fonagy P, Luyten P, Bateman A, Gergely G, Strathearn L, Target M, et al. Attachment and personality pathology. In: Clarkin JF, Fonagy P, Gabbard GO, editors. Psychodynamic psychotherapy for personality disorders. A clinical handbook. Washington, DC: American Psychiatric Publishing; 2010. p. 37–87.

    Google Scholar 

  47. Ryan RM, Deci EL. On assimilating identities to the self: a self-determination theory perspective on internalization and integrity within cultures. In: Leary MR, Tangney JP, editors. Handbook of self and identity. New York: Guilford Press; 2003. p. 253–72.

    Google Scholar 

  48. Fonagy P, Target M. Attachment and reflective function: their role in self-organization. Dev Psychopathol. 1997;9(4):679–700.

    PubMed  CAS  Google Scholar 

  49. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 2009;21(4):1355–81. doi:10.1017/s0954579409990198.

    PubMed  Google Scholar 

  50. Belsky DW, Caspi A, Arseneault L, Bleidorn W, Fonagy P, Goodman M, et al. Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. Dev Psychopathol. 2012;24(1):251–65. doi:10.1017/S0954579411000812.

    PubMed  PubMed Central  Google Scholar 

  51. Fearon P, Shmueli-Goetz Y, Viding E, Fonagy P, Plomin R. Genetic and environmental influences on adolescent attachment. J Child Psychol Psychiatry. 2013. doi:10.1111/jcpp.12171.

    PubMed  Google Scholar 

  52. Luyten P, Mayes LC, Fonagy P, van Houdenhove B. The interpersonal regulation of stress: a developmental framework. Manuscript submitted for publication. 2014.

    Google Scholar 

  53. Drevets WC, Price JL, Furey ML. Brain structural and functional abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Struct Funct. 2008;213(1–2):93–118. doi:10.1007/s00429-008-0189-x.

    PubMed  PubMed Central  Google Scholar 

  54. Johnson MK, Nolen-Hoeksema S, Mitchell KJ, Levin Y. Medial cortex activity, self-reflection and depression. Soc Cogn Affect Neurosci. 2009;4(4):313–27. doi:10.1093/scan/nsp022.

    PubMed  PubMed Central  Google Scholar 

  55. Savitz J, Drevets WC. Bipolar and major depressive disorder: neuroimaging the developmental-degenerative divide. Neurosci Biobehav Rev. 2009;33(5):699–771. doi:10.1016/j.neubiorev.2009.01.004.

    PubMed  PubMed Central  Google Scholar 

  56. Blatt SJ. Experiences of depression: theoretical, clinical and research perspectives. Washington, DC: American Psychological Association; 2004.

    Google Scholar 

  57. Panksepp J, Watt D. Why does depression hurt? Ancestral primary-process separation-distress (PANIC/GRIEF) and diminished brain reward (SEEKING) processes in the genesis of depressive affect. Psychiatry. 2011;74(1):5–13. doi:10.1521/psyc.2011.74.1.5.

    PubMed  Google Scholar 

  58. Blatt SJ, Luyten P. Depression as an evolutionary conserved mechanism to terminate separation-distress: only part of the biopsychosocial story? [Commentary on Watt & Panksepp]. Neuropsychoanalysis. 2009;11:52–61.

    Google Scholar 

  59. Gunderson JG. Disturbed relationships as a phenotype for borderline personality disorder. Am J Psychiatry. 2007;164(11):1637–40. doi:10.1176/appi.ajp.2007.07071125.

    PubMed  Google Scholar 

  60. Blatt SJ, Auerbach JS. Differential cognitive disturbances in three types of borderline patients. J Pers Disord. 1988;2:198–211.

    Google Scholar 

  61. Northoff G, Heinzel A, de Greck M, Bermpohl F, Dobrowolny H, Panksepp J. Self-referential processing in our brain–a meta-analysis of imaging studies on the self. Neuroimage. 2006;31(1):440–57.

    PubMed  Google Scholar 

  62. Mennin DS, Fresco DM. What, me worry and ruminate about DSM-5 and RDoC? The importance of targeting negative self-referential processing. Clin Psychol Sci Pract. 2013;20(3):258–67. doi:10.1111/cpsp.12038.

    Google Scholar 

  63. Lemma A, Target M, Fonagy P. The development of a brief psychodynamic intervention (dynamic interpersonal therapy) and its application to depression: a pilot study. Psychiatry. 2011;74(1):41–8. doi:10.1521/psyc.2011.74.1.41.

    PubMed  Google Scholar 

  64. Lee A, Hankin BL. Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence. J Clin Child Adolesc Psychol. 2009;38(2):219–31. doi:10.1080/15374410802698396.

    PubMed  PubMed Central  Google Scholar 

  65. Grunebaum MF, Galfalvy HC, Mortenson LY, Burke AK, Oquendo MA, Mann JJ. Attachment and social adjustment: relationships to suicide attempt and major depressive episode in a prospective study. J Affect Disord. 2010;123(1–3):123–30. doi:10.1016/j.jad.2009.09.010.

    PubMed  PubMed Central  Google Scholar 

  66. Blatt SJ, Luyten P. A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span. Dev Psychopathol. 2009;21(3):793–814.

    PubMed  Google Scholar 

  67. Blatt SJ, Homann E. Parent-child interaction in the etiology of dependent and self-critical depression. Clin Psychol Rev. 1992;12(1):47–91. doi:10.1016/0272-7358(92)90091-L.

    Google Scholar 

  68. Russell JJ, Moskowitz DS, Zuroff DC, Sookman D, Paris J. Stability and variability of affective experience and interpersonal behavior in borderline personality disorder. J Abnorm Psychol. 2007;116(3):578–88. doi:10.1037/0021-843X.116.3.578.

    PubMed  Google Scholar 

  69. Kopala-Sibley DC, Zuroff DC, Russell JJ, Moskowitz DS, Paris J. Understanding heterogeneity in borderline personality disorder: differences in affective reactivity explained by the traits of dependency and self-criticism. J Abnorm Psychol. 2012;121(3):680–91. doi:10.1037/a0028513.

    PubMed  Google Scholar 

  70. Conradi HJ, de Jonge P. Recurrent depression and the role of adult attachment: a prospective and a retrospective study. J Affect Disord. 2009;116(1–2):93–9. doi:10.1016/j.jad.2008.10.027.

    PubMed  Google Scholar 

  71. Pietrek C, Elbert T, Weierstall R, Muller O, Rockstroh B. Childhood adversities in relation to psychiatric disorders. Psychiatry Res. 2013;206(1):103–10. doi:10.1016/j.psychres.2012.11.003.

    PubMed  Google Scholar 

  72. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10(6):434–45.

    PubMed  CAS  Google Scholar 

  73. Champagne FA, Curley JP. Epigenetic mechanisms mediating the long-term effects of maternal care on development. Neurosci Biobehav Rev. 2009;33(4):593–600. doi:10.1016/j.neubiorev.2007.10.009.

    PubMed  Google Scholar 

  74. Gunnar M, Quevedo K. The neurobiology of stress and development. Annu Rev Psychol. 2007;58(1):145–73. doi:10.1146/annurev.psych.58.110405.085605.

    PubMed  Google Scholar 

  75. DeVries AC, Craft TK, Glasper ER, Neigh GN, Alexander JK. Social influences on stress responses and health. Psychoneuroendocrinology. 2007;32(6):587–603. doi:10.1016/j.psyneuen.2007.04.007.

    PubMed  Google Scholar 

  76. Neumann ID. Brain oxytocin: a key regulator of emotional and social behaviours in both females and males. J Neuroendocrinol. 2008;20(6):858–65. doi:10.1111/j.1365-2826.2008.01726.x.

    PubMed  CAS  Google Scholar 

  77. Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Mesman J, Alink LR, Juffer F. Effects of an attachment-based intervention on daily cortisol moderated by dopamine receptor D4: a randomized control trial on 1- to 3-year-olds screened for externalizing behavior. Dev Psychopathol. 2008;20(3):805–20. doi:10.1017/S0954579408000382.

    PubMed  Google Scholar 

  78. Wichers M, Geschwind N, Jacobs N, Kenis G, Peeters F, Derom C, et al. Transition from stress sensitivity to a depressive state: longitudinal twin study. Br J Psychiatry. 2009;195(6):498–503. doi:10.1192/bjp.bp.108.056853.

    PubMed  Google Scholar 

  79. Bifulco A, Kwon J, Jacobs C, Moran PM, Bunn A, Beer N. Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Soc Psychiatry Psychiatr Epidemiol. 2006;41(10):796–805. doi:10.1007/s00127-006-0101-z.

    PubMed  Google Scholar 

  80. Styron T, Janoff-Bulman R. Childhood attachment and abuse: long-term effects on adult attachment, depression, and conflict resolution. Child Abuse Negl. 1997;21(10):1015–23.

    PubMed  CAS  Google Scholar 

  81. Crowell SE, Beauchaine TP, Linehan MM. A biosocial developmental model of borderline personality: elaborating and extending Linehan’s theory. Psychol Bull. 2009;135(3):495–510. doi:10.1037/a0015616.

    PubMed  PubMed Central  Google Scholar 

  82. Risch N, Herrell R, Lehner T, Liang KY, Eaves L, Hoh J, et al. Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: a meta-analysis. JAMA. 2009;301(23):2462–71. doi:10.1001/jama.2009.878.

    PubMed  CAS  PubMed Central  Google Scholar 

  83. Calati R, Gressier F, Balestri M, Serretti A. Genetic modulation of borderline personality disorder: systematic review and meta-analysis. J Psychiatr Res. 2013;47(10):1275–87. doi:10.1016/j.jpsychires.2013.06.002.

    PubMed  Google Scholar 

  84. Carter CS, Grippo AJ, Pournajafi-Nazarloo H, Ruscio MG, Porges SW. Oxytocin, vasopressin and sociality. Prog Brain Res. 2008;170:331–6. doi:10.1016/S0079-6123(08)00427-5.

    PubMed  CAS  Google Scholar 

  85. Heinrichs M, Domes G. Neuropeptides and social behaviour: effects of oxytocin and vasopressin in humans. Prog Brain Res. 2008;170:337–50. doi:10.1016/S0079-6123(08)00428-7.

    PubMed  CAS  Google Scholar 

  86. Gordon I, Zagoory-Sharon O, Schneiderman I, Leckman JF, Weller A, Feldman R. Oxytocin and cortisol in romantically unattached young adults: associations with bonding and psychological distress. Psychophysiology. 2008;45(3):349–52. doi:10.1111/j.1469-8986.2008.00649.x.

    PubMed  Google Scholar 

  87. Insel TR, Young LJ. The neurobiology of attachment. Nat Rev Neurosci. 2001;2(2):129–36. doi:10.1038/35053579.

    PubMed  CAS  Google Scholar 

  88. Feldman R, Weller A, Zagoory-Sharon O, Levine A. Evidence for a neuroendocrinological foundation of human affiliation: plasma oxytocin levels across pregnancy and the postpartum period predict mother-infant bonding. Psychol Sci. 2007;18(11):965–70. doi:10.1111/j.1467-9280.2007.02010.x.

    PubMed  Google Scholar 

  89. Levine A, Zagoory-Sharon O, Feldman R, Weller A. Oxytocin during pregnancy and early postpartum: individual patterns and maternal-fetal attachment. Peptides. 2007;28(6):1162–9. doi:10.1016/j.peptides.2007.04.016.

    PubMed  CAS  Google Scholar 

  90. Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology. 2005;30(10):1010–6. doi:10.1016/j.psyneuen.2005.04.006.

    PubMed  CAS  Google Scholar 

  91. Meinlschmidt G, Heim C. Sensitivity to intranasal oxytocin in adult men with early parental separation. Biol Psychiatry. 2007;61(9):1109–11. doi:10.1016/j.biopsych.2006.09.007.

    PubMed  CAS  Google Scholar 

  92. Costa B, Pini S, Gabelloni P, Abelli M, Lari L, Cardini A, et al. Oxytocin receptor polymorphisms and adult attachment style in patients with depression. Psychoneuroendocrinology. 2009;34(10):1506–14. doi:10.1016/j.psyneuen.2009.05.006.

    PubMed  CAS  Google Scholar 

  93. Cyranowski JM, Hofkens TL, Frank E, Seltman H, Cai HM, Amico JA. Evidence of dysregulated peripheral oxytocin release among depressed women. Psychosom Med. 2008;70(9):967–75. doi:10.1097/Psy.0b013e318188ade4.

    PubMed  CAS  PubMed Central  Google Scholar 

  94. Gotlib IH, Hamilton JP, Cooney RE, Singh MK, Henry ML, Joormann J. Neural processing of reward and loss in girls at risk for major depression. Arch Gen Psychiatry. 2010;67(4):380–7. doi:10.1001/archgenpsychiatry.2010.13.

    PubMed  PubMed Central  Google Scholar 

  95. Bertsch K, Schmidinger I, Neumann ID, Herpertz SC. Reduced plasma oxytocin levels in female patients with borderline personality disorder. Horm Behav. 2013;63(3):424–9. doi:10.1016/j.yhbeh.2012.11.013.

    PubMed  CAS  Google Scholar 

  96. Bartz J, Simeon D, Hamilton H, Kim S, Crystal S, Braun A, et al. Oxytocin can hinder trust and cooperation in borderline personality disorder. Soc Cogn Affect Neurosci. 2011;6(5):556–63. doi:10.1093/Scan/Nsq085.

    PubMed  PubMed Central  Google Scholar 

  97. Stanley B, Siever LJ. The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry. 2010;167(1):24–39. doi:10.1176/appi.ajp.2009.09050744.

    PubMed  PubMed Central  Google Scholar 

  98. Luyten P, Fonagy P. Probing the interpersonal phenotype of borderline personality disorder: an attachment and mentalizing perspective. Manuscript submitted for publication. 2014.

    Google Scholar 

  99. Silk KR. The quality of depression in borderline personality disorder and the diagnostic process. J Pers Disord. 2010;24(1):25–37. doi:10.1521/pedi.2010.24.1.25.

    PubMed  Google Scholar 

  100. Zanarini MC, Frankenburg FR, DeLuca CJ, Hennen J, Khera GS, Gunderson JG. The pain of being borderline: dysphoric states specific to borderline personality disorder. Harv Rev Psychiatry. 1998;6(4):201–7.

    PubMed  CAS  Google Scholar 

  101. Southwick SM, Yehuda R, Giller EL. Psychological dimensions of depression in borderline personality disorder. Am J Psychiatry. 1995;152(5):789–91.

    PubMed  CAS  Google Scholar 

  102. Rogers JH, Widiger TA, Krupp A. Aspects of depression associated with borderline personality disorder. Am J Psychiatry. 1995;152(2):268–70.

    PubMed  CAS  Google Scholar 

  103. Wixom J, Ludolph P, Westen D. The quality of depression in adolescents with borderline personality disorder. J Am Acad Child Adolesc Psychiatry. 1993;32(6):1172–7. doi:10.1097/00004583-199311000-00009.

    PubMed  CAS  Google Scholar 

  104. Gratz KL, Breetz A, Tull MT. The moderating role of borderline personality in the relationships between deliberate self-harm and emotion-related factors. Personal Ment Health. 2010;4(2):96–107. doi:10.1002/Pmh.102.

    Google Scholar 

  105. Hawes DJ, Helyer R, Herlianto EC, Willing J. Borderline personality features and implicit shame-prone self-concept in middle childhood and early adolescence. J Clin Child Adolesc Psychol. 2013;42(3):302–8. doi:10.1080/15374416.2012.723264.

    PubMed  Google Scholar 

  106. Leichsenring F. Quality of depressive experiences in borderline personality disorders: differences between patients with borderline personality disorder and patients with higher levels of personality organization. Bull Menninger Clin. 2004;68(1):9–22.

    PubMed  Google Scholar 

  107. Fonagy P, Gergely G, Jurist E, Target M. Affect regulation, mentalization and the development of the self. New York: Other Press; 2002.

    Google Scholar 

  108. Aviram RB, Brodsky BS, Stanley B. Borderline personality disorder, stigma, and treatment implications. Harv Rev Psychiatry. 2006;14(5):249–56. doi:10.1080/10673220600975121.

    PubMed  Google Scholar 

  109. Bateman AW. Thick- and thin-skinned organisations and enactment in borderline and narcissistic disorders. Int J Psychoanal. 1998;79(Pt 1):13–25.

    PubMed  Google Scholar 

  110. Gabbard GO. Technical approaches to transference hate in the analysis of borderline patients. Int J Psychoanal. 1991;72(Pt 4):625–37.

    PubMed  Google Scholar 

  111. Yeh Z-T, Liu S-I. Depressive realism: evidence from false interpersonal perception. Psychiatry Clin Neurosci. 2007;61(2):135–41.

    PubMed  Google Scholar 

  112. Moore MT, Fresco DM. Depressive realism and attributional style: implications for individuals at risk for depression. Behav Ther. 2007;38(2):144–54.

    PubMed  Google Scholar 

  113. Domes G, Czieschnek D, Weidler F, Berger C, Fast K, Herpertz SC. Recognition of facial affect in borderline personality disorder. J Pers Disord. 2008;22(2):135–47. doi:10.1521/pedi.2008.22.2.135.

    PubMed  Google Scholar 

  114. Lynch TR, Rosenthal MZ, Kosson DS, Cheavens JS, Lejuez CW, Blair RJ. Heightened sensitivity to facial expressions of emotion in borderline personality disorder. Emotion. 2006;6(4):647–55. doi:10.1037/1528-3542.6.4.647.

    PubMed  Google Scholar 

  115. Schulze L, Domes G, Koppen D, Herpertz SC. Enhanced detection of emotional facial expressions in borderline personality disorder. Psychopathology. 2013;46(4):217–24. doi:10.1159/000341730.

    PubMed  Google Scholar 

  116. Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G, et al. The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol. 1996;64(1):22–31.

    PubMed  CAS  Google Scholar 

  117. Fischer-Kern M, Schuster P, Kapusta ND, Tmej A, Buchheim A, Rentrop M, et al. The relationship between personality organization, reflective functioning, and psychiatric classification in borderline personality disorder. Psychoanal Psychol. 2010;27(4):395–409. doi:10.1037/a0020862.

    Google Scholar 

  118. Gullestad FS, Johansen MS, Hoglend P, Karterud S, Wilberg T. Mentalization as a moderator of treatment effects: findings from a randomized clinical trial for personality disorders. Psychother Res. 2012. doi:10.1080/10503307.2012.684103.

    Google Scholar 

  119. Levy KN, Meehan KB, Kelly KM, Reynoso JS, Weber M, Clarkin JF, et al. Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol. 2006;74(6):1027–40. doi:10.1037/0022-006X.74.6.1027.

    PubMed  Google Scholar 

  120. Preissler S, Dziobek I, Ritter K, Heekeren HR, Roepke S. Social cognition in borderline personality disorder: evidence for disturbed recognition of the emotions, thoughts, and intentions of others. Front Behav Neurosci. 2010;4:182. doi:10.3389/fnbeh.2010.00182.

    PubMed  PubMed Central  Google Scholar 

  121. Ritter K, Dziobek I, Preissler S, Ruter A, Vater A, Fydrich T, et al. Lack of empathy in patients with narcissistic personality disorder. Psychiatry Res. 2011;187(1–2):241–7. doi:10.1016/j.psychres.2010.09.013.

    PubMed  Google Scholar 

  122. Sharp C, Pane H, Ha C, Venta A, Patel AB, Sturek J, et al. Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry. 2011;50(6):563–73. doi:10.1016/j.jaac.2011.01.017.

    PubMed  Google Scholar 

  123. Bolton JM, Pagura J, Enns MW, Grant B, Sareen J. A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. J Psychiatr Res. 2010;44(13):817–26. doi:10.1016/j.jpsychires.2010.01.003.

    PubMed  PubMed Central  Google Scholar 

  124. Sharp C, Green KL, Yaroslavsky I, Venta A, Zanarini MC, Pettit J. The incremental validity of borderline personality disorder relative to major depressive disorder for suicidal ideation and deliberate self-harm in adolescents. J Pers Disord. 2012;26(6):927–38. doi:10.1521/pedi.2012.26.6.927.

    PubMed  PubMed Central  Google Scholar 

  125. Luyten P, Fonagy P, Lowyck B, Vermote R. Assessment of mentalization. In: Bateman AW, Fonagy P, editors. Handbook of mentalizing in mental health practice. Washington, DC: American Psychiatric Publishing; 2012. p. 43–66.

    Google Scholar 

  126. Sharp C, Ha C, Carbone C, Kim S, Perry K, Williams L, et al. Hypermentalizing in adolescent inpatients: treatment effects and association with borderline traits. J Pers Disord. 2013;27(1):3–18.

    PubMed  Google Scholar 

  127. Tyrer P, Tom B, Byford S, Schmidt U, Jones V, Davidson K, et al. Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study. J Pers Disord. 2004;18(1):102–16.

    PubMed  Google Scholar 

  128. Barth J, Munder T, Gerger H, Nuesch E, Trelle S, Znoj H, et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med. 2013;10(5):e1001454. doi:10.1371/journal.pmed.1001454.

    PubMed  PubMed Central  Google Scholar 

  129. Levy KN, Beeney JE, Wasserman RH, Clarkin JF. Conflict begets conflict: executive control, mental state vacillations, and the therapeutic alliance in treatment of borderline personality disorder. Psychother Res. 2010;20(4):413–22. doi:10.1080/10503301003636696.

    PubMed  Google Scholar 

  130. Cash SK, Hardy GE, Kellett S, Parry G. Alliance ruptures and resolution during cognitive behaviour therapy with patients with borderline personality disorder. Psychother Res. 2014;24:132–45.

    PubMed  Google Scholar 

  131. Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. 2010;9(1):11–5.

    PubMed  PubMed Central  Google Scholar 

  132. Main M. Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple (incoherent) model of attachment. In: Parkes C, Stevenson-Hinde J, Marris P, editors. Attachment across the life circle. London: Routledge; 1991. p. 127–59.

    Google Scholar 

  133. Chisolm K. A three year follow-up of attachment and indiscriminate friendliness in children adopted from Russian orphanages. Child Dev. 1998;69:1092–106.

    Google Scholar 

  134. Owen MT, Cox MJ. Marital conflict and the development of infant-parent attachment relationships. J Fam Psychol. 1997;11:152–64.

    Google Scholar 

  135. Carlson V, Cicchetti D, Barnett D, Braunwald K. Disorganised/disoriented attachment relationships in maltreated infants. Dev Psychol. 1989;25:525–31.

    Google Scholar 

  136. Main M, Solomon J. Procedures for identifying infants as disorganized/disorientated during the Ainsworth strange situation. In: Greenberg M, Cicchetti D, Cummings E, editors. Attachment during the Preschool years: theory, research and interventions. Chicago: Chicago University Press; 1990. p. 121–60.

    Google Scholar 

  137. Lyons-Ruth K. Contributions of the mother-infant relationship to dissociative, borderline, and conduct symptoms in young adulthood. Infant Ment Health J. 2008;29(3):203–18. doi:10.1002/imhj.20173.

    PubMed  PubMed Central  Google Scholar 

  138. Crawford TN, Cohen PR, Chen H, Anglin DM, Ehrensaft M. Early maternal separation and the trajectory of borderline personality disorder symptoms. Dev Psychopathol. 2009;21(3):1013–30.

    PubMed  Google Scholar 

  139. Choi-Kain LW, Fitzmaurice GM, Zanarini MC, Laverdiere O, Gunderson JG. The relationship between self-reported attachment styles, interpersonal dysfunction, and borderline personality disorder. J Nerv Ment Dis. 2009;197(11):816–21. doi:10.1097/NMD.0b013e3181bea56e.

    PubMed  Google Scholar 

  140. Bifulco A, Moran PM, Ball C, Bernazzani O. Adult attachment style. I: its relationship to clinical depression. Soc Psychiatry Psychiatr Epidemiol. 2002;37:50–9.

    PubMed  CAS  Google Scholar 

  141. Bifulco A, Moran PM, Ball C, Lillie A. Adult attachment style. II: its relationship to psychosocial depressive-vulnerability. Soc Psychiatry Psychiatr Epidemiol. 2002;37:60–7.

    PubMed  CAS  Google Scholar 

  142. Fonagy P. An attachment theory approach to treatment of the difficult patient. Bull Menninger Clin. 1998;62(2):147–69.

    PubMed  CAS  Google Scholar 

  143. Main M. The organized categories of infant, child, and adult attachment: flexible vs. inflexible attention under attachment-related stress. J Am Psychoanal Assoc. 2000;48(4):1055–96.

    PubMed  CAS  Google Scholar 

  144. Westen D, Shedler J, Bradley B, DeFife JA. An empirically derived taxonomy for personality diagnosis: bridging science and practice in conceptualizing personality. Am J Psychiatry. 2012;169(3):273–84. doi:10.1176/appi.ajp.2011.11020274.

    PubMed  Google Scholar 

  145. Sperber D, Wilson DB. Relevance and meaning. Cambridge: Cambridge University Press; 2012.

    Google Scholar 

  146. Corriveau KH, Harris PL, Meins E, Fernyhough C, Arnott B, Elliott L, et al. Young children’s trust in their mother’s claims: longitudinal links with attachment security in infancy. Child Dev. 2009;80(3):750–61. doi:10.1111/j.1467-8624.2009.01295.x.

    PubMed  Google Scholar 

  147. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive therapy for depression. 2nd ed. New York: Guilford Press; 2013.

    Google Scholar 

  148. Watkins E, Teasdale JD. Adaptive and maladaptive self-focus in depression. J Affect Disord. 2004;82(1):1–8.

    PubMed  Google Scholar 

  149. Lemma A, Target M, Fonagy P. The development of a brief psychodynamic protocol for depression: dynamic interpersonal therapy (DIT). Psychoanal Psychother. 2010;24(4):329–46.

    Google Scholar 

  150. Hoglend P. Analys of transference in psychodynamic psychotherapy. Can J Psychoanal. 2004;12:279–300.

    Google Scholar 

  151. Hoglend P, Amlo S, Marble A, Bogwald KP, Sorbye O, Sjaastad MC, et al. Analysis of the patient-therapist relationship in dynamic psychotherapy: an experimental study of transference interpretations. Am J Psychiatry. 2006;163(10):1739–46.

    PubMed  Google Scholar 

  152. Hoglend P, Bogwald K-P, Amlo S, Marble A, Ulberg R, Sjaastad MC, et al. Transference interpretations in dynamic psychotherapy: do they really yield sustained effects? Am J Psychiatry. 2008;165(6):763–71. doi:10.1176/appi.ajp.2008.07061028.

    PubMed  Google Scholar 

  153. Johansson P, Hoglend P, Ulberg R, Bogwald KP, Amlo S, Marble A, et al. The mediating role of insight for long-term improvements in psychodynamic therapy. J Consult Clin Psychol. 2010;78(3):438–48.

    PubMed  Google Scholar 

  154. McCullough L, Winston A, Farber BA, Porter F, Pollack J, Laikin M, et al. The relationship of patient-therapist interaction to outcome in brief psychotherapy. Psychotherapy. 1991;28:525–33.

    Google Scholar 

  155. Kernberg OF. Internal world and external reality: object relations theory applied. New York: Jason Aronson; 1980.

    Google Scholar 

  156. Driessen E, Cuijpers P, de Maat SCM, Abbass AA, de Jonghe F, Dekker JJM. The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clin Psychol Rev. 2010;30(1):25–36.

    PubMed  Google Scholar 

  157. Abbass A, Town J, Driessen E. The efficacy of short-term psychodynamic psychotherapy for depressive disorders with comorbid personality disorder. Psychiatry. 2011;74(1):58–71.

    PubMed  Google Scholar 

  158. Town JM, Abbass A, Hardy G. Short-term psychodynamic psychotherapy for personality disorders: a critical review of randomized controlled trials. J Pers Disord. 2011;25(6):723–40.

    PubMed  Google Scholar 

  159. Leichsenring F, Abbass A, Luyten P, Hilsenroth M, Rabung S. The emerging evidence for long-term psychodynamic therapy. Psychodyn Psychiatry. 2013;41(3):361–84. doi:10.1521/pdps.2013.41.3.361.

    PubMed  Google Scholar 

  160. Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. Br J Psychiatry. 2011;199(1):15–22. doi:10.1192/bjp.bp.110.082776.

    PubMed  Google Scholar 

  161. Bateman A, Fonagy P. 8-year follow-up of patients treated for borderline personality disorder: mentalization-based treatment versus treatment as usual. Am J Psychiatry. 2008;165(5):631–8. doi:10.1176/appi.ajp.2007.07040636.

    PubMed  Google Scholar 

  162. Rossouw TI, Fonagy P. Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2012;51(12):1304–13.e3. doi:10.1016/j.jaac.2012.09.018.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, 3722, Leuven, 3000, Belgium

    Patrick Luyten PhD

  2. Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

    Patrick Luyten PhD & Peter Fonagy PhD, DipPsy, FBPSA, FBA, OBE

Authors
  1. Patrick Luyten PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Fonagy PhD, DipPsy, FBPSA, FBA, OBE
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Fonagy PhD, DipPsy, FBPSA, FBA, OBE .

Editor information

Editors and Affiliations

  1. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    Lois W. Choi-Kain

  2. McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA

    John G. Gunderson

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Luyten, P., Fonagy, P. (2015). Psychodynamic Treatment for Borderline Personality Disorder and Mood Disorders: A Mentalizing Perspective. In: Choi-Kain, L., Gunderson, J. (eds) Borderline Personality and Mood Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1314-5_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1314-5_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1313-8

  • Online ISBN: 978-1-4939-1314-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation