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What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication

Fonagy, P; Luyten, P; Allison, E; Campbell, C; (2017) What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation , 4 , Article 9. 10.1186/s40479-017-0062-8. Green open access

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Abstract

In Part 1 of this paper, we discussed emerging evidence suggesting that a general psychopathology or ‘p’ factor underlying the various forms of psychopathology should be conceptualized in terms of the absence of resilience, that is, the absence of positive reappraisal mechanisms when faced with adversity. These impairments in the capacity for positive reappraisal seem to provide a comprehensive explanation for the association between the p factor and comorbidity, future caseness, and the ‘hard-to-reach’ character of many patients with severe personality pathology, most notably borderline personality disorder (BPD). In this, the second part of the paper, we trace the development of the absence of resilience, defined as impairments in positive reappraisal mechanisms, to disruptions in the emergence of human social communication, based on recent evolutionary and developmental psychopathology accounts. We argue that BPD and related disorders may be reconceptualized as a form of social understanding in which epistemic hypervigilance, distrust or outright epistemic freezing is an adaptive consequence of the social learning environment. Negative appraisal mechanisms become overriding, particularly in situations of attachment stress. This constitutes a shift towards a more socially oriented perspective on personality psychopathology in which the absence of psychological resilience is seen as a learned response to the transmission of social knowledge. This shift in our views has also forced us to reconsider the role of attachment in BPD. The implications for prevention and intervention of this novel approach are discussed.

Type: Article
Title: What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s40479-017-0062-8
Publisher version: https://doi.org/10.1186/s40479-017-0062-8
Language: English
Additional information: Copyright © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Borderline personality disorder, Resilience, Epistemic trust, Mentalizing, Attachment, Psychopathology
UCL classification: UCL > School of Life and Medical Sciences
UCL > School of Life and Medical Sciences > Faculty of Brain Sciences
URI: http://discovery.ucl.ac.uk/id/eprint/1545291
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