Malins, Amanda; (2003) Attachment and theory of mind in borderline personality disorder. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Individuals with BPD are characterised by extreme difficulties in their interpersonal functioning. Recently, a deficit in Theory of Mind abilities (ToM) has been proposed to underlie these difficulties. Although there has been little research investigating this claim, studies by Stokes (2001) and Fonagy et al. (1996) have provided some initial support. Clinical observations of individuals with BPD in therapy suggest that ToM abilities may fluctuate. To date, studies using the Adult Attachment Interview (AAI) have indicated that the 'anxious-preoccupied' attachment style is the most frequently assigned attachment style for individuals with BPD. A high proportion of them are also categorised as 'unresolved in relation to loss, trauma and abuse' (Fonagy et al. 1996; Patrick et al., 1994). This category best relates to the most recently identified attachment style, 'disorganised attachment', and Fonagy et al. (2000) suggest that this is the characteristic attachment style of individuals with BPD. The present study investigates the constructs of attachment and ToM in women with BPD. Method: There are two parts to the present study. A pilot study was undertaken to create the short, equivalent forms of two ToM measures, the Story Comprehension Test (SCT) and the Reading the Mind in the Eyes Test (RMIET). These equivalent forms were required for the main study. In the main study, a group of pardcipants diagnosed with BPD (n = 22) were compared to a mixed clinical comparison group (n = 17) on a new attachment measure (Attachment Q-Sort, Fonagy et al., 2002) and the two ToM measures. The equivalent forms of the ToM measures were administered under two different conditions; a control/non-primed condition and a second condition where participants were primed to think about their personal attachment histories. Results: Contrary to the study's hypothesis, no deficit in ToM was found in BPD participants as compared to the clinical comparison group. The study provided some support that women with BPD may have a better ToM ability than women with mood-related disorders on one measure (which may be comparable to a non clinical population as measured in previous research), although this may be connected to whether or not they were in individual therapy at the time of testing, and their younger age. Whilst the Stokes (2001) study concluded that individuals with BPD may have a slight deficit compared to healthy individuals in understanding social situations (as measured in the SCT), the present study concluded they do not have a deficit compared to other women with mood-related disorders. It may be that general psychopathology is a contributing factor to any subtle deficit. In line with clinical observations, the current study provided a little support for a state or context dependent ToM deficit in women with BPD although again, differences in age and current therapy status between the two groups is associated with this finding. The results of the attachment component of this study provide further evidence that the preoccupied attachment style is the one most associated with individuals with BPD. It proposes further research with more participants to investigate the disorganised attachment style. The present study hints that these findings relate to the higher levels of psychopathology inherent in individuals with BPD but encourages more research to assess this notion further. Contrary to the study's hypothesis, it provides no support for a direct one-to-one correspondence between ToM and secure attachment in adults. The present study highlights the need for replication given the relatively low number of participants involved. Although more research is required, it suggests that the Attachment Q-Sort may be a useful tool for assessing attachment styles. Finally, suggestions for future research into both attachment and ToM are proposed.

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