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An Attachment Perspective on Borderline Personality Disorder: Advances in Gene–Environment Considerations

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Abstract

Accumulating evidence points to severe relationship dysfunction as the core epigenetic expression of borderline personality disorder (BPD). In adulthood, BPD is typified by disorganization within and across interpersonal domains of functioning. When interacting with their infants, mothers with BPD show marked withdrawal and frightening or frightened behavior, leading to disorganized infant–mother attachments. Linked to both infant disorganization and BPD is a maternal state of mind typified by unresolved mourning regarding past loss or trauma. Early risk factors for BPD in adulthood include maternal withdrawal in infancy and separation of 1 month or more from mother in the first 5 years of life. Likely contributing biological factors include genes linked to dopamine, serotonin, the hypothalamic-pituitary-adrenal axis, and neuropeptides. The complex gene-environment picture emerging confers risk or protection against BPD pathology in ways consistent with infants varying biological sensitivity to context. This line of research may refine early risk assessment and preventive mental health services.

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References

Papers of particular interest, published recently, have been highlighted as follows: • Of importance ••Of major importance

  1. • Gunderson JG, Lyons-Ruth K: BPD’s interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Pers Disord 2008, 22:22–41. This article charts similar ground to that covered in the current effort, proposing a companion gene-environment model for BPD, citing as risk factors anxious-resistant or ambivalent attachment as well as attachment disorganization.

    Article  PubMed  Google Scholar 

  2. •• Hill J, Pilkonis P, Morse J, et al.: Social domain dysfunction and disorganization in borderline personality disorder. Psychol Med 2008, 38:1–12. This article advances the seminal observation that disorganization within and across domains is a specific description of BPD obtained via the sensitive and reliable interview technique used by Hill et al. for mapping personality functioning.

    Article  Google Scholar 

  3. Levy KN, Kelly KM, Meehan KB, et al.: Change in attachment and reflective function in the treatment of borderline personality disorder with transference focused psychotherapy. J Consult Clin Psychol 2006, 74:1027–1040.

    Article  PubMed  Google Scholar 

  4. Morse JQ, Hill J, Pilkonis PA, et al.: Anger, preoccupied attachment, and domain disorganization in borderline personality disorder. J Pers Disord 2009, 23:240–257.

    Article  PubMed  Google Scholar 

  5. Scott LN, Levy KN, Pincus AL: Adult attachment, personality traits, and borderline personality disorder features in young adults. J Pers Disord 2009, 23:258–280.

    Article  PubMed  Google Scholar 

  6. Linehan M: Cognitive-Behavioral Treatment of Borderline Personality Disorder. Diagnosis and Treatment of Mental Disorders. New York: Guilford Press; 1993.

    Google Scholar 

  7. Bateman A, Fonagy P: Mentalization-based treatment for borderline personality disorder: a practical guide. New York: Oxford University Press; 2006.

    Google Scholar 

  8. Crawford TN, Cohen PR, Chen H, et al.: Early maternal separation and the trajectory of borderline personality disorder symptoms. Dev Psychopathol 2009, 21:1013–1030.

    Article  PubMed  Google Scholar 

  9. Main M, Solomon J: Discovery of an insecure-disorganized/disoriented pattern. In Affective Development in Infancy. Edited by Brazelton TB, Yogman M. Norwood, NJ: Ablex Publishing; 1986:95–124.

    Google Scholar 

  10. Main M, Solomon J: Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation. In Attachment in the Preschool Years: Theory, Research, and Intervention. The John D. and Catherine T. MacArthur Foundation Series on Mental Health and Development. Edited by Greenberg MT, Cicchetti D, Cummings EM. Chicago: University of Chicago Press; 1990:121–160.

    Google Scholar 

  11. Ainsworth MD, Blehar MC, Waters E, Wall S: Patterns of Attachment: Assessed in the Strange Situation and at Home. Hillsdale, NJ: Lawrence Erlbaum; 1978.

    Google Scholar 

  12. Boyce WT, Ellis BJ: Biological sensitivity to context: I. An evolutionary developmental theory of the origins and function of stress reactivity. Dev Psychopathol 2005, 17:271–301.

    Article  PubMed  Google Scholar 

  13. van IJzendoorn MH, Scheungel C, Bakermans-Kranenburg MJ: Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol 1999, 11:225–249.

    Article  PubMed  Google Scholar 

  14. MacDonald HZ, Beeghly M, Grant-Knight W, et al.: Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms. Dev Psychopathol 2008, 20:493–508.

    PubMed  Google Scholar 

  15. Carlson EA: A prospective longitudinal study of attachment disorganization/disorientation. Child Dev 1998, 69:1107–1128.

    CAS  PubMed  Google Scholar 

  16. Liotti G: Disorganized/disoriented attachment in the etiology of dissociative disorders. Dissociation 1992, 5:196–204.

    Google Scholar 

  17. Liotti G: Trauma, dissociation and disorganized attachment: three strands of a single braid. Psychotherapy 2004, 41:472–486.

    Google Scholar 

  18. Roisman GI: Adult attachment: toward a rapprochement of methodological cultures. Curr Dir Psychol Sci 2009, 18:122–126.

    Article  Google Scholar 

  19. •• Main M, Hesse E, Goldwyn R: Studying differences in language use in recounting attachment history. In Clinical Applications of the Adult Attachment Interview. Edited by Steele H, Steele M. New York: Guilford Press; 2008:31–68. This chapter is the only account in print of the rating and classification criteria applied to AAIs. The classification system itself has been reported on more than 10,000 times (see Bakermans-Kranenburg and van IJzendoorn [23•]).

    Google Scholar 

  20. Donnellan MB, Burt SA, Levendosky A, Klump KL: Genes, personality, and attachment in adults: a multivariate and behavioral genetic analysis. Pers Soc Psychol Bull 2008, 34:3–16.

    Article  PubMed  Google Scholar 

  21. Caspers K, Yucuis R, Troutman B, et al.: A sibling adoption study of adult attachment: the influence of shared environment on attachment states of mind. Attach Hum Dev 2007, 9:375–391.

    Article  PubMed  Google Scholar 

  22. Steele M, Hodges J, Kaniuk J, et al.: Forecasting outcomes in previously maltreated children: the use of the AAI in a longitudinal attachment study. In Clinical Applications of the Adult Attachment Interview. Edited by Steele H, Steele M. New York: Guilford Press; 2008:427–451.

    Google Scholar 

  23. • Bakermans-Kranenburg MJ, van IJzendoorn MH: The first 10,000 Adult Attachment Interviews: distributions of adult attachment representations in clinical and non-clinical groups. Attach Hum Dev 2009, 11:223–263. This meta-analytic report describes the dramatic increase in the use of the AAI in clinical research and points to linkages between insecure-dismissing interviews and adults with conduct or externalizing problems, whereas insecure-preoccupied and unresolved interviews are typical of adults with BPD.

    Article  PubMed  Google Scholar 

  24. • Steele H, Steele M, Murphy A: The Adult Attachment Interview: a clinical tool for facilitating and measuring process and change in psychotherapy. Psychother Res 2009, 19:633–643. This article provides an overview of the relevance of the AAI to clinical research and practice.

    Article  PubMed  Google Scholar 

  25. Siever LJ, Davis KL: A psycho-biologic perspective on personality disorders. Am J Psychiatry 1991, 148:1647–1658.

    CAS  PubMed  Google Scholar 

  26. Bowlby J: Loss: Sadness and Depression. Attachment and Loss, vol 3. London: Hogarth Press; 1980.

    Google Scholar 

  27. Hobson RP, Patrick M, Crandell L, et al.: Personal relatedness and attachment in infants of mothers with borderline personality disorder. Dev Psychopathol 2005, 17:329–347.

    Article  PubMed  Google Scholar 

  28. Hobson RP, Patrick MPH, Hobson JA, et al.: How mothers with borderline personality disorder relate to their year-old infants. Br J Psychiatry 2009, 195:325–330.

    Article  PubMed  Google Scholar 

  29. Hesse E, Main M: Frightened, threatening, and dissociative parental behavior: theory and associations with parental Adult Attachment Interview status and infant disorganization. Dev Psychopathol 2006, 18:309–343.

    Article  PubMed  Google Scholar 

  30. Lyons-Ruth K, Bureau J-F, Hennighausen KH, et al.: Parental helplessness and adolescent role-reversal as correlates of borderline features and self-injury. Paper presented at the Biennial Meeting of the Society for Research in Child Development. Denver, CO; April 2009.

  31. 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, 165:631–638.

    Article  PubMed  Google Scholar 

  32. Bokhorst CL, Bakermans-Kranenburg MJ, Fearon RMP, et al.: The importance of shared environment in mother-infant attachment security: a behavior genetic study. Child Dev 2003, 74:1769–1782.

    Article  PubMed  Google Scholar 

  33. O’Connor TG, Croft CM: A twin study of attachment in preschool children. Child Dev 2001, 72:1501–1511.

    Article  PubMed  Google Scholar 

  34. O’Connor TG, Croft CM, Steele H: The contribution of behavioral genetic studies to attachment theory. Attach Hum Dev 2000, 2:107–122.

    Article  PubMed  Google Scholar 

  35. Roisman GI, Holland A, Fortuna K, et al.: The Adult Attachment Interview and self-reports of attachment style: an empirical rapprochement. J Pers Soc Psychol 2007, 92:678–697.

    Article  PubMed  Google Scholar 

  36. Crawford TN, Livesley WJ, Jang KL, et al.: Insecure attachment and personality disorder: a twin study of adults. Eur J Psychol 2007, 21:191–208.

    Google Scholar 

  37. Cohen J: A power primer. Psychol Bull 1992, 112:155–159.

    Article  CAS  PubMed  Google Scholar 

  38. Steele H, Steele M: Clinical Applications of the Adult Attachment Interview. New York: Guilford Press; 2008.

    Google Scholar 

  39. Main M, Hesse E: Adult lack of resolution of attachment-related trauma related to infant disorganized/disoriented behavior in the Ainsworth Strange Situation: linking parental states of mind to infant behavior in a stressful situation. In Attachment in the Preschool Years: Theory, Research and Intervention. Edited by Cumming M. Chicago: University of Chicago Press; 1990:339–426.

    Google Scholar 

  40. Lyons-Ruth K, Jacobvitz D: Disorganized attachment: genetic factors, parenting contexts, and developmental transformation from infancy to adulthood. In Handbook of Attachment: Theory, Research, and Clinical Applications, edn 2. Edited by Cassidy J, Shaver P. New York: Guilford; 2008:666–697.

    Google Scholar 

  41. Lyons-Ruth K: Attachment relationships among children with aggressive behavior problems: the role of disorganized early attachment patterns. J Consult Clin Psychol 1996, 64:64–73.

    Article  CAS  PubMed  Google Scholar 

  42. Siever LJ, Weinstein L: The neurobiology of personality disorders: implications for psychoanalysis. J Am Psychoanal Assoc 2009, 57:361–398.

    Article  PubMed  Google Scholar 

  43. Bernier A, Meins E: A threshold approach to understanding the origins of attachment disorganization. Dev Psychol 2008, 44:969–982.

    Article  PubMed  Google Scholar 

  44. Gervai J, Nemoda Z, Lakatos K, et al.: Transmission disequilibrium tests confirm the link between DRD4 gene polymorphism and infant attachment. Am J Med Genet 2005, 132:126–130.

    Article  Google Scholar 

  45. Lakatos K, Toth I, Nemoda Z, et al.: Dopamine D4 receptor (DRD4) gene polymorphism is associated with attachment disorganization in infants. Mol Psychiatry 2000, 5:633–637.

    Article  CAS  PubMed  Google Scholar 

  46. Lakatos K, Nemoda Z, Toth I, et al.: Further evidence for the role of the dopamine D4 receptor (DRD4) gene in attachment disorganization: interaction of the exon III 48-bp repeat and the -521 C/T promoter polymorphisms. Mol Psychiatry 2002, 7:27–31.

    Article  CAS  PubMed  Google Scholar 

  47. Bakermans-Kranenburg MJ, van IJzendoorn MH: No association of the dopamine D4 receptor (DRD4) and -521 C/T promoter polymorphisms with infant attachment disorganization. Attach Hum Dev 2004, 6:211–218.

    Article  CAS  PubMed  Google Scholar 

  48. van IJzendoorn MH, Bakermans-Kranenburg MJ: DRD4 7-repeat polymorphism moderates the association between maternal unresolved loss or trauma and infant disorganization. Attach Hum Dev 2006, 8:291–308.

    Article  PubMed  Google Scholar 

  49. Bakermans-Kranenburg MJ, van IJzendoorn MH, Pijlman FTA, et al.: Differential susceptibility to intervention: dopamine D4 receptor polymorphism (DRD4 VNTR) moderates effects on toddlers’ externalizing behavior in a randomized control trial. Dev Psychol 2008, 44:293–300.

    Article  PubMed  Google Scholar 

  50. Belsky J, Bakermans-Kranenburg MJ, Van IJzendoorn MH: For better and for worse: differential susceptibility to environmental influences. Curr Dir Psychol Sci 2007, 16:300–304.

    Article  Google Scholar 

  51. Caspi A, Moffitt TE: Gene–environment interactions in psychiatry: joining forces with neuroscience? Nat Rev Neurosci 2006, 7:583–590.

    Article  CAS  PubMed  Google Scholar 

  52. Kochanska G, Philibert RA, Barry RA: Interplay of genes and early mother-child relationship in the development of self-regulation from toddler to preschool age. J Child Psychol Psychiatry 2009, 50:1331–1338.

    Article  PubMed  Google Scholar 

  53. Fox N, Hane AA, Pine DS: Plasticity for affective neurocircuitry: how the environment affects gene expression. Curr Dir Psychol Sci 2007, 16:1–5.

    Article  Google Scholar 

  54. Hane AA, Fox NA, Polak-Toste C, et al.: Contextual basis of maternal perceptions of infant temperament. Dev Psychol 2006, 42:1077–1088.

    Article  PubMed  Google Scholar 

  55. Barr CS, Dvoskin RL, Yuan Q, et al.: CRH haplotype as a factor influencing cerebrospinal fluid levels of corticotropin-releasing hormone, hypothalamic-pituitary-adrenal axis activity, temperament, and alcohol consumption in rhesus macaques. Arch Gen Psychiatry 2008, 65:934–944.

    Article  CAS  PubMed  Google Scholar 

  56. Israel S, Lerer E, Shaley I, et al.: Molecular genetic studies of the arginine vasopressin 1a receptor (AVPR1a) and the oxytocin receptor (OXTR) in human behavior: from autism to altruism with some notes in between. Prog Brain Res 2008, 170:435–449.

    Article  CAS  PubMed  Google Scholar 

  57. Bakermans-Kranenburg MJ, van IJzendoorn MH: Oxytocin receptor (OXTR) and serotonin transporter (5-HTT) genes associated with observed parenting. Soc Cogn Affect Neurosci 2008, 3:128–134.

    Article  PubMed  Google Scholar 

  58. • Stanley B, Siever LJ: The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry 2009 Dec 1 (Epub ahead of print). This overview proposes a role for neuropeptides in interpersonal behavior and reviews preclinical, imaging, and genetic studies relating to this proposal as well as outlining new strategies to test it.

  59. Oberlander TF, Weinberg J, Papsdorf M, et al.: Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics 2008, 2:97–106.

    Article  Google Scholar 

  60. Champagne FA, Curley JP: Epigenetic mechanisms mediating the long-term effects of maternal care on development. Neurosci Biobehav Rev 2009, 33:593–600.

    Article  PubMed  Google Scholar 

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Steele, H., Siever, L. An Attachment Perspective on Borderline Personality Disorder: Advances in Gene–Environment Considerations. Curr Psychiatry Rep 12, 61–67 (2010). https://doi.org/10.1007/s11920-009-0091-0

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