Borderline personality disorder as seen from an attachment perspective: a review

There is increasing evidence that both borderline personality disorder and PTSD can be partly understood as damage to the attachment system. Research on primates has shown how severe are the effects of a damaged attachment system. Distress symptoms produced by separation are similar to those seen in narcotic withdrawal and involve aggressive behaviour. Chronic stress in children can cause dysregulation of the normal stress response and maladaptive brain activities. Secure, avoidant, anxious‐ambivalent attachment in childhood can now be measured. Insecure children show needless aggression; avoidant children can become either abusers or victims. Disorganized attachment is a mixture of avoidant and anxious‐ambivalent behaviour and may lead to adult borderline personality disorder. Patterns of attachment are self‐perpetuating and may be transmitted across generations. PTSD is a syndrome resulting from a terrifying state of helplessness. Its manifestations are similar to those seen with disorganized attachment behaviours. Individuals can appear to cut themselves off from memories and feelings that are too painful to acknowledge. As a result trauma can become organized at a sensory and somatic level which is difficult to change. PTSD appears to alter neurophysiology and neuroanatomy. Traumatogenic stimuli may produce abnormal brain activity and, for example, an inability to speak. ‘Flips’ of mental state have been recorded both in patients who have been through childhood abuse and in borderline patients. The goal of treatment for borderline personality disorder should include the integration of dissociated self‐states. Copyright © 1999 Whurr Publishers Ltd.