ATTACHMENT RELATIONS IN BORDER PERSONAL DISORDER

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Attachment theory was developed by J. Bowlby and highlights the need for a person to form close emotional relationships, which are manifested in closeness and distance in contact with a caring person. Building a safety relationship is the goal of an attachment system that works as a regulator of emotional experience. On the part of the mother, attachment is expressed in caring for the child, attention to the signals that he gives, communication with him as with a social being, not being limited only to the satisfaction of physiological needs. It is known that a key aspect of borderline personality disorder (BPD) is interpersonal difficulties, accompanied by negative affectivity and impulsivity.

In the experiments carried out by M. Ainsworth, three main types of attachment were identified: secure and two insecure, avoidant and ambivalent attachments. Later, another type of attachment was described - disorganized. With this type of attachment, the child perceives the world as hostile and threatening, and the child's behavior is unpredictable and chaotic.

The formation of disorganized attachment occurs in cases where the object of attachment in the process of caring for a child makes significant and gross violations of this process, and is also unable to recognize and feel the needs of the child.

Due to the fact that disorganized attachment is formed in conditions of neglect of the child's needs and gross violations of caring for him, such an attachment system is not able to fulfill its main function: regulation of the state, including excitement, which is caused by fear.

At the same time, the reaction and behavior of the parents themselves often contribute to the emergence of fear in a child. The child finds himself in the trap of paradoxical demands: the parent's behavior provokes fear in the child, while the logic of the attachment system pushes the child to seek reassurance and relaxation of the affective state in this particular figure.

Parents of children with disorganized attachment are characterized by a high level of aggression, and also suffer from personality and dissociative disorders. However, a disorganized type of attachment can also form in the absence of caregiving disorders: overprotection can also lead to the formation of this type of attachment, combining mutually exclusive strategies for caring for a child with the inability of parents to regulate the child's excitement, which is caused by fear.

In addition, the formation of disorganized attachment can occur in conditions of mismatch of the affective notifications simultaneously presented by the mother in her communication with the child. Thus, when the child is in a state of obvious distress, the mother can simultaneously cheer up the child and be ironic about him. The response to this mixed stimulation is disorganized behavior in the child.

It is noted that in some cases, mothers of children with disorganized attachment when playing with their children have shown an inability to transmit meta-alerts that inform the child about the conventions of play. So, playing with the child, mothers realistically portrayed a predatory beast, grinned menacingly, growled angrily and howled ominously, chased the child on all fours. Their behavior was so realistic that the child, who did not receive meta-notifications from them that would confirm the conditionality of the situation, felt horror, as if being alone with a real scary beast pursuing them.

According to attachment theory, the development of the self occurs in the context of the regulation of affect in early relationships. Thus, a disorganized attachment system leads to a disorganized self-system. Children are designed in such a way that they expect their inner states to be mirrored in one way or another by other people. If the infant does not get access to an adult who is able to recognize and respond to his internal states, then it will be very difficult for him to understand his own experiences.

For a child to have a normal experience of self-awareness, his emotional signals must be carefully mirrored by the attachment figure. Mirroring should be exaggerated (i.e. slightly distorted) so that the infant understands the attachment figure's expression of feeling as part of his own emotional experience, and not as an expression of the attachment figure's emotional experience. When the child is unable to develop a representation of his own experience through mirroring, he assigns the image of an attachment figure as part of self-representation. If the attachment figure's reactions do not accurately reflect the child's experiences, he has no choice but to use these inadequate reflections to organize his inner states. Since imprecise reflections are poorly superimposed on his experiences, the child's self acquires the potential for disorganization, that is, lack of unity and fragmentation. Such a break with the self is called "alien self" to which subjective experiences of feelings and ideas, which are considered to be their own, but are not felt as such, can correspond.

The behavior of mothers that terrifies the child, and even shock is not necessarily dictated by their desire to really scare the child and terrify him, this behavior of mothers is due to the fact that they do not have the ability to understand how they are reflected in the child's psyche actions. It is assumed that such behavior and reactions of mothers are associated with their own untreated traumatization, thus, some non-integrated aspects of the mother's traumatic experience are translated into communication with the child.

Thus, the parent's behavior is so hostile and unpredictable for the child that it does not allow him to develop any specific interaction strategy. In this case, neither seeking closeness nor avoiding it does not help, since the mother, from a person who must provide protection and safety, herself turns into a source of anxiety and danger. The images of both myself and the mother in this case are very hostile and cruel.

One of the tasks of the self-defense system or the self-preservation system is to compensate for the inability of disorganized attachment to form and maintain the stability of the psyche, which becomes possible due to the feeling of protection and care from the object of attachment.

E. Bateman and P. Fonagi pointed to disorganized attachment as the most significant factor influencing the violation of the formation of the ability to mentalize. The authors define mentalization as a key socio-cognitive ability that enables people to create effective social groups. Attachment and mentalization are related systems. Mentalization has its origins in the feeling that the attachment figure understands you. The ability to mentalize makes important contributions to affective regulation, impulse control, self-monitoring, and a sense of personal initiative. Termination of mentalization most often occurs in response to attachment trauma.

Lack of mentalization is characterized by:

* An overabundance of detail in the absence of motivation of feelings or thoughts

* Focus on external social factors

* Focus on shortcuts

* Concern about rules

* Denial of involvement in the problem

* Accusations and quibbles

* Confidence about the feelings / thoughts of others

Good mentalization is inherent in:

- in relation to the thoughts and feelings of other people

* opacity - the recognition that a person does not know what is happening in the head of another, but at the same time has some idea of what others think

* lack of paranoia

* point of view acceptance - acceptance that things can look very different from different points of view

* sincere interest in the thoughts and feelings of others

* willingness to discover - not wanting to make unreasonable assumptions about what other people think and feel

* ability to forgive

* predictability - the feeling that, in general, the reactions of other people are predictable given the knowledge of what they think or feel

- perception of one's own mental functioning

* variability - understanding that a person's opinions and understanding of other people can change in accordance with how he himself changes

* developmental perspective - understanding that as you develop your views on other people deepen

* realistic skepticism - admitting that feelings can be confusing

* recognition of pre-conscious function - recognition that a person may not be fully aware of their feelings

* conflict - awareness of the presence of incompatible ideas and feelings

* mindset for introspection

* interest in difference

* awareness of the influence of affect

- self-representation

* developed teaching and listening skills

* autobiographical unity

* rich inner life

- shared values and attitudes

*caution

*moderation

The model of BPD development is built on the conceptual apparatus of attachment and mentalization. The key components of this model are:

1) early disorganization of primary attachment relationships;

2) the subsequent weakening of the main social-cognitive abilities, further weakening of the ability to establish a strong relationship with the attachment figure;

3) disorganized self structure due to disorganized attachment relationships and mistreatment;

4) susceptibility to temporary disturbances of mentalization with intensification of attachment and arousal.

Disturbance of mentalization causes a return of prementalistic modes of representation of subjective states, and these, in turn, in combination with mentalization disorders, give rise to common symptoms of BPD.

E. Bateman and P. Fonagi described three modes of mental functioning that precede mentalization: teleological mode; mental equivalence mode; pretend mode.

The teleological mode is the most primitive mode of subjectivity, in which changes in the mental state are considered real, then when they are confirmed by physical actions. Within the framework of this mode, the priority of the physical is in effect. For example, self-harming acts are teleologically meaningful because they force other people to take actions that prove caring. Suicide attempts are often made when a person is in modes of mental equivalence or pretense. In case of mental equivalence (in which it is internally equated with the external), suicide is aimed at destroying an alien part of oneself, which is perceived as a source of evil, in this case, suicidality is among other types of self-harm, for example, cuts. Suicide can also be characterized by existence in a pretense mode (lack of connection between internal and external reality), when the sphere of subjective experience and perception of external reality are completely separated, which allows a person with BPD to believe that he himself will survive, while the alien part will be destroyed forever. In non-mentalized modes of mental equivalence, body parts can be viewed as equivalents of specific mental states. The trigger for such acts is potential loss or isolation, i.e. situations when a person loses the ability to control their internal states.

A pseudo-mentalisation is associated with the pretense regime. This mode of perception of one's own inner world at the age of 2-3 years is characterized by a limited ability to represent. The child is able to think about representation as long as no connection is made between it and external reality. An adult practicing pseudo-mentalization is able to understand and even reason about mental states as long as they are not connected with reality.

Pseudo-mentalisation falls into three categories: intrusive, hyperactive imprecise, and destructively imprecise. Obsessive pseudo-metalization manifests itself in violation of the principle of opacity of the inner world, expansion of knowledge about feelings and thoughts beyond a specific context, representation of thoughts and feelings in an categorical manner, etc. Hyperactive pseudo-mentalization is characterized by too much energy, which is invested in thinking about what he feels or thinks another person, this is the idealization of insight for the sake of insight.

Concrete understanding is the most common category of bad mentalization associated with the regime of mental equivalence. This mode is also typical for children 2-3 years old, when internally equated with the external, the fear of ghosts in a child generates the same real experience that can be expected from a real ghost. Common indicators of concrete understanding are lack of attention to the thoughts, feelings and needs of other people, excessive generalizations and prejudices, circular explanations, specific interpretations extend beyond the framework within which they were originally used.

It is known that later mental trauma further weakens the mechanisms of attention control and is associated with chronic disturbances in the control of inhibition. Thus, a vicious circle of interactions between disorganized attachment, mental disturbance and trauma is formed, which contributes to the intensification of BPD symptoms.

Bateman, Fonagi identified two types of relationship patterns that are often found in BPD. One of them is centralized, the other is distributed. Individuals who exhibit a centralized relationship pattern describe unstable and inflexible interactions. The representation of the internal states of another person is closely related to the representation of oneself. Relationships are filled with intense, volatile and exciting emotions. The other person is often perceived as unreliable and inconsistent, unable to “love rightly”. Fears often arise about the partner's infidelity and abandonment. Individuals with a centralized pattern are characterized by disorganized, restless attachments, in which the object of attachment is perceived as both a safe place and a source of threat. The distributed pattern is characterized by withdrawal and distance. This pattern of relationships, in contrast to the instability of the centralized pattern, maintains a rigid distinction between self and alien.

Literature:

Bateman, Antony W., Fonagy, Peter. Psychotherapy for Borderline Personality Disorder. MentalizationBased Treatment, 2003.

Howell, Elizabeth F. Dissociative Mind, 2005

Main Mary, Solomon Judith. Discovery of a new, insecureAdisorganized / disoriented attachment pattern, 1996

Bateman U., Fonagy P. Treatment of Borderline Personality Disorder Based on Mentalization, 2014

Bowlby, J. Affection, 2003

Bowlby, J. Creating and Breaking Emotional Ties, 2004

Brish K. H. Attachment Disorder Therapy: From Theory to Practice, 2014.

Fonagi P. Common ground and divergence between psychoanalysis and attachment theory, 2002.