Understanding Borderline Personality Disorder from a Trauma-Informed Attachment-Based Perspective: Clinical Recommendations

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Che, Nicole
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Borderline personality disorder (BPD) is a common psychiatric inpatient disorder wherein individuals struggle with regulating emotions, sense of self, and interpersonal relationships. The biosocial developmental model of BPD posits that there are biological, environmental and developmental influences in the development of BPD. Individuals with BPD often seek inpatient and outpatient psychiatric services to help manage their symptoms. Many individuals with BPD report traumatic childhood histories, and it has long been theorized that childhood maltreatment in the form of abuse or neglect is linked with the development of BPD. Childhood maltreatment has also been linked with insecure attachment styles. Individuals with insecure attachment styles often engage in maladaptive behaviour, which presents with similar symptoms as BPD. Unfortunately, BPD is a diagnosis which carries high levels of stigma amongst mental health professionals. Individuals with borderline personality disorder are often seen as manipulative and difficult to work with, leading to poorer therapeutic relationship, poorer compliance to therapy and therapeutic outcomes. However, viewing BPD from a trauma-informed, attachment-based perspective can provide clinicians a deeper understanding of this diagnosis and alternative pathways to work with these individuals. Clinical recommendations are provided to help therapists view and treat BPD from a trauma-informed attachment-focused perspective.
borderline personality disorder , childhood abuse , attachment theory , therapeutic relationship , trauma-focused therapy