A controlled study of Hostile-Helpless states of mind among borderline and dysthymic women

Abstract

The aim of this study was to determine whether women with borderline personality disorder (BPD) are more likely than those with dysthymia to manifest contradictory Hostile-Helpless (HH) states of mind. A reliable rater blind to diagnosis evaluated features of such mental representations in transcripts of Adult Attachment Interviews from 12 women with BPD and 11 women with dysthymia of similar socioeconomic status (SES), all awaiting psychotherapy. In keeping with three hierarchical (non-independent) a priori predictions regarding the mental representations of women with BPD, the results were that (a) all those with BPD, compared with half the group with dysthymia, displayed HH states of mind; (b) those with BPD manifested a significantly higher frequency of globally devaluing representations; and (c) they exhibited a strong trend toward identifying with the devalued hostile caregiver (58% BPD vs. 18% dysthymic). In addition, significantly more BPD than dysthymic patients made reference to controlling behavior towards attachment figures in childhood. These findings offer fresh insights into the nature of BPD and extend previous evidence concerning affected individuals' patterns of thinking and feeling about childhood attachment figures.

Keywords:

• Borderline personality disorder
• attachment
• identification
• mental representation
• Hostile-Helpless

Acknowledgements

We are indebted to the patients who kindly agreed to take part in the study; to David Castle, Robert Howard, and Barbara Maughan who helped to administer the Adult Attachment Interviews; to Gwendolyn Atwood and Claudia Yellin for their contributions to earlier versions of the coding system; and to the support we received from NHS R&D funding in the UK and from the Livingston Fund of Harvard Medical School. Preparation of this paper was supported in part by grant #MH062030 to K. Lyons-Ruth and by a Fellowship to the Center for Advanced Study in the Behavioral Sciences, Stanford University, to P. Hobson.

Notes

1 Phi is a measure of strength of association for a 2 × 2 table; eta is a measure of strength of association for the F test.