PERSONALITY DISORDERS

Personality Disorders Caused By Physical Conditions

Personality Disorders Caused By Physical Conditions

Borderline personality disorder (BPD) is characterized by marked problems in emotion regulation, impulsivity and poor interpersonal relationships (American Psychiatric Association, 2000). The cognitive theory of personality disorders (PDs) hypothesizes that these problems are at least partly caused by cognitive schemas leading to biased evaluation and interpretation of environmental stimuli ([Beck and Freeman, 1990] and [Beck et al., 2004]). Beliefs or schemas are thought to be basic processing units that are organized according to their functions and content. A schema is considered hypervalent when the threshold for its activation is low and when it can be triggered by remote or trivial stimuli (Beck et al., 2004). For example, the hypervalent schema “The world (and others) are dangerous” would lead to biased information processing where a person interprets neutral situations as dangerous, feels anxious, and wants to get away.

Three basic schemata are thought to play a central role in BPD: “The world is (and others are) dangerous and malevolent”, “I am powerless and vulnerable”, and “I am inherently bad and unacceptable” ([Arntz, 2004] and [Pretzer, 1990]). Several authors have tested the hypothesis that BPD is characterized by these beliefs. For example, Dreessen and Arntz (1995) developed the Personality Disorder Belief Questionnaire (PDBQ) with beliefs from the Appendix of Beck and Freeman (1990) and additional BPD specific beliefs. A set of six beliefs appeared typical for BPD. These beliefs were characterized by loneliness, unloveability, rejection and abandonment by others, viewing the self as bad, and feeling they need to be punished; themes which all correspond with Pretzer's three basic schemas for BPD. Recently, Butler, Brown, Beck, and Grisham (2002) developed a BPD beliefs scale including 14 items (e.g., “I cannot trust other people”, “People will take advantage at me if I give them the chance”, “A person whom I am close to could be disloyal or unfaithful”) that discriminate between BPD patients and persons with other PDs. Using the World Assumption Scale, Giesen-Bloo and Arntz (2005) provided additional evidence for the three dominant beliefs in individuals with BPD. They suggested that these beliefs were associated with the severity of the borderline psychopathology.

Basic schemata in BPD have also been investigated with projective approaches such as the Thematic Apperception Test (TAT), while others have relied on narrative data to assess evaluation bias in BPD patients (e.g., [Nigg et al., 1992], [Segal et al., 1993], [Stuart et al., 1990], [Westen et al., 1990] and [Westen et al., 1990]). Some studies also asked patients with BPD to evaluate their current relationships, e.g., with relatives ([Benjamin and Wonderlich, 1994] and [Stern et al., 1997]). Other authors used standardized stimuli, but non-standardized, free response formats. For example, Arntz and Veen (2001) presented film characters in 10-minute film clips with emotional themes such as abandonment, rejection, and abuse and asked borderline and control participants for their spontaneous evaluations. Wagner and Linehan (1999) studied facial expression recognition in BPD with standardized slides of emotional faces and free ...