文档介绍：Psychotherapy Volume 34/Summer 1997/Number 2
ATTACHMENT, DETACHMENT AND BORDERLINE
PERSONALITY DISORDER
PAT SABLE
Los Angeles, California
In an attempt to expand understanding of lems in sustaining close relationships, with dra-
more severe pathology, attachment theory, matic shifts from idealization to devaluation; self-
destructive behavior, such as substance abuse or
developed by John Bowlby, is applied to suicidal attempts and gestures; volatile feelings,
borderline personality disorder in adults. unstable moods, and identity confusion. Along
Conceptualized as a condition of profound with impulsiveness and lack of self-control, there
insecure attachment, with extreme is an absence of empathy and cognitive awareness
vacillations between a desire for proximity of their impact on others which can lead to grandi-
and attachment and a dread and avoidance osity, distorted versions of reality, and even to
"remarkable cruelty" (Fonagy et al., 1991, p.
of engagement, borderline pathology 205). In conversations, responses are vague, tan-
reflects traumatic attachment experiences, gential, and overpersonalized, with affect and
beginning early in life. Besides the word usage odd. And in treatment, affective insta-
importance of trauma, disturbances in bility and demands for special consideration and
affect regulation and cognitive distortions instant availability can be overwhelming (Cal-
lahan, 1996; Holmes, 1993a; Johnson, 1991;
are emphasized. The secure base of a Nelsen, 1995; Schore, 1994; Stone, 1992; van
therapeutic bond provides consistency, der Kolk, 1987).
reliability, and affirmation while Although DSM-IV outlines a borderline pro-
encouraging exploration of separation and file, there is still a lack of agreement that these
loss experiences, both current and past, in prise one distinct diagnostic cat-
order to modify inner working models of egory (Fromm, 1995; Holmes, 1993a; Johnson,
1991). Fromm, for example, asserts that borde