Interpersonal Functioning

Having established that there are a range of affective, cognitive and behavioural symptoms that manifest in borderline personality, this leaves an

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important discussion surrounding the most marked feature associated with borderline personality: maladaptive interpersonal functioning. Disturbed interpersonal

functioning is the central feature of borderline personality, causing significant psychological distress for individuals (Gunderson, 2007). In fact, it is the very combination of maladaptive functioning across the other three domains outlined above that help explain why it is so difficult for people with elevated borderline personality traits to maintain adaptive and functioning interpersonal relationships. It has been observed that clinical patients with BPD possess a yearning to connect and be cared for, yet their need for unrealistic levels of availability and validation make this quest particularly challenging (Gunderson, 2011). As a result, there has been an abundance of research examining specifically what interpersonal dysfunction ‘looks like’ in borderline personality; in other words, what kinds of interpersonal

impairments are characteristic of borderline personality.

In a review conducted by Lazarus and colleagues (2014), a number of studies were examined and synthesised in an attempt to characterise interpersonal dysfunction in BPD into specific areas of impairment. Four domains were proposed: social

cognition, reactivity to interpersonal stressors, interpersonal aggression, as well as trust and cooperation (Lazarus et al., 2014). Social cognition refers to the way in which individuals interpret interpersonal situations. Individuals with BPD were found to have particular difficulty with emotional recognition, perceptual biases, deficits in theory of mind (i.e., an inability to understand or correctly interpret another person’s mental state) and limited problem solving abilities (Lazarus et al., 2014). Secondly, individuals with elevated borderline personality traits were found to demonstrate

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stronger reactions to interpersonal stimuli, often with heightened negative emotion (Lazarus et al., 2014). Interpersonal aggression was another area that differed, where people with higher borderline personality traits displayed increased aggression within interpersonal contexts, and are more likely to respond aggressively particularly in response to rejection cues (Lazarus et al., 2014). Lastly, trust and cooperation were also found to differ in those with elevated borderline personality levels, resulting in an impaired ability to participate and fully engage in their social networks and

relationships (Lazarus et al., 2014). Taken together, these impairments can result in turbulent relationships involving frequent conflict.

Interestingly, in light of the interpersonal challenges that people with borderline personality face, the ability to learn how to maintain functional romantic relationships plays a pivotal role in their ability to maintain stable functioning. In fact, research has consistently found that being in a well-functioning romantic relationship leads to positive outcomes for those with borderline personality (Linehan, 1993; Links & Helslegrave, 2000; Links & Stockwell, 2001). In a more recent longitudinal study conducted by Zanarini and colleagues (2015), the rates of marriage or sustained cohabitation as well as parenthood were followed over the course of 16 years in a sample of BPD patients. The study identified that remission from BPD symptoms was more strongly associated with those who married or cohabited with a partner for a sustained period of time. These recovered patients were significantly more likely to have stability in their personal lives; more specifically, they were less likely to divorce or break up with an intimate partner, perhaps indicative of increased commitment. In summary, results indicate that stable functioning as a spouse or

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partner is significantly associated with recovery status for BPD patients (Zanarini, Frankenburg, Bradford Reich, & Fitzmaurice, 2010). Speculatively, these results may potentially also apply to a community sample, where being in a stable romantic relationship may contribute to reduced distress and increased adaptive functioning even for those with non-clinical or subclinical levels of borderline personality traits.

To shed light on this a bit further, Kuhlken and colleagues (2014) conducted a study examining the impact of romantic relationship functioning on state-negative affect in a non-clinical sample with borderline personality traits. Findings from this research again support the fact that satisfying romantic relationships can be a protective factor for reducing borderline personality symptom presentation. In particular, the study found that the return of a romantic partner’s attention (whether real or perceived) along with a satisfying romantic relationship can reduce anger in individuals scoring higher for borderline personality symptoms (Kuhlken et al., 2014). Taken together with other research examining the impact of successful romantic relationships on borderline personality, it becomes apparent the importance of investigating the aspects that contribute to successful romantic functioning for those individuals with elevated borderline personality traits. In doing so, it is imperative that one remains cognisant of the various affective, cognitive and behavioural

manifestations that no doubt challenge the process of maintaining healthy romantic affiliations. Whilst this will be explored in more depth in the following sections as it is the central focus of this dissertation, a brief overview of the prevalence, impact and aetiology of BPD will be included first. This will provide some further context on borderline personality before looking more specifically at attachment and

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commitment processes, both of which play a significant role in romantic relationship functioning.

2.2.2 Prevalence and Impact

Borderline personality represents a significant economic cost to society, requiring a range of expensive treatment services, yet individuals can be highly resistant to recovery (Gunderson, 2011). Notably, individuals with BPD are seen to disproportionately present for treatment in both inpatient and outpatient clinics relative to other personality disorders, contributing to high rates of service utilisation and costs (Skodal et al., 2005). Existing research has identified varied prevalence estimates for BPD across both inpatient and community settings. The estimated global prevalence of BPD is between 1.4% and 5.9% within the community (Coid et al., 2006; Grant et al., 2008; Lenzenweger et al., 2007; Samuels et al., 2002; Trull, Tomko, Brown, & Scheiderer, 2010). In Australia, however, there has been limited epidemiological research identifying BPD prevalence rates. The most recent

Australian estimates were reported by Jackson and Burgess (2000) who identified a prevalence of 1%. There may be numerous explanations as to why varied estimates have been identified globally. Firstly, the diagnostic approach utilised to identify BPD may differ between clinicians, and secondly, cultural differences may impact on the perception of what constitutes a personality disorder.

Irrespective of the precise prevalence rate, the impact of borderline personality on society is high. In Australia, data suggests that BPD diagnoses contributes to the use of 23% of psychiatric outpatient services and 43% of psychiatric inpatient

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services within the public mental health system (NHMRC, 2012). In addition, there is also a high mortality rate of 10% of those diagnosed with BPD that successfully commit suicide (APA, 2013), resulting in significant life-years lost to society. These statistics describe the significant impact that BPD has on society overall, and

demonstrates the need for achieving successful intervention and treatment options to address the phenomenon.