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FUNDAP | ex - IAEPD 55
| PERSONA
factor (genetically based impulsivity, for example) is present, because of the need for
a complementary pharmacological treatment.
In a similar way, some patients from the bipolar or schizophrenic end of the spectrum
are misdiagnosed as borderline when the clinical features look like they meet
BPD criteria. But in the majority of the BPD spectrum of cases, trauma, attachment and
biological factors will interact in a complex way that will manifest differently in each
patient. What is essential is the need to understand the relative contribution of each of
these factors to a specific problem in a patient, because many aspects of treatment,
such as pharmacological interventions or EMDR therapy, would need to have more
weight depending on this evaluation. We think that it is important not to consider
these factors as contradictory with each other, but rather complementary and interactive.
Thus, to draw environmental and biological factors as extremes of a spectrum, as
we did, is not entirely adequate, because these factors are not mutually exclusive and
it is possible to find cases with high weights of both biological and environmental factors.
Figure 2. Groups of Borderline Personality Disorder
We could understand the existence of a continuum from secure attachment (right part of red arrow), passing
through attachment disruptions, to severe traumatization. At another level biologic-genetic factors could be
stronger at one extreme, and practically absent at the other, with an intermediate possibility where genetically
determined temperament generates interacting with other factors to develop in character traits. This representation
is not exact, because a strong genetic basis can be present (at the same time) in a severely traumatizing
environment. All the combinations are possible, forming specific individual configurations.
The clinic cases described below are examples of each subgroup, representing its
most relevant factor. However, the most common situation consists of the coexistence
of various factors, with different degrees of influence in each individual.
According TSDP, the origin of borderline symptomatology lies in attachment trauma.
However, TSDP can explain cases of BPD in the three groups, i.e., not only in the
first, most evident one. We will describe the differences among the three groups mentioned
before. Innate behavioral characteristics can evoke parental attachment disruptions
and attachment based BPD may involve traumatization, often of “hidden”
nature.
The first group, of “dissociative BPD”, comprises of BPD patients with tertiary or
secondary structural dissociation, with dissociative parts of the personality that have a
more developed first-person perspective, and in some cases even names or ages that
differ from the main part (the main ANP). Some of these parts may believe that they
are different people. In the intermediate group of “attachment-based BPD”, the
underlying personality structure is the same (usually secondary structural dissociation),
but the dissociative parts have less developed first-person perspectives, and the
patient can only notice dramatic changes in emotions, behaviors or cognitions, without
an inner experience of “having parts”, and general changes in elements constitut-