Dysfunctional Attitudes and Beliefs

O'Leary et al. (1991) reported that patients with BPD, with or without major depression, scored higher than controls on a broad measure of dysfunctional attitudes. Cognitive theorists and therapists have described several specific beliefs and attitudes common among individuals with BPD. Beck et al. (1990), suggested that the individual views him/herself as bad, unacceptable, and unlovable, which may be articulated in automatic thoughts such as "I deserve to be hurt," "I must be perfect," and "I need reassurance." Such a patient also views him/herself as weak, powerless, and vulnerable, which may lead to thoughts such as "I can't function on my own" and "I need others around." Finally, he/she views the world as malevolent or dangerous, and experiences thoughts such as "Others are dangerous" and "Others can't be trusted." Such beliefs are proposed to bias information processing through cognitive errors or distortions, such as dichotomous thinking, personalization, and overgeneralization, so that situations and people are perceived as more dangerous or malevolent than they actually are, and so on, and that these perceptions then lead to emotion dysregulation and adoption ofbehavioral strategies that serve a protective function but can become mal-adaptive when rigid or extreme. Examples are adoption of perfectionist standards, attempts to elicit reassurance about lovability, idealization and devaluation of others, attempts to avoid emotions, avoidance of control by others, and hypervigilance and lack of trust.

Beck et al. (1990) note that core beliefs of individuals with BPD often are based on a history of trauma or invalidation. Arntz (1994) particularly emphasizes the role of early trauma in giving rise to core beliefs, asserting that "every borderline has experienced chronic traumas in childhood" (p. 422), but he uses the term "trauma" in a broad sense that includes, for example, emotional unavailability of parents and conflict between parents. Such trauma is proposed to lead to developmental stagnation and, consequently, continuation of cognitive processing more typical of children, such as dichotomous thinking. Arntz suggests that "unprocessed trauma" is the primary cause of the emotional reactivity seen in BPD, and a history of being punished for emotional experience and expression leads to other common BPD characteristics, such as emotional reactivity, self-invalidation, and appearing more competent than one feels. However, empirical data suggest that far from all patients with BPD have experienced trauma, even adopting the broader definition used by Arntz.

Arntz, Dietzel, and Dreessen (1999) developed the Personality Disorder Beliefs Questionnaire (PDBQ) which includes 20 assumptions that are thought to characterize each personality disorder. Examples include "I will always be alone," "If others get to know me, they will find me rejectable and will not be able to love me," "I need to have complete control over my feelings otherwise things go completely wrong," "I am an evil person and I need to be punished for it," and "My feelings and opinions are unfounded." According to Arntz et al. the BPD assumptions most strongly differentiated the BPD patients from Cluster C patients and normal controls, compared with the assumptions proposed for patients with five other personality disorders. Arntz, Dreessen, Schouten, and Weertman (2004) found that six of the original 20 BPD assumptions discriminated BPD patients from five other personality disorders. These items are characterized by themes of (1) loneliness, (2) unlovability, (3) rejection/abandonment, and (4) viewing oneself as bad and in need of punishment. Beck's research group developed the Personality Belief Questionnaire (PBQ), which comprises beliefs proposed to be associated with each PD except BPD. Butler, Brown, Beck, and Grisham (2002) found that patients with BPD were best differentiated from patients with other PDs by 14 PBQ items from the Dependent, Paranoid, Avoidant, and Histrionic scales that reflect themes of dependency, helplessness, distrust, fears of rejection, abandonment, loss of emotional control, and attention seeking.

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