Borderline personality disorder and the search for meaning: an attachment perspective

To explore the links between the attachment theory-derived concept of disorganized attachment, and the psychiatric diagnosis of borderline personality disorder (BPD).

Literature search for characteristics of disorganized attachment. Clinical case material from psychotherapeutic work with patients suffering from BPD.

Disorganized attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatized/traumatizing caregivers are simultaneously a source of threat and a secure base. Interpersonal relationships in BPD including those with caregivers is similarly seen in terms of an approach-avoidance dilemma, which manifests itself in disturbed transference/countertransference interactions between therapists and BPD sufferers. Borderline personality disorder sufferers lack meaning in their lives because they are unable to play 'language games' with their potential intimates, resorting to actions rather than words to express feelings.

Possible ways of handling these phenomena are suggested, based on Main's (1995) notion of 'meta-cognitive monitoring', in the hope of re-instating meaning and more stable self-structures, in these patients' lives.