Attachment and mentalisation in Borderline Personality Disorder: a meta-analysis of attachment, and a mixed method evaluation of a group only mentalisation based treatment

Abstract

Dysfunction in interpersonal relationships is central to Borderline Personality Disorder (BPD) and provides the context in which self-harming behaviour, impulsivity and affective liability manifest (Lazarus et al., 2014). A growing evidence base exists for Mentalisation Based Treatment (MBT) in regard to symptom burden and extent of personality disturbance in BPD (Choi-Kain, Albert, & Gunderson, 2016). Less is known about patients’ experience of MBT, potential moderators or the utility of group only MBT.

METHOD: First, a meta-analysis examining the relationship between attachment organisation and BPD diagnosis was conducted. Second, a mixed method design was employed to assess change in interpersonal problems and symptomatic distress following a group only MBT intervention. Potential moderators were examined and patient narratives were elicited and qualitatively analysed.

RESULTS: Across 20 studies including 1,948 participants, we found significant, medium to large effect sizes linking BPD to insecure attachment organisation. The largest effect sizes were found for a negative relationship between BPD diagnosis and attachment security, and a positive relationship between BPD and unresolved, anxious and avoidant attachment. The results of the empirical study revealed a significant reduction in interpersonal problems and psychological distress over the course of the intervention. Pre-treatment level of interpersonal problems did not function as a moderator. Patients found the group to be a challenging but rewarding experience.

CONCLUSION: There is a strong relationship between BPD and insecure and disorganised attachment. Less intensive, group only MBT interventions may be effective in reducing levels of interpersonal problems and psychological distress in adults with a diagnosis of BPD.