Interpersonal difficulties are central to borderline personality disorder. Many of the core traits of BPD relate to interpersonal relationships – and in clinical settings, people with BPD often focus on their desires and fears in relationships.
For example, people with BPD may experience a fear of abandonment, patterns of unstable relationships, and the tendency to perceive others as either ‘all good’ or ‘all bad’ (a process known as splitting)’. Equally, intense emotional reactions and incidents of self-harm are frequently triggered by events within relationships.
Attachment theory provides important tools for characterising interpersonal relationships and the difficulties experienced by individuals with BPD. BPD traits tend to match typical characteristics of insecure attachment – including both preoccupied and fearful styles. Some experts even link oscillations between different insecure attachment styles with the unstable interpersonal tendencies found in BPD.
If attachment style and BPD features are closely linked, it also means that the environmental (and even genetic) factors that shape certain attachment styles may also make the development of BPD more likely. This includes relationships with attachment figures and other life events.
This blog explores the relationship between attachment theory and BPD – and how the connection may help us treat and prevent the disorder.
Attachment Theory: An Introduction
Attachment theory begins in early infancy when young children form their first relationships with caregivers. Young children seek proximity from caregivers to meet their needs, while caregivers respond by touching, holding, and soothing. Through these early relationships, children develop a concept of the self and the other – including valuations and expectations of how others will respond.
When a caregiver consistently fulfils a child’s physical and emotional needs, they may develop a secure attachment. This involves an inner sense of being worthy of love alongside perceptions of others as trustworthy. Confident that a caregiver will be available to meet their needs, a young child can comfortably explore its world, learn from others, and develop socially and emotionally.
Insecure attachments, on the other hand, usually develop when caregivers are unable to meet a child’s needs or harm or abuse them. Sometimes, young children may cling to a caregiver and experience extreme distress if they’re apart. In other cases, they may be avoidant of their caregiver and ambivalent about their presence. Some young children may express fear in the presence of caregivers while also seeking intimacy.
Research suggests that early-life attachment styles may continue to affect the way a young person acts in relationships until adolescence. As a young person grows older, other important relationships and life events also influence and change their attachment style, which remains dynamic and malleable throughout adolescence and adulthood.
Attachment Styles Among People with BPD
Research has found that the most common attachment styles among people with BPD are unresolved (relating to early life attachments), preoccupied, and fearful attachment styles. These insecure attachment styles involve a longing for intimacy accompanied by fears of dependency or rejection – traits that reflect the characteristics and behaviours of individuals with BPD.
Preoccupied attachment style is characterised by a sense of unlovability but with a positive evaluation of others. Individuals desire closeness but feel concerned about being undervalued. They may be preoccupied with their relationships and rely on the approval of others.
Fearful attachment style involves a negative self-image and doubt about the capacity, availability, and intention of others to care for them. Individuals seek intimacy but are fearful of rejection or being hurt, remaining mistrustful of others.
Unresolved attachment style relates to how individuals recount traumatic or early life experiences. Traumatic events appear unprocessed or unresolved, with recall characterised by long pauses or lapses in reasoning.
A 2004 review of attachment styles among people with BPD suggested that adults with borderline personality disorder are most likely to have an unresolved preoccupied attachment style in relation to their parents and fearful or preoccupied styles in their romantic relationships.
A 2009 study found that people with borderline personality disorder had more preoccupied and fearful attachment styles than people with major depression and a comparison group without BPD. It also found that individuals who displayed both fearful and preoccupied attachment styles were the most likely to have a BPD diagnosis.
Specifically, this mixed attachment style (preoccupied and fearful) may reflect some of the core traits of borderline personality disorder. For example, the phenomenon of splitting, when an individual categorises another as either all good or all bad, may be linked to moments of preoccupied or fearful attachment. These black-and-white categorisations theoretically underpin the patterns of devaluation and idealisation that are characteristic of BPD relationships.
When someone with BPD experiences preoccupied attachment, they’re more likely to value, depend on, and feel unworthy in relation to their partner. These traits may reflect instances of idealisation in relationships. On the other hand, fearful attachment may be connected to devaluation phases, characterised by mistrust of a partner and a fear of being hurt. The switch from idealisation to devaluation may be triggered by a perceived threat of abandonment in a close relationship.
The study also found that preoccupied and fearful attachment styles were connected to specific features of interpersonal dysfunction among people with BPD. This includes traits like fear of abandonment, unstable relationships, devaluation, and avoidance of being alone.
Attachment Style and Perceptions of the Self and Others
Borderline personality disorder is sometimes characterised as a disorder rooted in inaccurate ideas about oneself and other people. People with BPD usually have a negative self-image accompanied by changing valuations of others (idealisation and devaluation).
Equally, some theorists link attachment styles to different perceptions of oneself and others. For example, preoccupied attachment is based on a negative view of oneself, while fearful attachment involves a negative opinion of oneself and others. Taken together, the mixed attachment style of preoccupied and fearful may represent the self-other perceptions of people with BPD.
Addressing Unresolved Attachment
In some studies, a majority of people with borderline personality disorder experience unresolved attachment with respect to their early relationships. Unresolved attachment (a type of insecure attachment) happens when someone hasn’t resolved the trauma experienced with the loss of an attachment figure (like a parent) or maltreatment.
Research has found that among people with BPD, unresolved attachment styles are associated with more borderline symptoms and worse psychosocial functioning.
Addressing unresolved attachment – and moving closer to secure attachment styles – may help to reduce BPD symptoms and improve interpersonal relationships. Transference-focused psychotherapy (TFP) is a treatment for BPD that focuses on the relationship between an individual and therapist and how it is influenced by external relationships. Through TFP therapy, individuals with BPD may develop more coherent narratives of their relationships and improve their ability to integrate both positive and negative emotions (and perceptions of themselves and others) into a more cohesive whole. This can help to build a more secure attachment.
A 2007 study found that TFP helped to reduce both insecure attachment and unresolved trauma among people with BPD. Many people also experienced a significant shift from an insecure to a secure attachment style.
Attachment Theory, Aetiology, and Risk Factors for BPD
Attachment styles are largely shaped by environmental factors – particularly relationships with other people. Because attachment styles seem so closely linked to BPD, relationship experiences and events that are linked to certain attachment styles may also be risk factors for the disorder.
This, in turn, fits in with models of BPD aetology. Most evidence suggests that BPD is caused by the interaction of genetic vulnerabilities and environmental factors, particularly childhood experiences.
Importantly, it’s not only early-life relationships (with primary caregivers) that shape someone’s attachment style. Especially during adolescence and adulthood, other relationships (like friends and partners) and events (such as trauma and abuse) can influence and change attachment styles. Researchers think that genetic factors could also play a role.
Attachment Styles and Preventing and Treating BPD
In most studies, insecure attachment styles (particularly preoccupied and fearful) are almost ubiquitous among people with BPD. This points, once again, to the central role of relationship dynamics within borderline personality disorder pathology.
It also means that attachment styles may be a good indicator of risk for borderline personality disorder. For example, individuals with fearful or preoccupied attachment styles may be more likely to develop borderline personality traits. Consequently, those who have relationships or other experiences connected to insecure attachment may also be at a higher risk.
The connection between BPD and attachment style also has implications for the treatment of the disorder. Therapies and practical experiences that help to develop secure attachment may play a central role in treating the disorder and building effective recovery.
