Theories of Borderline Personality Disorder: An Investigation of Underlying Mechanisms

Julianne Tirpak, PhD

McLean Hospital – Fellow
Tirpak_Julianne poster

Scientific Abstract

Background: Extant treatments for borderline personality disorder are time-intensive, consist of multiple components, and are informed by different theoretical perspectives. Focusing on impaired interpersonal functioning in BPD, a hallmark characteristic of the disorder, may provide a useful microcosm for understanding the mechanisms driving BPD psychopathology.

Methods: This experimental therapeutics study utilized single case experimental design (SCED) to evaluate the effect of two distinct and brief mechanism-informed interventions for BPD and their effects on interpersonal conflict and purported mechanisms. Eight patients were randomized to receive either an emotion regulation (ER) or attachment security (AS) intervention. Frequency of daily interpersonal conflict was assessed via ecological momentary assessment. Mechanism engagement associated with each treatment approach were assessed weekly, along with downstream clinical end points. Data was analyzed using within-and between-group visual inspection for SCED, and effect sizes.

Results: Three participants responded to their assigned intervention by demonstrating ³50% decrease in interpersonal conflicts (nAS = 2, nER= 1), three partially responded (nAS = 2, nER = 1), and two did not respond (nER = 2). The majority of participants evidenced changes in mechanisms when receiving the associated intervention, and interestingly, in some cases, even when not receiving the corresponding intervention. There were decreases in global BPD symptoms for participants in both interventions and no significant differences between groups.

Conclusions: Results suggest overlap in the mechanisms maintaining BPD symptomatology and points to the importance of idiographic evaluation in BPD research and treatment. Mechanism identification is important for treatment refinement, efficiency, and cost-effectiveness.


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research Areas


Julianne Wilner Tirpak, PhD, Shannon Sauer-Zavala, PhD

Principal Investigator

Julianne Wilner Tirpak, PhD