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Dichotomous Thinking in Borderline Personality Disorder
Abstract
This study investigated dichotomous thinking (DT) in borderline personality disorder (BPD) to determine: (1) whether it is
unidimensional in nature—all-good or all-bad, or multidimensional—both good and bad; and (2) whether it is pervasive or specific
to BPD schemas. Replicating and extending a study by Veen and Arntz (2000, Cognitive Therapy and Research, 24, 23–45), the capacity of positive stimuli to elicit DT was also examined. Sixteen individuals with BPD, 16 individuals with
other personality disorders (OPDs), and 16 nonclinical controls evaluated characters in film clips depicting themes either
specific or nonspecific to BPD. DT was operationalized as the extremity of evaluations on visual analogue scales with bipolar
trait descriptions. The BPD group’s evaluations reflected a mix of positive and negative attributes, suggesting that DT is
multidimensional. DT in BPD was not confined to theoretically related stimuli, but occurred in response to nonspecific stimuli,
including emotionally positive stimuli.
... Theories derived from psychoanalysis propose that idealization and devaluation imply polarization in a person's internal model of self or others, referred to as splitting (Akhtar & Byrne, 1983;Fairbairn, 1952a;Kernberg, 1967Kernberg, , 1985Klein, 1946;Kohut, 1966). A related, and more general, concept in cognitive psychology is dichotomous thinking (Arntz & Veen, 2001;Beck et al., 2015;Linehan, 1993;Napolitano & McKay, 2007;Veen & Arntz, 2000), which entails a tendency "to evaluate experiences in terms of mutually exclusive categories rather than to see experiences as falling along continua" (Veen & Arntz, 2000, p. 23). Here, we adopt the simpler term, splitting, although there is much overlap between the two concepts. ...
... In support of these ideas, there is evidence that adults diagnosed with personality disorders make dichotomous evaluations of others' emotions in interpersonal settings (Arntz & Veen, 2001;Bender & Skodol, 2007;Kramer et al., 2013;Moritz et al., 2011;Napolitano & McKay, 2007;Perry et al., 2013;Preißler et al., 2010;Roepke et al., 2013;Sieswerda et al., 2005;Veen & Arntz, 2000;Zanarini et al., 2009). In a notable study, healthy adults, adults with BPD, and adults with other forms of personality disorder were asked to evaluate emotions displayed by different characters in film clips (Veen & Arntz, 2000). ...
... Consistent with dichotomous thinking, people with BPD were found to make significantly more extreme emotional evaluations than both sets of controls. Other studies find that dichotomous thinking, rated using a clinical questionnaire, correlates with overall symptom severity in BPD (Moritz et al., 2011) and occurs in the evaluation of positive as well as negative content (Napolitano & McKay, 2007). ...
People often form polarized beliefs, imbuing objects (e.g., themselves or others) with unambiguously positive or negative qualities. In clinical settings, this is referred to as dichotomous thinking or “splitting” and is a feature of several psychiatric disorders. Here, we introduce a Bayesian model of splitting that parameterizes a tendency to rigidly categorize objects as either entirely “Bad” or “Good,” rather than to flexibly learn dispositions along a continuous scale. Distinct from the previous descriptive theories, the model makes quantitative predictions about how dichotomous beliefs emerge and are updated in light of new information. Specifically, the model addresses how splitting is context-dependent, yet exhibits stability across time. A key model feature is that phases of devaluation and/or idealization are consolidated by rationally attributing counter-evidence to external factors. For example, when another person is idealized, their less-than-perfect behavior is attributed to unfavorable external circumstances. However, sufficient counter-evidence can trigger switches of polarity, producing bistable dynamics. We show that the model can be fitted to empirical data, to measure individual susceptibility to relational instability. For example, we find that a latent categorical belief that others are “Good” accounts for less changeable, and more certain, character impressions of benevolent as opposed to malevolent others among healthy participants. By comparison, character impressions made by participants with borderline personality disorder reveal significantly higher and more symmetric splitting. The generative framework proposed invites applications for modeling oscillatory relational and affective dynamics in psychotherapeutic contexts.
... Theories derived from psychoanalysis propose that idealization and devaluation imply polarization in a person's internal model of self or others, referred to as splitting (Akhtar & Byrne, 1983;Fairbairn, 1940;Kernberg, 1967;Kernberg, 1985;Klein, 1946;Kohut, 1966). A related, and more general, concept in cognitive theory is dichotomous thinking (Arntz & Veen, 2001;Beck et al., 2015;Napolitano & McKay, 2007;Veen & Arntz, 2000), which entails a tendency "to evaluate experiences in terms of mutually exclusive categories rather than to see experiences as falling along continua" (Veen, 2000, p23). Here we adopt the simpler term, splitting, although there is much overlap between the two concepts. ...
... In support of these ideas, there is evidence that adults diagnosed with personality disorder make dichotomous evaluations of others' emotions in interpersonal situations (for a review see Bender & Skodol, 2007;Arntz & Veen, 2001;Kramer et al., 2013;Moritz et al., 2011;Napolitano & McKay, 2007;Perry et al., 2013;Preißler et al., 2010;Roepke et al., 2013;Sieswerda et al., 2005;Veen & Arntz, 2000;Zanarini et al., 2009). In a notable study, healthy adults, adults with BPD, and adults with cluster C personality disorder were asked to evaluate emotions displayed by different characters in film clips (Veen & Arntz, 2000). ...
... Consistent with dichotomous thinking, people with BPD were found to make significantly more extreme emotional evaluations than both sets of controls. Other studies find that dichotomous thinking, rated using a clinical questionnaire, correlates with overall symptom severity in BPD (Moritz et al., 2011) and occurs in the evaluation of positive as well as negative content (Napolitano & McKay, 2007). ...
People often form polarized beliefs about others. In a clinical setting this is referred to as a dichotomous or ‘split’ representation of others, whereby others are not imbued with possessing mixtures of opposing properties. Here, we formalise these accounts as an oversimplified categorical model of others’ internal, intentional, states. We show how a resulting idealization and devaluation of others can be stabilized by attributing unexpected behaviour to fictive external factors. For example, under idealization, less-than-perfect behaviour is attributed to unfavourable external conditions, thereby maintaining belief in the other’s goodness. This feature of the model accounts for how extreme beliefs are buffered against counter-evidence, while at the same time being prone to precipitous changes of polarity. Equivalent inference applied to the self creates an oscillation between self-aggrandizement and self-deprecation, capturing oscillatory relational and affective dynamics. Notably, such oscillatory dynamics arise out of the Bayesian nature of the model, wherein a subject arrives at the most plausible explanation for their observations, given their current expectations. Thus, the model we present accounts for aspects of splitting that appear ‘defensive’, without the need to postulate a specific defensive intention. By contrast, we associate psychological health with a fine-grained representation of internal states, constrained by an integrated prior, corresponding to notions of ‘character’. Finally, the model predicts that extreme appraisals of self or other are associated with causal attribution errors.
... This cognitive style, which is termed multidimensional dichotomous thinking (c.f. Beck et al., 2001), has been repeatedly demonstrated in BPD (e.g., Arntz & ten Haaf, 2012;Napolitano & McKay, 2007). These studies provided evidence for multidimensional thinking when BPD patients evaluate other individuals, but only one study investigated whether multidimensional thinking also occurs in BPD patients' self-evaluations. ...
... According to several studies, BPD patients are prone to engage in multidimensional dichotomous thinking (Arntz & ten Haaf, 2012;Napolitano & McKay, 2007) which suggests that BPD patients maintain representations of self and others in an extremely valenced way that lacks integration. This mixture of extreme positive and negative self-evaluation might be the result of separate positive and negative self-representations that are activated simultaneously or in quick succession. ...
... The findings of the present study can be interpreted within the context of theory and empirical research on splitting and multidimensional dichotomous thinking, two cognitive styles that are theorized to be typical of patients with BPD. According to several studies, BPD patients are prone to engage in multidimensional dichotomous thinking (Arntz & ten Haaf, 2012;Napolitano & McKay, 2007), a thinking style in which individuals engage in extremely positive or extremely negative evaluations. We argue that multidimensional dichotomous thinking is consistent with the conceptualization of BPD patients Note. ...
Background and Objectives
Borderline personality disorder (BPD) is characterized by an unstable and incongruent self-concept. However, there is a dearth of empirical studies investigating self-concept in BPD. In order to bridge this research gap, the purpose of this study was to apply an in-depth analysis of structural aspects of the self-concept in BPD.
Methods
We examined the degree of compartmentalization, i.e., a tendency to organize knowledge about the self into discrete, extremely valenced (i.e., either positive or negative) categories (Showers, 1992).
Results
We hypothesized and found that BPD patients had the most compartmentalized self-concept structure and a higher proportion of negative self-attributes relative to both a non-clinical and a depressed control group. Moreover, BPD patients rated negative self-aspects as more important than positive ones relative to non-clinical controls.
Limitations
We cannot determine whether causal relationships exist between psychological symptoms and self-concept structure. Moreover, further comparisons to patients with other psychiatric disorders are necessary in order to further confirm the clinical specificity of our results.
Conclusions
Our findings indicate that a negative compartmentalized self-concept is a specific feature of BPD. Implications for future research, psychological assessment, and psychotherapeutic treatment are discussed.
... two groups when neutral or positive stimuli were displayed 11 . Several studies found a bias towards the negative evaluation of others in BPD when patients were asked to judge individuals in film clips 14,15 , while BPD patients also judged their partners more negatively than healthy individuals following a manipulated interaction 16 . Winter and her colleagues 17 found that BPD patients evaluated negatively and neutrally valenced social events as more negative than healthy controls. ...
... On the other hand, Veen and Arntz 15 found trait-level extremity but not dichotomous thinking in the case of BPD-specific film clips, but not in the case of non-specific film clips. Using similar stimuli in a phone call experiment, the same research group found support for dichotomous thinking but not for negativity 16 , whereas manipulated real-life interactions supported the influence of undesirable self-related feedback, and thus of negativity 18 . The question thus remains as to which process influences recall in persons with high-trait BPD, and its relevance to the stimulus. ...
The present study assessed selected factors that contribute to the recollection of emotional memories over time. Participants with high-trait borderline personality disorder (BPD) watched a randomly selected positive, negative, or neutral character in a video clip (stimulus) and were asked to recall the content immediately, then 2, 4, and 6 days later. In the final sample (N = 558, average age: 33 years, 65% female), general impression had the strongest effect on recall after accounting for the effect of current mood, extremity of the responses, and level of BPD, regardless of stimulus valence. The level of BPD had an effect only when negative evaluative wording (e.g., "guilty") was used. In conclusion, people with high-trait BPD tend to remember negative stimuli more negatively over time (unlike neutral or positive stimuli), and this effect is mostly related to general impression.
... The coping style is characterized by dichotomous and ambivalent and extreme emotional responses; the typical "black-and-white" and "all-or-nothing" thinking. This coping response is often the result of previous trauma and evokes high perceived distress and over time develops into a persistent dominant personality trait (Veen and Arntz, 2000;Napolitano and McKay, 2007;Arntz and Ter Haaf, 2012;Oshio, 2012;Salters-Pedneault, 2021a,b). ...
... Within art therapy, various approaches make use of opposites and are aimed at their integration. Art therapy combined with Dialectical Behavioral Therapy (DBT) for treatment of personality disorders focuses on the tension between opposites, applying processes of both acceptance and change (Haeyen, 2018;Linehan, 2020) moving through and with the opposites toward integration and harmony (Napolitano and McKay, 2007;Linehan, 2020;Salters-Pedneault, 2021a,b). Opposites as different sides of the self are also central in Gestalt Art Therapy and Jungian Art Therapy (Perls, 1973;Case and Dalley, 2014;Rhyne, 2016;Hamel and Hamel, 2020). ...
Introduction
Personality disorders can be characterized by emotion regulation problems, difficulties in self-regulation and by dichotomous, black-and-white thinking. Dealing with opposites as a mechanism of change used by art therapists might be beneficial for people diagnosed with a personality disorder. This study examined the overall question if and in what way dealing with opposites in art therapy is a mechanism of change in achieving personal therapeutic goals.
Method
A convergent parallel mixed-methods pilot study was performed among patients with a personality disorder (N = 32). Participants received four sessions of art therapy focused on opposites. They completed questionnaires on emotion regulation, positive and negative affect and sense of emotional balance before and after each session. Additionally, they completed a questionnaire on self-expression before and after the four sessions. Furthermore, 10 interviews (eight patients/two therapists) were conducted.
Results
Quantitative results comparing baseline versus after the four sessions showed a significant change indicating that there might be a positive change regarding self-expression and emotion regulation (t = −2.45, p = 0.02, ES d = 0.30). A significant change was measured in acceptance of emotional responses (Z = −2.66, p = 0.01) and the state of emotion was rated as more balanced (Z = −2.19, p = 0.03). No further significant changes were found. Qualitative results showed that using opposites in art therapy often helped to gain insight, self-exploration and self-awareness and could facilitate confrontation as well as acceptance although sometimes it was (too) confronting.
Discussion
Integration of conflicting emotions, behaviors, and thoughts were promoted by the explicit use of opposites and supporting coherent representation. Practice based recommendations are therefore to make more explicit use of dealing with opposites as a theme in art therapy. Also, we recommend more research on different mechanisms of change to refine the theory of change that provides an underpinning rationale and structure for art therapy. The results of this research should be regarded as exploratory given the small sample size and limited amount of therapy sessions.
... For example, individuals with BPD frequently struggle with identity disturbance or tremendous difficulty establishing and maintaining cohesive and stable values, beliefs about who they are, and behavior across contexts (APA, 2013;Kaufman et al., 2015;Meares et al., 2011;Wilkinson-Ryan & Westen, 2000). Research has also demonstrated that BPD is associated with dichotomous thinking (Napolitano & McKay, 2007), biases in attention and processing emotion-related information (von Ceumern-Lindenstjerna et al., 2010), and is characterized by impulsive responding (APA, 2013; Barteček et al., 2019). Taken together, this constellation of difficulties may affect how individuals with borderline personality symptoms evaluate and respond to assessment instruments. ...
... Many persons with borderline personality pathology exhibit dichotomous thinking, or a tendency to perceive and evaluate experiences in terms of mutually exclusive categories, rather than as falling along continua (Napolitano & McKay, 2007). This black-and-white cognitive style can be readily observed in the diagnostic criterion describing interpersonal relationships as "alternating between extremes of idealization and devaluation" (APA, p. 663, 2013). ...
Borderline personality disorder (BPD) is characterized by dichotomous thinking, biases in processing emotion-related information, impulsive responding, and identity disturbance — each of which may affect how individuals respond to assessment items. This study used item-response theory tree models to examine the association between number of self-reported BPD symptoms and response style bias on the NEO Five Factor Inventory-3, administered annually from ages 18 to 20 to 2196 community participants enrolled in the Pittsburgh Girls Study. Small to moderate negative correlations emerged between number of BPD symptoms and midpoint responding. Small correlations emerged between BPD symptoms and extremity responding. These patterns did not vary by age. Participants who endorsed higher initial BPD symptoms reported lower extraversion over time, whereas those initially endorsing midpoint extroversion reported greater decreases in BPD severity. Low initial agreeableness was associated with higher BPD symptom slopes. The current study found only small associations between response style biases and BPD symptoms among a sample with subthreshold symptoms for diagnosis.
... two groups when neutral or positive stimuli were displayed 11 . Several studies found a bias towards the negative evaluation of others in BPD when patients were asked to judge individuals in film clips 14,15 , while BPD patients also judged their partners more negatively than healthy individuals following a manipulated interaction 16 . Winter and her colleagues 17 found that BPD patients evaluated negatively and neutrally valenced social events as more negative than healthy controls. ...
... On the other hand, Veen and Arntz 15 found trait-level extremity but not dichotomous thinking in the case of BPD-specific film clips, but not in the case of non-specific film clips. Using similar stimuli in a phone call experiment, the same research group found support for dichotomous thinking but not for negativity 16 , whereas manipulated real-life interactions supported the influence of undesirable self-related feedback, and thus of negativity 18 . The question thus remains as to which process influences recall in persons with high-trait BPD, and its relevance to the stimulus. ...
The present study assessed selected factors that contribute to the recollection of emotional memories over time. Participants with high-trait borderline personality disorder (BPD) watched a randomly selected positive, negative, or neutral character in a video clip (stimulus) and were asked to recall the content immediately, then 2, 4, and 6 days later. In the final sample (N = 558, average age: 33 years, 65% female), general impression had the strongest effect on recall after accounting for the effect of current mood, extremity of the responses, and level of BPD, regardless of stimulus valence. The level of BPD had an effect only when negative evaluative wording (e.g., “guilty”) was used. In conclusion, people with high-trait BPD tend to remember negative stimuli more negatively over time (unlike neutral or positive stimuli), and this effect is mostly related to general impression.
... The majority of the research in this field focused on patients with specific types of PDs (e.g., borderline personality disorder; BPD), but other types of PDs and individuals with higher levels of PD traits also seem to share these biases (Poggi et al., 2019). Empirical findings suggest that individuals with PDs tend to show bias in their reports of others, while judging them in a more intense (positive or negative) manner (Arntz & Veen, 2001;Daros, Uliaszek, & Ruocco, 2014;Napolitano & McKay, 2007;Veen & Arntz, 2000). For example, individuals with higher levels of PD traits tend to evaluate others as being more supportive and helpful (Weertman, Arntz, Schouten, & Dreessen, 2006). ...
... Empirical evidence shows that individuals with PDs have a tendency to perceive and experience interpersonal interactions in a biased and intense manner, characterized by a heightened and exaggerated perception (Arntz & Veen, 2001;Daros et al., 2014;Napolitano & McKay, 2007;Veen & Arntz, 2000). The limited literature that examined this pattern in the realm of psychotherapy found evidence that patients with PDs experience different aspects of psychotherapy in a more intense manner than patients without PDs (Tufekcioglu et al., 2013). ...
Objective:
Psychopathology research suggests that individuals with higher levels of personality disorder (PD) traits, especially those with a comorbid major depressive disorder (MDD), tend to be highly aroused in interpersonal contexts, manifested by an intensified perception of interpersonal interactions. Little is known about the way this tendency manifests in the process of psychotherapy. The current study explored the patient's perception of techniques in psychotherapy among patients with higher vs. lower levels of PD, as well as the patient-therapist agreement on techniques used.
Design:
The study used an integration of qualitative and quantitative methodology on data from a randomized controlled trial (RCT) for the treatment of depression.
Method:
Sixty-nine patients with MDD participated in the study and were evaluated for PD symptoms prior to treatment. A set of multilevel analyses were conducted to assess the association between PD and perception of techniques, as well as a zoom-in exploration within a case study.
Results:
Patients with higher levels of PD reported more techniques implemented by the therapist than patients with lower levels. In addition, the agreement between patient and therapist on techniques was lower, such that patients with PDs reported more techniques than their therapist. The case study supported these findings and illustrates the potential for patients with PDs to perceive a greater use of techniques as a sign of therapist investment.
Conclusion:
Consistent with psychopathology research, the findings suggest that patients with PDs tend to experience techniques as more intense than the therapist, in comparison with patients without PD.
Practitioner points:
There are indications that patients with higher levels of personality disorder traits will tend to experience the techniques in psychotherapy in a more intense manner than patients with lower level personality disorder traits. It is likely that patients with higher levels of personality disorder traits will experience their therapists as more active than therapists think they are. Therapists of patients with higher levels of personality disorders should be sensitive of each of their patients' experiences. As the case study demonstrated at least in some cases patients with higher levels of personality disorder may experience the techniques in an intense manner as a sign of therapist investment, however, other patients may experience this differently. Therefore, it is crucial for the therapist to be aware of how the patient experienced the encounter - investment or intrusiveness. .
... However, the dichotomous thinking has subordinate dimensions and they possibly have different relationships with cognitive abilities. Previous studies regarding borderline personality disorder showed that dichotomous thinking tendencies among people with the disorders have multidimensional aspects (Napolitano & McKay, 2007;Veen & Arntz, 2000). And an empirical study also shows that the dichotomous thinking has three dimensions, preference for dichotomy, dichotomous belief, and profitand-loss thinking (Oshio, 2009). ...
... According to the previous studies, it is thought that tendency of the dichotomous thinking is associated with growing up in harsh environment. Dimensions of the dichotomous thinking have characteristics to pursue simplifications and short-term benefits, which are related to the borderline personality disorders (Napolitano & McKay, 2007;Veen & Arntz, 2000). And the relationships between the dichotomous thinking and aggression (Oshio et al., 2016), cluster B personality disorders (Oshio, 2012) indicate antisocial characteristics of the thinking style. ...
Dichotomous thinking has three dimensions: preference for dichotomy, dichotomous belief and profit-and-loss thinking. Previous studies imply that the dichotomous thinking is associated with low cognitive abilities and low level of education attainment. In the present study, we examined the relationships between dichotomous thinking and cognitive abilities, educational attainment in Japanese undergraduate sample and wider population sample who have different educational background. They completed Dichotomous Thinking Inventory and one of four cognitive tasks: The Cattel's Culture Fair Intelligence Test, Tanaka B method Intelligence Scale, syllogism test or the BAROCO short. Overall, correlation coefficients between the dichotomous thinking and the cognitive tasks were small but significantly negative in undergraduate sample. In wider population sample, dichotomous beliefs were negatively associated with cognitive ability, while profit-and-loss thinking was positively associated. Additionally, multiple regression analyses revealed that people with low level educational background show higher dichotomous thinking tendency. These findings indicate that the relationship between the dichotomous thinking and cognitive ability depends on the dimension, whereas dichotomous thinking is generally related to low educational attainment.
... Moreover, their descriptions of others are characterized by multidimensional dichotomous thinking, a cognitive style that refers to the tendency to evaluate experiences in terms of mutually exclusive categories rather than falling along continua (Beck et al., 2001). Film characters, for example, are rated as either extremely negative or positive (Napolitano and Mckay, 2007;Veen and Arntz, 2000), as are real interaction partners (Arntz and ten Haaf, 2012). ...
... It is conceivable that this variability is related to other characteristics of BPD such as diminished self-concept clarity . In contrast to previous empirical investigations of disturbed self (de Bonis et al., 1995;Roepke et al., 2011;Vater et al., 2015;Wilkinson-Ryan and Westen, 2000) and other representations in BPD (Arntz and ten Haaf, 2012;Napolitano and Mckay, 2007;Veen and Arntz, 2000), the present study tested (a) the contents of selfgenerated mental activity and (b) sampled ongoing mental activity at multiple time points. Testing at multiple time points may be more valid than single measurements, as has been demonstrated for affective dysregulation in BPD (Ebner-Priemer et al., 2015, 2007, and it also allows a direct test of instability because participants are not asked to integrate across experiences themselves in their judgments. ...
... Moreover, the nature of retrospective self-report may result in an inaccurate assessment of the severity of personality pathology or invalidation. BPD symptoms are suggested to associate with dichotomous cognitive style (Napolitano & McKay, 2007) and impulsive responding (Barteˇek et al., 2019). Moreover, borderline-relevant traits, such as rejection sensitivity, may elevate children's perception of neglect and abuse and contribute to the development of BPD through trait-by-environment interactions (Bungert et al., 2015;Chesin et al., 2015). ...
This study examined the indirect effect via Criterion A (personality functioning) of the Alternative Model for Personality Disorders (AMPD) in the relationship between retrospective reports of perceived parental invalidation and borderline personality traits measured by Criterion B (pathological personality traits). A total of 3,019 college students completed self-report scales of the Chinese Invalidating Family Scale, Level of Personality Functioning Scale-Brief Form 2.0, and Personality Inventory for DSM-5. It was found that the indirect effect of personality functioning was significant for the association between levels of perceived overall-B = 0.52, 95% CI [0.47, 0.57], maternal-B = 0.83, [0.75, 0.91], and paternal-B = 0.97, [0.87, 1.08] invalidation, and BPD traits. The outcomes of the research suggested the critical role of personality functioning as a potential mediator in the pathological effect of perceived parental invalidation on the development of borderline personality disorder features. While the study is limited by the use of self-report measurement, retrospective responding, and cross-sectional design, significant implications on the biosocial model and AMPD were discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
... However, there is limited research about dichotomous thinking, especially the way to assess this thinking pattern [2,13,14]. According to Padesky [15], detection of particular thinking pattern could help clients to identify maladaptive schemas, and thus gives rise to the possibility of identifying alternative schemas and result in improvement in affect. ...
... From a psychology perspective, it might come as little surprise that nuanced reputations and tolerance for a few negative experiences with others help to resolve disagreements. So-called dichotomous thinking 60thinking in simple terms of binary opposition instead of seeing shades of gray-is assumed to be beneficial for quick decisionmaking and taking control of situations, but at the same time has been found to be a cognitive distortion correlated with personality disorders [61][62][63][64] . This bias is particularly prevalent in Cluster B and C disorders such as borderline personality disorder and narcissistic personality disorder, which are known for destructive tendencies in interpersonal relationships and/or difficulties maintaining bonds with others [65][66][67] . ...
The field of indirect reciprocity investigates how social norms can foster cooperation when individuals continuously monitor and assess each other’s social interactions. By adhering to certain social norms, cooperating individuals can improve their reputation and, in turn, receive benefits from others. Eight social norms, known as the “leading eight," have been shown to effectively promote the evolution of cooperation as long as information is public and reliable. These norms categorize group members as either ’good’ or ’bad’. In this study, we examine a scenario where individuals instead assign nuanced reputation scores to each other, and only cooperate with those whose reputation exceeds a certain threshold. We find both analytically and through simulations that such quantitative assessments are error-correcting, thus facilitating cooperation in situations where information is private and unreliable. Moreover, our results identify four specific norms that are robust to such conditions, and may be relevant for helping to sustain cooperation in natural populations.
... As characterized, intolerance of uncertainty seems to relate to black-and-white mentality, maybe as two sides of the same coin; however, in principle, black-and-white mentality can appear without intolerance of uncertainty. This construct, also known as splitting or dichotomous thinking (37), is related to several mental conditions, such as depression, borderline personality disorder, and eating disorders (38) where the profiles tend to be different from those on the autistic spectrum. (4) Black-and-white mentality: This facet is also conceptually close to strict adherence to rules: even though black-and-white mentality is a broad cognitive feature, it suggests intolerance to exceptions. ...
Characterizations of autism include multiple references to rigid or inflexible features, but the notion of rigidity itself has received little systematic discussion. In this paper we shed some light on the notion of rigidity in autism by identifying different facets of this phenomenon as discussed in the literature, such as fixed interests, insistence on sameness, inflexible adherence to routines, black-and-white mentality, intolerance of uncertainty, ritualized patterns of verbal and non-verbal behavior, literalism, and discomfort with change. Rigidity is typically approached in a disjointed fashion (i.e., facet by facet), although there are recent attempts at providing unifying explanations. Some of these attempts assume that the rigidity facets mainly relate to executive functioning: although such an approach is intuitively persuasive, we argue that there are equally plausible alternative explanations. We conclude by calling for more research on the different facets of rigidity and on how they cluster together in the autistic population, while suggesting some ways in which intervention could benefit from a finer-grained view of rigidity.
... Тип ПРЛ с преобладанием «когнитивной диссоциации» и нарушениями самоидентификации (19 мужчин, 10 женщин) характеризовался доминированием диссоциативных и обсессивно-компульсивных расстройств. Психопатологическую структуру данных состояний формировали когнитивные искажения по типу дихотомического «черно-белого» мышления [24]. В клинической картине преобладала склонность к рефлексии с навязчивым анализом событий текущей и прошлой жизни. ...
Background: Borderline personality disorder (BPD) in adolescence has a high prevalence and a signicant polymorphism of the psychopathological structure which creates considerable difculties to conduct differential diagnostics and assessing comorbidity with other disorders. To date, special research has not been carried out to explore BPD in adolescents that highlights the relevance of the present study. Objectives: identication of the borderline personality disorder (BPD) clinical features, leading psychopathological syndromes and differential diagnostics criteria in adolescence. Patients and methods: 71 young patients (16–25 years old) with borderline personality disorder were examined by clinical psychopathological and psychometrical methods (PBQ-BPD, TAS, BIS-11). This study includes 28 women (39%) and 43 men (61%) who were examined as inpatient or outpatient in the Mental Health Research Centre in 2019–2021. Results: key symptoms complexes were identied and presented by affective instability, dissociative state with identity disturbance and addictive behavior. Based on the analysis of the clinical picture and the discovered patterns, three types of BPD in adolescents were identied: with an “affective storm” (type I); with a dominance of impulsive and addictive features such as “adrenaline addiction” (type II); with a dominance of “cognitive dissociation” and self-identity disorder (type III). Distinctive features of the clinical pictures of affective and behavioral disorders for each type of BPD in adolescence were found and psychopathological signs and their impact on further dynamics were determined, taking into account an auto-aggressive behavior and a high level of suicidality. Conclusions: the found psychopathological patterns of BPD formation in adolescence help to assess the disorders of personality and social functioning and to predict the risk of auto- aggression and suicidal activity for the diagnostic and prognostic assessment of borderline personality disorder in adolescence.
... The most commonly evident cognitive distortion was "should statements" (9.17%), followed by "jumping to conclusions," "all-or-none thinking," "labeling," and "personalization." Previous studies have indicated the presence of jumping to conclusions (Moritz et al., 2011;Puri et al., 2018) and dichotomous thinking (Arntz & ten Haaf, 2012;Moritz et al., 2011;Napolitano & McKay, 2007) in individuals with BPD. Findings of this study show that there is a need for exploring other cognitive distortions in individuals with BPD also as they seemingly manifest many cognitive distortions that can have a bearing on their thought process. ...
Objectives
Cognitive processes, such as schema modes and cognitive distortions, may play a role in the genesis and maintenance of affective, interpersonal, and behavioral difficulties in individuals with Borderline Personality Disorder (BPD). This study aimed at exploring the schema modes and cognitive distortions in individuals with BPD.
Methods
Using a mixed‐method approach, 30 individuals with BPD and 30 healthy participants were assessed on the Borderline Personality Questionnaire, the Schema Mode Inventory, the Cognitive Distortions Scale, and a semi‐structured interview schedule.
Results
The BPD group had higher scores than the control group on all the maladaptive schema modes and cognitive distortions subscales. The child modes were the commonest and were also the strongest correlate of BPD symptomatology. Qualitative analysis of the content of the semi‐structured interview also corroborated these findings.
Conclusions
There could be many schema modes and cognitive distortions operating behind the diverse psychopathology seen in BPD.
... These are patients with an exaggerated concern about their self-definition who easily experience criticism and disapproval from others, which may result in more (extreme) angry, sad, and fearful reaction (Luyten & Blatt, 2011). At the same time, this vulnerability may also result in more extreme shifts in positive emotions, which is in line with findings that patients with BPD show evidence for dichotomous thinking (Oshio, 2012) in reaction to both negative and positive stimuli (Napolitano & McKay, 2007). For dependency, results are less clear-cut, with patients with BPD scoring higher on DEP showing more WS variance in anger but less WS variance in anxiety and feeling relaxed. ...
Affective variability is a defining feature of borderline personality disorder (BPD). We hypothesize that patients with BPD who score higher on self-criticism and/or dependency-patients with a relative emphasis on self-definition and interpersonal relatedness, respectively-are characterized by more affective variability in positive and negative emotions. To examine this hypothesis, a sample of 32 patients with BPD reported their momentary feelings of anger, depression, anxiety, cheerfulness, and relaxation in an experience sampling study with 10 random signals scheduled per day for 8 days. Using heterogeneous linear mixed models, results indicate that patients with BPD who score higher on self-criticism show more within-person variance (WPV) in anger, depression, anxiety, cheerfulness, and feeling relaxed, whereas patients who score higher on dependency show more WPV in anger but less WPV in anxiety and feeling relaxed. Consequently, individual differences in affective variability in BPD are, after adjustment for the confounding between the mean and WPV of affect, related to personality vulnerabilities like self-criticism and dependency. These results add evidence to two-polarities models of personality and the existing view that there is substantial heterogeneity in BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... Nella teoria cognitiva, il termine "pensiero dicotomico" (o "bianco-e-nero") descrive un processo simile alla scissione, ma una significativa differenza è la multidimensionalità (per esempio, la bipolarità). Di conseguenza, I pazienti con DBP giudicano gli altri in maniera estrema, sia in senso positivo che negativo (Arntz and Veen, 2001;Napolitano and McKay, 2007). ...
Metacognitive Training for Borderline Personality patients translated in italian language
... There are 2 main theories for the contradictory shifts in evaluation patterns of self and other in BPD. First, the cognitive theory of BPD proposes that interpersonal issues are caused by dysfunctional cognitive schemas, which activate the cognitive distortion called DT. 11 These maladaptive cognitive schemas revolve around perpetual fears related to rejection, abandonment, incompetency, helplessness, vulnerability, and not being loved. Cognitive theorists, such as Beck and colleagues, 12 point out that a pervasive cognitive bias, or schemas, used by those with BPD to evaluate the world negatively, contributes to the belief that others have malevolent intentions and are untrustworthy. ...
The Borderline personality disorder (BPD) diagnosis has its origins in the concept of borderline personality organization (BPO). BPO is rooted in psychoanalytic object relations theory (ORT) which conceptualizes BPD and BPO to exhibit a propensity to view significant others as either idealized or persecutory (splitting) and a trait-like paranoid view of interpersonal relations. From the ORT model, those with BPD think that they will ultimately be betrayed, abandoned, or neglected by significant others, despite periodic idealizations. This article synthesizes the extant literature splitting and trust impairments in BPD, identifies avenues for further investigation, and discusses the relative promise of different methods to evaluate these clinical processes.
... There is a relative dearth of literature examining cognition of individuals with BPD. For example, cognitive distortions have a direct bearing on the thought processes of an individual, however, the only cognitive distortion that has received considerable attention in case of BPD is 'dichotomous thinking' (Arntz and ten Haaf, 2012;Napolitano and McKay, 2007;Veen and Arntz, 2000). Dichotomous thinking leads to processing of information in extremes, thus, causing difficulty for an individual in having a comprehensive view of an event (accepting both positive and negative aspects). ...
Individuals with Borderline Personality Disorder (BPD) frequently manifest psychotic symptoms. Certain cognitive biases have been implicated in the genesis and maintenance of psychotic symptoms. The present study aimed at exploring whether individuals with BPD manifest these cognitive biases. Twenty-eight individuals with BPD and 28 healthy participants were assessed on four sub-domains of the Davos Assessment of Cognitive Biases Scale, viz. jumping to conclusions, belief inflexibility, attention for threat and external attribution. The BPD group had significantly higher scores on all the four cognitive biases in comparison to the healthy controls. Thus, the findings of the present study indicate that individuals with BPD manifest cognitive biases implicated in psychosis more prominently than healthy individuals. These findings can be used to improve the existing psychotherapeutic techniques for BPD.
... Also, these patients tend to attribute overly negative features to otherwise neutral interpersonal interactions (Barnow et al., 2009;Sieswerda, Barnow, Verheul, & Arntz, 2013). It was also shown that patients with BPD present with cognitive biases toward certain types of negative information (Arntz & Veen, 2001;Baer, Peters, Eisenlohr-Moul, Geiger, & Sauer, 2012;Napolitano & McKay, 2007). According to A. T. Beck (1963Beck ( , 2005, such cognitive biases are conceptualized in relationship with beliefs and thoughts, contributing to maintain several emotional disorders and impeding the course and outcome of treatment. ...
Biased thinking is a common feature of patients presenting with borderline personality disorder (BPD). For the treatment of BPD, it was shown that the individualizing of the treatment, by using the motive-oriented therapeutic relationship (MOTR), had a beneficial short-term effect on process and outcome. So far, it remains unclear what the role of early change in biased thinking is in these treatments. The present study aims to assess whether there is a link between the MOTR, change in biased thinking, and outcome. The sample (N = 60) is based on a randomized controlled trial with two conditions: (a) 30 patients in a 10-session version of psychiatric management, and (b) 30 patients in a 10-session version of psychiatric management augmented with the MOTR. For each patient, three sessions (intake, middle, late) were selected, transcribed, and rated using the Cognitive Errors Rating Scale (CERS). An overall decrease of negative cognitive errors during 10 sessions of treatment was observed, independently of the treatment condition. No specific effect related to change in biased thinking may be attributed to the individualizing of the treatment. These results are discussed with regard to mechanisms of change in treatments for BPD, in particular with regard to the central role that biased thinking, as well as the MOTR, might play early in treatment.
... Relatively few researchers have examined absolutist thinking in PTSD and schizophrenia, and these have often been limited or produced mixed results (e.g., Colbert, Peters, & Garety, 2010;Joseph & Gray, 2011). Conversely, there is a widespread consensus, based on a multitude of studies, that BPD and ED are firmly linked to absolutist thinking (e.g., Alberts, Thewissen, & Raes, 2012;Napolitano & McKay, 2007;Veen & Arntz, 2000). We also measured the frequency of negative emotion terms to further support the assumption that the four mental health groups had comparable levels of negative emotions. ...
Absolutist thinking is considered a cognitive distortion by most cognitive therapies for anxiety and depression. Yet, there is little empirical evidence of its prevalence or specificity. Across three studies, we conducted a text analysis of 63 Internet forums (over 6,400 members) using the Linguistic Inquiry and Word Count software to examine absolutism at the linguistic level. We predicted and found that anxiety, depression, and suicidal ideation forums contained more absolutist words than control forums (ds > 3.14). Suicidal ideation forums also contained more absolutist words than anxiety and depression forums (ds > 1.71). We show that these differences are more reflective of absolutist thinking than psychological distress. It is interesting that absolutist words tracked the severity of affective disorder forums more faithfully than negative emotion words. Finally, we found elevated levels of absolutist words in depression recovery forums. This suggests that absolutist thinking may be a vulnerability factor.
... As such potentially dysfunctional appraisal processes, cognitive biases affect emotion regulation, cognitive processing, coping and tend to maintain the prevalence and pervasiveness of core cognitive and interpersonal schemas (Beck et al., 1979;Gross, 2001;White, 1974). Empirical evidence supports the conception of biased cognitive appraisal contributing to unfavourable outcome, including onset et maintenance of psychological problems, such as depression (Blake, Dobson, Sheptycki, & Drapeau, 2016;Kwon & Oei, 1992;Tang, DeRubeis, Beberman, & Pham, 2005), anxiety disorders (Butler & Mathews, 1983;Lucock & Salkovskis, 1988;Weems, Berman, Silverman, & Saavedra, 2001), borderline personality disorder (Arntz & Veen, 2001;Baer, Peter, Eisenlohr, Geiger, & Sauer, 2012;Kramer, Vaudroz, Ruggeri, & Drapeau, 2013;Layden, Newman, Freeman, & Morse, 1993;Napolitano & McKay, 2007), eating disorders (Shafran, Teachman, Kerry, & Rachman, 1999) and gambling addictions (Delfabbro & Winefield, 2000). ...
The concept of biased thinking – or cognitive biases – is relevant to psychotherapy research and clinical conceptualization, beyond cognitive theories. The present naturalistic study aimed to examine the changes in biased thinking over the course of a short‐term dynamic psychotherapy ( STDP ) and to discover potential links between these changes and symptomatic improvement. This study focuses on 32 self‐referred patients consulting for Adjustment Disorder according to DSM ‐ IV ‐ TR . The therapists were experienced psychodynamically oriented psychiatrists and psychotherapists. Coding of cognitive biases (using the Cognitive Errors Rating Scale; CERS ) was made by external raters based on transcripts of interviews of psychotherapy; the reliability of these ratings on a randomly chosen 24% of all sessions was established. Based on the Symptom Check List SCL ‐90‐R given before and after, the Reliable Change Index ( RCI ) was used. The assessment of cognitive errors was done at three time points: early (session 4–7), mid‐treatment (session 12–17), and close to the end (after session 20) of the treatment. The results showed that the total frequency of cognitive biases was stable over time ( p = .20), which was true both for positive and for negative cognitive biases. In exploring the three main subscales of the CERS , we found a decrease in selective abstraction ( p = .02) and an increase in personalization ( p = .05). A significant link between RCI scores (outcome) and frequency of positive cognitive biases was found, suggesting that biases towards the positive might have a protective function in psychotherapy.
Practitioner points
Therapists may be attentive to changes in biased thinking across short‐term dynamic psychotherapy for adjustment disorder.
Therapists may foster the emergence of positive cognitive biases at mid‐treatment for adjustment disorder.
... .10 e.g., Dunn et al., 2002;Hill, Hall, Appleton, & Kozub, 2008;Stoeber, 2011Hill et al. 20143 1995e.g., Broh, 2002Gore, Farrell, & Gordon, 2001 2010 2014 2 e.g., Lethbridge, Watson, Egan, Street, & Nathan, 2011;Napolitano & McKay, 2007e.g., 20092009Sundgot-Borgen & Torstveit, 2004Elison & Partridge 2012 Anshel, Kim, & Henry 2009 Neatness/Organization e.g., Stoll et al., 2008Stoeber 2011Stoeber, Otto, Pescheck, Becker, & Stoll 20072010 ...
Correlations between factors characteristic of competitive sports (athletic events and competitive levels) and dichotomous thinking were investigated. A questionnaire survey was conducted with university students in university athletic clubs (N=200, 67 men and 133 women, mean age=19.5, SD=1.2). The results indicated the following. (1) Dichotomous Thinking Inventory (DTI, Oshio, 2009) is appropriate for use with athletes. (2) Athletes in general use more dichotomous thinking, compared to average Japanese university students. (3) No significant differences in DTI scores were observed between individual and group events, although the possibility of a hierarchical structure consisting of micro (individual athletes)–macro (athletic group: athletic event) was suggested. (4) DTI score of male athletes tended to be higher in the high-competitive, compared to the low-competitive group. These results indicate that dichotomous thinking, which could be maladaptive, might have adaptive functions in sports.
... Zudem schließt dichotomes Denken im Gegensatz zum Konzept der Spaltung extreme Bewertungen mit verschiedenen Valenzen auf der positiv-negativ Dimension nicht aus (Veen & Arntz, 2000). Die Annahme einer Multidimensionalität konnte auch in Studien belegt werden: Borderline-Patienten bewerteten andere Personen zwar in extremen aber trotzdem gemischten -positiven und negativen -Valenzen (Napolitano & McKay, 2007;Veen & Arntz, 2000). ...
Research suggests that the consideration of (meta-)cognitive biases may prove beneficial for the treatment of BPD, as dysfunctional thinking styles may play an important role in the development and maintenance of symptoms. Based on several well-replicated research findings including own studies, our working group developed the Metacognitive Training – Borderline (B-MCT). The objective of this low-threshold cognitive-behaviorally oriented group intervention is to raise the patients' awareness of dysfunctional thinking patterns and to help them reduce cognitive distortions. Hence, the B-MCT represents an add-on intervention for inpatient or outpatient treatment, which specifically targets these issues.
... Several studies have reported that patients with BPD make negativistic and schema-related evaluations of others (for a summary, see Sieswerda, Barnow, Verheul, & Arntz, 2013). Moreover, patients with BPD show dichotomous thinking in that they tend to judge other people in an extreme (positive and negative) manner (Arntz & ten Haaf, 2012;Arntz & Veen, 2001;Napolitano & McKay, 2007;Veen & Arntz, 2000). Interestingly, BPD patients do not provide just "simple" or "automatic" explanations for the behavior of others, but their explanations tend to be as complex as those of healthy controls (Arntz & ten Haaf, 2012). ...
We aimed to examine the profile of interpersonal attributions in BPD. We hypothesized that patients show more mono-causal and internal attributions than healthy controls. A revised version of the Internal, Personal, Situational and Attributions Questionnaire was assessed in 30 BPD patients and 30 healthy controls. BPD patients and controls differed significantly in their attributional pattern. Patients displayed more mono-causal inferences, that is, they had difficulties considering alternative explanatory factors. For negative events, patients made more internal attributions compared to healthy controls. We concluded that mono-causal "trapped" thinking might contribute to (interpersonal) problems in BPD patients by fostering impulsive consequential behaviors, for example, harming one's self or others. A self-blaming tendency likely promotes depressive symptoms and low self-esteem.
... Accordingly, schema therapy (Van Asselt et al., 2008;Young, Klosko, & Weishaar, 2003) focuses on situational factors triggering maladaptive schemas and behaviors. This approach has been indirectly applied to research Borderline PD (BPD; Napolitano & McKay, 2007;Veen & Arntz, 2000). Morf and Rhodewalt (2001) applied this approach to the study of Narcissistic PD. ...
Espousing a Cognitive-Affective Processing System (CAPS, Mischel & Shoda, 1995) perspective, the authors examined a state–trait interaction pertaining to automatic categorization in individuals with histrionic personality disorder (HPD) features. An experience of intimacy was induced via event recall, and automatic processing of dislike information was evaluated by a tailored task switching paradigm. In Experiment 1, participants switched between classifying names of acquaintances according to Gender and classifying adjectives according to Valence. In Experiment 2, participants reacted to names of acquaintances and switched between Gender and Valence rules. HPD levels were evaluated by the Personality Disorder Questionnaire-4 and Axis I symptoms were controlled for using the brief symptoms inventory. In both Experiments, the results showed an increased automatic processing of task-irrelevant, dislike and hate information with increasing HPD score only in the intimacy induction group but not in the control group. However, only in Experiment 2, which was designed to induce higher automaticity, was the difference between the two groups significant. Findings are consistent with an activation of a maladaptive, intimacy-related, schema underlying HPD.
... To date, it has been shown that single cognitive errors such as dichotomous thinking*or allor-nothing thinking*are associated with BPD (Napolitano & McKay, 2007;Veen & Arntz, 2000). High frequencies of biases, i.e., judging others aggressively and negatively (in addition to less positively, compared to controls), were reported elsewhere (Barnow et al., 2009). ...
Abstract Borderline Personality Disorder (BPD) is characterized by both maladaptive thinking and problematic schemas. Kramer and colleagues (2011) showed that using the motive-oriented therapeutic relationship (MOTR), based on the individualized understanding of the patient according to Plan Analysis (Caspar, 2007), can improve treatment outcomes for BPD. The present process-outcome pilot study aimed to examine the effects of the motive-oriented therapeutic relationship on the cognitive biases of patients with BPD. Change in biased cognitions in N=10 patients who were subject to MOTR was compared to that of N=10 patients who received psychiatric-psychodynamic treatment (Gunderson & Links, 2008). Results show a greater decrease in over-generalizations in patients who received MOTR, compared to the patients who received the psychiatric-psychodynamic treatment. These changes were related to outcome in various ways. These findings underline the importance of an individualized case formulation method in bringing about therapeutic change.
... We did not find evidence of dichotomous thinking and splitting in BPD. Other studies (Arntz & ten Haaf, 2012;Napolitano & McKay, 2007;Veen & Arntz, 2000) did find indications of dichotomous thinking in BPD. Smaller contrasts in this study resulted mainly from high levels of dichotomous thinking of the control participants. ...
Cognitive models explain extreme thoughts, affects, and behaviors of patients with Borderline Personality Disorder (BPD) by specific mal-adaptive schemas and dichotomous thinking. Psychodynamic theories ascribe these to splitting. This study expanded the study of Veen and Arntz (2000) and investigated whether extreme evaluations in BPD are (1) dichotomous, negativistic, or split; (2) limited to specific (schema-related) interpersonal situations; and (3) related to traumatic childhood experiences. BPD (n = 18), cluster C personality disorder (n = 16), and nonpatient (n = 17) groups were asked to judge 16 characters portrayed in film fragments in a specific or nonspecific context and with negative, positive, or neutral roles on visual analogue scales. These scales were divided in negative-positive trait opposites related to BPD schemas, negative-positive trait opposites unrelated to BPD schemas, and neutral trait opposites. Interpersonal evaluations of patients with BPD were (1) negativistic; (2) schema related; and (3) partially related to traumatic childhood experiences. Negative evaluations of caring characters in an intimate context particularly characterized BPD. No evidence was found for dichotomous thinking or splitting in BPD.
... Some researchers have focused on the relations between dichotomous thinking and personality disorders (Napolitano & McKay, 2007; Wenzel, Chapman, Newman, Beck, & Brown, 2006); however, they have not seemed to point out the content of it. The correlation analyses in this study indicate that cognitive therapists should deal with the patients' need and worldview to think dichotomously, rather than their benefit, profit, cost, and loss. ...
Dichotomous thinking is an individual's propensity to think in terms of binary opposition. While this thinking style may be useful for quick decision-making, some clinical psychologists have indicated that such a style is related to personality disorders. Oshio (2009) revealed that the Dichotomous Thinking Inventory (DTI) has significant positive correlations with borderline personality and narcissism. This study examines whether dichotomous thinking is associated with cluster A, B, and C personality disorders. The participants comprised 152 Japanese undergraduates (84 male and 68 female). They completed the DTI and Ten Personality Styles scale (10 PesT; Nakazawa (2006)), developed from the definitions of personality disorders in the DSM-IV. Structural equation modeling supported the hierarchical factor structure of personality disorders. The dichotomous thinking effects cluster level of disorders more than other levels. The results indicated that thinking dichotomously may lead to wide-ranging personality disorders.
... To date, it has been shown that single cognitive errors such as dichotomous thinking*or allor-nothing thinking*are associated with BPD (Napolitano & McKay, 2007;Veen & Arntz, 2000). High frequencies of biases, i.e., judging others aggressively and negatively (in addition to less positively, compared to controls), were reported elsewhere ( Barnow et al., 2009). ...
Individuals with depression process information in an overly negative or biased way (e.g., Henriques & Leitenberg, 2002) and demonstrate significant interpersonal dysfunction (e.g., Zlotnick, Kohn, Keitner, & Della Grotta, 2000). This study examined the relationship between cognitive errors (CEs) and interpersonal interactions in early psychotherapy sessions of 25 female patients with major depression. Transcripts were rated for CEs using the Cognitive Error Rating Scale (Drapeau, Perry, & Dunkley, 2008). Interpersonal patterns were assessed using the Structural Analysis of Social Behavior (Benjamin, 1974). Significant associations were found between CEs and markers of interpersonal functioning in selected contexts. The implications of these findings in bridging the gap between research and practice, enhancing treatment outcome, and improving therapist training are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
... Quite consistently, dysfunctional beliefs and dichotomous thinking (DT) have been reported in BPD (Arntz, Dreessen, Schouten, & Weertman, 2004;Butler, Brown, Beck, & Grisham, 2002), whereby patients with BPD seem to evaluate others in extreme but mixed (positive and negative) terms instead of "all good" versus ''all bad" (Napolitano & McKay, 2007;Veen & Arntz, 2000). Moreover, patients seem to display DT only when confronted with BPD-specific stimuli (Veen & Arntz, 2000). ...
Whereas a large body of research has linked borderline personality disorder (BPD) with affective rather than psychotic disorders, BPD patients frequently display psychotic and psychosis-prone symptoms, respectively. The present study investigated whether cognitive biases implicated in the pathogenesis of psychotic symptoms, especially delusions, are also evident in BPD. A total of 20 patients diagnosed with BPD and 20 healthy controls were administered tasks measuring neuropsychological deficits (psychomotor speed, executive functioning) and cognitive biases (e.g., one-sided reasoning, jumping to conclusions, problems with intentionalizing). Whereas BPD patients performed similar to controls on standard neuropsychological tests, they showed markedly increased scores on four out of five subscales of the Cognitive Biases Questionnaire for Psychosis (CBQp) and displayed a one-sided attributional style on the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) with a marked tendency to attribute events to themselves. The study awaits replication with larger samples, but we tentatively suggest that the investigation of psychosis-related cognitive biases may prove useful for the understanding and treatment of BPD.
Maladaptive daydreaming (MD) is defined as a long-hour fantasizing that disrupts the individual’s daily func-
tioning and enables an escape from unpleasant internal experiences. Previous studies indicate the significant role
of daydreaming in emotion dysregulation. Considering the emotionality in people with borderline personality
disorder (BPD), it can be assumed that MD functions as one of the strategies for coping with emotions in this
group. The study aimed to explore the co-occurrence of MD with BPD symptoms. Additionally, the study will
examine the role of BPD symptoms, experiential avoidance (EA), emotion dysregulation, and dissociation in the
maintenance of MD. The sample included 167 adults (136 women, 28 men, 3 other/non-binary). MD symptoms
correlated positively with BPD symptoms, dissociation, emotion dysregulation, and experiential avoidance. Two
models explaining the symptoms of MD were compared. Model 1 did not include EA - after adding this variable,
the fit of model 2 increased (SRMR = 0.095). EA predicted emotional dysregulation and dissociation, which in
turn explained MD symptoms. The results allow for clinical cues for specialists and interventions focused on
developing acceptance in treating MD and BPD symptoms.
Introduction:
Splitting, as a defense mechanism in Kernberg's theory, plays a significant role in the development and maintenance of polarized and oscillating representations of self/other characteristics of borderline personality disorder (BPD). Although the notion of splitting can be considered from a structural and a functional point of view, almost all empirical studies to date have focused on the former elements to the detriment of related cognitive processes.
Methods:
To further investigate the cognitive processes related to splitting, 60 participants were administered the Splitting Index and indexes of resistance to proactive interference (PI) using the interpersonal recent negative task with words that reflect negative or positive interactions compared to neutral words.
Results:
The use of splitting was uniquely and significantly predicted by a higher capacity to resist PI and a lower capacity to consistently maintain this resistance when presented with negative words, above and beyond BPD traits, primitive defenses, and the presentation of neutral words. Results showed no evidence of a relationship between splitting and resistance to PI with positive words.
Conclusion:
Results appear compatible with Kernberg's conceptualization of splitting as an active defense process that relates to an unstable capacity to inhibit negative representations of the object from entering working memory.
Binary or dichotomous thinking may lead to aggression throughout people’s lifespan; additionally, relationships are likely to be affected by types of aggression (i.e. physical aggression, verbal aggression, anger, and hostility) as well as gender and age. Using large-scale data (N = 2,315), the current study tested if age or gender moderated dichotomous thinking’s correlation with four different types of aggression. Participants (Mage = 36.1, SD = 16.2, range = 18–69) completed the Dichotomous Thinking Inventory and the Buss-Perry Aggression Questionnaire. Dichotomous thinking differentially affected aggression depending on participants’ age: dichotomous thinking and aggression were more strongly correlated in younger participants. Individuals’ tendency to think dichotomously appeared relatively stable; however, age appeared to moderate dichotomous thinking’s effects.
Objectives. Biased thinking (to some extent overlapping with the concepts of cognitive distortions and cognitive errors) is a key concept in cognitive therapy of Borderline Personality Disorder (BPD). Specific contents and cognitive processes related to BPD functioning are known. However, most studies are based on self-report measures which present a number of important limitations, in particular the difficulty in assessing non-conscious processes infused by affect. So far, no studies were conducted using valid observer-rated methodology addressing the question of biased thinking in BPD as it unfolds spontaneously in session.
Design. This is a controlled interview study comparing two matched groups, BPD patients and healthy controls.
Methods. A total of N= 25 clinical dynamic interviews with patients presenting with BPD were transcribed and rated using the Cognitive Errors Rating Scale (Drapeau, Perry, & Dunkley, 2008); their cognitive profiles were compared to those of N= 25 healthy controls who underwent the same procedure.
Results. Overall, results indicated that no between-group difference in the frequency of specific biases was found. However, heightened levels of negative cognitive biases, in particular over-generalizing and fortune-telling, were associated with BPD. Furthermore, negative over-generalizing was associated with the number of BPD symptoms.
Conclusions. These results have high levels of ecological validity and are promising for the refinement of cognitive theory of BPD. Clinical implications for assessment and intervention are discussed.
This study investigated whether dichotomous thinking is characteristic of borderline personality disorder (BPD). Patients with BPD (N = 16), control patients with Cluster-C personality disorder (PD; N = 12), and normal controls (N = 15) evaluated personalities from film clips in a structured response format. Film clips were presented with emotional themes, which were hypothesized to be either specific or nonspecific for borderline pathology, and with neutral themes. Dichotomous thinking was operationalized as the extremity of evaluations on a list of visual analogue scales (VASs) with bipolar trait descriptions. Patients with BPD made more extreme evaluations (dichotomous thinking) on BPD-specific film clips, but not on control film clips, than subjects of both control groups. The extreme evaluations of patients with BPD were not either all good or all bad, which indicates that patients with BPD do not engage in unidimensional good–bad thinking (splitting), but are capable of viewing others in mixed, although extreme, terms (multidimensional dichotomous thinking).
The common approach to the multiplicity problem calls for controlling the familywise error rate (FWER). This approach, though, has faults, and we point out a few. A different approach to problems of multiple significance testing is presented. It calls for controlling the expected proportion of falsely rejected hypotheses – the false discovery rate. This error rate is equivalent to the FWER when all hypotheses are true but is smaller otherwise. Therefore, in problems where the control of the false discovery rate rather than that of the FWER is desired, there is potential for a gain in power. A simple sequential Bonferroni-type procedure is proved to control the false discovery rate for independent test statistics, and a simulation study shows that the gain in power is substantial. The use of the new procedure and the appropriateness of the criterion are illustrated with examples.
Three types of borderline psychopathology are differentiated. Borderline schizophrenia, like schizophrenia, is characterized by impairment in the articulation of fundamental boundary differentiations. Cognitive disturbances in borderline schizophrenia are manifested as Rorschach contamination-tendency responses, wherein independent percepts tend inappropriately to fuse. Two relatively stable types of borderline personality disorder are also distinguished, both types characterized by impaired evocative constancy. Cognitive disturbances in borderline personality disorders manifested as Rorschach confabulation responses, wherein exaggerated reactions and associations disrupt realistic thinking and perception. Anaclitic borderline personality disorder involves central concerns with abandonment and rejection; introjective borderline personality disorder involves central concerns with criticism and censure. In anaclitic borderline personality disorder, confabulatory thinking expresses intense affect elaborations and preoccupations with dependence and relatedness. In introjective borderline personality disorder, confabulatory thinking is overspecific, grandiose, and/or oversymbolic, and expresses concerns about self-worth and self-definition. These various cognitive disturbances have significant implications for differential diagnosis and for understanding both interpersonal relationships and potential for psychosis among the three borderline conditions.
The PDQ (Personality Diagnostic Questionnaire) is a self-report questionnaire derived from the personality disorders section of the original DSM-III. The authors report the results of a study to determine the extent to which a PDQ index of overall personality disturbance agrees with clinicians' assessments in 552 patients with and without personality disorder. The results showed that the PDQ-derived total PDQ score may be used to differentiate patients with a high likelihood for personality disturbance from those with a lower likelihood of personality disturbance.
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
Malevolent object relations as well as splitting have long been considered by psychodynamic theorists as central features of borderline personality disorder. We tested the hypotheses that borderlines would a) perceive their parents more negatively than both nonborderline major depressive patients and nonpatient normal controls, and b) split their representations of their parents into opposites more than the comparison subjects. Borderlines (N = 31), who were identified by the Diagnostic Interview for Borderlines, Research Diagnostic Criteria major depressives (N = 15), and nonpatient controls (N = 14) were asked to rate each parent on the Adjective Check List (ACL; Gough and Heilbrun, 1983). Seven ACL scales were studied: Favorable, Unfavorable, Critical Parent, Nurturing Parent, Nurturance, Aggression, and Dominance. Correlations were performed between scores for mother and father on the various scales for each of the three cohorts. Analysis of variance and one-way t-tests with Bonferroni correction were used to test group differences. Borderlines rated their parents, especially their fathers, not only as more unfavorable on negative scales than depressives or normals, but as less favorable on positive scales than the comparison groups. Analysis of covariance revealed that a significant portion of the variance in father scores, but not in mother scores, was related to age of respondent and history of sexual abuse. While borderlines did not appear to split their parents into one good and one bad parent, they did show significantly less correlation between parents on the Favorable scale when compared with either depressives or normal subjects. The results imply that borderlines have a greater tendency to view the world in negative, malevolent ways than to split their object representations.
The authors gave the self-report Personality Diagnostic Questionnaire--Revised (PDQ-R) to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders. The PDQ-R was not a substitute for a structured interview assessment of axis II disorders because many of its diagnoses were false positives. Its high sensitivity and moderate specificity for most of the axis II disorders suggest, however, that it is an efficient instrument for screening patients with DSM-III-R personality disorders.
The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.
Prisoners of hate: The cognitive basis of anger, hostility, and violence Cognitive therapy of personality disorders Cognitive therapy of depression Controlling the false discovery rate: A practical and powerful approach to multiple testing
- A T Beck
- A T Beck
- A J Rush
- B F Shaw
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