Borderline Personality Disorder Revisited: A Theory-Driven Rationale for Trauma-Focused Treatment

Abstract

Borderline personality disorder (BPD) has long been conceptualized as a chronic and pervasive disorder characterized by emotional dysregulation, an unstable self-image, and disturbed interpersonal functioning. Dominant treatment approaches have emphasized lengthy psychotherapeutic and skills-based interventions based on assumptions of patient fragility and limited affect tolerance. However, converging evidence from clinical trials increasingly challenges this paradigm. Drawing on the Adaptive Information Processing (AIP) model and recent empirical advances in this field, this study aims to substantiate the proposition that the core features of BPD can be conceptualized as manifestations of maladaptively stored traumatic and attachment-related memories originating from adverse childhood experiences. From this perspective, BPD symptomatology reflects the state-dependent activation of pathogenic memory networks. We reviewed and integrated empirical findings demonstrating that trauma-focused therapy can be safely and effectively applied to individuals with BPD, leading not only to significant symptom reduction but also to improvements in functioning in daily life and, in many cases, remission of the BPD diagnosis. We argue for trauma-focused therapy as a time-efficient intervention that targets the developmental origins of BPD, even in the absence of comorbid posttraumatic stress disorder.