title: Attachment and mentalization in female patients with comorbid narcissistic and borderline personality disorder.
abstract: We investigated attachment representations and the capacity for mentalization in a sample of adult female borderline patients with and without comorbid narcissistic personality disorder (NPD). Participants were 22 borderline patients diagnosed with comorbid NPD (NPD/BPD) and 129 BPD patients without NPD (BPD) from 2 randomized clinical trials. Attachment and mentalization were assessed on the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1996). Results showed that as expected, compared with the BPD group, the NPD/BPD group was significantly more likely to be categorized as either dismissing or cannot classify on the AAI, whereas the BPD group was more likely to be classified as either preoccupied or unresolved for loss and abuse than was the NPD/BPD group. Both groups of patients scored low on mentalizing, and there were no significant differences between the groups, indicating that both NPD/BPD and BPD individuals showed deficits in this capacity. The clinical implications of the group differences in AAI classification are discussed with a focus on how understanding the attachment representations of NPD/BPD patients helps to illuminate their complex, contradictory mental states.
authors.affiliation: Department of Psychology, City University of New York.
authors.forename: Diana
authors.initials: D
authors.lastname: Diamond
authors.affiliation: Department of Psychology, Pennsylvania State University.
authors.forename: Kenneth N
authors.initials: KN
authors.lastname: Levy
authors.affiliation: Department of Psychiatry, Weill Cornell Medical College.
authors.forename: John F
authors.initials: JF
authors.lastname: Clarkin
authors.affiliation: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna.
authors.forename: Melitta
authors.identifier: 0000-0002-8744-4725
authors.initials: M
authors.lastname: Fischer-Kern
authors.affiliation: Department of Psychology, Long Island University - Brooklyn.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Cain
authors.affiliation: Department of Psychoanalysis and Psychotherapy, Medical University of Vienna.
authors.forename: Stephan
authors.identifier: 0000-0001-7455-1380
authors.initials: S
authors.lastname: Doering
authors.affiliation: Department of Psychology, Clinical Psychology, and Psychotherapy, Ludwig-Maximilians-Universitaet.
authors.forename: Susanne
authors.initials: S
authors.lastname: Hörz
authors.affiliation: Institute of Psychology, University of Innsbruck.
authors.forename: Anna
authors.initials: A
authors.lastname: Buchheim
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008875:Middle Aged; D009769:Object Attachment; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology*; D056345:Theory of Mind; D055815:Young Adult