The Construct of Effortful Control: An Approach to Borderline Personality

Disorder Heterogeneity

Hoerman, Clarkin, Hull & Levy (2005)

Background

● Borderline Personality Disorder Heterogeneous DSM-IV (Diagnostic and Statistical Manual of Mental

Disorders) Have to meet 5 out of 9 criteria to be diagnosed

● Avoiding abandonment● Unstable and intensive personal relationships● Impulsivity● Identity disturbance ● Feeling of emptiness● Suicidal tendencies● Affective instability● Difficulty controlling anger● Dissociation

Effortful Control

● Ability to inhibit a predominant response in favour of a subdominant one.

● Related to executive attentional network● Positively correlated with conscious

development and negatively with aggression.

Effortful Control and BPD

● Hypothesised that 3 subgroups of BPD patients can be identified, based on 3 subscales of effortful control: Inhibitory control – capacity to suppress positively

toned impulses and avoid inappropriate approach Activation control - capacity to suppress negatively

toned impulses and avoid inappropriate avoidance Attentional control – capacity to intentionally shift

attention

Methods

● Participants: 47 patients diagnosed with BPD● Measures:

The Adult Temperament Questionnaire (Effortful Control)

The Brief Symptom Inventory (Depression, Hostility, Anxiety & Psychoticism)

The Multidimensional Personality Questionnaire (Social Potency, Social Closeness & Alienation)

The Inventory of Personality Organization (Identity Diffusion, Reality Testing & Primitive Defences)

Results

Results

Cluster 1

(High Effortful Control)

Cluster 2 Cluster 3

(Low Effortful Control)

Anxiety

Psychoticism

Alienation

ID diffusion

Primitive defences

Low

Low

Low

Low

Low

Low

Medium

Low

Medium

Medium

High

High

High

High

High

Conclusion

● There are 3 different levels of pathology within BPD sample, with the group with high effortful control exhibiting the least, and the group with low effortful control exhibiting the most problems in different areas of functioning

Limitations

● Small sample size N=47 Cluster I n=17 Cluster II n=19 Cluster III n=11

● No control group● 3 clusters chosen in advance – not empirically

derived● Self-reports – perhaps the disorder affects the

way the patients perceive themselves??