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How Addiction Changes You: A Clinical Study on Substance Abuse, Attachment Style and Reflective Function in Borderline Personality Disorder
Guido Nosari*, Boso Marianna, Sacco Giulia, Urru Anna, Valentina Ciappolino, Tiraboschi Giorgio, Monti Maria Cristina and Edgardo Caverzasi
Background: Borderline Personality Disorder (BPD) and Substance Use Disorder (SUD) co-morbidity, often described as “Dual Diagnosis” (DD), is a severe and complex condition. Attachment abnormalities and Reflective Functioning (RF) impairments are crucial in BPD, but may be also implicated in SUD. Aim of the present study is to investigate psychopathological dimensions, attachment style and the RF in two distinct groups of patients, respectively affected by SUD with BPD and by SUD without BPD.
Methods: 2 groups of subjects with diagnosis of “SUD with BPD” (40 patients) and for “SUD without BPD” (30 patients), were included and assessed with the Addiction Severity Index (ASI), Adult Attachment Questionnaire (AAQ), Reflective Function Questionnaire (RFQ).
Results: Significant differences between both groups were shown in pharmacological therapy (p<0.0001), substitutive therapy (p=0.025), suicide attempts (p=0.005), self-harming behavior (p<0.001), trauma (p=0.003). ASI reported significant differences in social relationships (p=0.0115) and psychiatric condition (p=0.0003). RFQ showed statistically significant differences on the Uncertainty Scale (p=0.0340). The SUD with BPD group showed a prevalent dismissing attachment style (58%), with a low percentage of disorganized attachment style (3%). The SUD without BPD group showed a prevalent secure style (47%), followed by the dismissing style (30%).
Conclusions: A comprehensive assessment in all SUD subjects with psychiatric symptoms and history of psychological trauma is crucial, since it allows to start a tailored intervention for DD patients, aimed to minimize the poor outcome related with this condition. Additional psychotherapy could be proposed for SUD patients with a dismissive attachment style.