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Abstract
Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric
disorder that is associated with very high personal and socioeconomic costs. This
paper provides a state-of-the-art review of the relationship between complex trauma
and key features of BPD, with a focus on problems with self-coherence and self-continuity.
We first review evidence for the high prevalence of complex trauma in BPD patients.
This is followed by a discussion of emerging knowledge concerning the biobehavioral
mechanisms involved in problems related to self and identity in BPD. We emphasize
three biobehavioral systems that are affected by complex trauma and are centrally
implicated in identify diffusion in BPD: the attachment system, mentalizing or social
cognition, and the capacity for epistemic trust-that is, an openness to the reception
of social communication that is personally relevant and of generalizable significance.
We formulate a new approach to personality and severe personality disorders, and to
problems with self and identity in these disorders, rooted in a social-communicative
understanding of the foundations of selfhood. We also discuss how extant evidence-based
treatments address the above-mentioned biobehavioral systems involved in identity
diffusion in BPD and related disorders, and the supporting evidence. We close the
paper with recommendations for future research.