The experience of aloneness in borderline personality disorder

266 Pages·2011·1.08 MB·English

University of Wollongong
Research Online
University of Wollongong Thesis Collection University of Wollongong Thesis Collections
2011
The experience of aloneness in borderline
personality disorder
Yvette Vardy
University of Wollongong
Recommended Citation
Vardy, Yvette, The experience of aloneness in borderline personality disorder, Doctor of Psychology (Clinical) thesis, University of
Wollongong. School of Psychology, University of Wollongong, 2011. http://ro.uow.edu.au/theses/3412
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The experience of aloneness in borderline personality disorder

Yvette Vardy B.A. Hons. (Psych). M. Clin. Psych.

This thesis is presented as part of the requirements for the
award of Doctor of Psychology (Clinical)
from the
University of Wollongong

School of Psychology
2011

Thesis Certification
I, Yvette Vardy, declare that this thesis, submitted in partial fulfilment of the
requirements of the award of Doctor of Psychology (Clinical), in the School of
Psychology, University of Wollongong, is wholly my own work unless otherwise
referenced or acknowledged. The document has not been submitted for qualifications
at any other academic institution.

Yvette Vardy
Aloneness in BPD ii
ABSTRACT
Intolerance of aloneness may be considered a core feature of borderline personality
disorder (BPD) that potentially underlies a range of symptoms. Proposed as a DSM-
III diagnostic criterion, surprisingly, only one empirical study has investigated
aloneness in BPD (Richman & Sokolove, 1992) and none have examined the actual
experience of individuals with BPD when alone. This thesis extends the
understanding and operationalisation of this experience. Transcripts from qualitative
interviews with 12 participants with BPD were analysed using a phenomenological
approach based on Giorgi’s method (1985). The essence of negative time alone was
broadly characterised by either depression and lethargy, or by conflicting thoughts
and escalating distress, and was frantically avoided. Positive time alone was felt as
relief from the intrusive demands and insecurities of relating, and was craved. Study I
findings formed the basis of a self-report time alone scale administered in an online
questionnaire battery in Study II. Responses from 112 individuals with BPD revealed
a three factor structure to the questionnaire: (a) Cannot Cope Alone, (b) Need to
Escape from Others, and (c) Consumed in Intolerable Distress. All three subscales had
very good to excellent internal consistency. Correlations with the Mental Health
Inventory (Berwick et al., 1991), the Aloneness and Evocative Memory Scale
(Richman, 1986) and the Hurvich Experiences Inventory- Revised (Hurvich, 1990)
suggested good construct validity. A comparison with the BPD sample and 105 non-
BPD controls showed very large differences between groups on all subscales and the
total score, suggesting further investigation into aloneness in BPD is warranted.
Aloneness in BPD iii
ACKNOWLEDGEMENTS
First and foremost, I would like to thank my mother, Pamela Vardy, who has spent
countless hours supporting and encouraging me, reading through my drafts and
sharing her thoughts with me. She deserves an honorary doctorate in her own right! I
would also like to thank Alan Diversi, Cordell Vardy and all my friends who have
endured this long road with me, including Graeme Cochrane for his assistance with
the qualitative analysis. Without their support completing this doctorate would have
never been possible. Thanks to my supervisors Prof. Brin Grenyer and Dr Hamish
McLeod for their patience and guidance along the way. Lastly, I would like to
acknowledge Wesley Private Hospital, Ashfield, the Affect Regulation Clinic,
University of Wollongong and South East Illawarra Area Health Service, the various
bulletin boards and email groups who facilitated my research, and all the individuals
who participated in my study. Thank you so much.
Aloneness in BPD iv
TABLE OF CONTENTS
Introduction, Literature Review and Study Rationale...................................................1
Intolerance of Aloneness............................................................................................3
Theories of Aloneness in BPD...................................................................................6
The Need for Time Alone......................................................................................6
Signaling the Need.................................................................................................7
Development of the Capacity to be Alone.............................................................8
The Holding Environment and Internal Representation......................................12
Separation-Individuation and a Failure in Object Constancy..............................15
Annihilation Anxiety...........................................................................................20
Experiential Avoidance........................................................................................23
The False Self......................................................................................................25
Attachment...........................................................................................................26
Loss of Stream of Consciousness........................................................................32
Summary and Current State of Empirical Research............................................35
Brief Statement of Aims, Method and Analysis......................................................38
Study I: A Qualitative Investigation of Aloneness in Patients with BPD....................40
Method.....................................................................................................................41
Participants...........................................................................................................41
Procedure.............................................................................................................42
The Interview.......................................................................................................43
Analysis................................................................................................................45
Study I – Results......................................................................................................50
General Feeling about Time Alone......................................................................50
The Essence of a Negative Experience of Time Alone.......................................51
Aloneness in BPD v
Intrusive negative thoughts...........................................................................52
Insecurity, conflict and indecision................................................................52
Self-recrimination.........................................................................................53
Inability to control escalating panic and rage...............................................54
Maladaptive attempts to escape distress.......................................................55
Filling time to avoid aloneness.....................................................................55
Others provide reassurance and direction.....................................................56
Lethargy, inactivity and amotivation............................................................56
Feeling depressed and depleted....................................................................57
The Essence of a Positive Experience of Time Alone.........................................58
Freedom without compromise......................................................................58
Settled and in touch with self........................................................................58
Feeling flawed, insecure and fearing rejection.............................................59
Relating is effortful and self-sacrificing.......................................................59
Others invade their boundaries, intrude on self............................................60
Overwhelming stress and anger around others.............................................60
Desperate need to remove themselves..........................................................60
Both a Negative Experience Alone and with Others...........................................61
Study I – Discussion................................................................................................61
General View about Time Alone.........................................................................64
Intrusive Negative Thoughts................................................................................66
Internal Conflict, Indecision and a Lack of Self-Direction..................................69
Judgments from Self and Other...........................................................................73
Sensitivity to External Stimuli and Neglect of Internal Signals Around Others.75
Restorative Time Alone.......................................................................................77
Aloneness in BPD vi
Conclusions, Limitations and Further Research..................................................77
Study II: The Development of a Self-Report Measure of Experiences Alone............80
Item Development....................................................................................................83
Stage 1 Pilot Testing: Individuals with Borderline Personality Disorder............84
Stage 2 Pilot Testing: Healthy Individuals..........................................................86
Stage 3 Pilot Testing: Experienced and Qualified Respondents..........................90
Study II – Method....................................................................................................92
Participants...........................................................................................................92
Measures..............................................................................................................93
McLean Screening Instrument- BPD............................................................93
Hurvich Experience Inventory - Revised. ....................................................94
Aloneness and Evocative Memory Scale. ....................................................95
The Mental Health Inventory – 5..................................................................96
Demographic questions................................................................................97
Procedure.............................................................................................................97
Study II– Results......................................................................................................98
Group Allocation.................................................................................................98
Patient group.................................................................................................99
Control group................................................................................................99
Group Comparisons...........................................................................................100
Data Screening...................................................................................................103
Reliability...........................................................................................................105
Factor analysis............................................................................................105
Internal consistency....................................................................................110
Validity..............................................................................................................112
Aloneness in BPD vii
Content validity. .........................................................................................112
Correlations with related measures.............................................................112
Gender and age in the BPD sample............................................................115
Contrasted groups.......................................................................................117
Additional between-groups comparison with matched samples................119
Study II Discussion................................................................................................123
The Three Factors of the Borderline Experience of Aloneness.........................123
Factor 1: Cannot Cope Alone.....................................................................124
Factor 2: Need to Escape from Others........................................................126
Factor 3: Consumed in Intolerable Distress................................................128
Relationship between the three factors.......................................................129
Construct Validity of the ETAS.........................................................................130
The Mental Health Inventory- 5 (MHI-5). .................................................130
The Aloneness and Evocative Memory Scale (AEMS).............................131
The Hurvich Experience Inventory- Revised (HEI-R)...............................132
The Current DSM-IV Conceptualisation of BPD..............................................133
Clinical Use of the ETAS..................................................................................135
General Discussion....................................................................................................138
Limitations.............................................................................................................139
Conclusions and Future Research..........................................................................142
References..................................................................................................................144
Appendix A: Condensed Interviews..........................................................................161
Appendix B: Ratings of Interview Meaning Units by Two Independent Raters.......212
Appendix C: Consensus Categories of Meaning Units by Both Researchers...........215
Appendix D: Consensus Categories into Essential Themes......................................220
Aloneness in BPD viii
Appendix E: Rater Codings of Number of Participants Endorsing Each Theme......221
Appendix F: Email Invitation/ Notice to Participants................................................222
Appendix G: Evaluation of Questionnaire.................................................................223
Appendix H: Scale Review- Experienced and Qualified Respondents.....................224
Appendix I: Internet Study.........................................................................................241
Appendix J: Suppressed and excluded items from scale...........................................251
Appendix K: Experience of Time Alone Scale..........................................................253