Rep36 Understanding Personality Disorder

2.1.2 Psychodynamic perspectives
The psychodynamic approach refers both to
long-term classical psychoanalysis and a variety of
shorter psychoanalytic psychotherapies. Recent
theorising has shifted from an early focus on
unconscious conflicts arising from instinctual
libidinal (pleasure-seeking) and aggressive drives
to a greater concern with more conscious,
reality-oriented (ego) functions and object
relations. Object relations refer to enduring
patterns of relating to others and the processes
of thought and emotion that guide these
relationships (Westen, 1991). Thus, intimate
relationships are believed to be externalisations
of internal mental representations of
interpersonal functioning formed early in
development through relationships with
caretakers. Consequently, distressing and
dysfunctional relationships characteristic of
personality disorder reflect distortions in these
internal representations.
Although more eclectic, attachment theory is
also linked to object relations theory (Ainsworth
& Bowlby, 1991). The motivation of offspring to
form a secure relationship with the parent is
universal among mammals. Attachment theory
focuses on the quality of infant-caregiver
attachment during the first year of life as a
determinant of later cognitive and social
development. Early attachment is held to affect
later behaviour through an ‘internal working
model’ of intimate relationships. As a result of
insecure attachment, for example, children may
come to expect that others are not available for
support and cannot be trusted. Such children
are subsequently likely to select and shape
disordered interactions that recreate aspects of
relationships experienced earlier. 
Childhood attachment patterns may be risk
factors for later problems, but their effects on
adult behaviour depend on other developmental
experiences. Nevertheless, some aspects of
personality disorder may represent disturbances
of attachment. Fonagy (1998), for example,
proposes that borderline personality disorder is a
disorder of attachment, separation tolerance,
and ability to understand others’ mental states
(‘theory of mind’).
Kernberg (1996) has developed an influential
object relations approach to personality disorder.