Exploring attribution style and metacognitive process in borderline personality disorder

Abstract

Introduction Borderline Personality Disorder is a complex mental health problem where affective instability and interpersonal relationship of the person is markedly disrupted. Various biological, developmental, psychological and contextual factors are indicated for this disruption along with other signs and symptoms of BPD. This study explored metacognition and attributional style in Borderline Personality Disorder (BPD). Both metacognitive ability and attribution style impacts an individual‘s quality of social interaction and mental health and these two have been found to be impaired in different psychiatric conditions including personality disorders. A comprehensive literature review identified some gap in knowledge regarding the role of these two variables in the cases of borderline personality disorder.

Rationale: The present study is conceived to address the generic knowledge gap regarding the relation between cognitive constructs (such as, metacognitive process, and attribution style) (see Semerari, et al., 2014) as well as contextual knowledge gap from a low resourced Asian culture that is Bangladesh.

Objective: The present study aims to understand the attribution style and metacognitive process in borderline personality disorder. To achieve this overarching objective, several specific objectives were formulated as follows: 1) To assess metacognitive skills in BPD; 2) To assess attribution styles in BPD; 3) To explore relation between different metacognitive skills and four BPD sectors of psychopathology that is to say, affective, interpersonal, behavioral and cognitive/self; 4) To explore the relation between internal, personal and situational attribution style and four sectors of BPD psychopathology that is to say, affective, interpersonal, behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD.

Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research.

Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years).

Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD.

Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh.

Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD.

Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research.

Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years).

Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD.

Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh.

Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured behavioral and cognitive/self; 5) To explore relation between different metacognitive skills and attribution styles in BPD.

Method Design: Mixed method sequential approach using both quantitative and qualitative methods was employed to investigate the objectives of the present research.

Participants: 40 diagnosed with BPD and 40 screened as without BPD took part in the research. Both groups were matched on the basis of age (average age being bpd=25.96 years and normal =26.68 years), sex (male=31, female=9) and education (average years of education, bpd=13.72 years; normal=13.92 years).

Inclusion and Exclusion Criteria: Status of diagnosis of BPD was the key inclusion criteria for the two groups of participants. While to be included in the Group 1 i.e., the BPD patient, the participants needed to have a confirmed diagnosis of BPD while to be included in the Group 2 i.e., the normal control, the participants needed to be screened out of BPD.

Ethical clearance: For data collection ethical clearance was obtained from the respective Ethics Committees of the Department of Clinical Psychology, University of Dhaka and National Institute of Mental Health and Hospital, Bangladesh.

Measures: The metacognitive self-assessment scale (MSAS) and Internal Personal and Situational Attribution Questionnaire (IPSAQ) were used to assess the metacognition and attributional style of the participants respectively. Both the scales were translated in bangla following the forward-backward translation procedures. Cronbach‘s alpha ranged between 0.623 and 0.830 for all MSAS subscales and for overall metacognitive function as measured by total MSAS score was 0.898. Cronbach‘s alpha for the IPSAQ Bangla from the current sample was 0.754. For qualitative part indepth interview was conducted following a topic guide, which were recorded and transcribed for analysis.

Analysis: For quantitative part of the study, analysis of data comprised of both descriptive and inferential statistical procedure using SPSS. The analysis of qualitative part consisted of open coding, followed by focused coding and finally extracting of themes.

Result Quantitative: Results showed that total metacognitve ability of the participants with BPD (M = 31.40, SD = 8.136) was found less than the total metacognitve ability of the participants without BPD (M = 42.07, SD = 5.070). An independent t-test showed that the difference between ability scores was significant and effect size was large (t = 7.042; df=65.326, p = 0.000, two-tailed, d=0.80). In all subscale scores of metacognition, viz., monitoring, integration, differentiation, decentration and mastery, with BPD was low compared to the without BPD sample, and the differences were significant in all sub-scales scores except decentration. As for Attribution style BDP group showed greater tendency towards internal attribution style for negative events than without BPD group and also attributed the cause of negative events to others and situational factors significantly less. As regards internalizing bias BPD group scored less and as regards personalizing bias, for with BPD and without BPD on average more than half the attributions for negative events were ascribed to other people which in other words is blaming others for negative events. Pearson Correlation among SCID score, Metacognition and Attributional Style scores were calculated. Total score on SCID of the BPD group has showed a significant negative correlation with Monitoring and Decentration; and affect domain on SCID has a significant negative correlation with Decentration. Whereas, SCID Interpersonal Sector has a significant positive correlation with Personalizing Bias. Other results inform about significant correlation between different metacogntive abilities with attribution style of the BPD. Thus Negative-internal attribution has negative correlation with Decentration and Mastery. Whereas, Negative-situational has positive correlation with Decentration and Mastery. On the other hand Personal Bias has significant negative correlation with Monitoring, Decentration and Mastery. All these correlations hint to BPD‘s characteristic thinking and behavior patterns, like self and other blaming, hostility and depression etc. As regards severity of BPD psychopathology, affective domain has found to be the highest followed by Interpersonal, behavioral and self/cognitive domains.

Qualitative: Five core themes themes were extracted which were as follows: ―prioritization of emotion‖; ―thought emotion fusion‖; ―failed subtle communication‖; ―primacy of personal view‖; ―loop of self-criticism and rumination.‖ Discussion The findings gives a cognitive profile consisting of two significant variables that explains some difficulties of the borderline people in self and relational context. Qualitative findings have further supported and elucidated the findings. Findings of this study is supported in many ways by similar research for different disorders, and further the findings has implications for clinical intervention in BPD. Thus training the BPD patients on enhancing metacognitive skills and educating to deal with negative attribution style seem to have good prognostic outcome in BPD intervention. Limitation & Conclusion: Non-probabilistic sampling, small sample size, and drawing the sample only from urban, educated and middle and upper socioeconomic strata, are some limitations of the present study. However, being a research of first of its kind on Bangladeshi BPD population further studies addressing different aspects of metacognition and attribution is deemed necessary.