مفروضات جهانی و نقش تروما در اختلال شخصیت مرزی

The present study tested whether borderline personality disorder (BPD) is characterized by specific worldviews as hypothesized by cognitive models, using Janoff-Bulman's [(1989) Social Cognition, 7, 113–136] world assumptive model of negative effects of trauma. A second aim of this study was to investigate the role of trauma in the content of worldviews of BPD patients. Fifteen BPD patients, 14 patients with Cluster C personality disorders (PD), 19 patients with axis-I psychopathology and 21 non-patients filled out the World Assumptions Scale, the Personality Disorder Belief Questionnaire, a childhood trauma checklist (assessing physical, emotional and sexual abuse) and the BPD Checklist (severity of BPD psychopathology). BPD patients appear to view the world as malevolent and perceive less luck independent of trauma but dependent of BPD psychopathology. Furthermore, BPD patients have low self-worth and persist in specific beliefs independent of trauma or severity of BPD psychopathology. Pretzer's theory of BPD can be largely supported through Janoff-Bulman's world assumptive model. World assumptions of BPD patients can better be explained by the severity of BPD psychopathology than by the presence of trauma.

The concept of worldviews or world assumptions was first defined by Parkes (1971) and Bowlby (1980). They referred to world assumptions as internal cognitive structures that provide expectations about the world, which enable the individual to develop goals for the future and regulate its daily functioning. World assumptions are built and solidified over many years. They often go unquestioned because of the individual's need to maintain stability (Janoff-Bulman, 1992). According to Beck, Freeman and Associates (1990), personality disorders (PD) are characterized by specific sets of assumptions. With respect to borderline personality disorder (BPD), Pretzer (1990) hypothesized that the basic assumptions focus on three themes: (1) the world is (i.e. others are) dangerous and malevolent, (2) I am powerless and vulnerable and (3) I am inherently unacceptable. Arntz (1994) and Arntz, Dietzel, and Dreessen (1999) demonstrated that a set of assumptions (assessed with the personality disorder belief questionnaire (PDBQ)), derived from the work by Pretzer (1990), were indeed specific for BPD and appeared to be stable. The BPD assumptions seem to constitute an essential characteristic of BPD. In her work with victims of traumatic events, Janoff-Bulman (1989), Janoff-Bulman (1991) and Janoff-Bulman (1992) found that most people usually operate on the basic belief of invulnerability. This invulnerability is more or less a derivative from the view that a sense of safety and security is fundamental for the development of a healthy personality and is first developed in early childhood through interaction with the environment. At the basis of personality stands a set of relatively stable fundamental cognitive, on invulnerability based, assumptions about the world en self (the so called assumptive world). Janoff-Bulman developed a heuristic model specifying the content of these invulnerability-related assumptions. Her model consists of three primary categories, with each category consisting of several assumptions. These categories are (1) perceived benevolence of the world, (2) meaningfulness of the world and (3) worthiness of self. The first category involves a base rate notion of benevolence/malevolence and is represented by two basic assumptions: the benevolence of the impersonal world and the benevolence of people. The second category, meaningfulness of the world, refers to distributional principles. Assumptions in this category involve the belief that positive and negative events and outcomes are distributed according to the principles of justice (goodness or badness of one's moral character), controllability (engaging in appropriate or inappropriate behaviour) or chance (randomness, meaninglessness). These distributional assumptions do not necessarily exclude each other; people tend to believe in all three principles but to a various extent. Worthiness of self forms the third category and focuses on the self. The three self-relevant assumptions of this category parallel the mentioned distributional principles namely self-worth, self-controllability and luck. These self-relevant assumptions explicitly deal with the distributional principles on a personal, individual level in contrast with the assumptions of ‘meaningfulness of the world’. For example, ‘chance’ assumptions concerns the random distribution of outcomes related to people in general whereas ‘luck’ regards this aspect to oneself. To explore and compare basic assumptions of victims and non-victims, Janoff-Bulman (1989) developed the World Assumptions Scale (WAS) made up of eight four-item subscales (6-point Likert scales). She found that people, who experienced a traumatic event many years ago, hold more negative views with respect to perceived self-worth, chance and benevolence of the impersonal world than people who did not. Thus, according to this view, people who experienced negative aftermaths of a trauma have developed negative assumptions regarding perceived self-worth, chance and benevolence of the impersonal world. The assumptive model of negative effects of trauma of Janoff-Bulman (1989) and the cognitive theory of Pretzer (1990) for BPD do have a striking similarity. BPD's basic theme ‘the world is dangerous and malevolent’ does fit the negative assumptions in Janoff-Bulman's category of perceived benevolence of the world. ‘I am powerless and vulnerable’ and ‘I am inherently unacceptable’ can be related to assumptions of the categories meaningfulness of the world and worthiness of self. More specifically, ‘I am powerless and vulnerable’ can be placed next to the assumptions of controllability, chance, self-controllability and luck. ‘I am inherently unacceptable’ is linked with the assumptions of justice and self-worth. Given this, it is possible to test whether Pretzer's basic assumptions are indeed characteristic of BPD by using Janoff-Bulman's theoretical framework. From the above it can be hypothesized that, according to the world assumptive model, BPD individuals view the impersonal world and people as highly malevolent, believe that outcomes are not distributed by the principles of justice, are uncontrollable and determined by chance and do not believe in their self-worth, self-controllability and luck. A second aspect in this study is the role of trauma in the content of worldviews. As said before, Janoff-Bulman found differences in worldviews between victims and non-victims in a sample of undergraduates who were not extensively checked on the presence of psychopathology. Gluhoski and Wortman (1996) also found significant differences in worldviews, specifically in perceptions of vulnerability and self-view, for subjects of a community sample who had experienced any type of trauma but were not screened on the presence of psychopathology. Turning to BPD psychopathology, it is known that a large percentage of BPD patients has experienced childhood trauma, sexually, physically, emotionally or a combination of those (Fossati, Madeddu, & Maffei, 1999; Herman, Perry, & van der Kolk, 1989; Sabo, 1997). The findings of Arntz et al. (1999) support the hypothesis that dysfunctional assumptions underlying BPD pathology developed from childhood trauma. This is also to be expected from Janoff-Bulman's theory. To make sure that the BPD patients in the current study have the same specific BPD beliefs previously found (Arntz et al., 1999; Arntz, Dreessen, Schouten, & Weertman, 2004), and to compare BPD's worldviews with BPD specific beliefs, the PDBQ-BPD section was added. If BPD patients indeed have the hypothesized different world views compared to control groups, the question arises if this can be explained by the high level childhood traumas BPD patients have experienced or by the severity of BPD psychopathology (checked for with the BPD Checklist) itself.