Identity-related autobiographical memories and cultural life scripts in patients with Borderline Personality Disorder

Abstract

Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to organize one’s autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups.

Introduction

Identity diffusion is one of the defining characteristics of Borderline Personality Disorder (BPD) and the essential symptoms and behavioral dysfunctions in BPD can be related to diffusion of identity (Jørgensen, 2006, Jørgensen, 2010). Identity disturbance, manifested in sudden and dramatic changes in self-concept, goals, personal values, career plans and religious beliefs, is one of the DSM-IV diagnostic criteria for BPD (American Psychiatric Association, 2000). Patients with BPD are characterized by impulsivity, affective and behavioral instability, and severe interpersonal problems. According to Kernberg (2004), one of the key features differentiating neurotic personality organization (milder forms of character pathology) and borderline personality organization (more severe character pathology) is “the presence of normal identity integration as opposed to the syndrome of identity diffusion” (p. 61). Research on autobiographical memory has shown that the ability to remember our personal past is essential for providing a sense of identity and continuity in life (e.g., see Conway & Pleydell-Pearce, 2000, for a review). However, surprisingly little is known about the possible effects of identity disturbances as observed in BPD on autobiographical memory. In the present study, we examined characteristics of autobiographical memory in patients with BPD as an attempt to learn more about the relationship between identity diffusion and autobiographical memory in BPD.

Jørgensen (2010) has related human identity to a number of features, including “a sense of the self as a relatively delimited, coherent, and stable center of behavior or autonomous acts” (p. 347) and the conception of oneself as an individual “with specific, distinct, and stable traits, boundaries, needs, and characteristics, and a unique life-story (self-narrative)” (Jørgensen, 2010, p. 347). Jørgensen differentiates between four levels of identity: ego, personal, social, and collective identity. This implies a distinction between, on the one hand, structural and primarily unconscious levels of identity and, on the other hand, mainly conscious aspects of identity. Contemporary conceptions of narrative identity (e.g., McAdams, 1988) include conscious aspects of identity which are related to personal and social identity, whereas unconscious aspects of identity, related to the integration of inner object relations and conceptualized as ego-identity (cf. Kernberg’s concept of personality organization), are understood as a structural precondition for the construction of a coherent and meaning-generating self-narrative or narrative identity. In accordance with Kernberg’s object relations theory (Kernberg, 1976), it is assumed that the quality of generated self narratives is related to the level of integration of structural ego-identity and that individuals with disturbed ego-identity (such as BPD-patients) have trouble constructing a coherent and mature narrative identity.

McAdams (1988) proposed that one way in which individuals make sense of their lives and construct their identity is through the use of narratives. Such identity-serving life stories often vary in terms of coherence and consistency. McAdams and Pals (2006) defined the ability to construe one’s life as an ongoing story as an essential part of the adaptive personality. They state that an ongoing life story “that incorporates the reconstructed past and the imagined future into a more or less coherent whole” (p. 209) provides one’s life with a sense of unity, purpose and meaning. Following this view, it seems reasonable to assume that deficits in this ability are related to personality pathology.

The ability to construct a coherent life narrative relies on memory, notably autobiographical memory. Therefore, the qualities of one’s autobiographical memories – such as their emotionality, specificity, level of detail, and coherence may also play a key role in identity-construction. Singer and Salovey (1993) also suggest that autobiographical memories may play a key role in identity construction, in particular, self-defining memories. These are defined as a subset of autobiographical memories that are particularly central to the person’s life story and identity. Such memories are expected to be affectively intense, vivid, repetitive, linked to other memories, and to focus on enduring concerns or unresolved conflicts. Similarly, according to Conway and Pleydell-Pearce (2000), one of the essential functions of autobiographical memory is to ground the self and provide a sense of identity. In summary, a number of models of autobiographical memory suggest that these types of memory may play a central role in meaning making and identity construction.

Given the importance of autobiographical memory for identity and the central role of identity diffusion in BPD, surprisingly little is known about autobiographical memory in BPD. Earlier studies have focused on the specificity of autobiographical memories, that is, whether or not autobiographical remembering refers to a particular event taking place on a specific day in the past (e.g., Kremers et al., 2004, Kremers et al., 2006a, Kremers et al., 2006b). The goal of the present study is to examine autobiographical memory in BPD on a number of dimensions that are all central to, but probe different aspects of, autobiographical memory. Four key aspects of autobiographical memories and self-narratives are addressed: their emotional valence, specificity, relation to cultural life scripts, and narrative structure (coherence).

Multiple studies of autobiographical memory in normal adults have shown a marked dominance of emotionally positive compared to emotionally negative memories (see Walker, Skowronski, & Thompson, 2003, for review). One possible explanation for this is the fading of affect bias—that is, the finding that the emotional intensity of emotionally negative events fades more quickly in memory than does the intensity of emotionally positive memories, at least in non-depressed individuals (Walker et al., 2003). A complementary explanation may be that autobiographical memory is primarily organized in terms of positively biased cultural life scripts (Berntsen & Rubin, 2004) and/or that autobiographical memory in normal individuals works to maintain a positive self-image (Conway & Pleydell-Pearce, 2000). The increased accessibility of positive relative to negative memories is absent in depression (e.g., Williams & et al., 2007) and it is likely that a similar lack of positivity bias is also present in BPD. Firstly, because of the high comorbidity of depression in BPD (Zanarini et al., 1998), and similarly to depressed individuals, individuals with BPD also experience high levels of emotional dysphoria (Korner, Gerull, Meares, & Stevenson, 2008) as well as dysfunctional emotion regulation (Domes et al., 2006, Linehan, 1993). Second, patients with BPD also present a highly unstable and negative self-image which is related to preoccupied and disorganized attachment (Bartholomew, Kwong, & Hart, 2001).

Typically, autobiographical memories refer to specific events located in a particular time and space. In contrast to specific memories, categorical or overgeneral autobiographical memories lack important details and do not refer to specific episodes that took place at a specific time and location. Overgeneral memories have been frequently observed in depression, especially in response to emotionally positive cue words (Williams et al., 2007). Overgeneral memory has also been reported in a number of other clinical disorders, such as posttraumatic stress disorder (McNally et al., 1995), bipolar disorder (Scott, Stanton, Garland, & Ferrier, 2000), autism (Crane, Goddard, & Pring, 2010), and Obsessive Compulsive Disorder (Wilhelm, McNally, Baer, & Florin, 1997).

Being able to understand and generate solutions to experienced problems in daily life requires an ability to access one’s memory and retrieve specific memories of how one has coped with similar situations and problems in the past (e.g., Pillemer, 2003). Memories function “to make life as we are currently meeting it more familiar and easier to adapt to” (Stern, 2004, p. 199). Similarly, the ability to create vivid, detailed and realistic conceptions of future situations and the future in general – partly based on memories for the past – is essential for one’s ability to anticipate and make adaptive preparations to solve future problems (e.g., Schacter, Addis, & Buckner, 2007). On the other hand, the retrieval of distressing memories can provoke emotional dysregulation and give rise to dysfunctional interpersonal behavior which, in some cases, will compromise relationships and the recognition of one’s identity by others.

Prior findings concerning the specificity of autobiographical memories in BPD are mixed. Some studies have found that BPD-patients produce significantly less specific and more general autobiographical memories compared to normal controls (Jones et al., 1999, Maurex et al., 2010). Other studies have found no differences (Arntz et al., 2002, Renneberg et al., 2005) or differences that could be explained by comorbid depressive symptomatology (Kremers et al., 2004, Kremers et al., 2006a, Kremers et al., 2006b). Efforts to understand the psychological processes involved have related overgeneral memories to a number of factors, including avoidant coping styles (Hermans, Defranc, Raes, Williams, & Eelen, 2005), the tendency to dissociate in an effort to avoid unbearable feelings activated when specific traumatic events are recalled (Williams, 1996), rumination and reduced executive control (see Williams et al., 2007, for a review).

Life scripts are culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. They are used to process life stories and organize one’s autobiographical memories temporally and thematically. Life scripts function as prescriptive time-tables for major life events, typically role transitions (Berntsen & Rubin, 2004). Internalization of the cultural life script, that is, the construction of an individual life script in general accordance with the dominant cultural life script, is part of the normal socialization process. Knowledge of cultural life scripts are communicated not only through one’s lived experience but primarily transmitted from older to younger generations, for example through literature, movies and other narratives circulating in one’s culture. Cultural life scripts are assumed to be important for socially adaptive behavior, self-development and identity development. A mature identity is anchored in a stable identification with common ideas about a ‘normal life’ within a given culture. Cultural life scripts represent such shared ideas of a ‘normal life’ and help to establish coherence in individual self-narratives and narrative identities (Habermas & Bluck, 2000). The life script is used to process life stories, organize personal memories in time, and works as a point of reference when evaluating one’s past and present life and imagining one’s future (Berntsen & Bohn, 2010). Findings reported by Bohn and Berntsen (2008) suggest that the acquisition of a cultural life script is an important precondition for the ability to tell a coherent life story in childhood. Individuals who have not internalized the cultural life script are thus lacking an important source for structuring their life-story, and developing an adaptive narrative identity.

The construction of vivid and coherent autobiographical memories and self-narratives requires the capacity to connect and make sense of lived experiences both at specific points in time and across the life span (Thorne, 2000). The process of analyzing life stories and personally significant autobiographical memories “reveals how people construct meaningful accounts of their lives, selecting from a myriad of experiences those events that are most important” (p. 46), and linking aspects of these events into coherent and meaningful stories.

Important characteristics of BPD, such as an unstable and primarily negative self-image, poor self-regulation (impulsivity, affective instability, dysphoria, etc.) and compromised mentalization are likely to be related to the quality of personal memories. Mentalization (Bateman & Fonagy, 2004) is important for the creation of a coherent identity and coherent autobiographical memories. It is an imaginative mental activity by which the individual interprets the behavior of the self and others as being meaningful (Holmes, 2006, pp. 31–32). When mentalizing, one creates meaning- and coherence-generating narratives and intentional narratives. Through this process the past and present behavior of the self and others is related to internal mental states (in oneself and in others), including intentions, feelings, and conceptions of reality. Mentalization is thus required to make sense of events and to form coherent personal narratives. Consequently, one might assume that compromised mentalization, seen in most BPD-patients (Bateman & Fonagy, 2004), will manifest itself in incoherent and impoverished self-narratives and autobiographical memories.

Habermas and Bluck (2000, p. 749) introduced the related concept of autobiographical reasoning, which is a self-reflective process through which the person links his or her own concrete life experiences to the self and attempt to relate their personal past and present. This process introduces a biographical perspective that frames one’s individuality and identity in terms of specific personal memories and a specific life-story. It integrates the memories of the individual with the cultural concept of biography which refers to culturally shared expectations about the content and structure of a normal life story. In this way, autobiographical reasoning is related to the concept of the cultural life script (Berntsen & Rubin, 2004). Like the ability to mentalize, the development of autobiographical reasoning is a likely precondition for the construction of elaborated and coherent self-narratives and is intimately related to a mature ego-identity. Thus, an incoherent ego-identity or identity diffusion, an essential characteristic of BPD (Kernberg, 2004), is likely to manifest itself in incoherent and confusing autobiographical memory- and self-narratives.