Diamant, Ilan; (1998) The theory of mind in borderline personality disorder: Evidence from representation of deception. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis concerns the development of the capacity to mentalise in those with borderline personality disorder. The concept of borderline disorder is reviewed. A model describing the effect of childhood experiences of abuse in developing the capacity of theory of mind is presented. The concept of lying is introduced. Understanding the concept of lying can be shown as depending on the capacity to mentalise. Based on the theory of prototypical analysis, the 'Concept of lying' scale was developed. It measures judgement of veracity and affective response to different conditions varied in their emotional charge. Three main studies are described. In the first study, two groups consisting of 34 severely disturbed personality disorder patients (assessed by DSM AXIS-I and AXIS-II diagnoses) and 30 control subjects were assessed in their concept of lying. Results confirmed the hypothesis that borderline patients would manifest deficiencies in taking into consideration others' minds. The results are discussed in terms of a cognitive-developmental theory maintaining that children firstly acknowledge others' intentions and subsequently, others' beliefs. In the second study the same 34 experimental subjects were compared with a new group consisting of 20 control subjects. We added the NART measure of IQ and the CECA measure of childhood experience of care and abuse. Results show that childhood experiences of sexual abuse are correlated with negative affective response (r = .46). It produces cognitive deficiencies in judging lying, especially in mentalising others' beliefs (r = .33). These are correlated with the diagnosis of borderline personality disorder (r = .27). In the third study groups were interviewed about their concept of lying in relation to experiences of being lied to, or telling lies. In this study, 18 experimental subjects were compared with 14 control subjects. The results show a qualitative difference that is explained on the basis of patients' deficiency in holding a mature concept of lying. The general discussion examines four issues: the implications for understanding lying in neurotic patients and in individuals with borderline personality disorder; the theory of mind and borderline personality disorder; object relationships, lying and psychic functioning in borderline personality disorder; and clinical implications for therapy with abused individuals and with abused liars.

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