How Individuals Diagnosed with Borderline Personality Disorder Experience their ‘Schema Modes’ or other States of Self

Abstract

Schema therapy (ST) (Young, 1990; Young, Klosko & Weishaar, 2003) is an integrative therapy originally developed for individuals with Borderline Personality Disorder (BPD). As the model developed, the concept of ‘modes’ was introduced. Modes are thought of as ‘parts’ of the self that are expressed through one’s current predominant state and can change moment-by-moment (Young, Klosko & Weishaar, 2003). The authors proposed five central modes for BPD, namely ‘Abandoned Child’, ‘Angry and Impulsive Child’, ‘Punitive Parent’, ‘Detached Protector’ and ’Healthy Adult’; although the latter was believed to be ‘weaker’ in this client group. There is a dearth of qualitative studies that explore schema modes in patients with BPD and mixed empirical evidence for the prominence of BPD modes, as measured by Young’s Schema Mode Inventory (SMI) (Young et al., 2007). However, such quantitative research can only examine the prevalence of the modes included within the measure and cannot identify whether modes occur outside of a ST context. Furthermore, the SMI cannot tap into an individual’s perspective. Due to gaps in the literature, this mixed-methods study aimed to explore whether modes or any other states of self could be identified in individuals with a diagnosis of BPD or Emotionally Unstable Personality Disorder (EUPD), and if so, how participants talked about them and to what extent they compared with Young et al.’s mode concept. To meet this aim, 7 working-age adults (women) with a diagnosis of EUPD were recruited from a single NHS Trust, and participated in a semi-structured interview incorporating mode vignettes and completed the SMI. Interviews were transcribed verbatim and analysed using deductive and inductive Thematic Analysis (TA). 5 superordinate deductive themes and 13 sub-themes were derived. The main themes were: Vulnerable Distress, Explosive Anger and Rage, Closing Down, Self-Loathing, and Resilience. A single inductive theme was identified: Feeling like Myself is Subject to Change. The deductive themes were then triangulated with the scored SMI ratings. The findings from the TA suggested that participants broadly identified with four of the central modes and their experiences were in keeping with Young’s theory. For the Healthy Adult mode however, there were high levels of resilience described, as well as challenges remaining within or connecting to that mode. All participants reported a sense of self that was in flux due to their modes and various disparities and similarities were highlighted between the SMI and interview transcripts. No other states of self were evident across the transcripts. The findings of this research have strong clinical implications for the way services engage women with EUPD or BPD and foster their resilience. Future research could focus more on understanding mode sequences, and nuances of the Healthy Adult mode.