Jeremy Holmes

Disorganised attachment and borderline personality disorder: a clinical perspective   51

Summary The aim of this paper is to explore the links between the attachment-theory derived concept of disorganised attachment, and the psychiatric diagnosis of Borderline Personality Disorder (BPD). Disorganised attachment can be understood in terms of an approach-avoidance dilemma for infants for whom stressed or traumatised/traumatising caregivers are simultaneously a source of threat and a secure base.  Interpersonal relationships in BPD including those with care givers is similarly seen in terms of approach-avoidance dilemmas, which manifests themselves in disturbed transference/countertransference interactions between therapists and BPD sufferers.  Possible ways of handling these phenomena are suggested, based on Main's (1995) notion of ';meta-cognitive monitoring', in the hope of re-instating meaning and more stable self-structures, in these patients' lives.