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Couples’ Negative Interaction Behaviors and

Borderline Personality Disorder

Béatrice de Montigny-Malenfant , Marie-Ève Santerre , Sébastien Bouchard ,

Stéphane Sabourin , Ariane Lazaridès & Claude Bélanger

To cite this article: Béatrice de Montigny-Malenfant , Marie-Ève Santerre , Sébastien Bouchard ,

Stéphane Sabourin , Ariane Lazaridès & Claude Bélanger (2013) Couples’ Negative Interaction
Behaviors and Borderline Personality Disorder, The American Journal of Family Therapy, 41:3,
259-271, DOI: 10.1080/01926187.2012.688006

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The American Journal of Family Therapy, 41:259–271, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2012.688006

Couples’ Negative Interaction Behaviors

and Borderline Personality Disorder

BÉATRICE DE MONTIGNY-MALENFANT and MARIE-ÈVE SANTERRE

School of Psychology, Université Laval, Québec, Canada

SÉBASTIEN BOUCHARD
Clinique des troubles relationnels de Québec, Québec, Canada

STÉPHANE SABOURIN
School of Psychology, Université Laval, Québec, Canada
ARIANE LAZARIDÈS
Departement of Psychology, Université du Québec à Montréal, Montréal, Canada
CLAUDE BÉLANGER
Departement of Psychology, Université du Québec à Montréal, Montréal, Canada, Faculty of
Medicine, McGill University, Montréal, Canada, and Douglas Mental Health University
Institute, Montréal, Canada

Borderline personality disorder (BPD) is a severe mental health

problem predisposing to dysfunctional interaction behaviors and
negative couple outcomes. This study aimed to assess, through di-
rect observation, the quality of relationships of couples in which
women were diagnosed with BPD. The sample consisted of 28 cou-
ples in which the woman had BPD, and 82 community couples.
Couples’ interactions were coded using three scales—withdrawal/
avoidance, dominance, and criticism/attack/conflict—from the
Global Couple Interaction Coding System. Couples in which the
women had BPD evidenced significantly more negative behaviors,
particularly dominance behaviors, than community couples. More-
over, in BPD couples, women adopted Criticism/Attack/Conflict be-
haviors more frequently than men.

Preparation of this article was supported by the Fonds de la Recherche en Santé du

Québec and the Centre de recherche interdisciplinaire sur les problèmes conjugaux et les
agressions sexuelles.
Address correspondence to Béatrice de Montigny-Malenfant, School of Psychology,
Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Bureau 1116,
QC G1V 0A6, Canada. E-mail: [email protected]

259
260 B. de Montigny-Malenfant et al.

Borderline Personality Disorder (BPD) is a serious mental disorder that

predisposes to clinically significant couple distress and union dissolution
(Bouchard & Sabourin, 2009). It is characterized by unstable interpersonal
relationships, self-image, and emotions, as well as by marked impulsivity
(American Psychiatric Association [APA], 2000). This instability often results
from intense and chronic fears of abandonment in intimate relationships
typical of people with BPD (Gunderson & Hoffman, 2005). Scheirs and Bok
(2007) underlined that the core characteristics of BPD represent a heavy
burden not only for those with the disorder, but also for their families, chil-
dren and partners. In addition, whether they are guided by traditional or
recent evidence-based models of treatment (Clarkin, Yeomans, & Kernberg,
2006; Giesen-Bloo et al., 2006), clinicians describe the social and marital
functioning of people with BPD as being chaotic (Lachkar, 1992). Yet early
preliminary empirical data only partially support these observations, which
are primarily derived from case studies. Moreover, to our knowledge, there
are no studies of direct interactions within couples in which one partner has
BPD. In order to explore this avenue of research, the aim of this study was
to observe negative conflict resolution behaviors among these couples and
to compare these behaviors to those of a community control group.
A conceptual analysis of the diagnostic criteria used in the DSM-IV-TR
suggests that seven of the nine criteria for BPD are potentially associated with
a reduction in the quality of interpersonal and couple relationships (Hoffman,
Buteau, Hooley et al., 2003). These seven criteria include frantic efforts to
avoid abandonment (real or imagined), volatile interpersonal relationships
characterized by rapid oscillations between idealization and devaluation of
the other, identity disturbance and unstable self-image, marked impulsivity
in several areas (for example, sex, substance abuse, impulsive spending),
suicidal and self-mutilation behaviors, affective instability associated with
marked reactivity of mood, and intense and inappropriate anger behaviors
(Gunderson & Hoffman, 2005).
These theoretical observations are also supported by clinical case study
series concluding that BPD is associated with severe couple dysfunction and
volatile interaction patterns (Fruzzetti & Fruzzetti, 2003; Lachkar, 1992). In-
deed, several clinicians report a paradoxical representation of these couple
relationships, characterized by intense need for closeness and attention, but
in which aggressive behaviors marked by rejection, contempt and hate to-
ward the partner are also manifested (Fruzzetti & Fruzzetti, 2003; Links &
Stockwell, 2001). The majority of clinicians also agree on the greater pres-
ence of pathological jealousy within these couples (Fruzzetti & Fruzzetti,
2003; Stone, 1985). This jealousy may be rooted in the history of abandon-
ment and sexual trauma often common to the childhoods of people present-
ing BPD. These experiences engender feelings of shame and humiliation,
as well as fears of abandonment that are often re-experienced in adult cou-
ple relationships (Fruzzetti & Fruzzetti, 2003) and transformed into violence
 Conflict Resolution Behaviors 261

(Dutton, Van Ginkel, & Landolt, 1996). According to Stone (1985), jealousy
may be partly the result of interpretative biases regarding the intentions and
feelings of one’s partner. Consequently, people with BPD may be intrusive,
demanding and accusatory regarding their partner’s fidelity.
Clinical observations also suggest that the partners of people with BPD
may contribute to the chaotic relationships that are thought to characterize
these couples. They may, for example, manifest feelings of confusion and
be unable to predict their partner’s mood shifts. This burden may produce
feelings of powerlessness and exhaustion, and may eventually lead to the
desire to end the relationship (Stone, 1985). On the other hand, according to
Weddige (1986), the partners of people with BPD tend to blame themselves
for some of their partners’ dysfunctional behaviors, more specifically suicidal
and self-mutilation behaviors. In order to avoid these dysfunctional behav-
iors and displays of anger from the partner with BPD, the partner without
BPD may give in to the other’s demands and become excessively devoted
(Weddige, 1986).
Among couples in which one partner has BPD, the limited available em-
pirical evidence shows that patterns of unstable self-image and mood typical
of BPD may represent an obstacle to the coveted person’s ability for com-
mitment in close relationships (Bouchard & Sabourin, 2009). BPD is signifi-
cantly associated with couple dysfunction, intimate violence, as well as with
a pattern of episodic relationship instability (Bouchard, Sabourin, Lussier, &
Villeneuve, 2009). Other studies also emphasize both physical and psycho-
logical violence (Zanarini et al., 1999). For example, Zanarini and colleagues
(1999) compared individuals with BPD to people with other personality dis-
orders. Their findings revealed that women with BPD were twice as likely
to be victims of physical and sexual violence in adulthood than women suf-
fering from other personality disorders. In addition to increased violence,
some authors have demonstrated that BPD, or its traits, are associated with
the frequency of couple conflicts (Daley, Burge, & Hammen, 2000), clinically
significant couple distress among both partners, and a self-reported demand-
withdraw communication style (Bouchard et al., 2009). However, the usual
pattern observed in community couples, in which women make demands
and men withdraw (Christensen et al., 2006), was reversed in BPD coupes.
In these couples, men reported making more demands and women felt they
withdrew more frequently. These couples also reported less constructive
mutual communication and more discussion avoidance. The self-reported
nature of these data must be underlined, and direct observations of commu-
nication behaviors are needed. In addition, observed effect size coefficients
were often moderate and did not support the monolithic, overly chaotic
vision of couple relationships endorsed by some clinicians.
Other findings call for caution before concluding that a BPD diagnosis
necessarily implies severely disorganized couple relationships. More specifi-
cally, while emphasizing the risks incurred by these individuals with regards
262 B. de Montigny-Malenfant et al.

to relationship quality and stability, many studies have also demonstrated

the presence of viable short- and medium-term unions. For example, a sig-
nificant proportion (nearly 30%) of people with BPD who are in a loving
relationship live together or are married (Bouchard et al., 2009; Giesen-Bloo
et al., 2006; Zanarini, Frankenburg, Hennen et al., 2005). Other preliminary
findings reveal the presence of lower rates of couple dissatisfaction among
these couples than among those in couple therapy (Verreault, Sabourin,
Lussier, Normandin, & Clarkin, 2013). Past studies have also been plagued
by methodological problems that limit the generalizability of results: 1) most
of the conclusions are based on studies of mixed groups of patients pre-
senting different personality disorders and not BPD alone (Chen et al., 2004;
Gutman et al., 2006); 2) some studies used samples of students who only
present borderline personality traits (Daley et al., 2000), whereas others used
samples of hospitalized patients (Zanarini et al., 1999); 3) few studies mea-
sured the psychological characteristics of the partners of people with BPD,
or the evaluation that both partners make of the quality of their relationship
(Bouchard et al., 2009; Daley et al., 2000); 4) researchers do not system-
atically distinguish whether it is the man or the woman who has BPD in
such couples; and 5) all of the studies assessed the quality of the couple
relationship using self-report measures. The use of these measurement in-
struments provides a subjective assessment of relationship behaviors that
is subject to minimization or over-reporting biases. Currently, it appears as
though no studies have investigated couples in which one member has BPD
using direct observation of their behaviors.
This study thus aims to evaluate the quality of relationships of couples
in which women were diagnosed with BPD, using behavioral observation
of their interactions. The first hypothesis stipulated that, compared to com-
munity couples, couples in which the woman had BPD would present more
overall negative problem-solving behaviors during their interactions. These
negative behaviors refer to withdrawal, dominance or attack behaviors to-
ward their partner. Such behaviors are generally considered to be indicators
of chaotic and dysfunctional relationships (Fruzzetti & Fruzzetti, 2003). The
second hypothesis was that among couples in which the woman had BPD,
women would manifest more negative problem-solving behaviors than their
partners.

METHOD
Participants
BPD COUPLES
The sample of BPD couples was comprised of 28 heterosexual married
(n = 7), cohabiting (n = 12), and non-cohabiting (n = 9) couples. The
average age of the women and men from the clinical group was 33.68 years
 Conflict Resolution Behaviors 263

(SD = 10.88) and 37.46 years (SD = 12.54) respectively. The women met
the DSM-IV diagnostic threshold for BPD according to both their psychiatrist
and the SCID-II-borderline section. They met a mean of 7.39 BPD criteria
(SD = 1.40) out of a possible total of nine. Women with BPD had a mean
Global Assessment of Functioning score (GAF; APA, 2003) of 48.82 (SD =
5.34). The mean GAF score of their partners was 67.46 (SD = 8.93). Mean
duration of relationship was 6 years (SD = 9.16). Cohabitating couples had
been living together for a mean duration of 5 years and 1 month (SD =
8.25 years). Most of the women (M = 11.36 years of school, SD = 2.8) and
their partners (M = 12 years, SD = 2.9) had completed high school.
Women with BPD and their partners were invited to participate in the
study by therapists from a hospital-based treatment program for severe per-
sonality disorders. To be eligible, women had to have been diagnosed with
BPD, and be in a heterosexual couple relationship for at least two months
in which both partners were 18 years old or older. They also had to agree
to be videotaped during a conflict resolution discussion in a research lab-
oratory. The sample originally consisted of 35 couples, but seven couples
were removed from the study: six couples refused to be videotaped and one
couple was excluded because both partners reported severe and persistent
psychotic symptoms.

COMMUNITY COUPLES
The nonclinical sample included 82 couples, 39 of which were married and
43 were cohabiting. Women were on average 34.01 years old (SD = 8.62),
whereas their partners were on average 36.79 years old (SD = 9.61). Couples
had been living together for an average of seven years and seven months
(SD = 7.51 years). The average number of years of education for women
was 15.71 years (SD = 2.91) and 16.41 years (SD = 3.81) for their partners.
Participants were selected from an original sample of 315 couples recruited
from within the community through various media for a study conducted
in a university-based research laboratory (Lazaridès, Bélanger, & Sabourin,
2010a, 2010b). To be eligible, participants had to be 18 years old or older,
cohabiting or married for more than six months and agree to be videotaped
during a conflict resolution discussion.

Measures
COMMUNICATION BEHAVIORS
The Global Couple Interaction Coding System (GCICS; Bélanger et al., 1993)
was used to assess communication behaviors. This macroanalytic coding
system measures three negative and two positive dimensions of couples’
264 B. de Montigny-Malenfant et al.

problem-solving interactions. In the current study, only the three negative

dimensions were selected since 1) negative behaviors are better predictors of
marital adjustment than positive behaviors, and 2) there is a strong negative
correlation between negative and positive behaviors (Bélanger et al., 1993).
Indeed, the correlations are –.74 for men and –.66 for women (p < .005).
The three negative dimensions are: (a) Withdrawal/Avoidance: withdrawing
from discussion, avoidant nonverbal behavior, (b) Dominance: control and
direction of the discussion, and (c) Criticism/Attack/Conflict: criticism, blame,
threat, nonverbal hostility display, negative mind-reading and negative es-
calation. Stubbornness, considered to be a passive aspect of dominance,
was also included in this dimension (Gottman & Krokoff, 1989). A global
score is calculated by averaging scores on these three dimensions. All neg-
ative dimensions are rated on a 4-point Likert scale: 0 = not displayed, 1
= weakly displayed, 2 = moderately displayed, and 3 = strongly displayed.
The GCICS’s discriminant validity was supported in a study showing that
these communication behaviors are related to couple satisfaction (Bélanger
et al., 1993). Intraclass correlation coefficients for Withdrawal/Avoidance,
Dominance and Criticism/Attack/Conflict were, respectively, .61, .76, and
.84 for women and .84, .79, and .90 for men (Bélanger et al., 1993).

Procedure
After signing a consent form, clinical and community couples were video-
taped during a 15-minute conflict resolution discussion. The topic of the
discussion was a medium-intensity conflict chosen based on partners’ an-
swers to the Potential Problem Checklist (Patterson, 1976). Before beginning
the discussion, the experimenter made sure that the participants agreed upon
the chosen topic.
Couples’ 15-minute discussions were coded by two teams of two under-
graduate and graduate students in psychology who received training in cod-
ing problem-solving interactions with this instrument. The discussions were
divided into three 5-minute segments. Each segment was viewed twice: once
to code the woman’s behaviors and once to code the man’s behaviors. For
each of the three negative dimensions, the woman’s behaviors were given
a score on the 4-point Likert scale according to the frequency, intensity and
duration of the behaviors observed during each of the three segments. For
example, “absence of assertive behaviors” is one of the verbal behaviors
coded in the Withdrawal/Avoidance dimension, whereas “gives orders, in-
structions or advice” is one of the verbal behaviors coded in the Dominance
dimension.
After viewing the three 5-minute segments, a total score, not displayed,
weakly displayed, moderately displayed, and strongly displayed, was as-
signed to each behavior within the dimensions based on the three segments.
 Conflict Resolution Behaviors 265

Then, an overall score for the entire dimension (for example, Criticism/
Attack/Conflict) was established by adding the total scores obtained on each
of the behaviors from this dimension. Moreover, a global score for all of the
negative dimensions was obtained by averaging the overall scores on the
three dimensions. This procedure was applied to code both the women and
men’s behaviors. Finally, a global score for each couple was calculated by
averaging the scores of each member of the couple on the negative behav-
ior dimensions. For clinical couples, intercoder agreement was calculated
on 18 out of the 28 couples with intraclass correlation coefficients, using
the global scores on all of the three negative behavior dimensions. Average
intercoder agreement was .93, which denotes near-perfect agreement ac-
cording to Bech and Clemmensen (1983). Intercoder agreement for control
group couples was also calculated for 25 couples. The intercoder agreement
ranged from .84 to .90, which is also nearly perfect according to Bech and
Clemmensen’s scales (1983).

RESULTS
Differences Between Couples
Educational background represents a potentially confounding variable since
it is generally acknowledged by researchers that patients with severe per-
sonality disorders, as well as their partners, are less educated. In the present
study, couples in which the woman had BPD (M = 11.71, SD = 2.37) had
significantly fewer years of education than couples from the control group
(M = 16.00, SD = 2.84), t (108) = –7.18, p < .05. Thus, this variable was con-
trolled through analysis of covariance (ANCOVA). This ANCOVA allowed a
comparison of the clinical and community couples on the negative behavior
scores while controlling for the variability explained by education. The re-
sults of this ANCOVA showed that education did not significantly contribute
to the variance in global score for the three negative dimensions, F (1, 107) =
0.00, p > .05.
When the three negative behaviors were combined, couples in which
the woman was diagnosed with BPD (M’ = 0.81, SD = 0.08) had significantly
higher global scores than community couples (M = 0.56, SD = 0.04), F (1,
107) = 7.5, p < .05, η2 = .07. When each negative behavior was analyzed
separately, the results showed that BPD couples (M = 1.25, SD = 0.71)
had significantly higher scores on the Dominance dimension than couples
from the control group (M = 0.69, SD = 0.44), t (108) = 4.89, p < .05,
d = 0.14. No significant difference was observed for Withdrawal/Avoidance
(BPD couples, M = 0.46, SD = 0.45, and community couples, M = 0.49,
SD = 0.43), t (108) = −0.24, p > .05, d = 0.13) or Criticism/Attack/Conflict
(BPD couples, M = 0.66, SD = 0.67, and community couples, M = 0.50, SD
= 0.50, t (108) = 1.35, p > .05, d = 0.00).
266 B. de Montigny-Malenfant et al.

Correlations were computed to determine whether the negative dimen-

sions were interrelated. The results showed that these three dimensions were
positively related. Indeed, there was a significant positive correlation be-
tween the Dominance and Criticism/Attack/Conflict dimensions, r = .52,
p < .05. However, the relationship between the Withdrawal/Avoidance,
Dominance (r = −.20, p > .5) and Criticism/Attack/Conflict dimensions
(r = –.11, p > .05) did not reach significance.

Between-Partner Differences on Negative Behaviors Within BPD

Couples
The between-partner differences on negative behaviors within BPD couples
was not significant for global negative behavior scores (women with BPD,
M = 0.83, SD = 0.57, men, M = 0.75, SD = 0.41, t (27) = 0.70, p > .05,
d = 0.13). However, when comparing overall scores from each of the three
dimensions separately, the results revealed that women (M = 0.86, SD =
0.97) obtained a significantly higher score on the Criticism/Attack/Conflict
dimension than their partners (M = 0.46, SD = 0.64), t (27) = 2.17, p < .05, d
= 0.41. There were no significant sex differences for Withdrawal/Avoidance
(women with BPD, M = 0.39, SD = 0.57, men, M = 0.54, SD = 0.84, t (27)
= −0.68, p > .05, d = 0.13) or Dominance (women with BPD, M = 1.25,
SD = 0.80, men, M = 1.25, SD = 0.98, t (27) = 0.00, p > .05, d = 0.00).

DISCUSSION

The main objective of this study was to assess relationship quality us-
ing behavioral observation of interactions within couples in which women
were diagnosed with BPD. Relationship quality was measured through with-
drawal/avoidance, dominance, and criticism/attack/conflict, the three neg-
ative dimensions of a macroanalytic scoring system of marital interactions,
the GCICS. Two hypotheses were formulated. The first hypothesis, that cou-
ples in which the woman had BPD would present more negative general
problem-solving skills during their interactions than community couples, was
confirmed. Indeed, during their interactions, these couples obtained higher
overall scores on the negative behavior dimensions. Both community and
BPD couples displayed withdrawal and criticism behaviors during conflict
resolution. However, couples in which the woman had BPD adopted more
dominance behaviors than community couples. Thus, in BPD couples, there
was more asymmetry in efforts to directly control or dominate the conver-
sation. In these couples, both partners were more stubborn, more resistant
and less inclined to change their opinion. When discussing to find solutions
for a relationship problem, they both attempted to control the conversation.
 Conflict Resolution Behaviors 267

As expected, BPD was associated with various negative problem-solving

communication behaviors typically displayed in dysfunctional couple inter-
actions. This is an important finding for three reasons. First, past observa-
tional studies of community and clinically distressed couples have repeatedly
shown that these negative conflict-resolution behaviors lower relationship
quality and stability (Snyder, Heyman, & Haynes, 2008). Thus, to our knowl-
edge, this is the first study to extend these findings to couples in which the
woman has been diagnosed with BPD. The partners of couples in which
one member had BPD used aggressive and dysfunctional behaviors towards
one another when attempting to solve problems. These aggressive and dys-
functional behaviors may have long-term negative repercussions on BPD
and exacerbate the disorder’s symptoms. This exacerbation may in turn fuel
couple distress and hinder relationship satisfaction (Schumacher & Leonard,
2005).
Second, the small number of past studies on couple relationships in BPD
has been solely based on self-report questionnaires, which are vulnerable to
social desirability. The conclusion that BPD is related to clinically significant
couple distress now rests on more robust empirical grounds. The results of
past self-report studies show that BPD couples resort to negative behaviors
and are involved in dissatisfying couple relationships. For example, Bouchard
and colleagues (2009) observed that BPD predicted self-reported communi-
cation avoidance. The results of the present study constitute an important
extension of these findings, as they establish that these couples also present
a notable objective decrease in affirmative behaviors during videotaped dis-
cussions, indicating withdrawal from communication. This interaction pattern
may negatively impact problem-solving effectiveness as well as relationship
quality and stability.
Third, the results cast doubt on the generalized, highly chaotic vision
of couple relationships presented in most clinical accounts of BPD. No sig-
nificant difference between community and BPD couples was observed for
avoidance and criticism behaviors. Moreover, the significant difference re-
ported for dominance produced a small effect size. Thus, the presence of
BPD is certainly not the only factor responsible for the adoption of nega-
tive behaviors in problem-solving situations. This is not to say that severely
chaotic couple relationships are not overrepresented in BPD samples. This
should remain an open-question awaiting further empirical data. The de-
velopment of a more balanced, evidence-based perspective is important
because the very negative portrayal of couples in which one partner has
BPD probably limits their access to effective couple treatment.
The second hypothesis, that women with BPD would present more neg-
ative problem-solving behaviors than their partners, was not confirmed when
all negative behaviors were cumulated. The results suggest that women with
BPD and their partners generally adopt similar levels of avoidance, domi-
nance and criticism behaviors. A priori, these findings may appear surprising,
268 B. de Montigny-Malenfant et al.

as clinicians often expect the partner with BPD adopt more negative behav-
iors within the couple. These results rather suggest that when one member
of a couple has BPD, both partners contribute to negative interactions. One
possible explanation for the lack of difference between women with BPD
and their partners may be the presence of mental disorders among part-
ners of women suffering from BPD. There is some evidence that the rate
of personality disorders in these partners is significantly higher than in the
general population (Bouchard et al., 2009). This observation partially sup-
ports the prevalent clinical hypothesis that these partners share negative
personality traits, possibly through assortative mating (Merikangas, 1982).
This may explain why both partners adopt dysfunctional behaviors during
couple interactions.
However, when examining each of the negative interaction behaviors
separately, women with BPD used more criticism and verbal attack behav-
iors than their partners. This result may be explained by the symptoms
inherent to BPD. Indeed, people who present this disorder have a greater
propensity for irritability, as well as for intense and inappropriate displays
of anger. Future studies should assess whether personality traits associated
with criticism—negative affectivity, impulsivity, and so on—moderate the
association between BPD and criticism/attack behaviors. It is again impor-
tant to remain cautious, as the effect size associated with this within-couple
difference was small (Cohen, 1988).
There are some limitations to the present study. First, couples in which
the woman had BPD would ideally have been matched to couples from
the general population according to age, number of years of education, and
duration of the relationship. It would have thus been possible to ensure that
these factors did not account for the observed between-group differences.
However, analysis of covariance showed that number of years of education
did not contribute significantly to negative behavior dimension ratings. Sec-
ond, it is important that future studies include comparison groups formed of
patients suffering from a non-BPD personality disorder, or of partners from
clinically distressed couples. This would help determine if certain negative
interaction couple behaviors are specific to BPD. Third, the behavioral mea-
sure used in the present study, the GCICS, was not specifically adapted to
dysfunctional behaviors typical of BPD, and its negative interaction behaviors
are not mutually exclusive. For example, a partner may have a high rating
on the dominance dimension while using criticism to dominate. As such, it is
possible that certain negative dimensions are under- or over-estimated when
using a macroanalytic couple coding system. In future studies, interaction
behaviors should be analyzed using a coding system specifically designed
to identify the interpersonal manifestations of BPD. Finally, in the present
study, community couples were not screened for BPD. As such, it is possible
that some of these partners may have suffered from BPD.
 Conflict Resolution Behaviors 269

At a clinical level, our results provide clinicians, who may encounter an

increasing number of couples where one member has BPD, with initial evi-
dence on their clients’ interaction patterns. The slowly growing database on
these couples can be used to guide couple assessment. The results tentatively
indicate that the well-recognized pattern of heterogeneity in BPD symptoma-
tology should also be considered when assessing couple functioning. As a
consequence, this population should not be automatically denied couple
treatment (see Links & Stockwell, 2001 for a discussion of this issue). Case-
by-case decisions should be made using evidence-based couple assessment
practices (Snyder et al., 2008), supplemented by measures examining the
severity of personality pathology (Caligor & Clarkin, 2010). For the time be-
ing, there are no evidence-based guidelines specifically designed to treat
couples in which one partner suffers from BPD. However, working from
empirically supported therapy manuals developed for individuals diagnosed
with BPD, preliminary clinical recommendations for couple treatment can
be identified. Fruzzetti and Fruzzetti (2003) have adapted dialectical behav-
ior therapy for couples. Pervasive emotional dysregulation is viewed as the
central feature of BPD and as an etiological factor leading to chaotic couple
relationships. Communication and validation training is thus supplemented
by emotion regulation techniques. Mindfulness, distress tolerance, and rad-
ical acceptance are applied to deescalate conflicts before they grow out of
proportions. Kernberg (1995) has promoted an object relation treatment for
couples, which is based on transference-focused psychotherapy, an indi-
vidual model of therapy for BPD that is supported by randomized clinical
trials (Caligor & Clarkin, 2010). In this approach, the couple’s dominant ob-
ject relations are first identified and clarified (e.g., self as weak, vulnerable,
and abandoned versus a partner that is perceived as mean, exploitative and
needed in the context of an affective relation based on suspicion and resent-
ment). This clarification process allows each partner to become aware of the
distortions that are brought in the relationship. Partners also progressively
learn to modulate extreme affects. Both these approaches take into account
the negative couple behaviors identified in the present study and aim to
improve affect regulation through different techniques. Thus, in certain con-
ditions, couple therapy may be an essential component of an integrated
treatment approach to BPD.

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