Context: The borderline personality disorder (BPD) encompasses an unstable self-image, often with excessive self-criticism, emotional instability and excessive anger. Anger can be classified as primary assertive anger and as secondary rejecting anger. This rejecting anger can express itself by accusing another person or by being very critical and harsh with oneself. This can be expressed in the self-criticism via the emotion of contempt directed at the self. Anger prone subjects were found to express high levels self-contempt in their self-criticism. A previous study found that an increase in assertive anger was mediated the decrease in symptoms, while no decrease in rejecting anger was found. But there was no paradigm to measure it.
Objectives: It is expected that BPD patients show high levels of self-contempt. The aim of this study was to explore in the setting of an experimental procedure the change in self-contempt in BPD patients after a brief treatment and its relationship with a possible change in symptoms.
Methodology: 8 female BPD patients were recruited for this study. The treatment consisted in 10 therapy sessions following a manual adapted from the “Good Psychiatric Management” (GPM) over a 3-months period. Assessments took place before and after the treatment. It consisted in a two-chair dialogue with 3 sub-steps; they were first asked to imagine a situation of failure, then to change chair and be self-critical about this situation, then to change back again and respond to this critic. Self-contempt was coded during the second sub-step using a specific coding scheme. Symptoms were assessed before and after treatment.
Results: This study has found that a brief therapy already has an effect on the level of rejecting anger in BPD patients, and more specifically self-contempt. We have showed that a high level of self-contempt before treatment is associated with good outcome concerning the symptomatology and could thus be a possible predictor of good outcome. We have linked the decrease in self-contempt after treatment with the decrease in symptoms.
Conclusions: Our pilot study was vastly limited by the small sample, not permitting us to draw firm conclusions, and it should be repeated in a larger sample to confirm our findings. Its exploratory nature did not allow us to show causality between two variables. The two-chair dialogue could be used to screen for BPD patients showing high levels of self-contempt, and thus be possible good responders to brief treatment. Self-contempt could be an early target for treatment if its decrease is later shown to be a mechanism of symptom change.