Seeing Through the Borderline Lens: How Family Perceptions and Attributional Bias Shape Borderline Personality Disorder

Abstract

Borderline Personality Disorder (BPD) is marked by emotional dysregulation and interpersonal instability, with family environment recognized as a key etiological factor. While previous research has examined family characteristics from either the patient’s or relative’s perspective, this study systematically compares patientfamily dyads using genogram analysis and attributional bias assessment. This study compared patients with BPD and their relatives using genogram analysis and attributional bias assessment to investigate associations between symptom severity, attributional biases, and perceptions of emotional relationships and risk behaviors (ERRB). Six female patients with BPD receiving outpatient treatment in Brazil and six family members participated. Data were collected remotely and included a BPD symptom measure, an attributional bias task, and semistructured interviews for genogram construction exploring family ERRB. Patients showed higher intentionality scores (p = .0357) and more reports of physical abuse (p = .0235), whereas family members reported more distant/poor relationships (p = .0198). Categorical symptom severity correlated with suspected alcohol and drug use (p = .0117), and personalization bias predicted continuous symptom severity (β = 0.16, p = .0283). Qualitative analysis identified significant relationships within each dyad and the family members involved. These findings highlight how attributional biases and ERRB shape BPD symptoms and suggest that integrating family narratives with cognitive assessments enriches clinical understanding of underlying mechanisms.