What a Sense of Control Could Do for Borderline Personality

Perhaps you are one of those people who takes for granted the idea that what happens to you is a function of your own actions. The harder you work, the more you gain. Your community group is raising money through a half marathon, and you’d like to participate. Because your endurance skills aren’t exactly perfect, you decide to start getting in shape. Even though the odds of your winning seem low, you can at least improve enough, through diligent exercise, to make it to the end.

Now consider how you might feel if the thought of preparing for such an arduous test of your stamina seems completely overwhelming. Yes, you could start training, but you can also imagine the many things that, out of your control, could go wrong. The last time you tried something like this, the fates seemed to conspire, and bad weather plus poorly fitting sneakers led you to skulk away and hope no one saw how quickly you seemed to give up.

As it turns out, the distinction between what’s called an “internal” locus of control, in which you feel you control your destiny, and “external” locus of control, in which you attribute personal outcomes to luck or fate, is an important component of personality. In its heyday, research on locus of control occupied much of the focus of social and personality psychology. In determining its relationship to well-being, investigators eventually came to the conclusion that although an internal locus of control is somewhat adaptive, it can also become a barrier to psychological health when people can’t actually change the outcomes of their trials and tribulations. After all, you couldn’t really do much about the weather, could you?

Borderline Personality Disorder and Sense of Control

Despite the relative disappearance of locus of control from the literature, psychologists continue to investigate the related quality of personal agency, or the belief that effort will pay off. From this perspective, University of Wollongong’s Talia Hashworth and colleagues (2022) decided to frame their understanding of borderline personality disorder (BPD) as a manifestation of the loss of personal agency.

Specifically, the Australian researchers were intrigued by the possibility that the belief that they don’t control their life outcomes could contribute to symptoms in people with BPD such as a weak sense of self, attachment difficulties, impulsiveness, and emotional instability. Low personal agency could also make individuals with BPD feel that they are at the mercy of others when it comes to important relationship rewards such as affection and attention.

Citing evidence from prior studies, Hashworth and her colleagues proposed that by focusing an intervention on the sense of personal agency, it might be possible to help individuals with BPD benefit from psychotherapy. Previous findings, they note, suggest that people with BPD have a lower sense of personal agency. More to the point, though, an earlier intervention study showed that individuals with BPD who showed favorable results of treatment also reported improvement in their control of emotions along with increased personal agency. Nevertheless, the authors summed this previous research up by noting that “there is minimal knowledge regarding the influence of personal agency on treatment outcomes within a clinical sample” (p. 2).

Testing the Personal Agency Effect in Therapy

To address the gaps in this literature, the U. Wollongong researchers recruited a sample of 57 adults (mean age of 36 years; 90 percent female) with current or lifetime BPD diagnoses, 41 of whom were available for follow-up assessment at the 12-month time point (37 were available immediately after treatment ended). They were treated in an outpatient clinic with dialectical behavior therapy (DBT), the evidence-based approach known to have a high level of effectiveness. In addition to measuring BPD symptoms, the authors also asked participants to complete standard measures of depression and anxiety. In addition, using a measure based on what’s called the “alternative model for personality disorders” from the Diagnostic and Statistical Manual of Mental Disorders (the psychiatric diagnostic manual), the research team assessed the pathological personality traits thought to be associated with higher levels of severity in people with BPD.

The authors measured personal agency with an instrument developed early in the locus of control research era (Hill & Bale, 1980) that focuses specifically on mental health. You can rate yourself on these sample items from their scale:

1. People with psychological problems should play a large part in planning their treatment.
2. The lives of people with psychological problems are so complicated that it is almost impossible for them to figure out what they should do to make things better.
3. When an individual goes to a therapist for help, that individual should expect to take most of the responsibility for getting better.

(The first and third item represent internal and the second represents external locus of control with respect to mental health and therapy.)

Because this scale is intended to assess therapy-specific aspects of locus of control, or personal agency, it avoids some of the theoretical issues involved in general locus of control measures.

Turning to the results, as the authors predicted, the sample members showed reductions in their BPD symptoms after treatment, and again one year later. Depression and anxiety scores showed no change, nor did pathological personality traits, but, as Hashworth et al. noted, therapy focused on BPD symptoms.

The prediction that personal agency would affect the outcome of therapy was supported by the finding that those with higher scores at intake also showed the greatest improvement. Personal agency itself, however, did not show changes across the course of the study. As the authors concluded, “personal agency may be a stable variable and may be resistant to change” (p. 7). Yet, personal agency “may be a key factor influencing therapeutic change” (p. 6).

Implications for Helping Those With BPD

If indeed personal agency serves to predict the positive outcome of therapy but itself is difficult to change, the Australian findings suggest that one way to help an individual with BPD is to explore their feelings about how much control they have over their inner states. You might ask this individual questions along the lines of the locus of control measure just to see how much they feel they could ever change. Moving on from there, you might explore their own sense of control over their emotions and ability to regulate those emotions.

By showing that personal agency helped to predict therapeutic outcomes, the U. Wollongong research also has implications for a broader level of understanding of the value of feeling in control, particularly for outcomes that actually can respond to your influence. Returning to the example of the half marathon, you can’t determine whether it rains or not, but you can decide on the level of effort you put into your preparation. If something goes wrong, at least you will have done what you could to ensure a successful outcome.

For those with BPD, the Hashworth et al. findings provide a new way of looking at their symptoms. Do they feel helpless and demoralized about change? Do they enter into treatment, when they do, expecting the worst? You can see that even the best form of therapy, which in this case was DBT, might prove ineffective in individuals who hand over the power for change to a therapist. Although a lifetime of BPD symptoms may lead them to feel they can’t do anything about their condition, a reframing of their sense of autonomy could potentially help them make inroads into their long-standing disorder.

To sum up, research on personality shows that change is always possible. For those with personality disorders, whose personalities may have become rigidly maladaptive, the knowledge that they can change may very well help to break this vicious cycle and provide a path toward fulfillment.