{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:13:34Z","timestamp":1792088014189,"version":"4.4.0"},"reference-count":41,"publisher":"Guilford Publications","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bulletin of the Menninger Clinic"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>This article revisits the Bateson group's concept of the double bind, originally proposed as an etiological theory of schizophrenia, and reinterprets it as a central framework for understanding borderline personality disorder (BPD). We propose that paradoxical communication patterns in early development, characterized by contradictory and entrapping messages, become internalized and give rise to the structural and interpersonal paradoxes that define BPD. Drawing upon psychodynamic theory, empirical research, and contemporary object relations perspectives, we conceptualize BPD as a \u201cdisorder of paradox\u201d in which love and fear, autonomy and dependence, approach and avoidance coexist in irresolvable tension. The double bind provides a unifying model linking developmental origins, phenomenology, and clinical manifestations of BPD, while illuminating the transference dilemmas encountered in psychotherapy. Understanding paradox as the organizing principle of BPD restores coherence and depth to the disorder's psychodynamic formulation and offers guidance for treatment.<\/jats:p>","DOI":"10.1521\/bumc.2026.90.2.168","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:44:21Z","timestamp":1780937061000},"page":"168-185","source":"Crossref","is-referenced-by-count":1,"title":["Toward a double bind theory of borderline personality disorder"],"prefix":"10.1521","volume":"90","author":[{"given":"Mark L.","family":"Ruffalo","sequence":"first","affiliation":[{"name":"Assistant Professor of Psychiatry, University of Central Florida College of Medicine, Faculty, New Jersey Institute for Training in Psychoanalysis, and Adjunct Assistant Professor of Psychiatry, Tufts University School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerold J.","family":"Kreisman","sequence":"additional","affiliation":[{"name":"Associate Clinical Professor of Psychiatry, Saint Louis University School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"377","reference":[{"key":"ref1","volume-title":"Borderline psychopathology and its treatment.","author":"Adler G.","year":"1985"},{"key":"ref2","volume-title":"Psychotherapy with borderline patients: An integrated approach.","author":"Allen D. 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