Abstract
BackgroundImpairments in the domain of interpersonal functioning such as the feeling of loneliness and fear of abandonment have been associated with a negative bias during processing of social cues in Borderline Personality Disorder (BPD). Since these symptoms show low rates of remission, high rates of recurrence and are relatively resistant to treatment, in the present study we investigated whether a negative bias during social cognitive processing exists in BPD even after symptomatic remission. We focused on facial emotion recognition since it is one of the basal social-cognitive processes required for successful social interactions and building relationships.MethodsNinety-eight female participants (46 symptom-remitted BPD [r-BPD]), 52 healthy controls [HC]) rated the intensity of anger and happiness in ambiguous (anger/happiness blends) and unambiguous (emotion/neutral blends) emotional facial expressions. Additionally, participants assessed the confidence they experienced in their own judgments.ResultsR-BPD participants assessed ambiguous expressions as less happy and as more angry when the faces displayed predominantly happiness. Confidence in these judgments did not differ between groups, but confidence in judging happiness in predominantly happy faces was lower in BPD patients with a higher level of BPD psychopathology.ConclusionsEvaluating social cues that signal the willingness to affiliate is characterized by a negative bias that seems to be a trait-like feature of social cognition in BPD. In contrast, confidence in judging positive social signals seems to be a state-like feature of emotion recognition in BPD that improves with attenuation in the level of acute BPD symptoms.
Highlights
Impairments in the domain of interpersonal functioning such as the feeling of loneliness and fear of abandonment have been associated with a negative bias during processing of social cues in Borderline Personality Disorder (BPD)
Emotion intensity ratings When evaluating the intensity of the expressed facial emotion in ambiguous blends of happy and angry expressions, ratings differed between remitted BPD (r-BPD) subjects and healthy controls (HC) participants depending on the presented blend and the type of the required rating (“group” x “rating” x “blend”: F(2,192) = 5.31, p = .008, ηp2 = .052, see Fig. 1, Table 2): r-BPD subjects assessed predominantly happy blends as less happy (p = .010) and as more angry (p = .040), while no differences were observed for the evaluation of the other anger/happiness blends
When evaluating the intensity of the expressed facial emotion in neutral/emotion blends, r-BPD subjects assessed as a trend neutral/happy blends as less happy compared with HC subjects (“group” x “rating” x “blend”: F(1,102) =3.69, p = .058, ηp2 = .037, post hoc comparison for the rating of happiness in neutral/happy blends: p = .080, all other p > .47 for details see Fig. 1b)
Summary
Impairments in the domain of interpersonal functioning such as the feeling of loneliness and fear of abandonment have been associated with a negative bias during processing of social cues in Borderline Personality Disorder (BPD). Remission was here defined as no longer meeting study criteria for BPD (DSM-III-R) for a period of at least 4 years These promising findings are qualified by a markedly lower cumulative rate (54%) of recovery, i.e., remission combined with the achievement of a good overall outcome indicated by having ‘at least one emotionally sustaining relationship with a close friend or life partner’ and working ‘consistently, competently and on a full-time basis’ [5, 6]. This is consistent with treatment studies revealing low levels of social and vocational functioning even after BPDspecific psychotherapeutic interventions [7,8,9]. Both treatment and long-term prospective studies suggest high symptom instability as indicated by unstable treatment effects at follow-up [7], as well as faster and more frequently occurring symptomatic recurrence and loss of recovery in comparison with other axis II disorders [5]
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