Abstract
ObjectivesBorderline personality disorder (BPD) is portrayed by unstable relationships, fears of abandonment and heightened sensitivity to social rejection. Research has shown that these characteristics may lead to inappropriate social behavior including altered approach-avoidance behavior. However, it has remained unclear how social exclusion may affect approach-avoidance behavior in patients with BPD.DesignWe assessed social approach-avoidance behavior and the impact of social exclusion in a sample of 38 patients with BPD and 40 healthy control participants.MethodsWe used an explicit joystick-based approach-avoidance task (AAT) after playing a virtual ball-tossing game (Cyberball), which simulates the exclusion of the participant by two other players. In the AAT, participants were required to push or pull emotional stimuli, more specifically happy and angry facial expressions, with either direct or averted gaze direction.ResultsPatients with BPD approached happy stimuli less and showed overall less differential approach-avoidance behavior toward individuals expressing positive or negative facial emotions compared to healthy participants, who showed more approach behavior for happy compared to angry facial expressions. Moreover, borderline symptom severity correlated inversely with the AAT score for happy facial expressions and positively with subjective unpleasantness during social exclusion as well as rejection sensitivity. However, social exclusion did not influence approach-avoidance tendencies.ConclusionPatients with BPD showed altered approach-avoidance behavior, which might affect social interactions in the patient’s everyday lives and may therefore impede social interaction.
Highlights
Borderline personality disorder (BPD) is characterized by fears of abandonment, poor emotion regulation, difficulties in impulse control, fragile self-images, and unstable relationships with significant others
BPD frequently co-occurs with depressive symptoms and suicidal ideas (Beatson and Rao, 2013), whereby emotion dysregulation seems to be related to negative affect, emotional hypersensitivity and maladaptive coping mechanisms (Carpenter and Trull, 2013)
Mood states are influenced by social stimuli such as facial expressions of emotions
Summary
Borderline personality disorder (BPD) is characterized by fears of abandonment, poor emotion regulation, difficulties in impulse control, fragile self-images, and unstable relationships with significant others. Difficulties in emotion regulation are known to impact patients’ tolerance of social closeness and intimacy, and often cause aversive responses such as disruption of social relationships (Skodol et al, 2002). With regard to individuals with BPD, it is known that patients evaluate expressions of low mood as more severe than healthy controls, and even tend to judge neutral affective stimuli as negative. Together, this bias in appreciating other people’s emotions in more negative ways may contribute to difficulties in regulating interpersonal distance (Barnow et al, 2009; Baer et al, 2012) and impact patients’ approach-avoidance behavior
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