The wandering mind in borderline personality disorder: Instability in self- and other-related thoughts (original) (raw)
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Psychiatry Research, 2017
Disturbed interpersonal relationships and misreading of others' intentions are core symptoms of borderline personality disorder (BPD). Despite these impairments, some studies have found an enhanced theory of mind (ToM) in BPD patients. Taking this into consideration, the current study attempts to further understand these discrepancies by separating ToM into two domains: affective and cognitive. Moreover, the study considered the role of comorbid symptoms of depression in these patients. Subjects were 21 patients with BPD, 23 patients with BPD and comorbid major depressive disorder (MDD), and 25 healthy controls (HC). ToM was measured with the Reading the Mind in the Eyes Test (RMET) and the Faux Pas Task, which assessed the affective and cognitive aspects of ToM, respectively. In addition, all participants were evaluated with the Beck Depression Inventory (BDI). Results showed that in both BPD groups (i.e., BPD
Theory of mind disturbances in borderline personality disorder: A meta-analysis
Psychiatry Research
Impairments of theory of mind (ToM) are widely accepted underlying factors of disturbed relatedness in borderline personality disorder (BPD). The aim of this meta-analysis a was to assess the weighted mean effect sizes of ToM performances in BPD compared to healthy controls (HC), and to investigate the effect of demographic variables and comorbidities on the variability of effect sizes across the studies. Seventeen studies involving 585 BPD patients and 501 HC were selected after literature search. Effect sizes for overall ToM, mental state decoding and reasoning, cognitive and affective ToM, and for task types were calculated. BPD patients significantly underperformed HC in overall ToM, mental state reasoning, and cognitive ToM, but had no deficits in mental state decoding. Affective ToM performance was largely task dependent in BPD. Comorbid anxiety disorders had a positive moderating effect on overall and affective ToM in BPD. Our results support the notion that BPD patients' have specific ToM impairments. Further research is necessary to evaluate the role of confounding factors, especially those of clinical comorbidities, neurocognitive functions, and adverse childhood life events. Complex ToM tasks with high contextual demands seem to be the most appropriate tests to assess ToM in patients with BPD.
Nobody? Disturbed Self-Experience in Borderline Personality Disorder and Four Kinds of Instability
Time and Body, 2020
Borderline Personality Disorder (BPD) is a complex psychological condition which severely affects many different aspects of the life of persons suffering from it. Its broad impact is reflected in the DSM-criteria of diagnosis, which applies if five out of the nine following symptoms are present: unstable personal relationships, identity disturbances, impulsivity, self-mutilation, affective instability due to reactivity of mood, chronic feelings of emptiness, intense anger or difficulties in controlling anger, peculiar behavior to avoid abandonment, and paranoid ideation. Such a variety of symptoms implies heterogeneity in the manifestation of BPD across individuals. Yet in all cases BPD appears to consist in "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity" (American Psychiatric Association, 2013, p. 663), as the DSM's definition suggests. While there is broad agreement on the latter, two related questions have remained unanswered in the vast literature on BPD. Both concern its clinical picture: (1) How does the BPD instability pattern emerge and persist over time? (2) How do phenomena associated with the different kinds of instability relate to each other? Not only do researchers diverge significantly in their understanding of the development of BPD, the causal factors that are taken to underlie the BPD instability pattern are as multifarious as trauma in young age, emotional, sexual or physical abuse, parental neglect or invalidation in the home environment, neurophysiology (lack of oxytocin), and organic brain disease or trauma (Cameron, Calderwood & McMurphy, 2018; Keinänen, Johnson, Richards & Courtney, 2012). Moreover, while correlations between instability in identity, affect, and interpersonal relationships have been described by numerous empirical studies, it is still an open question how exactly these symptoms interrelate. Should they be conceived in atomistic terms, i.e., is the instability pattern and its related phenomena held together by different causes? Or is a holistic view more accurate, according to which there is an intrinsic connection between the different forms of instability and related phenomena? This paper aims to gather evidence for a holistic account of the BPD instability pattern by examining the experiences associated with BPD instability in the spheres of identity, affect, and interpersonal relationships and describing their phenomenological structure. Descriptions
European Archives of Psychiatry and Clinical Neuroscience
Current psychopathology attempts to understand personality disorders in relation to deficits in higher cognition such as mindreading and metacognition. Deficits in mindreading are usually related to limitations in or a complete lack of the capacity to understand and attribute mental states to others, while impairments in metacognition concern dysfunctional control and monitoring of one’s own processes. The present study investigated dysfunctional higher cognition in the population of patients with borderline personality disorder (BPD) by analyzing the accuracy of metacognitive judgments in a mindreading task [reading the mind in the eyes Test (RMET)] and a subsequent metacognitive task based on self-report scales: a confidence rating scale (CR) versus a post-decision wagering scale (PDW). It turned out that people from the BPD group scored lower in the RMET. However, both groups had the same levels of confidence on the PDW scale when giving incorrect answers in the RMET test. As ini...
Journal of Psychopathology and Behavioral Assessment
Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of selffocused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.
Identification of Mental States and Interpersonal Functioning in Borderline Personality Disorder
Personality disorders, 2016
Atypical identification of mental states in the self and others has been proposed to underlie interpersonal difficulties in borderline personality disorder (BPD), yet no previous empirical research has directly examined associations between these constructs. We examine 3 mental state identification measures and their associations with experience-sampling measures of interpersonal functioning in participants with BPD relative to a healthy comparison (HC) group. We also included a clinical comparison group diagnosed with avoidant personality disorder (APD) to test the specificity of this constellation of difficulties to BPD. When categorizing blended emotional expressions, the BPD group identified anger at a lower threshold than did the HC and APD groups, but no group differences emerged in the threshold for identifying happiness. These results are consistent with enhanced social threat identification and not general negativity biases in BPD. The Reading the Mind in the Eyes Test (RME...
Journal of Personality Disorders, 2013
Cognitive models explain extreme thoughts, affects, and behaviors of patients with Borderline Personality Disorder (BPD) by specific maladaptive schemas and dichotomous thinking. Psychodynamic theories ascribe these to splitting. This study expanded the study of Veen and Arntz (2000) and investigated whether extreme evaluations in BPD are (1) dichotomous, negativistic, or split; (2) limited to specific (schemarelated) interpersonal situations; and (3) related to traumatic childhood experiences. BPD (n = 18), cluster C personality disorder (n = 16), and nonpatient (n = 17) groups were asked to judge 16 characters portrayed in film fragments in a specific or nonspecific context and with negative, positive, or neutral roles on visual analogue scales. These scales were divided in negative-positive trait opposites related to BPD schemas, negative-positive trait opposites unrelated to BPD schemas, and neutral trait opposites. Interpersonal evaluations of patients with BPD were (1) negativistic; (2) schema related; and (3) partially related to traumatic childhood experiences. Negative evaluations of caring characters in an intimate context particularly characterized BPD. No evidence was found for dichotomous thinking or splitting in BPD. Various theories have hypothesized that extreme thoughts or representations are central in borderline personality disorder (BPD). Extreme thoughts