Difficulties with being socially accepted: An experimental study in borderline personality disorder.

Abstract

Anxious preoccupation with real or imagined abandonment is a key feature of borderline personality disorder (BPD). Recent experimental research suggests that patients with BPD do not simply show emotional overreactivity to rejection. Instead, they experience reduced connectedness with others in situations of social inclusion. Resulting consequences of these features on social behavior are not investigated yet. The aim of the present study was to investigate the differential impact of social acceptance and rejection on social expectations and subsequent social behavior in BPD. To this end, we developed the Mannheim Virtual Group Interaction Paradigm in which participants interacted with a group of computer-controlled avatars. They were led to believe that these represented real human coplayers. During these interactions, participants introduced themselves, evaluated their coplayers, assessed their social expectations and received feedback signaling either acceptance or rejection by the alleged other participants. Subsequently, participants played a modified trust game, which measured cooperative and aggressive behavior. Fifty-six nonmedicated BPD patients and 56 healthy control participants were randomly and double-blindly assigned to either the group-acceptance or group-rejection condition. BPD patients showed lower initial expectations of being socially accepted than healthy controls. After repeated presentation of social feedback, they adjusted their expectations in response to negative, but not to positive feedback. After the experience of social acceptance, BPD patients behaved less cooperatively. These experimental findings point to a clinically relevant issue in BPD: Altered cognitive and behavioral responses to social acceptance may hamper the forming of stable cooperative relationships and negatively affect future interpersonal relationships. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The link between rejection sensitivity and borderline personality disorder: A systematic review and meta‐analysis

“…Where studies were conducted in similar locations or with similar authors, authors were contacted to identify overlapped samples. Four BPD samples partially overlap (Bungert, Koppe, et al ., ; Bungert, Liebke, et al ., ; Liebke et al ., ; Thome et al ., ). As the authors contacted were not certain of the extent of this, All four are reported in the narrative review.…”

“…In non‐clinical samples, RS correlated with BPD features, with variation in effect sizes ( r = .11 to .63). Two studies did not find a significant effect in five different community samples and a clinical sample, though the effect size remained small to moderate ( r = .16 to .35; Brown, ; Liebke et al ., ). Large effect sizes were found in studies of moderate quality; however, quality did not differentiate moderate and small effects.…”

The paradoxical decline and growth of trust as a function of borderline personality disorder trait count: Using discontinuous growth modelling to examine trust dynamics in response to violation and repair

“…Rather, it has been measured at a single point in time [32], aggregated across multiple time points [18,33], or restricted to focus on a single phase of trust [17]. To the authors' knowledge, only one study has accounted for trust dissolution and trust restoration by manipulating trustee reciprocity to differentiate between three phases: cooperative reciprocity, where the trustee returned a profit across five consecutive rounds; trust rupture, where the trustee kept the entire investment; and trust repair, where the trustee behaved cooperatively following rupture [18]. Trust was operationalized as the amount transferred by the investor to the trustee for investment, averaged across the aggregated rounds of each phase.…”

Exploring nonverbal synchrony in borderline personality disorder: A double‐blind placebo‐controlled study using oxytocin

“…The evaluation of social signals, in turn, is biased by individual differences in personality traits including rejection sensitivity (RS) – the susceptibility to interpret social cues as signs of rejection (Staebler, Helbing, Rosenbach, & Renneberg, ) – which is relevant for mental health in general, and for BPD in particular (Gao, Assink, Cipriani, & Lin, ). Put another way, individuals with BPD appear to process signals of social acceptance in deviant ways (Liebke et al , ), and they perceive exclusion in a negatively biased way and feel more readily excluded than healthy controls (Renneberg et al , ). The association between RS and BPD has been reported at a medium effect size (pooled r = .413) in a meta‐analysis (Gao et al , ), and a recent overview has shown that emotional abuse and neglect were linked to RS (Foxhall et al , ).…”