Self–other disturbance in borderline personality disorder: Neural, self-report, and performance-based evidence.

Abstract

Individuals with borderline personality disorder (BPD) display an impoverished sense of self and representations of self and others that shift between positive and negative poles. However, little research has investigated the nature of representational disturbance in BPD. The present study takes a multi-modal approach. A card sort task was employed to investigate complexity, integration and valence of self-representation in BPD. Impairment in maintenance of self and other representations was assessed using a personality representational maintenance task. Finally, functional magnetic resonance imaging (fMRI) was used to assess whether individuals with BPD show neural abnormalities related specifically to the self and what brain areas may be related to poor representational maintenance. Individuals with BPD sorted self-aspects suggesting more complexity of self-representation, but also less integration and more negative valence overall. On the representational maintenance task, individuals with BPD showed less consistency in their representations of self and others over the 3-hour period, but only for abstract, personality-based representations. Performance on this measure mediated between-group brain activation in several areas supporting social cognition. We found no evidence for social cognitive disturbance specific to the self. Additionally, the BPD group showed main effects, insensitive to condition, of hyperactivation in the medial prefrontal cortex, temporal parietal junction, several regions of the frontal pole, the precuneus and middle temporal gyrus, all areas crucial social cognition. In contrast, controls evidenced greater activation in visual, sensory, motor and mirror neuron regions. These findings are discussed in relation to research regarding hypermentalization and the overlap between self- and other-disturbance.

Borderline Personality Disorder and Automatic Processing of Valence and Self-Other Relevance Information

“…Thus, BPD patients appear to be able to perceive and differentiate self- versus other-relevant information like healthy controls at an automatic processing level. Our data suggest that there exist no abnormalities in the automatic differentiation between self- and other-related information during the perception of affective words in BPD, even though research using self-report and interviewing techniques has observed abnormalities in representations of the self and others in patients with BPD [19,26] and a lack of differentiated and integrated representations of the self and others [27]. …”

“…There is evidence that as childhood experiences of punishment increase, the ability in adulthood to accurately identify affect in others and understand social situations deteriorates [25]. Findings from previous research using self-report and interviewing techniques have found empirical evidence for abnormalities in the representations of the self and others in patients with BPD [19,26]. …”

“…Recently, BPD patients were found to exhibit activation abnormalities in a network comprising medial prefrontal and temporoparietal brain areas during processing of self- and other-related information [19]. It has been argued that medial prefrontal and temporoparietal mentalizing dysfunction in the course of development might leave individuals with difficulties in decoupling their representations of another person's experience from their self-representations [27].…”

“…BPD patients are frequently characterized by instable, maladaptive mental representations of the self, others, and the self in relation to others [19]. A lack of differentiated and integrated representations of the self and others can be subsumed under identity disturbance [20].…”

Using Functional Neuroimaging to Refine the Diagnostic Construct of Borderline Personality Disorder

“…These difficulties comprise one of the symptom criteria, found in section II of DSM-5: "Identity disturbance: markedly and persistently unstable self-image or sense of self [12]." To test the neural correlates of this clinical phenomenon, Beeney and colleagues [78] conducted a study examining self-report measures of self-representation with an fMRI task designed to tap into self-and other-reflection. In the task, participants were 1) asked to evaluate themselves on a certain trait, 2) asked how a close friend would evaluate them on that trait, and 3) asked how that close friend would evaluate themselves on the trait.…”