Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face

Abstract

BackgroundA markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.MethodsA sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).ResultsIndividuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.ConclusionOur study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.

Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates

“…In a meta-analysis by Buchman-Wildbaum et al [ 2 ], the presence of a BPD diagnosis had large effects on the reported levels of shame but based on measures other than the HFS. In a recent study by Biermann et al [ 24 ], BPD patients reported higher levels of shame-proneness (measured with the Test of Self-Conscious Affect; TOSCA-3, German version; [ 54 ]) compared to HCs. However, experimental manipulation of the focus towards oneself vs. others leads to more reported shame in HCs compared to more reported self-disgust in BPD patients.…”

“…This might be the reason why the rating of emotionality of the sentences did not differ between patients and HCs. However, even though the emotional intensity did not differ, differences in neural processing might be informative with regard to different cognitive processes that may be involved in shame and guilt in BPD patients and HCs [ 23 , 24 ]. One reason for comparable judgements in BPD and healthy participants might be that patients with BPD know about the most common, socially frequent judgements of healthy others.…”

“…Winter and colleagues [ 23 ] discuss that elevated proneness for aversive social emotions in BPD might be due unstable and negative self-concept (e.g., reported low self-esteem) and possibly altered self-related motives, which might lead to increased reactivity to self-relevant cues. In a recent experiment, Biermann et al [ 24 ] showed that the focus on one-self vs. others seems to play a key role in explaining the altered social emotional reaction of BPD patients compared to HCs, which seems to be related to self-critical and self-harming processing. As shame and guilt are social emotions, they play a vital role in regulating social behavior and are influenced by one’s history of social learning.…”