Social cognition and social functioning in people with borderline personality disorder and their first-degree relatives

Abstract

Background A few papers studying healthy, first-degree relatives of people with borderline personality disorder (BPD) have found that this group presents attention and memory problems. However, current research has not analyzed their social cognition. Materials and Methods We designed an age-, gender- and education-level matched case-control study involving 57 people with BPD, 32 of their first-degree relatives, and 57 healthy controls in Spain in 2018–2019. All were assessed for social cognition and functioning using the Movie for Assessment of Social Cognition and the Social Functioning Scale; other potential confounders were also collected (marital status, occupation and household variables). Results There were differences in the social cognition domain of overmentalizing errors, with the BPD group scoring significantly higher than controls; however, there was no significant difference with relatives; in the social functioning domain of family relationships, with the controls showing the highest scores. Social engagement/withdrawal, interpersonal behavior, independence-competence, prosocial activities, full scale and categorization domains showed the same pattern: the BPD group had lower scores than their relatives and the controls. Relatives were significantly different from BPD patients in family relationships, social engagement/withdrawal and interpersonal behavior, as well as on the full Social Functioning Scale (both as a linear and categorical variable). However, only controls showed differences with relatives in family relationships. Conclusions All in all, relatives show similar levels of social cognition and functioning compared with controls, and people with BPD show some alterations in different domains of both social cognition and functioning.

Theory of Mind in Borderline Personality Disorder: A Possible Endophenotypic Factor?

“…To the best of our knowledge, two studies have analyzed social cognition in first-degree relatives of patients with BPD [ 23 , 45 ], and none used the MASC subscales to assess ToM through the interpretation of emotions, thoughts and intentions. This classification is particularly relevant, with direct implications for the analysis of patients’ relational styles, the most suitable marker for the diagnosis of BPD [ 30 ].…”

“…Statistical power was calculated using the previous work of Ortega-Díaz et al [ 23 ] in which different variables were collected for the study using unbalanced one-way analysis of variance (ANOVA) for the BPD patient ( n = 57), relative ( n = 32) and control ( n = 57) groups. The effect sizes were calculated for the three subscores (emotions, intentions and thoughts).…”

“…In the study by Domes et al [ 22 ], they showed a bias towards the perception of anger. In the studies of Sharp et al [ 9 ] and Ortega et al [ 23 ], overmentalization errors were seen in adolescent patients with borderline traits and in adult patients with BPD, respectively. According to Green et al [ 11 ], “social cognition refers to the mental operations underlying social interactions, which include processes involved in perceiving, interpreting, and generating responses to the intentions, dispositions, and behaviors of others”.…”

“…Deficits in ToM have been investigated in studies with relatives in various psychiatric diagnoses, including studies with relatives in bipolar disorder [ 32 , 33 , 34 ] or schizophrenia [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Although there was a meta-analysis on ToM and BPD in 2017 [ 19 ], almost all studies on relatives of BPD have been based on interviews and self-report measures of diagnoses and symptoms, only two studies used neuropsychological measures [ 43 , 44 ] and, to the best of our knowledge, only two studies have investigated social cognition in first-degree relatives of BPD patients [ 23 , 45 ]; none have examined ToM or relational style through an audiovisual test. Gulamani [ 45 ] reports that probands and relatives showed a stronger tendency than controls to misinterpret sad and fearful faces, concluding that biases associated with the perception of sad and fearful faces are found in both patients and family members.…”

Key themes in recent research on interpersonal functioning in borderline personality disorder

“…One study 22 found that the close relatives of individuals with BPD exhibit some signs of the difficulties in social cognition and interaction that are characteristic of individuals with BPD. This is relevant to attempts to better understand the aetiology, and hence also the treatment, of BPD.…”