Social Cognition in Borderline Personality Disorder: Evidence for Disturbed Recognition of the Emotions, Thoughts, and Intentions of others

Abstract

Disturbed relatedness is a core feature of borderline personality disorder (BPD), and impaired social cognition or deficits in “mentalization” are hypothesized to underlie this feature. To date, only weak empirical evidence argues for impairment in the recognition of emotions, thoughts, or intentions in BPD. Data from facial emotion recognition research indicate that these abilities are altered in BPD only if tasks are complex. The present study aims to assess social cognitive abilities in BPD. Sixty-four women with BPD and 38 healthy controls watched the “Movie for the Assessment of Social Cognition” (MASC), a newly developed film displaying social interactions, and asking for an assessment of the intentions, emotions, and thoughts of the characters. In addition, participants completed an established but less ecologically valid measure of social cognition (“Reading the Mind in the Eyes”; RME). In the RME task, BPD patients did not display impairment in social cognition compared to healthy controls. By contrast, on the more sensitive MASC, women with BPD showed significantly impaired abilities in social cognition compared to healthy controls in their recognition of emotions, thoughts, and intentions. Comorbid PTSD, intrusions, and sexual trauma negatively predicted social cognitive abilities on the more sensitive MASC. Thus, our results suggest impaired social cognitive abilities in BPD. Especially for comorbid PTSD, intrusive symptoms, and history of sexual trauma predicted poor outcomes on social cognition tasks.

Thinking about assessment: Further evidence of the validity of the Movie for the Assessment of Social Cognition as a measure of mentalistic abilities.

“…However, the average MASC score observed in our nonclinical adult sample, as well as in its sub-groups based on gender, was markedly lower than the average MASC scores reported in the literature for healthy controls (e.g., Dziobek et al, 2006;Dziobek et al, 2011;Lahera et al, 2014;Preissler et al, 2010). This finding may be explained by linguistic differences and cultural differences in social interaction between Italy and other European countries; however, it is also possible that this finding reflects the use of community dwelling (i.e.…”

“…the MASC performance) in NPD and deficits in BPD compared to healthy controls. A significant association between BPD features and hypermentalizing was consistently observed in adolescent inpatients (Sharp et al, 2011, but this finding was not replicated in adult women suffering from BPD, although they showed a significantly lower the MASC total score than healthy comparison women (Preissler et al, 2010).…”

“…The MASC has high test-retest reliability (r = 0.97; Dziobek et al, 2006). In terms of validity, adults with Asperger Syndrome score significantly and substantially lower than nonclinical controls on the MASC total score (Dziobek et al, 2006), and women with BPD score significantly lower than nonclinical controls on the total score as well as on the emotion, thought, and intention sub-scores (Preissler et al, 2010).…”

“…Available data suggest that the total the MASC score possesses adequate internal consistency, as indicated by Cronbach's alpha values greater than .80, at least in small-to-moderate adult samples with Asperger Syndrome (Dziobek et al, 2006) or BPD (Preissler et al, 2010), and nonclinical controls. The MASC has high test-retest reliability (r = 0.97; Dziobek et al, 2006).…”

Aberrant link between empathy and social attribution style in borderline personality disorder

“…Previous findings regarding empathy in BPD have been conflicting: some studies showed that patients exhibit less empathy compared to controls (Minzenberg et al, 2006;Preißler et al, 2010;Fertuck et al, 2009), while others found evidence for heightened empathy (Franzen et al, 2011;Dinsdale and Crespi, 2013) in patients. Although this conflicting pattern has been explained by referring to the different domains of empathy that show reduced cognitive empathy in BPD patients with unchanged or even heightened affective empathy (reviewed in Dinsdale and Crespi, 2013), here we found that even the affective domain of empathy may be reduced, possibly reflecting a compensatory response in order to protect from emotional contagion through the emotions of others that has been found in BPD (Dinsdale and Crespi, 2013).…”