Theory of Mind in Borderline and Cluster-C Personality Disorder

Abstract

Borderline Personality Disorder (BPD) is associated with interpersonal problems, such as intense, unstable relationships and fears of abandonment. It has been hypothesized that deficits in social cognitive capacities explain these difficulties. One important aspect of social cognition is theory of mind (ToM)-the capacity to infer others' mental state. We tested ToM capacities with Happé's advanced ToM-test in 16 BPD patients, 16 Cluster-C PD patient controls, and 28 nonpatients. Social reasoning (WAIS Picture Arrangement), general intelligence, and current mood were also assessed. With and without controlling for intelligence, social reasoning, and mood, no evidence for deficits in ToM in BPD patients was found. In fact, both Cluster B and Cluster C patient groups tended to show generally superior performance to the nonpatients on the subscales of Happé ToM-test. All tests correlated similarly with intelligence in the 3 groups. These findings do not support the hypothesis that BPD patients have inferior theory of mind capacities.

Impairments of Interpersonal Functioning: Empathy and Intimacy in Borderline Personality Disorder

“…In one study, male forensic patients with a personality disorder (n = 13; n = 5 BPD subjects and n = 9 subjects with antisocial personality disorder) performed significantly better in the revised RME test and the modified ‘Strange Stories' test than male forensic patients with Asperger's syndrome (n = 13) or schizophrenia (n = 13) [78]. In another study, female patients with BPD (n = 16) had lower ToM test scores than patients with cluster C personality disorder (n = 16) in the ‘Strange Stories' test [67]. When patients with narcissistic and comorbid BPD were excluded, patients with BPD (n = 27; 25 females) showed more impairments in the MASC than patients with narcissistic personality disorder (n = 22; 8 females) [76], which could indicate worse ToM abilities in patients with BPD compared to patients with cluster C personality disorder [67] or narcissistic personality disorder [76].…”

“…However, a meta-analysis found only low to moderate correlations between the RME test, the ‘Strange Stories' test, and the ‘Faux Pas' test [66], and results depended on the task and its complexity. Thus, female patients with BPD (n = 16) tended to perform better than healthy women (n = 28) in the ‘Strange Stories' test in which participants have to detect bluffs, mistakes, persuasions, or white lies [67]. In contrast, BPD patients (n = 20; 18 females) showed impaired cognitive ToM abilities in comparison to healthy controls (n = 22; 19 females) in the Understanding ‘Faux Pas' test when they listened to 20 stories and answered questions that detected the occurrence of a faux pas following each story [50].…”

The Borderline Empathy Paradox: Evidence and Conceptual Models for Empathic Enhancements in Borderline Personality Disorder

“…For example, Russell, Tchanturia, Rahman, and Schmidt (2007) reported a male advantage for Happé's cartoon task, but Bosacki (2000) reported female superiority on a similar task in healthy preadolescents. With respect to BPD, Arntz et al (2009) found enhanced performance of the borderline group relative to nonclinical control subjects on Happé's (1994) Advanced ToM task. Interpretation of these results is severely limited by the relative lack, or absence, of male subjects in most studies of BPD.…”

“…Thus, in all three studies where empathic skills were examined in interactive social environments, individuals with BPD demonstrated increased abilities to accurately infer mental states and respond appropriately to the behavior of others, relative to control subjects (Flury et al, 2008;Franzen et al, 2011;Ladisich & Feil, 1988). By contrast, in tasks requiring mental state attributions from passive stimuli, individuals with BPD demonstrated enhanced skills in three tests from four studies (Happé's Advanced ToM test, Arntz et al, 2009; RMET for negative emotions only, Scott et al, 2011;overall RMET score, Fertuck et al, 2009 andFrick et al, 2012), conserved skills for three tests from four studies (MSAT, Ghiassi et al, 2010; affective understanding of faux pas, Harari et al, 2010;RMET, Preißler et al, 2010; RMET for positive and neutral emotions, Scott et al, 2011), and reduced skills for two tests from two studies (cognitive understanding of faux pas, Harari et al, 2010;MASC, Preißler et al, 2010). This apparent contrast in results between studies using interactive and passive stimuli suggests that interactive stimuli may be relatively more sensitive in demonstrating the skills of individuals with BPD, and therefore highlights the need for future research to examine borderline social cognition through interactive study environments and relatively realistic social interactions.…”

“…Fertuck et al (2009) suggested that enhanced mentalizing in BPD engenders reduced interpersonal functioning through a combination of negative expectations upon entering social interactions and reduced executive cognitive control, resulting in the inability to modify incorrect appraisals of social situations. Similarly, Arntz et al (2009) suggested that impulsivity, emotional reactivity, and working memory deficits observed in BPD may inhibit the borderline individual's ability to apply intact mentalizing skills in emotionally charged situations, therefore contributing to social dysfunction.…”