“Patients with borderline personality disorder (BPD) show intense reactions to perceived abandonment, a high degree of mistrust, and a distorted, negative perception of others,” say the authors of the research led by Evelyn Levay of Simmelweis University in Hungary. “They misinterpret social cues with a pronounced negative bias, or fail to accurately perceive positive and neutral cues.”
One example of this bias can be found in research showing that borderline personalities are more likely to rate a person as untrustworthy when viewing a neutral photo of their face than non-borderline personalities.
To further explore the link between distrust and borderline personality disorder, Levay and her research team recruited 60 adults (30 diagnosed with BPD and 30 healthy individuals) to participate in a 15-minute in-person experiment. In the experiment, participants were asked to make a series of hypothetical monetary decisions, dividing a sum of money between themselves and another person.
Participants could either make selfish decisions (opting to keep most of the money for themselves), equitable decisions (evenly splitting the money between themselves and the other person), or altruistic decisions (offering the other player more money than they kept for themselves). The researchers also asked participants to predict how the other player would act when given the same options.
They found that while borderline personalities exhibited the same amount of generosity in the game as healthy individuals, they expected others to act more selfishly than the healthy individuals did.
“Our tentative idea for explaining this difference is related to the developmental history of patients with BPD,” say the researchers. “Early maltreatment, neglect, and abuse is an important factor in BPD. The pattern we found might derive from a family environment where cooperation of the child was obligatory whereas the environment did not reciprocate it. Rather, their cooperation was met with selfishness and disregard for the needs of the child.”
This idea squares with another recent study suggesting that borderline personality disorder has its roots in early childhood trauma more than genetic vulnerability.
One encouraging result from this experiment was that borderline personalities behaved just as generously as healthy individuals. In other words, a person’s instinct to be fair may be unaffected by BPD.
“It has been established that people with BPD are sensitive to injustice and that even though actual cooperative behavior is impaired in BPD, most likely it is the reactive part of cooperation — that is, the ability to forgive and not retaliate — that shows impairment not their proneness to be fair.”
The authors hope their work leads to progress in the development of effective treatments for borderline personality disorder.
“Most of the evidence-based therapies of BPD address distrust in some way,” say the researchers. “There are effective psychotherapies, like Schema Therapy, Dialectical-Behavior Therapy, Mentalization Based Therapy, and Transference Focused Therapy, although around half of the patients in these studies did not change substantially. It is a further scientific question of whether distrust plays an essential role in non-responding to therapy.”