Abstract
Studies on natural long-term course of borderline personality disorder (BPD) as well as on treatment outcome suggest that social integration remains seriously unsatisfactory in the majority of the subjects concerned. Identification of typical borderline problems in social interaction should facilitate both, treatment development and elucidation of the related neuropsychological mechanisms and underpinnings. This review focusses on the experimental investigation of three core domains of social interaction: social affiliation, cooperation and hostility. Data converge, that patients meeting criteria for BPD show a tendency to misinterpret neutral situations, feel socially rejected during normative inclusion conditions and reveal difficulties in repairing cooperation after experiencing disappointment. While from a clinical perspective, most attention has been focused on relationships of BPD patients with their significant others, the literature suggests that encounters with unknown individuals also indicate impairments in interaction behavior, and that such impairments can be linked to altered cerebral processing. Considering these findings psychosocial treatments should extend the programs and develop trainings in normative behavior.
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Zanarini MC, Frankenburg FR, Hennen J, et al. The McLean Study of Adult Development (MSAD): overview and implications of the first six years of prospective follow-up. J Pers Disord. 2005;19:505–23.
Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: a 10-year prospective follow-up study. Am J Psychiatry. 2010;167:663–7.
Lieb K, Zanarini MC, Schmahl C, et al. Borderline personality disorder. Lancet. 2004;364:453–61.
Bateman A, Fonagy P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry. 2009;166:1355–64.
Giesen-Bloo J, van Dyck R, Spinhoven P, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006;63:649–58.
Doering S, Horz S, Rentrop M, et al. Transference-focused psychotherapy v. treatment by community psychotherapists for borderline personality disorder: randomised controlled trial. Br J Psychiatry. 2010;196:389–95.
Bohus M, Haaf B, Simms T, et al. Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial. Behav Res Ther. 2004;42:487–99.
Pistorello J, Fruzzetti A, Maclane C, et al. Dialectical Behavior Therapy (DBT) Applied to College Students: A Randomized Clinical Trial. J Consult Clin Psychol. 2012;80:982–94.
Association, A.P. Diagnostic and Statistical Manual – Revised Text Edition. 4th ed. Washington, DC: APA; 2000.
Gunderson J, Zanarini MC, Kisiel CL. In: Widiger TA et al., editors. Borderline personality disorder., in DSM-IV Sourcebook. Washington: American Psychiatric Association; 1996. p. 717–33.
Crick NR, Dodge KA. A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychol Bull. 1994;115:74–101.
Nisbett RE, Wilson T. The halo effect: evidence for unconscious alteration of judgments. J Pers Soc Psychol. 1977;35:250–6.
Rusch N, Holzer A, Hermann C, et al. Self-stigma in women with borderline personality disorder and women with social phobia. J Nerv Ment Dis. 2006;194:766–73.
Woollaston K, Hixenbaugh P. Destructive whirlwind: nurses’ perceptions of patients diagnosed with borderline personality disorder. J Psychiatr Ment Health Nurs. 2008;15:703–9.
Russell JJ, Moskowitz DS, Zuroff DC, et al. Stability and variability of affective experience and interpersonal behavior in borderline personality disorder. J Abnorm Psychol. 2007;116:578–88.
Stepp SD, Pilkonis PA, Yaggi KE, et al. Interpersonal and emotional experiences of social interactions in borderline personality disorder. J Nerv Ment Dis. 2009;197:484–91.
Clifton A, Pilkonis PA, McCarty C. Social networks in borderline personality disorder. J Pers Disord. 2007;21:434–41.
Bouchard S, Godbout N, Sabourin S. Sexual attitudes and activities in women with borderline personality disorder involved in romantic relationships. J Sex Marital Ther. 2009;35:106–21.
Bouchard S, Sabourin S. Borderline personality disorder and couple dysfunctions. Curr Psychiatry Rep. 2009;11:55–62.
Bouchard S, Sabourin S, Lussier Y, Villeneuve E. Relationship quality and stability in couples when one partner suffers from borderline personality disorder. J Marital Fam Ther. 2009;35:446–55.
Hobson RP, Patrick MPH, Hobson JA, et al. How mothers with borderline personality disorder relate to their year-old infants. Br J Psychiatry. 2009;195:325–30.
Stepp SD, Whalen DJ, Pilkonis PA, et al. Children of mothers with borderline personality disorder: identifying parenting behaviors as potential targets for intervention. Personal Disord. 2012;3:76–91.
Alden LE, Wiggins JS, Pincus AL. Construction of circumplex scales for the inventory of interpersonal problems. J Pers Assess. 1990;55:521–36.
Horowitz LM, Rosenberg SE, Baer BA, et al. Inventory of interpersonal problems: psychometric properties and clinical applications. J Couns Clin Psychol. 1988;56:885–92.
Barnow S, Stopsack M, Grabe HJ, et al. Interpersonal evaluation bias in borderline personality disorder. Behav Res Ther. 2009;47:359–65.
• Stepp SD, Hallquist MN, Morse JQ, Pilkonis PA. Multimethod investigation of interpersonal functioning in borderline personality disorder. Personal Disord. 2011;2:175–92. This is the first study which compares the suitability of different methods to assess impairments in social interaction behavior in BPD.
Hill J, Pilkonis P, Morse J, et al. Social domain dysfunction and disorganization in borderline personality disorder. Psychol Med. 2008;38:135–46.
Morse JQ, Hill J, Pilkonis PA, et al. Anger, preoccupied attachment, and domain disorganization in borderline personality disorder. J Pers Disord. 2009;23:240–57.
Buhrmester D, Furman W, Wittenberg MT, Reis HT. Five domains of interpersonal competence in peer relationships. J Pers Soc Psychol. 1988;55:991–1008.
Muralidharan A, Sheets ES, Madsen J, et al. Interpersonal competence across domains: relevance to personality pathology. J Pers Disord. 2011;25:16–27.
Riggio RE. Social Skills Inventory Manual: Research Edition. Palo Alto: Consulting Psychologists Press Inc; 1989.
McKay D, Gavigan CA, Kulchycky S. Social skills and sex-role functioning in borderline personality disorder: relationship to self-mutilating behavior. Cogn Behav Ther. 2004;33:27–35.
Luborsky L. In: Luborsky L, Crits-Christoph P, editors. The relationship anecdotes paradigm (RAP) interview as a versatile source of narratives., in Understanding transference: The core conflictual relationship theme method. Washington, DC: American Psychological Association; 1998. p. 109–20.
Drapeau M, Perry JC. The Core Conflictual Relationship Themes (CCRT) in borderline personality disorder. J Pers Disord. 2009;23:425–31.
Drapeau M, Perry JC, Korner A. Interpersonal patterns in borderline personality disorder. J Pers Disord. 2012;26:583–92.
Reis HT, Wheeler L. In: Zanna MP, editor. Studying social interaction with the Rochester Interaction Record., in Advances in experimental social psychology. San Diego: Academic Press; 1991. p. 269–318.
Linehan MM. Cognitive– behavioral treatment of borderline personality disorder. New York: Guilford Press; 1993.
Renneberg, B., Mücke, M., Wallis, H., et al. Wie sozial kompetent sind Patientinnen mit Borderline-Persönlichkeitstörung ? Verhaltenstherapie und Verhaltensmedizin. 2003;24:329–45.
Williams KD, Jarvis B. Cyberball: a program for use in research on interpersonal ostracism and acceptance. Behav Res Methods. 2006;38:174–80.
Renneberg B, Herm K, Hahn A, et al. Perception of social participation in borderline personality disorder. Clin Psychol Psychother, 2011.
•• Ruocco AC, Medaglia JD, Tinker JR, et al. Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder. Psychiatry Res. 2010;181:233–6. It is the only study which investigates not only the subjective experience, but also the cerebral mechanisms associated with social interaction during social exclusion in a real-life situation in BPD.
Staebler K, Renneberg B, Stopsack M, et al. Facial emotional expression in reaction to social exclusion in borderline personality disorder. Psychol Med. 2011;41:1929–38.
Lawrence KA, Chanen AM, Allen JS. The effect of ostracism upon mood in youth with borderline personality disorder. J Pers Disord. 2011;25:702–14.
Moor BG, Guroglu B, Op de Macks ZA, et al. Social exclusion and punishment of excluders: neural correlates and developmental trajectories. NeuroImage. 2012;59:708–17.
Hess YD, Pickett CL. Social rejection and self- versus other-awareness. J Exp Soc Psychol. 2010;46:453–6.
Onoda K, Okamoto Y, Nakashima K, et al. Does low self-esteem enhance social pain? The relationship between trait self-esteem and anterior cingulate cortex activation induced by ostracism. Soc Cogn Affect Neurosci. 2010;5:385–91.
Ayduk O, Zayas V, Downey G, et al. Rejection sensitivity and executive control: joint predictors of borderline personality features. J Res Pers. 2008;42:151–68.
McCabe K, Houser D, Ryan L, et al. A functional imaging study of cooperation in two-person reciprocal exchange. Proc Natl Acad Sci U S A. 2001;98:11832–5.
Unoka Z, Seres I, Aspan N, et al. Trust game reveals restricted interpersonal transactions in patients with borderline personality disorder. J Pers Disord. 2009;23:399–409.
King-Casas B, Sharp C, Lomax-Bream L, et al. The rupture and repair of cooperation in borderline personality disorder. Science. 2008;321:806–10.
• Franzen N, Hagenhoff M, Baer N, et al. Superior ‘theory of mind’ in borderline personality disorder: an analysis of interaction behavior in a virtual trust game. Psychiatry Res. 2011;187:224–33. This study analyzes social cognitive processes, i.e. emotion recognition, embedded within an interactive context. In that, the authors could show that emotion recognition per se is unimpaired in BPD, but deviates in regard to its impact on actual interaction behavior when it has to be coordinated with other social cognitive processes to guide behavior.
Meyer-Lindenberg A. Trust me on this. Science. 2008;321:778–80.
Bartz J, Simeon D, Hamilton H, et al. Oxytocin can hinder trust and cooperation in borderline personality disorder. Soc Cogn Affect Neurosci. 2011;6:556–63.
Kollock P. Social dilemmas: the anatomy of cooperation. Rev Sociology. 1998;24:183–214.
Cherek DR, Moeller FG, Schnapp W, Dougherty DM. Studies of violent and nonviolent male parolees. I. Laboratory and psychometric measurements of aggression. Biol Psychiatry. 1997;41:514–22.
Buss A. The psychology of aggression. New York: John Wiley and Sons; 1961.
Dougherty DM, Bjork JM, Huckabee HC, et al. Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Res. 1999;85:315–26.
McCloskey MS, New AS, Siever LJ, et al. Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder. J Psychiatr Res. 2009;43:1036–48.
•• New AS, Hazlett EA, Newmark RE, et al. Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder. Biol Psychiatry. 2009;66:1107–14. By using experimental control conditions, the authors were able to show that aggressive behavior in BPD is not only linked to provocations of a social partner, but is observable in neutral situations as well.
Frith CD, Frith U. How we predict what other people are going to do. Brain Res. 2006;1079:36–46.
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Lis, S., Bohus, M. Social Interaction in Borderline Personality Disorder. Curr Psychiatry Rep 15, 338 (2013). https://doi.org/10.1007/s11920-012-0338-z
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DOI: https://doi.org/10.1007/s11920-012-0338-z