People with Borderline Personality Disorder: Good at Reading Others’ Emotions?

In recent years, several researchers have hypothesized that persons with Borderline Personality Disorder may have deficits in reading emotional facial expressions in other people. The ability to accurately read other people’s emotions enable us to respond appropriately to others and to feel empathy. When this ability to accurately perceive and interpret other people’s facial expressions is compromised, our interpretations of other people’s internal states is inaccurate, which may lead to emotional distress and dysregulation, to inappropriate responses, and to potentially inappropriate social behaviors. In turn, emotion dysregulation can affect interpersonal relationships – just think of someone lashing out in anger at another person.

Many experts have noted that people with Borderline Personality Disorders struggle with difficulties in regulating their emotions, and also with establishing and maintaining interpersonal relationships. In fact, the two difficulties likely interrelated, in that people with Borderline Personality Disorders are extremely sensitive to interpersonal situations – for instance, one of the criteria for Borderline Personality disorder are frantic efforts to avoid real or perceived abandonment. On the other hand, the intense emotional reactions to interpersonal difficulties, such as anger outbursts, can in turn affect interpersonal relationships.

The results of several studies that have looked into this question are summarized in a review by Gregor Domes and his colleagues, which was recently published in the Journal of Personality Disorders. The authors summarize findings from different studies that looked at how people with BPD interpreted emotional facial expressions, as compared to people who did not have BPD. What they found was that, across different studies, people with BPD tended to have some subtle deficits in interpreting facial expressions, in that they generally had a tendency interpret neutral or ambiguous faces as expressing negative emotions, particularly anger or fear. One possible conclusion the authors draw from this is that people with BPD may have a tendency to expect a threat and interpersonal difficulties from other people and that they see the world as dangerous.

In their review, Domes and his co-authors also look at another line of research, which looks at processes in the brain that have to do with the regulation of emotions and the processing of information. Not surprisingly, there are some findings that demonstrate that intense emotional arousal can interfere with the processing of information. Moreover, there were a number of studies that showed that people with BPD had some abnormalities in brain areas that regulate and modulate emotional arousal, and that their brain responded differently to negative scenes and facial expressions. What Domes and his colleagues concluded was that, in people with BPD, the emotional arousal interferes with the ability to accurately read facial expressions.

My colleague Eric Fertuck and his team in fact just published a paper in the journal Psychological Medicine about this topic. What is striking about their study is that that persons with Borderline Personality Disorder, when not under emotional distress, were particularly good at accurately reading facial expressions, in that they were on average better at it than volunteers who did not have a personality disorder. What the authors pointed out, though, was that people with BPD might well be hyper-attuned to other people’s facial expressions and then tend to personalize the emotional state of the other person. For instance, they might believe that a person is enraged at them when in fact the person might just a little annoyed about something else. Clearly, more research is needed on this fascinating topic. In the meantime, please let us know your own thoughts and experiences with this!

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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