Borderline Personality Disorder And The Ability To Understand Other People

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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 ...Read More

I’ve got some follow up for you on a blog post I wrote a couple of months ago on the apparent difficulty people with Borderline Personality Disorder (BPD) have reading other people’s emotions and intentions.  This is a question that the field has puzzled over for quite some time, as we do know that people with Borderline Personality have difficulties in interpersonal relationships.  Some experts believe that this has to do with difficulties in accurately interpreting and reading other people.  As noted previously: To date, the research on this question appears to have gathered mixed results, so that we don’t have a conclusive answer.

Enter Dr. Eric Fertuck and his colleagues.  Dr. Fertuck is a Columbia University and New York State Psychiatric Institute researcher and expert on Borderline Personality Disorder.  At a recent conference of the Society for Biological Psychiatry, Dr. Fertuck presented preliminary findings from a current research project on this topic. Dr. Fertuck and his colleagues are evaluating a model to understand emotion and personality perception in people with BPD, and how they make decisions about other people’s personality traits.  By also admistering fMRIs, the researchers are trying to find out whether, at the brain level, people with BPD have a different pattern of brain activation when it comes to evaluating social situations.


The researchers asked participants to look at pictures of faces and to determine whether the faces looked a) fearful, or b) trustworthy. They found no difference between women with or without BPD with regard to reading the emotion of fearfulness in the faces.  However, when it came to deciding whether someone was trustworthy (which is considered a personality trait), researchers found that for the most ambiguous faces without any clear emotional expression, it took participants with BPD longer to decide whether someone was trustworthy, and they tended to judge those faces significantly less trustworthy than the comparison group. 

At the brain level, the images gathered through fMRIs showed that people with BPD tended to exhibit increased activity in an area of the brain called the orbitofrontal cortex. This is an area that has been implicated in evaluating whether a particular stimulus will be rewarding or not.  “While these results are still very preliminary, what this could mean is that people with BPD are very invested trying to figure out whether or not to trust someone.   People with BPD are also very rejection sensitive.  This means that they expect rejection more often and are very concerned about it,” explains Dr. Fertuck. ”It looks like they are generally accurate readers of other people’s emotional expressions.  However, when they are given more ambiguous, non-emotional faces, they are biased towards viewing them as less trustworthy. “

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 While Dr. Fertuck’s findings are preliminary, they may have implications for treatment.  “The results tell you what to expect when someone with BPD is in a relationship, including the relationship with a therapist. “ says Dr Fertuck. “People with BPD can have a tough time trusting their therapists.  Sometimes, the rejection sensitivity is so high that they try to abandon you before they have to contend with the fear that the therapist will reject them. Down the road, the fMRI findings may also have implications for medication treatment.  Neuopeptides, such as oxytocin and opioids are implicated in pro-social behavior, and might at some point in the future be subject to clinical trials.“

So, what’s the take-home message? “Overall, the message is hopeful” says Dr. Fertuck, ”Of course everybody is different, but in general and under typical circumstances people with BPD seem accurate readers of others’ emotions, in fact they can be very good at reading subtle emotional cues.  However, they do have trouble figuring out whom to trust and depend upon.  If individuals with BPD get the right kind of help and are open to working on trust issues with a therapist with expertise in BPD, improvement is likely.”



*If you are interested in participating in the study and live in the New York area, you can call Dr. Fertuck’s program at 212-543-6544.

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