Difficulties with anger control are known to characterize people with borderline personality disorder (BPD). If you have a friend or loved one with this disorder, you know how little unexpected things can lead them to sudden outbursts of uncontrollable rage. Perhaps you commit an unintended slight against a cousin with BPD by sitting next to someone else at a family occasion. It wasn’t clear to you that your presence in the seat was expected by your cousin, so you casually continued a conversation with one of your in-laws as you slipped into adjoining seats. The fierce stare that your cousin flashes your way makes you realize that you committed a huge faux pas and later, in a series of angry texts, you’re subjected to a torrent of abuse.
In addition to having problems with control of aggressive outbursts, Erik Baumann of the Asklepios Fachklinikum Tiefenbrunn in Rosdorf, Germany and colleagues (2020) note that people with BPD have strong internally-directed levels of anger. According to sources they cite, in addition to being more prone to engage in physical fights with others or to use a weapon against other people, up to 80% of people with this disorder engage in acts of self-harm, and 85% have attempted suicide. Indeed, the German authors note that these findings have led other researchers to propose that there is an angry subtype within BPD.
In tapping into the extreme anger that can be shown by some individuals with BPD toward themselves, Baumann et al suggest that the best measures would not involve ordinary self-report questionnaires. In their words, “A person's self-concept is characterized both by explicit, consciously accessible self-related processes and by implicit and unconscious self-related schemas, attitudes, feelings, and cognitions that are not necessarily congruent” (p. 2).
As in assessing other unconscious attitudes, the German researchers suggest that the widely used Implicit Association Test (IAT) might just provide the key. Indeed, the case is particularly strong for using a measure that goes below the surface to study BPD. Individuals with this disorder may listen more to their internal, unfiltered, messages as they react to the events going on around them. When they’re under stress, this possibility is even more likely.
In the words of the authors, people with BPD undergo “implicit information processing that cannot be counter-balanced by consciously accessible and controllable processes” (p. 2). When aggressiveness is factored into the picture, the situation becomes even more unbalanced. Even in individuals without BPD, inner feelings of anger are more likely to lead to aggressive action when under stress. Consider your own reactions. Haven’t the times you’ve lost control of your anger happened when your life isn’t going your way? Eventually, however, you calm down and are able to regain your self-control.
Using a version of the IAT designed to measure self-directed aggressiveness, Baumann et al. compared 29 women on an inpatient psychiatric unit with 21 healthy controls. The participants averaged 28 years of age, with most between the ages of 18 and 38. They were asked to complete self-report measures that included scales of spontaneous aggression, reactive aggression, irritability, aggression inhibition, and aggression directed toward the self. Additionally, they were clinically evaluated for BPD symptoms.
The version of the IAT used in the German study evaluated automatic associations to word pairs that combined, for example, the tendency to associate “me” with “peaceful,” vs. “me” with “aggressive.” Participants first practiced a sorting task in which they were told to push one computer key if the word on the screen in front of them represented an aggressive term, and another key if the word represented a peaceful term. In the key trials measuring implicit associations, participants were instructed to respond as quickly as possible to a sorting task with pairs of words. In one block of trials, “peaceful” and “me” were presented together along with “aggressive” and “other.” In the critical trials, participants responded to the combination of “aggressive” and “me,” vs. “peaceful” and “other.” Their job remained pressing the corresponding computer key that would sort into “aggressive” or “peaceful.” If you tend to associate yourself with aggressive qualities, you’ll respond more quickly to the “aggressive-me” combination more quickly than to the “aggressive-other.”
Using empirically established criteria, the authors derived statistical difference scores that signified the individual has an implicit association to an aggressively-based self-concept. Given that the women with BPD had higher aggressiveness scores overall, the question was whether there would be a stronger relationship between IAT self-directed aggressiveness and scores on the aggressiveness scale for women with BPD compared to the healthy controls. To test this prediction, the authors correlated IAT self-aggression with the self-report aggression questionnaire and then added the degree of BPD symptom level to the equation.
As the authors predicted, the higher the BPD symptoms, the stronger the association between IAT scores and the self-report aggressiveness measure. Overall, the women with BPD scored higher on all measures of aggressiveness but particularly on the scales measuring irritability, anger directed toward the self, and how much the individual attempted to keep her aggression under control. The addition of IAT scores further differentiated the two groups of women, suggesting that unconscious self-directed anger is an important feature when studying people with BPD.
Together, the findings indicate, in the words of the German authors, that there is a need to differentiate between the outward expressions of self-targeted aggression and the inner, less consciously accessible forms of anger toward oneself in BPD. As they note, what’s particularly key about these results is that because people with BPD may not realize how high their self-directed aggression has become in a given situation, the more likely they may be to act out those angry feelings that are outside of conscious awareness and control. In the words of the German authors, people with BPD experience “dysfunctional, schema-driven processing” in which their self-concept develops around a set of negatively biased interpretations of their experiences. Primed in this way, they are bound to view social interactions in a less than positive light, and those interactions, in turn, will only reinforce their negative self-views.
The authors suggest that the present findings could have important implications for therapy. In addition to seeing themselves as angry, as shown in this study, other findings point to the implicit biases that people with BPD have to see themselves in terms of other negative emotions such as shame and disgust. Targeting those implicit self-evaluations, therapists could engage in a classical conditioning type of method in which they attempt to teach their patients to form newer and more positive associations that can define their inner self-evaluations. Because this study was conducted on women patients only, however, such an approach would need to be tested on males as well, and with a comparison group who has another psychological disorder.
Anger directed at the self is one piece, then, of the aggressiveness that people with BPD are prone to experiencing. Indeed, returning to the example of the cousin who became enraged at your apparent cold shoulder, you can see how negative inner self-representations can precipitate the aggressiveness directed at people who had no intention of causing offense. It's as if they're primed to become angry because their self-concept is partly defined as having this undesirable quality.
To sum up, the Baumann et al. findings provide an intriguing way of understanding the high levels of anger that people with BPD have as defining features of their self-concepts. Poised to react with aggressiveness both to their own qualities and the behavior of others, they may benefit from attempts to help them look at themselves in a more favorable, and potentially peaceful, light.
Facebook image: Kitja Kitja/Shutterstock
Baumann, E., Schmidt, A. F., Jelinek, L., Benecke, C., & Spitzer, C. (2020). Implicitly measured aggressiveness self-concepts in women with borderline personality disorder as assessed by an Implicit Association Test. Journal of Behavior Therapy and Experimental Psychiatry, 66, 101513. doi: 10.1016/j.jbtep.2019.101513