How Mind Reading Suffers in Borderline Personality Disorder

For those with borderline, mind reading is an elusive skill.

Posted Jan 26, 2021

The ability to “read the room” allows you to figure out what the people around you are thinking and feeling. As much as you may be tempted, for example, to tell a joke to inject some humor into a boring video call, you get the sense that this might not be an opportune moment for levity. You can laugh inwardly at your amusing thought, but you know that it’s one you’ll have to share only with yourself.

For people with borderline personality disorder (BPD), whose emotional life can be rocky at best, the ability to gauge how other people feel can suffer dramatically. The inner state of those with BPD, rather than the state of the people around them, determines whether they laugh, cry, or become unduly fearful. It is a well-established finding that emotional dysregulation, or the inability to control emotions, is impaired in borderline personality disorder. Could poor mind-reading contribute to this instability?

According to a new study by the University of Lower Silesia’s Tomasz Cyrkot and colleagues (2021), for people with BPD, “a combination of high sensitivity to emotional stimuli, elevated stated of arousal, and a low return to emotional baseline, shaped by social context, can impair the ability to read other people’s mental states” (p. 1). However, as the Polish research team notes, previous research on the ability to read both the emotions and thoughts of other people is inconclusive with respect to these theoretical features of BPD.

Cyrkot and his fellow researchers propose that a distinction should be made between the individual’s ability to read emotions and the ability to read the mental state of other people. In reading emotions, you rely heavily on nonverbal cues, particularly the expression in people’s eyes. In reading mental states, by contrast, you try to see the world the way other people see it, or what’s called “Theory of Mind (ToM)".

To test both of these key “room-reading” abilities in people with BPD compared to controls, the researchers used two separate tasks. The “Reading the Mind in the Eyes Test (RMET)” involves showing people the eyes alone in photographs shown in a series of trials on a computer screen.  The emotions shown in these eyes cover a broad range, from positive (e.g. playful, friendly, interested) to negative (upset, worried regretful), as well as a set of neutral emotions (contemplative, serious, concerned).

The emotion of the individual whose eyes are shown is pre-established, so it is possible to measure someone’s accuracy in reading the emotions in a factual sense. In other words, people's eyes were photographed when they were enacting a specific emotion as instructed by the RMET creators. "Angry" eyes would then be angry by definition, because the subject who was photographed was actually trying to look angry.

In the second task, assessing ToM, the authors asked participants to rate their confidence in their RMET judgments, considered to be a measure of “metacognition,” or your sense of your ability to gauge what others are thinking and feeling. After this, participants completed another ToM task in which they bet imaginary money on their recognition accuracy. To see how this task worked, think about your own mind-reading ability. Would you be willing to bet a lot or a little on the accuracy of your judgments by seeing only someone's eyes?

The BPD sample consisted of 33 patients in a psychiatric ward in Lubin, Poland, all of whom met the diagnostic criteria for the disorder. Psychology college students comprised the healthy control sample whose test scores on a standard diagnostic measure showed that they had neither BPD, psychotic symptoms, nor any kind of addiction. The BPD sample was several years older than the college student sample, so the research team decided to take age into account when interpreting group differences.

Both groups also completed another psychiatric disorder scale. The findings from this scale revealed that the BPD sample also met the criteria for other disorders, including mood and anxiety disorders, eating disorders, and alcohol dependency. Such co-occurrence of other psychological disorders in BPD is not uncommon, it should be noted.

As the authors predicted, the BPD sample made more errors in the RMET test, showing that they actually did have difficulty in this feature of mind-reading. The BPD sample also seemed to lack confidence in their RMET responses. However, they nevertheless went on to make larger wagers on their judgments, despite their awareness of their mind-reading deficits, compared to the non-BPD sample. 

Together these findings suggest, in the words of the authors, “that overconfidence in errors may be a more general processing mechanism of denial that prevents BPD patients from re-assessing available social cues adequately” (p. 8). By blithely going on to make bets on their judgments without taking into account their lower confidence judgments, then, people with BPD seemed unable to make adjustments in their evaluations of other people’s feelings when their judgments were incorrect, and worse, when they knew they were incorrect.

This betting on wrong answers in the realm of social judgments might support, the authors maintain, the kind of impulsivity that people with BPD exhibit in their daily lives. Whereas non-BPD individuals might hesitate before rushing into a challenging situation involving important social cues, those with BPD seem to ignore the possibility that they could be wrong.

Returning now to the example of what people without BPD do when they are in that Zoom call, it would appear from the study’s findings that those with BPD will be likely to make a potentially damaging faux pas. Research on the lives of people with BPD consistently shows how they throw roadblocks in front of possible routes to success. This lack of emotion-reading ability can clearly become one of those roadblocks.

Although the authors didn’t discuss the clinical implications of their findings, it would seem that the RMET itself could provide a basis for working with people with BPD to help them improve their accuracy as well as their tendency to ignore warning signs that their judgments might not be correct. Using feedback from the test could help these individuals learn to take a more modest approach to evaluating their abilities when faced with a challenging social task.

To sum up, mind reading is an important life skill that appears to suffer in people with BPD. For anyone who’s ever made a bad error in judgment, you can understand how difficult this can make their lives. If someone you care about has BPD, such understanding may help you, and them, gain greater emotional equanimity.

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References

Cyrkot, T., Szczepanowski, R., Jankowiak-Siuda, K., Gawęda, Ł., & Cichoń, E. (2021). Mindreading and metacognition patterns in patients with borderline personality disorder: Experimental study. European Archives of Psychiatry and Clinical Neuroscience. doi:10.1007/s00406-020-01227-7