Can One Quality Be at the Core of Borderline Personality?

New research examines the core quality of borderline personality disorder.

Posted Oct 08, 2019

People with borderline personality disorder (BPD) engage in frantic efforts to avoid being abandoned, have an unstable sense of identity, feel chronically empty, have difficulty controlling their anger, and may engage in self-harm. If you know someone with BPD, you undoubtedly have experienced the rage that can occur when this person feels neglected, vehemently blaming you for not being caring or supportive enough.

Prominent psychological theories of BPD vary in the explanations they provide for its development, including genetic determinants, early childhood experiences, difficulties in understanding how others feel, and a hypersensitivity and hyperreactivity to cues from other people.

In summarizing these perspectives on BPD’s origins, Marco Cavicchioli and Cesare Maffei (2019), of the Vita-Salute San Raffaele University and San Raffaele-Turro Hospital (Milan, Italy), believe that there is a more concise and theoretically viable way to explain BPD and, by extension, its diagnostic features. Their analysis begins with the criticism that the BPD theories are based on the idea that the disorder is somehow an entity distinct from normal personality. As they note, “all these theories are not based on a theory of normal personality, such as trait-based or sociocognitive approaches, which are necessary to explain the continuum existing between adaptive and maladaptive personality” (p. 1).

Despite the fact that the DSM-5 retained the previous categorical system that groups people into distinct diagnoses, personality disorder researchers maintain that a dimensional approach provides a more realistic understanding, allowing as well for a more useful diagnostic framework. A personality “disorder,” according to those who argue for this dimensional approach, should be viewed as an extreme on a continuum ranging from adaptive to maladaptive. Everyone has a personality, in other words, but for some people, that personality creates serious and chronic difficulties living in the world.

Cavicchioli and Maffei propose that, instead of relying on genetic explanations or problems in reading and then reacting to the emotions of others, a better framework is provided by the “cognitive-affective personality system” (CAPS; Mischel & Shoda, 1995). CAPS is based on the view of personality as consisting of ways of reacting to situations. Personality is not a set of consistent traits, either inherited or developed early in life, but is based on an interaction between the person and the situation. You don’t have the trait of extraversion, CAPS would argue. You’ll act in an extraverted way if the situation draws this out within you, such as being at a social gathering with people you know. If you’re in a different situation, such as when you’re placed in a room with complete strangers, you won’t act in this extraverted way.

CAPS proposes that these interactions involve the way people encode a situation, their expectancies and beliefs, their feelings, their goals and values, and their plans for self-regulation or self-monitoring. You don’t want to stick out like a sore thumb in a situation where no extraversion is called for, to return to the previous example. People with a personality disorder would be unable to distinguish situations in which certain behaviors and feelings are called for and those in which it is not appropriate. For example, narcissistic individuals would believe that it is always appropriate to dominate in a social situation, even if they would be better served by taking a back seat to the action.

What can CAPS do for the understanding of BPD? The Italian research team proposes that there is one core feature of personality that can help to explain these consistent maladaptive reactions of people with the disorder. This one feature is rejection sensitivity, which is “defined as a personality dimension that describes the cognitive-affective processing disposition to anxiously expect, readily perceive, and intensely react (emotionally or behaviorally) to signals of interpersonal rejection” (p. 2). Primed with this expectation, people with BPD would therefore go into situations with other people believing that they’ll be rejected, even if the people in this situation have no intention of excluding them.

With this background, Cavicchioli and Maffei approached the question of whether rejection sensitivity could be viewed as the underlying factor in BPD by conducting a meta-analysis in which they examined consistencies across previous studies that would support this approach. They hypothesized that people with BPD would have “a pervasive and inflexible disposition to expect rejection … (and would) perceive rejection even in social inclusion situations.” This expectation would, secondly, lead them to experience anger in response to that perceived rejection. Furthermore, the high rejection sensitivity should lead individuals with BPD to “report intense feelings of exclusion even in social inclusion situations” (p. 4). For BPD, then, the dynamic becomes one in which situations are always viewed as constituting rejection due to their own distorted expectations.

To understand these hypotheses regarding BPD and rejection sensitivity, consider how you feel when you’re aware that other people are excluding you by, for example, not inviting you to a group dinner involving several of your friends. You might become angry, but would you become enraged? Would you believe that they’re not inviting you because they are rejecting you or, perhaps, is there a more innocuous interpretation? Perhaps the occasion was specific to those particular people such as someone’s anniversary or a bachelorette party. Once you realize this, you’re fine with not being included. The next time a celebration rolls around where you’d be a logical person to invite, you won’t immediately assume you’ll be excluded and then become infuriated over just that thought. All of this would be the opposite of how a person with BPD would respond, according to the Italian researchers.

In the meta-analysis, Cavicchioli and Maffei identified 39 studies that fit their inclusion criteria of examining expectancies and beliefs of rejection, the ways in which situations were interpreted, and the feelings and emotions that participants reported experiencing. In some of these studies, inclusion and exclusion were manipulated experimentally via a cyber ball game in which participants are led to believe that they were being either included in a ball toss or left out by other players (the other players are actually simulated). The studies all involved comparisons between healthy controls and people who were diagnosed with BPD or those who had high BPD self-report scores.  

The main conclusion to emerge from the meta-analysis was that, as the authors predicted, people with BPD showed indeed had those “pervasive and inflexible expectancies of rejection across several situations,” leading to the conclusion that “rejection expectancies are one of the core features of the disorder” (p. 8). With this expectancy at its core, individuals with BPD are convinced they will be rejected, perceive situations from this perspective, and then react with the negative affectivity of anger when they actually are being rejected (as in the cyber ball game). They are unable to adapt to situations in which they are actually being included, however, keeping their rejection monitors inappropriately high. The authors also suggest that the expectation of rejection, even when not called for in the situation, is higher in younger individuals and then, once established, leads increasingly mature individuals to regulate themselves to continue to avoid situations where they might be rejected, thereby perpetuating the disorder over time.

To sum up, the social cognitive explanation of BPD could result in a reformulation that would regard its causes as involving expectations that remain invariant across situations. Taking this more situational approach could have implications for treating people with this disorder, helping them to understand and perhaps control their hypersensitivity to exclusion. Rather than putting people with BPD into an all-or-nothing category, understanding these distorted expectations could help pave the way for their greater fulfillment in their understanding of other people and themselves.

References

Cavicchioli, M., & Maffei, C. (2019). Rejection sensitivity in borderline personality disorder and the cognitive–affective personality system: A meta-analytic review. Personality Disorders: Theory, Research, and Treatment. doi:10.1037/per0000359.supp (Supplemental).

Mischel, W., & Shoda, Y. (1995). A cognitive-affective system theory of

personality: Reconceptualizing situations, dispositions, dynamics, and

invariance in personality structure. Psychological Review, 102, 246 – 268. http://dx.doi.org/10.1037/0033-295X.102.2.246