Personality Disorders

More Questionable Personality Disorders Research

Performance vs. ability, "mentalization" issues, and parent-child interactions.

Posted Apr 21, 2020

 Tim Green/Flickr
Source: Tim Green/Flickr

Previously I have discussed how researchers make unwarranted assumptions about their subjects in interpreting their results. What follows is an example in which a common presumption in research is brought into question. This is followed by two examples of studies that presume facts not in evidence.

The difference between “cannot” and “do not:” Ignoring motivation, and ignorance of the concept of “false self.”

Shane MS; Groat LL. “Capacity for upregulation of emotional processing in psychopathy: all you have to do is ask.” Social Cognitive & Affective Neuroscience, 13(11):1163-1176, 2018.

Could it be that a psychopath’s apparent lack of empathy stems from differences in motivation rather than ability? This article is evidence that such is the case. Perhaps people who routinely engage in anti-social acts suppress empathic responses because doing that allows them to play their role in their family. That what has been observed represents false selves? 

In this study, high-psychopathy participants showed atypical, significantly reduced neural responses in the brain on an fMRI to negatively-toned pictures under passive viewing conditions. However, this effect seemed to disappear when the subjects were merely instructed to try to maximize their naturally occurring emotional reactions to these same pictures!

Thus, the participants appeared capable of deliberately manifesting certain emotional responses rather than others. Of note was that the magnitude of these requested emotional responses was comparable to levels exhibited by low-psychopathy participants’ during passive processing.

A high index of suspicion versus an “inability” to correctly read others

Quek et. al., “Mentalization in Adolescents with Borderline Personality Disorder.: a Comparison with Health Controls.” Journal of Personality Disorders, 33 (2):145-165, 2018.

Mentalization refers to an individual’s capacity to understand and interpret the meaning of others’ behavior by considering underlying thoughts, feelings, intentions, and desires. This was “measured” in adolescent subjects with borderline personality disorder (BPD) and normal controls while they interpreted the mental states of others shown in pictures, videos, and narrative vignettes of people in various social situations.

The authors mention that the ability to mentalize is thought to develop within the context of, and is dependent on, the quality of infant-parent interactions. In the experiment, the differences between the performance of the BPD subjects compared to the control group on the various tests became much greater when the material they interpreted suggested attachment-related stress.

Additionally, the major differences between BPD subjects and controls seemed to primarily involve what the authors describe as hypermentalization (that is, making much more complex inferences than expected about social cues, signs, and mental states) by the BPD subjects, rather than through a loss of detail.

Despite all this, the authors don’t seem to consider the obvious possibility that the influence of attachment figures’ on their children’s ideas about the social behaviors of others continues unabated long after they are no longer infants.

How might you evaluate the motives of other people if you were to grow up in a family environment characterized by your being constantly invalidated and given highly confusing double messages about how you are supposed to think and behave, and even being abused if you seem to have guessed wrong about that? Do you think you might have a higher index of suspicion about other people’s intentions than someone who did not grow up in that environment? Ya think?

Changing parent’s behavior towards BPD children can make them better—so did their behavior have nothing to do with their kids having developed the disorder in the first place?

Grenyer et. al., “A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons with Borderline Personality Disorder.” Journal of Personality Disorders 33 (2):214-228, 2018.

Researchers into BPD have developed an interest in the “burdens” on parents and caretakers of having a child or adult child with the disorder. Such “carers” are the subject of this particular study, and were recruited through flyers distributed to mental health services, local media, patient advocacy groups, and patient family and support networks. The recruits were put into groups and given a lot of “psychoeducation” about their charges.

Even though the carers were evaluated for being critical and over-involved with their BPD children, there was nothing mentioned about seeing if the parents had been guilty of physically or sexually abusing their charges when the BPD patients were children. Every empirical study done on this subject in BPD patients finds a fairly high level of significant abuse history. Of course, parents who respond to flyers and volunteer to be research subjects in this sort of study are unlikely to have been seriously abusive. So right away, the experiments are selecting for a somewhat atypical sample of parents of children with BPD.

The psychoeducation provided for the subjects was supposedly based on the Bowen family therapy theory. The researchers seemed to know absolutely nothing about some of the major tenets of that theory: those that involve the intergenerational transfer of dysfunctional family patterns. The researchers mention nothing about the parents being somewhat responsible for the development of the disorder in their kids in the first place!

That they seem to make this assumption is even more awe-inspiring when you look at what was being taught to the parents and which led to improvement in the BPD child’s behavior as well as in the parent-child relationship. They were taught to:

  1. Be non-judgmental, validating, attentive, and appropriate.
  2. Reduce their reactivity and try to remain calm and “mindful.”
  3. Attend to their own needs through staying connected with friends and family, attending to their own physical and mental health, and taking breaks.
  4. Model appropriate assertiveness and setting appropriate boundaries and ground rules for the relationship.
  5. Get outside help when crises arise and have a crisis plan.

So, if they had to be taught these things, and if doing those things leads to improvements in their children, maybe the fact that they were doing the opposite of those things all the time previous to the experiment was what was creating their child’s problems in the first place.