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Personality

Borderline Personality: Are They Bad at Reading Others?

Those with borderline personality disorder are said to be poor at "mentalizing."

Key points

  • "Mentalization-based therapy" presumes that clients with borderline personality disorder (BPD) misread others.
  • However, those with BPD have a reputation for being excellent manipulators, which would require them to accurately read others.
  • Apparent "deficiencies" in the BPD population are often due to a role they play to stabilize a dysfunctional family.
  • Similar "mentalization" issues are often seen in a variety of other disorders besides BPD, according to a recent study.
 "Mental Health" by SerenaWong, C.C. 0 Public Domain
Source: Wikimedia Commons: "Mental Health" by SerenaWong, C.C. 0 Public Domain

One of the current theories about what creates borderline personality disorder (BPD) is that somehow they are defective in their ability to mentalize, or have an accurate “theory of mind.” This means they do a poor job of figuring out what is going on in the heads of other people. They are said to have problems understanding the intention or purpose behind other people's behavior from their tone of voice, facial expression, and body posture. In studies, this is mostly found on tests where they are supposed to read faces or interpret videos of people in various activities.

A whole school of psychodynamic psychotherapy for BPD has arisen called mentalization-based treatment, first described by Fonagy and Bateman. Other types of therapy with patients with other diagnoses also help them learn how to better interpret the motives of others, so a bad guess on that is hardly specific to BPD.

I always thought the idea that patients with BPD were particularly bad at reading other people was very amusing in light of the fact that, in my extensive experience, speaking with other therapists as well as in my own experiences, these very same people are so good at drawing three particular responses from therapists: a sense of anxious guilt, anxious helplessness, or fury. They are so good at it that they make most therapists hate them. They can ascertain the therapist’s weak points and then go right for the jugular. How can they be bad mentalizers if they can do that?

When you live in an unstable, confusing environment in which double messages are flying back and forth and you can’t really predict what mood a parent is going to be in when they drop in on you, you become better at reading others than most people so you can quickly adjust to any new contingencies. And as I have repeatedly pointed out, error management theory would predict that you would err on the overreacting rather than underreacting, because the consequences of minimizing parental guilt and hostility are so frightful. This normal tendency is then mistakenly seen as something pathological.

Another big issue in research on personality disorders that bears upon this issue is that when patients are in studies responding to various stimuli in the study situation, they may be responding with a false self or persona (as described by psychoanalysts Jung and Winnicott)—in this case, the spoiler. This is, as my readers know, a role I believe they are playing to maintain smooth family functioning (family homeostasis). This makes them look impaired when in fact they are not. Performance is not the same as ability, as I described in a previous post. If you are not a good actor in situations in which fooling people is paramount, you wouldn’t be very good at doing so.

And to effectively play the role of spoiler, you have to make yourself be way more impaired than you actually are. In particular, you have to pretend that you lack the ability to see both the good and bad in people simultaneously (so-called “splitting”), or evaluate both their strengths belied by their reputation among therapists for being master manipulators! Deficient mentalization, huh?

One new study by Bora of so-called mentalization “abnormalities” was based on a review of the existing literature. The author just assumes that what the studies see is “maladaptive” and therefore abnormal, but found no evidence of any primary neuro-social cognitive deficit. Hardly surprising in light of what I just wrote about. Instead, the author attributes the imaginary abnormality to their “meta-social cognitive style,” whatever that is. Again, it’s as if these patients exist in some social vacuum where certain assumptions would always be completely highly adaptive for anyone who didn’t have a deficient “theory of mind.”

A second study by McLaen et. al looked at "hypermentalizing"—the tendency to over-attribute mental states to other—and found it was common, as I mentioned earlier, in a wide range of disorders rather than in borderline personality disorder in particular.

References

Bateman, A.W., Fonagy, P. (2004). "Mentalization-based treatment of BPD." Journal of Personality Disorders. 18 (1): 36–51.

Bora, “A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment?,” Psychological Medicine. 51(15):2541-2551, 2021 11).

McLaren, V. et. al. "Hypermentalizing and Borderline Personality Disorder: a Meta-Analytic Review. American Journal of Psychotherapy 75(1): 21-31)

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