Why Are Borderline Personalities So Distrustful Of Others?
Researchers Evelyn Levay and Zsolt Unoka discuss the link between BPD and distrust.
By Mark Travers, Ph.D. | October 5, 2021
A new study appearing in Frontiers in Psychology provides firm evidence of a tendency among Borderline personalities to expect the worst of people. Needless to say, this is not a recipe for psychological health and happiness.
I recently spoke with the authors of the research, Evelyn Levay and Zsolt Unoka of Semmelweis University in Hungary, to learn more about their findings. Here is a summary of our conversation.
What inspired you to investigate the topic of distrust and Borderline Personality Disorder, and what did you find?
Zsolt: My clinical experiences inspired me to work with BPD patients and to understand the role of distrust in rupture and trust in repairing therapeutic alliances. According to previous research, patients with borderline personality disorder (BPD) show intense reactions to perceived abandonment, a high degree of mistrust, and a distorted, negative perception of others that contribute significantly to interpersonal problems.
To deepen our understanding of BPD patients' interpersonal problems, scientists started to use economic games to understand their decision-making processes. Economic games provide scientific rigor and, at the same time, involve "hot" interpersonal decision-making tasks. The tendency to negatively evaluate others can sabotage various forms of social interactions and this possibly contributes to the results of previous research that shows a lack of cooperation and signs of mistrust in BPD.
Previous studies that investigated trust with economic games in BPD had contradictory findings. In our study, we investigated to what extent BPD patients are inclined to cooperate in interpersonal situations.
Generosity was measured by a game that does not enforce strategic thinking. It only asks subjects to distribute specific amounts of money between themselves and another person as they prefer. We wanted to measure the subject's primary social motivation and expectations as the two main determinants of cooperative behavior.
We presumed that impaired cooperation in BPD is not due to their reluctance to cooperate but rather to their expectation of selfishness and disregard from others. Thus, our study's goal was to examine BPD patients' generosity and investigate their basic expectations about other people's social motives.
To do this, participants were asked to divide specific amounts of money between themselves and an unknown fictitious other. In one condition, subjects had to divide the sums of money as they thought the unknown fictitious other would do it. We compared the results of patients with BPD and healthy subjects. We found significant differences between the two groups regarding the expectations about the other's generosity. The BPD group expected significantly more selfish orientation from the other, while their own generosity did not differ significantly from that of the control group.
Our tentative idea for explaining this difference is related to the developmental history of patients with BPD. Early maltreatment, neglect, and abuse is an important etiological factor in BPD. The pattern we found might derive from a family environment where cooperation of the child was obligatory whereas the environment did not reciprocate it. Rather, their cooperation was met with selfishness and disregard for the needs of the child.
Can you give a brief description of Borderline Personality Disorder?
Zsolt: Borderline Personality Disorder (BPD) is characterized in DSM-5 by nine symptoms, and only five are enough to get the diagnosis. The first characteristic symptom is the fear of abandonment and a frantic effort to avoid real or imagined abandonment. This symptom is part of a wider group of phenomena, which core mechanism may be related to ingroup-outgroup categorization of the self. In the long history of the evolution of our species, being in an outgroup was very dangerous. Seclusion, rejection, abandonment were life-threatening for us. The physical and emotional pain developed as a signal of life-threatening situations. BPD patients are overly sensitive to any sign of rejection, and for them being lonely causes an intense feeling of emotional pain. This fear of abandonment and high rejection sensitivity may relate to their insecure attachment history, early traumatic interpersonal experiences, and their neurobiological vulnerability may also play a role. Their fear of rejection plays an essential role in their unstable and stormy interpersonal relationships, alternating between idealization and devaluation.
We can hypothesize that interpersonal distrust may contribute to fear of abandonment and turbulent relationships. It is a further question of whether a biologically determined unstable mood leads to unstable relationships or unstable relationships leads to mood swings. Most of the time, their problems with emotion regulation are induced by interpersonal conflicts, or self-critical thoughts.
One characteristic expression of their emotional dysregulation is inappropriate, intense anger, or difficulty controlling anger, which leads to frequent displays of temper, constant anger, and recurrent physical fights. Other symptoms could be understood as coping with intense emotional pain: impulsive substance abuse, binge eating, inappropriate sexual behavior, self-harming behavior, dissociative symptoms like emptiness, disintegrated identity, and transient psychotic-like episodes with hallucinations and paranoid thoughts.
BPD is more common in women than men. Did you find any gender differences in your study?
Evelyn: According to epidemiologic studies, the significant overrepresentation of women with BPD in clinical samples is mainly due to the fact that they are more willing to seek help. On the other hand, they gain more attention because specific symptoms like impulsivity manifest differently amongst women, e.g., they are more prone to self-harm than men with BPD. Since men and women often exhibit different BPD characteristics, and social value orientation shows gender differences, it is reasonable to think that gender could also affect our findings. Unfortunately, we did not have enough sample sizes to address this question, but this could be an interesting question for future research.
Is it possible for someone with a BPD diagnosis to overcome their distrust of others?
Zsolt: Most of the evidence-based therapies of BPD address distrust in some way. There are effective psychotherapies, like Schema Therapy, Dialectical-Behavior Therapy, Mentalization Based Therapy, and Transference Focused Therapy, although around half of the patients in these studies did not change substantially. It is a further scientific question of whether distrust plays an essential role in non-responding to therapy.
What might the average person (i.e. a non-psychologist) be able to learn from your investigation? Are there any practical wisdoms you'd like to convey?
Evelyn: One conclusion for everyday life could be that besides our own responsibility to act prosocially we also have a fair chance and thus a responsibility to facilitate prosocial behavior in others — simply by honestly expressing our point of view, our thoughts and feelings. By expressing ourselves clearly we can reduce ambiguity in everyday social situations, and thus the partner’s need to rely on presumptions regarding our state of mind.