That people with borderline personality disorder are particularly sensitive to rejection seems to be part and parcel of their psychological makeup. An insecure attachment style, in which people constantly fear being abandoned or neglected, is regarded as one of the most critical factors at play in leading to the instability and identity difficulties they face as adults. If you know someone who has borderline personality disorder, or at least some features of the disorder, you are acutely aware of how hard it is for this person to feel that the people close to them can be trusted. When you’re out together, this person can become enraged if your attention wavers or, even worse, you turn away completely and talk to other people. You need to look directly into this person’s eyes when you’re having a conversation, and you always have to be available should this person need to reach you. Failing to return a text can seem like the end of the world, quite literally, precipitating a meltdown if not an ear-meltdown.

New research by Heidelberg University’s Lisa Liebke and colleagues (2018) tested the theory that, rather than being only sensitive to social rejection, people with borderline personality disorder are sensitive even to acceptance. Testing this counterintuitive notion, the German researchers proposed that people with this disorder process social information differently than people who do not have this disorder, and that’s what leads to their inability to accept being accepted. The cognitive processes that they use to interpret social information biases them toward chronically feeling rejected, even when objectively the opposite is happening to them. Their “reduced experience of social connectedness” (p. 3), in the words of the authors, mean that they never feel included in situations when others are in fact reaching out to them as part of the group. You might, according to this view, make extra room at the table when these individuals come to join you at a restaurant, but instead of regarding your invitation as stemming from genuine liking toward them, they interpret the offer as a form of rejection. They might, if this is the case, wonder why you didn’t just wait for them to show up in the first place.

To test the existence of this “negative evaluation bias,” the research team developed what they call the “Mannheim Virtual Group Interaction Paradigm (MVGIP)” to create a realistic situation involving a computer simulation in which participants would feel either socially accepted or rejected by what they believed to be six other participants. The experiment involved a meet and greet phase (Phase 1), in which the participants were introduced to avatars of these experimentally-created other people, followed by a rating task in which they evaluated the other “people,” (Phase 2), leading to the next occurrence, in which they received feedback about how other the others liked them (Phase 3).  In Phase 3, the manipulation involved acceptance (being told they were liked) or rejection (being given negative ratings).

In the next part of the experiment, the participants played a “Trust Game” in which they were led to believe that they were playing with new people who they could either compete with or cooperate with in a simulated money investment task where joint strategies determined individual payoffs. The first co-player, the "trustee" (again, a simulated player), would first show cooperation, then break that bond of trust by not cooperating, and then finally, would go back to being cooperative, appearing to restore the initial trust. The second co-player, a “provocateur,” was introduced to induce antisocial behavior (anger and rage) on the part of the real participant. The idea was that, when the individual with borderline personality disorder felt betrayed by the “trustee,” this betrayal would turn into rage toward the provocateur (measured by taking money away in the investment task) when, in reality, that second co-player had done nothing to deserve such wrath.

This complex experimental procedure could guarantee that the behavior of people with borderline personality could be observed in real time and compared, through manipulation of the conditions of the simulated game, with people who did not have borderline personality disorder. The measures used to test the social acceptance bias hypothesis included expectations of acceptance or rejection (positive or negative ratings from the co-players), emotional responses to acceptance or rejection, behavior toward the trustee in the cooperation-betrayal game, and punitive behavior to the provocateur, measured in the form of taking money away.

The participants consisted of 56 female patients with borderline personality disorder, matched by age and education with typical controls. As the authors expected, the borderline personality group had higher anticipation of rejection than did the healthy controls. The patients also became angrier after rejection than the healthy controls, but they also became angry even after the task led them to feel accepted. The trust game produced results that further supported the idea of a negative social inclusion bias in people with borderline personality disorder. When given the opportunity to invest in a cooperative fashion with their co-player (before the rejection occurred), the borderline individuals exposed to the acceptance condition were less likely to exhibit this prosocial type of approach, or in the words of the authors, “suggesting a disadvantageous effect of positive social encounters on subsequent interactions in BPD (borderline personality disorder)” (p. 10), even when those subsequent interactions were with total strangers.

What was so striking about these results is that during the cooperative phase of the trust game, participants were led to believe that they were sharing profits in a 50-50 fashion with their co-player. That those with borderline personality disorder perceived this behavior negatively might, according to the authors, be due to the fact that they didn’t regard this equal split as fair. Those borderline personality disorder patients might need their partners to offer up a larger share in order to feel that they are truly being treated in an equitable fashion. Even more odd, the break of cooperation and subsequent efforts by the co-player to make up did not produce any differences between the borderline and healthy participants. As the authors note, “This suggests that patients with BPD are well able to forgive their social partner for disruptions in cooperation and reestablish cooperative behavior over a course of multiple interactions when the first step is made by the patients’ interaction partner” (p. 10). Given this desire to reestablish positive relations, the additional finding that individuals with BPD and healthy controls reacted similarly to the provocateur then appears to make sense.

With this experimental method, the German authors were able to show that, in a completely standardized social situation, where the only features that changed were under experimental control, people with BPD have low expectations for their social partners that they cannot adjust upward when other people seem to show interest or concern in them. What’s more, being treated well by their interaction partners leads the BPD individuals to become suspicious of people not involved with that interaction who in fact are behaving fairly toward them.

To sum up, the “mismatch of expectations and experiences” (p. 11) that seems to characterize people with borderline personality disorder seems to be one that can only further aggravate their suspicions that the people they have relationships with don’t truly care. In your relationship with these individuals, it would seem that the only way to ensure harmony is to keep in mind that acceptance alone isn’t enough to smooth the rough waters that can face you and your partner. Apart from whatever therapeutic interventions might be involved, focusing on the expectations, not just the experiences, would seem to be the key to ensuring stable and fulfilling interactions.

References

Liebke, L., Koppe, G., Bungert, M., Thome, J., Hauschild, S., Defiebre, N., … Lis, S. (2018). Difficulties with being socially accepted: An experimental study in borderline personality disorder. Journal of Abnormal Psychology. https://doi-org.silk.library.umass.edu/10.1037/abn0000373.supp (Supplemental)


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Why people with borderline personality are so hard to please: New study suggests that, rather than being only sensitive to social rejection, people with borderline personality disorder are sensitive even to acceptance, so they chronically feel rejected, even when the opposite is happening to them.