Fear of positive evaluation in borderline personality disorder

A second chance for first impressions: evidence for altered impression updating in borderline personality disorder

BACKGROUND

Individuals with borderline personality disorder (BPD) frequently alter between idealizing and devaluing other persons, which has been linked to an increased tendency to update self-relevant beliefs and impressions. We hypothesized that increased impression updating could stem from reduced attitude contextualization, i.e., a process in which impression-disconfirming information is linked to contextual cues.

METHODS

Individuals diagnosed with BPD and controls (recruited online, with unknown diagnostic status) completed an impression formation paradigm. They first learned about the positive or negative behaviors of others in one Context A (e.g., Person 1 is helpful), followed by learning about behaviors of the opposite valence in a second Context B (Person 1 is rude). We also manipulated between participants whether the observed behaviors were directed toward the study participants (self-relevant) or, more generally, at other people (other-relevant). The contexts were marked by differently-colored backgrounds (e.g., yellow vs. blue), to avoid influences of prior knowledge or experiences. After exposure to information in both contexts, participants rated their impressions of the persons in Context A, Context B, and, crucially, a previously unknown Context C (white background). We examined whether the initial or an updated impression (re-)emerged in Context C.

RESULTS

Initial impressions remained stable and dominated the ratings of controls across contexts A, B, and C for both self-relevant and other-relevant behaviors, consistent with contextualizing impression-disconfirming information. As expected, however, individuals with BPD only showed updated impression ratings in Context C for self-relevant behaviors, consistent with the assumed reduced tendency to contextualize impression-disconfirming self-relevant information. Further exploratory analyses suggest that more severe BPD symptoms predicted more pronounced impression updating in the self-relevant condition.

CONCLUSIONS

The findings help to illuminate the mechanisms underlying interpersonal problems in individuals with BPD. People with BPD are not just more inclined to discard positive first impressions but to re-evaluate disliked others when they behave positively, contributing to the volatility of interactions with others. Contextualization has known and modifiable antecedents, and the study may thus provide potential targets for therapeutic intervention. Future studies will need to replicate the findings with specified controls.

Childhood emotional maltreatment and sensitivity to social rejection in emerging adults

BACKGROUND

Enhanced responsiveness to social rejection may be a transdiagnostic mechanism through which childhood emotional maltreatment predisposes individuals to interpersonal and mental health problems. To investigate this mechanism, as a first step, more detailed investigations are needed regarding the assumed association of childhood emotional maltreatment with rejection sensitivity in later life.

OBJECTIVE

The present work examines the hypothesis that among different subtypes of childhood maltreatment, in particular forms of emotional maltreatment (emotional abuse and neglect) relate to rejection sensitivity in emerging adults.

PARTICIPANTS AND SETTING

In study 1, 311 emerging adults (18-25 years) participated in a retrospective cross-sectional assessment. In study 2, 78 emerging adults (18-25 years) were included in an experiment (O-Cam paradigm) which involved the experience of social rejection (vs. inclusion).

METHODS

Study 1 investigates whether intensities of childhood emotional abuse and neglect have unique associations with trait rejection sensitivity, when considering all maltreatment subtypes (emotional abuse, sexual abuse, physical abuse, emotional neglect, physical neglect) simultaneously. Study 2 examined whether childhood emotional abuse and neglect moderate the experience of social rejection in terms of need depletion, sadness and anger after social rejection (vs. inclusion).

RESULTS

Study 1 indicates that emotional abuse and neglect have unique associations with rejection sensitivity. Study 2 results show that only a higher intensity of emotional abuse has extensive effects on need depletion and sadness after social rejection (vs. inclusion).

CONCLUSIONS

In particular, experiences of childhood emotional abuse may relate to rejection sensitivity in young adulthood.

Unmet expectations: social inclusion and the interaction between social anxiety and ambiguous or positive feedback

Introduction

This study explores the impact of preferential inclusion on fulfilling basic needs following ambiguous or positive social feedback, considering the moderating effect of social anxiety.

Methods

Participants (N = 438) received either positive or ambiguous social feedback and engaged in a social participation or preferential social inclusion task. They completed measures of the fulfillment of their fundamental needs, social anxiety, and other personality traits.

Results

The results indicate that preferential social inclusion (Uberball condition) enhances the fulfillment of fundamental needs compared to social participation (Cyberball inclusion condition). Furthermore, receiving positive social feedback considerably strengthens the negative relationship between social anxiety and fundamental need fulfillment when followed by ordinary social participation relative to preferential social inclusion presumably because these individuals react more strongly to unmet expectations of extreme social acceptance.

Discussion

This research suggests that individuals with high social anxiety may not experience the usual benefits of social participation unless they experience extreme social inclusion.

Fear of positive evaluation mediates the relationship between self-efficacy and fear of negative evaluation in nursing students: A cross-sectional study

BACKGROUND

Fear of evaluation (including the negative and positive ones) has been the focus of scholarly attention as one of the core components of social anxiety. However, most existing research has focused on participants with social anxiety. Previous research has suggested that self-efficacy and fear of positive evaluation are associated with fear of negative evaluation. Still, it remains unknown whether there is an association between the three. For undergraduate nursing students in complex social environments, understanding the association between self-efficacy and fear of positive and negative evaluation is essential to facilitate the high-quality development of nursing talent.

OBJECTIVE

We aimed to explore the mediating role of fear of positive evaluation in the relationship between self-efficacy and fear of negative evaluation.

METHODS

A cross-sectional survey was conducted on 824 undergraduate nursing students using the Brief Fear of Negative Evaluation Scale-Straightforward Items, the Fear of Positive Evaluation Scale, and the General Self-Efficacy Scale. Pearson correlation analysis was used to explore the correlation of the variables. t-test or ANOVA was used as a univariate analysis. A bootstrap test was conducted to verify the mediating effect through the SPSS macro plugin PROCESS v3.3, with P < 0.05 indicating a statistically significant difference.

FINDINGS

Self-efficacy, fear of positive evaluation, and fear of negative evaluation were significantly associated. Self-efficacy directly and negatively predicted fear of negative evaluation (B = -3.14, p < 0.001). Fear of positive evaluation partially mediated between self-efficacy and fear of negative evaluation, with a mediating effect size of 38.22 %.

DISCUSSION

Self-efficacy can directly and negatively influence fear of negative evaluation. Meanwhile, it can also indirectly reduce the fear of negative evaluation by reducing the fear of positive evaluation. Nursing educators can improve the fear of negative evaluation by increasing students' self-efficacy and encouraging them to view positive assessments correctly.

Fear of compassion from others explains the relation between borderline personality disorder symptoms and ineffective conflict resolution strategies among patients with substance use disorders

BACKGROUND

Borderline personality disorder (BPD) pathology is common among patients with substance use disorders (SUDs) and associated with a variety of negative outcomes, including worse SUD outcomes. One particularly relevant outcome with links to substance use problems that is likely to be elevated among SUD patients with BPD symptoms is ineffective conflict resolution strategies in romantic relationships. However, no research to date has examined the relation of BPD pathology to strategies for managing conflict in romantic relationships among patients with SUDs, or the factors that may increase the use of ineffective strategies within this population. Thus, this study examined the relations of BPD symptoms to ineffective responses to romantic relationship conflict surrounding substance use among residential patients with SUDs, as well as the explanatory roles of fear of compassion from and for others in these relations.

METHODS

Patients in a community-based correctional SUD residential treatment facility (N = 93) completed questionnaires, including a measure of BPD symptoms, fear of compassion from and for others, and strategies for responding to conflict surrounding substance use in romantic relationships.

RESULTS

Fear of compassion from others accounted for significant variance in the relations of BPD symptoms to the ineffective conflict resolution strategies of reactivity, domination, and submission, whereas fear of compassion for others only accounted for significant variance in the relation between BPD symptoms and the strategy of separation (which is not always ineffective).

CONCLUSIONS

Together, findings suggest that it is fear of compassion from others (vs. fear of compassion for others) that explains the relation between BPD symptoms and ineffective responses to romantic relationship conflict surrounding substance use among SUD patients. Findings highlight the potential utility of interventions aimed at reducing fears of compassion and increasing comfort with and tolerance of compassion from both others and oneself among SUD patients with BPD symptoms in order to strengthen relationships and reduce risk for relapse.

Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy

BACKGROUND

In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text messaging interface.

METHODS

The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in text messages. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework.

RESULTS

Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. Whereas HC showed a negativity bias when implicitly asked about the literalness of the statement, patients with BPD perceived praising utterances as less praising when explicitly asked about their perceived intention. Neither empathy nor schizotypy explained outcomes beyond borderline symptoms.

CONCLUSIONS

This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased when asked about the literality of a statement, they perceived praising remarks as less positive on explicit measurements. The results highlight the importance of congruent, transparent communication in promoting epistemic trust in individuals with BPD.

Functional Impairment in Borderline Personality Disorder: The Mediating Role of Perceived Social Support

Borderline personality disorder (BPD) is characterized by instability in relationships, mood fluctuations, and erratic behavior. This study investigates the relationship between pathological personality traits and functional disability, the status of perceived social support in BPD, as well as its mediating role in this relationship. In this cross-sectional study, 192 Spanish women (BPD group, N = 97; healthy control group, N = 95) completed, through two online platforms, a battery of tests including: the Personality Inventory for DSM-5 Brief Form (PID-5-BF), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Perceived Social Support subscale of the Quality of Life Questionnaire (QLQ). The results show that perceived social support was significantly lower in the BPD group, which also presented a significantly higher disability score than the control group. Pathological personality traits affected functionality both directly and indirectly through perceived social support, as this variable was a significant mediator in both groups. We conclude that perceived social support is impaired in BPD patients, and enhancing it as a complementary therapy to evidence-based treatments could help preserve the functionality of patients while pathological traits are regulated. This study also encourages future research to delve into the relevance of other psychosocial variables on the functionality of subjects with BPD, and the need of enhancing them in therapy.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.

Processing of increased frequency of social interaction in social anxiety disorder and borderline personality disorder

We investigated how patients with social anxiety disorder (SAD) and patients with borderline personality disorder (BPD) process an increase in the frequency of social interaction. We used an EEG-compatible version of the online ball-tossing game Cyberball to induce an increase in the frequency of social interaction. In the first condition, each player received the ball equally often (inclusion: 33% ball reception). In the following condition, the frequency of the ball reception was increased (overinclusion: 45% ball reception). The main outcome variable was the event-related potential P2, an indicator for social reward processing. Moreover, positive emotions were assessed. Twenty-eight patients with SAD, 29 patients with BPD and 28 healthy controls (HCs) participated. As expected, HCs and patients with BPD, but not patients with SAD, showed an increase in the P2 amplitude from the inclusion to the overinclusion condition. Contrary to our expectations, positive emotions did not change from the inclusion to the overinclusion condition. EEG results provide preliminary evidence that patients with BPD and HCs, but not patients with SAD, process an increase in the frequency of social interaction as rewarding.

Ego-resiliency in borderline personality disorder and the mediating role of positive and negative affect on its associations with symptom severity and quality of life in daily life

Borderline personality disorder (BPD) is a serious mental health condition associated with severe symptoms of distress and poor quality of life (QoL). Research outside the field of BPD suggests that ego-resiliency is negatively associated with psychopathology and positively associated with a range of positive life outcomes. Thus, ego-resiliency may be a valuable construct for furthering our understanding and treatment of BPD. However, the mechanisms linking ego-resiliency to psychopathology and QoL in relation to BPD have not been examined and explored by research. This study has addressed this gap in the collective knowledge by evaluating whether within-person associations between daily reports of positive affect (PA) and negative affect (NA) mediated the relationship between ego-resiliency, BPD symptom severity, and QoL. For 21 consecutive days, 72 women diagnosed with BPD completed end-of-day electronic assessments regarding ego-resiliency, PA and NA, symptom severity, and QoL. Multilevel structural equation modelling established that PA and NA were parallel mediators linking ego-resiliency with BPD symptom severity and QoL. As hypothesized, the path to QoL was stronger through PA than through NA. The mediation paths through NA and PA to BPD symptom severity were both significant, but their strength did not differ. Our findings align with the assertions of theories on emotion, thus suggesting a two-factor approach to PA and NA. Future research can build on these findings by developing psychotherapeutic interventions designed not only to reduce symptom severity but also to enhance PA in individuals with BPD and determine whether an increase in PA is associated with improved QoL.