Social cognition and emotion regulation difficulties in young women with borderline personality disorder

© 2014 Dr. Sarah-Ann Pey Sharn TayDisturbances in both emotion regulation and social cognition have been proposed as central mechanisms underlying the development and maintenance of Borderline Personality Disorder (BPD). It has also been suggested that dysfunction in social-cognitive capacities, such as facial emotion recognition (FER) and theory of mind (ToM), might contribute to emotion dysregulation, and to the development of BPD. The primary aim of this study was to investigate if dysfunctional emotion regulation and social cognition are present early in the course of BPD, and to examine the specificity of these to the disorder. Additionally, the mediating role of emotion regulation in the relationship between social cognition and BPD status was explored. Female participants aged 15 – 24 years with a diagnosis of BPD (n = 41) or MDD (n = 37) completed a self-report measure of emotion regulation, the Difficulties in Emotion Regulation Scale, and four experimental tasks assessing social-cognitive abilities. The Face Morph Task was used as a test of both FER accuracy and emotional sensitivity. The Reading the Mind in the Eyes Test, Happé’s Cartoon Task and The Animations Task were used to assess various aspects of ToM, namely, affective and cognitive dimensions, as well as mental state attribution and reasoning abilities. Compared with the MDD group, the BPD group reported higher overall difficulties with emotion regulation, and more specifically on impulse control and emotional clarity. Although both groups displayed mostly comparable FER accuracy, there was evidence of a heightened sensitivity for disgust in the BPD group. Additionally, the BPD group demonstrated impairments on both affective and cognitive components of ToM. Hierarchical logistic regression analyses revealed that respective models containing emotion dysregulation and the social-cognitive abilities of sensitivity to facial emotions, affective and cognitive ToM significantly predicted BPD status even after controlling for age, intelligence, and depression. Interestingly, results indicated that emotion dysregulation and disturbed social cognition may be separate rather than linked aspects of vulnerability to BPD in this youth sample. Taken together, these findings suggest that emotion dysregulation, including a potentially increased sensitivity to certain facial emotions, and impaired ToM likely help generate and maintain the chronic patterns of emotional and interpersonal dysfunction seen in individuals with BPD. Given that these results were demonstrated in young people with first-presentation BPD, this study provided further support for the importance of early intervention, reinforcing the notion that emotion regulation and mentalising are both valuable targets for treatment