1. BORDERLINE PERSONALITY DISORDER AND TRUST
Trust and borderline personality features: direct trust appraisal and indirect trust learning
Anita Poggi1, Paola Ricciardelli1, Juliette Richetin1, Emanuele Preti1 & Eric Fertuck2 Università degli Studi di Milano-Bicocca1 & City College of New York2
BORDERLINE PERSONALITY DISORDER AND TRUST
Many of the typical symptoms of Borderline Personality Disorder (BPD) occur within interpersonal contexts
Such disturbances are connected to deficits in BPDs’ social cognition: perception, processing, and emission of social signals that mantainBPDs’ impairments in social relations.
BPD have a generalized mistrust of others (Fertuck, Grinbald & Stanley, 2013; Miano, Fertuck, Arntz & Stanley, 2012).
Such mistrust of others results in appraisal of greater untrustworthiness in neutral faces, greater sensitivity to others’ untrustworthiness and behavioral untrustworthiness (Fertuck, Grinbad, & Stanley, 2013; Miano, Fertuck, Arntz, & Stanley, 2012).
Despite the wide interest about the possible clinical implications of untrustworthiness bias in BPD, only few studies focused on the possible connections between these.
We aim at exploring the relations between BPD, trust appraisal and trust learning (assessed directly and indirectly).
METHOD
2 independent studies to investigate 1) the effects of BPD traits on direct and indirect trust appraisal and Gaze Cueing Effect (facilitation of congruency between gaze of cue and target position) and 2) the effects of BPD traits on trust learning assessed directly and indirectly
Study 2
126 female participants (M age = 22.58, SD = 2.28)
Borderline Personality Disorder Checklist (BPDCL) (Giesen-Bloo et al., 2006).
Trust rating of neutral faces before GCP.
GCP with manipulation of trustworthiness: half identities trustworthy (always congruent gaze) half untrustworthy (always incongruent gaze).
Trust rating after GCP: trust learning assessment.
Behavioral Intentions: trust learning assessment.
Study 1
125 female participants (M age = 22.13, SD = 2.69)
Borderline Personality Disorder Checklist (BPDCL) (Giesen-Bloo et al., 2006).
Trust rating of neutral faces: explicit trust appraisal assessment.
Gaze Cueing Procedure (GCP) (Driver et al., 1999): to assess gaze cueing effect (facilitation of congruency between gaze of cue and target position).
RESULTS
3. No bias of BPD for Trust learning - ratings (fig. 3)
Study 2:
Untrustworthy faces (through GCP) received lower trust ratings than trustworthy faces after the task, F(1,105) = 3.198, p = 0.07, η2 =0.03
No influence of BPD features on such effect
1. Untrustworthiness bias of BPD for Direct Trust Appraisal (Fig. 1 e Fig. 2). In both Study 1 and Study 2 we found a negative association between BPD traits and trustworthiness ratings: increasing BPD features trustworthiness ratings decrease.
Fig. 1
Fig. 2
Fig. 3
2. No bias of BPD for Indirect Trust Appraisal
We found a gaze cueing effect so that incongruent cues caused significantly longer reaction times to targets than congruent ones, F(1,105) = 18.70, p < .001, η2 = 0.15 and no BPD influence on such effect F(1,104) = .34, p =.563. That means that, independently from BPD traits, individuals' responses to targets are facilitated (faster) by congruent gaze cues.
4. No bias of BPD for Trust learning - Behavioral Intentions
No significant differences in Behavioral Intentions towards trustworthy and untrustworthy faces after manipulation, F(1,105)=.928, p=.338
No influence of BPD features.
CONCLUSIONS
Higher BPD features are associated with lower direct trust toward faces but not with:
indirect trust appraisal: shorter reaction times towards congruent gaze cued targets regardless of BPD features.
trust learning measured through trust ratings: significant differences in trust ratings after manipulation regardless of BPD features.
trust learning measured through Behavioral Intentions: no significant differences in BI towards trustworthy or untrustworthy identities regardless of BPD features.
In conclusion, in a non-clinical sample, higher BPD features do not impair trust learning but affect trust appraisal.
Our results provide additional evidence to a specific social-cognitive impairment in BPD: the untrustworthiness bias. Such impairment express itself in both cooperative behavior (e.g., King-Casas, Sharp, Lomax-Bream, Lohrenz, Fonagy, & Montague, 2008) and in therapy context. In early phases of treatment, indeed, it is very common to see in BPD patients a lack of trust toward the therapist that takes the form of intense paranoid transference (Yeomans, Clarkin, & Kernberg, 2015). For this reason future research should focus on claryfing whether BPD traits are connected to an untrustworthiness bias and the potential role of the different typical BPD features such as Rejection Sensitivity, Effortful Control etc.
REFERENCES
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Fertuck, E. A., Grinband, J., & Stanley, B. (2013). Facial trust appraisal negatively biased in borderline personality disorder. Psychiatry Research, 207(3),
Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, Kremers, I Nadort, M, Arntz A: (2006). Outpatient psychotherapy for borderline personality disorder. Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006; 63: 649–658.
King-Casas, B., Sharp, C., Lomax-Bream, L., Lohrenz, T., Fonagy, P., & Montague, P. R. (2008). The rupture and repair of cooperation in borderline personality disorder. Science (New York, N.Y.), 321(5890), 806–810.
Miano, A., Fertuck, E. A., Arntz, A., & Stanley, B. (2013). Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. Journal of Personality Disorders, 27(4),
Yeomans F. E., Clarkin J.F., Kernberg O.F. (2015) Transference-Focused Psyhotherapy for Borderline Personality Disorder: A Clinical Guide. Washington, DC: American Psychiatric Publishing.