Decreased sensitivity to facial emotions in adolescents with Borderline Personality Disorder☆
Introduction
Borderline Personality Disorder (BPD) affects almost 15% of the general population and can be observed among up to 50% of inpatients adolescents (Becker et al., 2002). Severe social dysfunction in this pathology is well documented at this age and is one of the most enduring features of the pathology over time (Levy et al., 1999, Miller et al., 2008). BPD in adolescents has been shown to be a significant predictor over and above axis-I disorders and other personality disorders not only for general functioning but also for peer and family relationships (Chanen et al., 2007). In particular, these patients experience fewer and shorter friendships, less enjoyment of others; they lack the presence of a confident and of romantic relationships and take part in fewer social activities than adolescents with other pathologies (Bernstein et al., 1993). The explanation for this high level of social dysfunction remains unclear and the precise cognitive impairments underlying the relationship instability remain to be investigated. In particular, though emotion perception is a central feature of interpersonal communication, little is known about emotion perception abilities in BPD adolescents.
In contrast, research on adults is currently highlighting a link between relationship difficulties and other's emotion perception in BPD. Linehan (1993) has hypothesized that borderline emotion dysregulation consists of a heightened emotional sensitivity, an inability to regulate intense emotional responses, and a slow return to emotional baseline. In this perspective, studies investigating facial emotion recognition have been conducted in these patients (reviewed by Domes et al., 2009). Levine et al. (1997) found that BPD patients were less accurate at recognizing anger, fear, and disgust than healthy controls. Bland et al. (2004) observed also impairment in recognition accuracy of fear, anger, and sadness. Wagner and Linehan (1999) found that women with BPD were less accurate in appraising neutral faces than controls and showed a negativity bias toward fear that they over-reported in non-fear stimuli. In summary, most studies observed impairment in emotion recognition accuracy in BPD but they could not determine whether sensitivity to emotion was affected, because they did not use progressive stimuli to measure the detection thresholds for emotion recognition.
More recently, Lynch et al. (2006) and Domes et al. (2008) measured emotional sensitivity with intensity varying stimuli. In line with works of Blair et al. (2001), authors in these studies used a dynamic paradigm, in which a morphing technique allows displaying emotional facial expressions in their deployment over time, from neutrality to a fully expressed emotion, and therefore measuring sensitivity to emotion at different degrees of the stimulus. The results are still contradictory. Lynch et al. (2006) observed that borderline adults (n=20) had a higher sensitivity to anger and happiness than controls, i.e. they identified these emotions at lower level of intensity than controls. This was the first morphing study revealing increased sensitivity to emotional expressions regardless of their valence in BPD. The authors suggested that faster latencies of response to emotional stimuli at low levels of emotional intensity exacerbate difficulties in emotion regulation. However, they asked for replication. Domes et al. (2008) observed comparable overall detection thresholds on the emotion recognition task in adults with BPD (n=25) and controls. Differences in the experimental protocols could account for result differences with the preceding study, but these two studies show that sensitivity in BPD can be measured and results are still exploratory.
So far, little information has been collected on emotion recognition in adolescents with BPD, showing that these patients (n=30) did not accurately estimate the intensity of static facial emotions but had no deficit in naming the displayed emotions (Ceumern-Lindenstjerna et al., 2007). Another study with a morphing paradigm in youth with features of BPD (n=21) found no evidence of heightened sensitivity to facial emotions. Here again, adolescents were accurate in recognizing fully expressed emotions (Jovev et al., 2011). Authors hypothesized that emotional sensitivity might develop later in the course of the pathology or be only present in severe BPD. The inclusion of sub-syndromic patients (from 3 DSM IV criteria for BPD) in the sample may also explain the lack of significant difference between BPD and controls, by reducing the contrast between groups.
However, BPD symptoms and social dysfunction exhibited by adolescent patients suggest that the underlying cognitive features are already present at this age. Furthermore, immaturity of neuronal development in healthy adolescent frontal lobe may also account for difficulties in processing emotional information and potentiate BPD difficulties (Giedd et al., 1999, Sowell et al., 1999). For these reasons, sensitivity to facial emotion needs to be explored further. This is the aim of the present work. We therefore explored the ability of young in- and outpatients with BPD to recognize dynamic facial emotions, with a paradigm that included the possibility to test their sensitivity at low level of emotion as much as their ability to recognize a fully expressed emotion. Additionally, we performed for the first time in such studies a low-level control task in order to exclude the possibility that patients were less sensitive to emotions because of psychomotor or low-attentional impairments.
Section snippets
Participants
The study sample was issued from a European network investigating BPD in adolescence (European Research Network on Borderline Personality Disorder, EURNET BPD). The research network involved 5 psychiatric centers specialized in adolescents in France, Belgium, and Switzerland. Twenty-two in- and outpatient female adolescents (15 to 19 years old) were screened following the DSM-IV criteria for BPD. Non-inclusion criteria were diagnosed schizophrenia and any chronic or life-threatening medical
Sample characteristics
All participants were native European adolescents. Most of them belonged to families with high economic status: 52.9% of the fathers of adolescents with BPD were executives versus 68.2% for the control group (p=0.33). The patient group included 14 in-patients (63.6%) and 8 outpatients (36.4%). Seventeen patients (77.2%) were currently under psychotropic medication. None of the control participants reported any current medication use.
All subjects from the BPD group had at least one axis-I
Discussion
BPD in adolescent is characterized by a severe relationship dysfunction, but so far little is known about the way these patients process facial expressions of emotion. Our results show that adolescents with BPD have lower sensitivity to facial emotions of anger and happiness than controls (as indicated by the higher recognition thresholds), but have no impairment at identifying fully expressed emotion (as indicated by the absence of a significant difference in the final success rate between
Acknowledgment
This research was supported by grants from the French Pediatric Society, Lilly Institute, and Wyeth Foundation. We are very grateful to Prof Boris Birmaher for his helpful suggestions.
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2021, Current Opinion in PsychologyCitation Excerpt :For example, it is well known that children with a history of early life stress, particularly neglect or abuse, struggle to recognize emotional facial expressions, and the degree of their inaccuracy predicts their general social competence [66,67]. Adolescent girls with a diagnosis of BPD have been shown to need more perceptual information than those without such a diagnosis in order to accurately judge simple facial expressions of happiness and anger [68]. We have recently systematically reviewed the literature on the impact of trauma on the development of social cognition [69∗∗].
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2017, Psychiatry ResearchCitation Excerpt :Effortful control buffers the link between relational vulnerabilities and BPD features (Ayduk et al., 2008; De Panfilis et al., 2016) and differentiates between high and low functioning subgroups of BPD patients (Hoermann et al., 2005). Notably, effortful control reflects the efficiency of executive attention (Posner and Rothbart, 2009), and executive/attentional control has been proposed as an influential determinant of facial emotion recognition in BPD (e.g., Domes et al., 2009; Robin et al., 2012; Lowyck et al., 2016). For instance, the finding of lower facial emotion recognition accuracy for full intensity negative emotions in BPD may be explained by bottom-up impairments in cognitive control: the hyperarousal evoked by highly salient emotional stimuli deplete cognitive resources and interfere with facial emotion identification (Daros et al., 2013).
Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing
2017, Psychiatry ResearchCitation Excerpt :There was no evidence for impaired emotion recognition abilities in BPD compared to HC. This is in line with some previous studies reporting on emotion recognition of full emotional facial expressions in BPD vs HC (Domes et al., 2008; Dyck et al., 2009; Lynch et al., 2006; Mier et al., 2013; Robin et al., 2012; v Ceumern-Lindenstjerna et al., 2007; Wagner and Linehan, 1999), but not in line with studies that used complex stimulus material like video clips to investigate cognitive empathy (Dziobek et al., 2011; Niedtfeld et al., 2016; Preissler et al., 2010). One explanation could be that there was no time limit for the decision process (Dyck et al., 2009).
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Author note: Some data from this article has been previously presented at the annual meeting of the American Psychiatric Association in San Diego (May 2007), and at the first Congress on “Borderline Personality Disorder” in Berlin (July 2010).