Personality Disorders: Theory, Research, and Treatment, Vol 16(2), Mar 2025, 122-136; doi:10.1037/per0000697
Individuals with borderline personality disorder (BPD) often hold pervasive and negative self-views and experience feelings of low connectedness toward others despite effective treatment. This study aimed to identify neural and affective mechanisms of identity disturbance in BPD that contribute to difficulties in relating to others. Participants diagnosed with BPD (N = 34) and nonclinical controls (NCC; N = 35) completed a within-subject social feedback task inside a magnetic resonance imaging scanner. Participants received character evaluations, supposedly from a panel of three members who provided either predominantly negative, intermediate, or positive feedback. Multilevel analysis and event-related functional magnetic resonance imaging analysis compared the BPD and NCC group on mood, affiliation, and neural responses to the feedback and the panel. Results indicate that people with BPD had more negative self-views and reported lower mood after negative and intermediate feedback compared to NCC. People with BPD also felt less close to the member providing predominantly positive feedback compared to NCC, which appeared to be mediated by degree of fearful attachment. People with BPD showed altered bold responses to social feedback in temporal parietal junction and the anterior cingulate cortex compared to NCC. Findings indicate that people with BPD experience pervasive negative self-views that may interfere with forming relationships. New interactions may reinforce a fearful pattern of relating as existing (negative) views of the self are activated and subject to confirmation. These complexities have important clinical implications for the therapeutic alliance. Balancing a supportive and expressive stance may foster the therapeutic alliance while challenging negative self-views. (PsycInfo Database Record (c) 2025 APA, all rights reserved)