Sophie A. Lazarus

Interpersonal functioning in borderline personality disorder: a systematic review of behavioral and laboratory-based assessments.

It is widely accepted that interpersonal problems are a central area of difficulty for those with borderline personality disorder (BPD). However, empirical elucidation of the specific behaviors, or patterns of behaviors, characterizing interpersonal dysfunction or dissatisfaction with relationships in BPD is limited. In this paper, we review the literature on interpersonal functioning of individuals with BPD by focusing on studies that include some assessment of interpersonal functioning that is not solely self-report; that is, studies with either behavioral laboratory tasks or manipulation of interpersonal stimuli in a controlled laboratory setting were included. First, we review the literature relevant to social cognition, including perceptual biases, Theory of Mind/empathy, and social problem-solving. Second, we discuss research that assesses reactivity to interpersonal stressors and interpersonal aggression in BPD. Next, we review the literature on trust and cooperation among individuals with BPD and controls. Last, we discuss the behavior of mothers with BPD in interactions with their infants. In conclusion, we specify areas of difficulty that are consistently identified as characterizing the interpersonal behaviors of those with BPD and the relevant implications. We also discuss the difficulties in synthesizing this body of literature and suggest areas for future research.

Interpersonal partner choices by individuals with elevated features of borderline personality disorder.

Theoretical accounts and clinical conceptualizations of borderline personality disorder (BPD) highlight pervasive interpersonal dysfunction. Recent investigations have found differences in the interpersonal interactions and social networks of individuals with BPD compared to healthy controls. However, there are few laboratory investigations of these processes and the interpersonal choices made by individuals with BPD. The authors aimed to determine if participants with elevated BPD symptoms made different interpersonal choices than others in a behavioral laboratory task. The authors found that in a condition with no constraint on future time available, participants with elevated BPD symptoms were more likely to choose novel partners (compared to familiar partners) than other participants. In an effort to understand interpersonal constructs related to differential partner choice, the authors tested the contribution of interpersonal sensitivity and interpersonal aggression in the full sample. Interpersonal aggression was associated with an increased likelihood of choosing a novel partner, but interpersonal sensitivity was not related to partner choice. Implications, limitations, and future directions are discussed.

Momentary Patterns of Covariation Between Specific Affects and Interpersonal Behavior: Linking Relationship Science and Personality Assessment.

Relationships are among the most salient factors affecting happiness and wellbeing for individuals and families. Relationship science has identified the study of dyadic behavioral patterns between couple members during conflict as an important window in to relational functioning with both short-term and long-term consequences. Several methods have been developed for the momentary assessment of behavior during interpersonal transactions. Among these, the most popular is the Specific Affect Coding System (SPAFF), which organizes social behavior into a set of discrete behavioral constructs. This study examines the interpersonal meaning of the SPAFF codes through the lens of interpersonal theory, which uses the fundamental dimensions of Dominance and Affiliation to organize interpersonal behavior. A sample of 67 couples completed a conflict task, which was video recorded and coded using SPAFF and a method for rating momentary interpersonal behavior, the Continuous Assessment of Interpersonal Dynamics (CAID). Actor partner interdependence models in a multilevel structural equation modeling framework were used to study the covariation of SPAFF codes and CAID ratings. Results showed that a number of SPAFF codes had clear interpersonal signatures, but many did not. Additionally, actor and partner effects for the same codes were strongly consistent with interpersonal theory’s principle of complementarity. Thus, findings reveal points of convergence and divergence in the 2 systems and provide support for central tenets of interpersonal theory. Future directions based on these initial findings are discussed.

Disorganized Attachment and Personality Functioning in Adults: A Latent Class Analysis.

Though researchers have attended to disorganized attachment in infants and children, they have infrequently focused on the character of disorganized attachment in adults. In this study, we aimed to identify clusters of participants based on attachment levels and styles, seeking to better delineate severity and stylistic differences in disorganized attachment than has been previously articulated. We used a new assessment approach focused on a hierarchy of attachment organization, including secure, insecure (dismissive and preoccupied), rigid-controlling (hostile control and compulsive caregiving), and disorganized (contradictory, impoverished, and unresolved) levels of attachment. Clinical evaluators used information from diagnostic and attachment-based interviews to rate participants on each of these aspects of attachment. Latent class analysis (LCA) revealed a 4-class solution, including a secure (n = 33), insecure (n = 110), and 2 disorganized classes. One disorganized class (disorganized-oscillating) was characterized by elevations on contradictory and preoccupied styles (n = 77) and another (disorganized-impoverished) showed elevations on impoverished and dismissive styles (n = 53). The disorganized-oscillating class exhibited elevated personality disorder (PD) severity and general symptom severity, borderline personality disorder (BPD), histrionic, and antisocial dimensional scores, and the most severe identity disturbance compared with the other classes. The impoverished-dismissive class exhibited the highest avoidant and schizoid PD dimensional scores of the classes, and higher PD severity compared with the insecure and secure classes. These results highlight the possibility of identifying distinct classes of attachment organization, differentiated both by aspects of severity and interpersonal style. They also shed light on the manifestation of attachment disorganization in adults.

An examination of social network quality and composition in women with and without borderline personality disorder.

Borderline personality disorder (BPD) is characterized by interpersonal difficulties including fears of abandonment, unstable relationships, and intense and inappropriate anger (American Psychiatric Association, 2013). However, there is limited research aimed at understanding the social networks of individuals with BPD, particularly in comparison to others. In this study, we compared the social networks of women with BPD to a group of women who did not meet criteria for any psychological disorders (i.e., healthy control (HC) group). Participants recruited from the community and local clinics completed a diagnostic evaluation and the social network assessment, a measure designed to assess the number and perceived quality of partners with whom participants frequently interact. Women in the BPD group had smaller social networks, characterized by less satisfaction and support, and more conflict and criticism among partners than women in the HC group. In addition, the networks of women with BPD were more variable in terms of these quality variables compared to the networks of HC women. However, the 2 groups did not differ on overall closeness or variability in closeness in relationships. Finally, women with BPD reported more relationships in which there had been a significant change or rupture in the past month. These findings suggest that interpersonal distress experienced by women with BPD occurs in the context of smaller and less satisfying social networks compared to the networks of their peers. The examination of additional control groups and longitudinal social network change will further characterize interpersonal dysfunction experienced in BPD.

Social disadvantage and borderline personality disorder: A study of social networks.

Examining differences in social integration, social support, and relationship characteristics in social networks may be critical for understanding the character and costs of the social difficulties experienced of borderline personality disorder (BPD). We conducted an ego-based (self-reported, individual) social network analysis of 142 participants recruited from clinical and community sources. Each participant listed the 30 most significant people (called alters) in their social network, then rated each alter in terms of amount of contact, social support, attachment strength and negative interactions. In addition, measures of social integration were determined using participant’s report of the connection between people in their networks. BPD was associated with poorer social support, more frequent negative interactions, and less social integration. Examination of alter-by-BPD interactions indicated that whereas participants with low BPD symptoms had close relationships with people with high centrality within their networks, participants with high BPD symptoms had their closest relationships with people less central to their networks. The results suggest that individuals with BPD are at a social disadvantage: Those with whom they are most closely linked (including romantic partners) are less socially connected (i.e., less central) within their social network.

Interpersonal problems across levels of the psychopathology hierarchy

We examined the relationship between psychopathology and interpersonal problems in a sample of 825 clinical and community participants. Sixteen psychiatric diagnoses and five transdiagnostic dimensions were examined in relation to self-reported interpersonal problems. The structural summary method was used with the Inventory of Interpersonal Problems Circumplex Scales to examine interpersonal problem profiles for each diagnosis and dimension. We built a structural model of mental disorders including factors corresponding to detachment (avoidant personality, social phobia, major depression), internalizing (dependent personality, borderline personality, panic disorder, posttraumatic stress, major depression), disinhibition (antisocial personality, drug dependence, alcohol dependence, borderline personality), dominance (histrionic personality, narcissistic personality, paranoid personality), and compulsivity (obsessive-compulsive personality). All dimensions showed good interpersonal prototypicality (e.g., detachment was defined by a socially avoidant/nonassertive interpersonal profile) except for internalizing, which was diffusely associated with elevated interpersonal distress. The findings for individual disorders were largely consistent with the dimension that each disorder loaded on, with the exception of the internalizing and dominance disorders, which were interpersonally heterogeneous. These results replicate previous findings and provide novel insights into social dysfunction in psychopathology by wedding the power of hierarchical (i.e., dimensional) modeling and interpersonal circumplex assessment.

Borderline personality disorder symptoms and affective responding to perceptions of rejection and acceptance from romantic versus nonromantic partners.

We examined event-contingent recording of daily interpersonal interactions in a diagnostically diverse sample of 101 psychiatric outpatients who were involved in a romantic relationship. We tested whether the unique effect of borderline personality disorder (BPD) symptoms on affective responses (i.e., hostility, sadness, guilt, fear, and positive affect) to perceptions of rejection or acceptance differed with one’s romantic partner compared with nonromantic partners. BPD symptoms were associated with more frequent perceptions of rejection and less frequent perceptions of acceptance across the study. For all participants, perceptions of rejecting behavior were associated with higher within-person negative affect and lower within-person positive affect. As predicted, in interactions with romantic partners only, those with high BPD symptoms reported heightened hostility and, to a lesser extent, attenuated sadness in response to perceptions of rejection. BPD symptoms did not moderate associations between perceptions of rejection and guilt, fear, or positive affect across romantic and nonromantic partners. For all participants, perceived acceptance was associated with lower within-person negative affect and higher within-person positive affect. However, BPD symptoms were associated with attenuated positive affect in response to perceptions of accepting behavior in interactions with romantic partners only. BPD symptoms did not moderate associations between perceptions of acceptance and any of the negative affects across romantic and nonromantic partners. This study highlights the specificity of affective responses characteristic of BPD when comparisons are made with patients with other personality and psychiatric disorders. Implications for romantic relationship dysfunction are discussed.