Hostname: page-component-f554764f5-68cz6 Total loading time: 0 Render date: 2025-04-17T23:59:30.742Z Has data issue: false hasContentIssue false
  • English
  • Français

Facial emotion recognition in borderline personality disorder

Published online by Cambridge University Press:  13 November 2012

A. R. Daros ,
K. K. Zakzanis  and
A. C. Ruocco
A. R. Daros
Affiliation:
Department of Psychology, University of Toronto Scarborough, Toronto, Canada
K. K. Zakzanis
Affiliation:
Department of Psychology, University of Toronto Scarborough, Toronto, Canada
A. C. Ruocco*
Affiliation:
Department of Psychology, University of Toronto Scarborough, Toronto, Canada
*
*Address for correspondence: A. C. Ruocco, Ph.D., C.Psych., Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, CanadaM1C 1A4. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Emotion dysregulation represents a core symptom of borderline personality disorder (BPD). Deficits in emotion perception are thought to underlie this clinical feature, although studies examining emotion recognition abilities in BPD have yielded inconsistent findings.

Method

The results of 10 studies contrasting facial emotion recognition in patients with BPD (n = 266) and non-psychiatric controls (n = 255) were quantitatively synthesized using meta-analytic techniques.

Results

Patients with BPD were less accurate than controls in recognizing facial displays of anger and disgust, although their most pronounced deficit was in correctly identifying neutral (no emotion) facial expressions. These results could not be accounted for by speed/accuracy in the test-taking approach of BPD patients.

Conclusions

Patients with BPD have difficulties recognizing specific negative emotions in faces and may misattribute emotions to faces depicting neutral expressions. The contribution of state-related emotion perception biases to these findings requires further clarification.

Keywords

Affect perceptionborderline personality disorderemotion perceptionemotion recognition
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 9 , September 2013 , pp. 1953 - 1963
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Adolphs, R (2002). Neural systems for recognizing emotion. Current Opinion in Neurobiology 12, 169–177.CrossRefGoogle ScholarPubMed
Arntz, A, Veen, G (2001). Evaluations of others by borderline patients. Journal of Nervous and Mental Disease 189, 513–521.CrossRefGoogle ScholarPubMed
Bell, C, Bourke, C, Colhoun, H, Carter, F, Frampton, C, Porter, R (2011). The misclassification of facial expressions in generalised social phobia. Journal of Anxiety Disorders 25, 278–283.CrossRefGoogle ScholarPubMed
Borenstein, M, Hedges, L, Higgins, J, Rothstein, H (2010). Comprehensive Meta-Analysis. Biostat: Englewood, NJ.Google Scholar
*Bland, AR, Williams, CA, Scharer, K, Manning, S (2004). Emotion processing in borderline personality disorders. Issues in Mental Health Nursing 25, 655–672.CrossRefGoogle ScholarPubMed
Calder, AJ, Beaver, JD, Davis, MH, van Ditzhuijzen, J, Keane, J, Lawrence, AD (2007). Disgust sensitivity predicts the insula and pallidal response to pictures of disgusting foods. European Journal of Neuroscience 25, 3422–3428.CrossRefGoogle ScholarPubMed
Chapman, HA, Anderson, AK (2012). Understanding disgust. Annals of the New York Academy of Sciences 1251, 62–76.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Domes, G, Czieschnek, D, Weidler, F, Berger, C, Fast, K, Herpertz, SC (2008). Recognition of facial affect in Borderline Personality Disorder. Journal of Personality Disorders 22, 135–147.CrossRefGoogle ScholarPubMed
Domes, G, Schulze, L, Herpertz, SC (2009). Emotion recognition in borderline personality disorder – a review of the literature. Journal of Personality Disorders 23, 6–19.CrossRefGoogle ScholarPubMed
Downey, G, Feldman, SI (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology 70, 1327–1343.CrossRefGoogle ScholarPubMed
*Dyck, M, Habel, U, Slodczyk, J, Schlummer, J, Backes, V, Schneider, F, Reske, M (2009). Negative bias in fast emotion discrimination in borderline personality disorder. Psychological Medicine 39, 855–864.CrossRefGoogle ScholarPubMed
Ebner-Priemer, UW, Badeck, S, Beckmann, C, Wagner, A, Feige, B, Weiss, I, Lieb, K, Bohus, M (2005). Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. Journal of Psychiatric Research 39, 85–92.CrossRefGoogle ScholarPubMed
Ekman, P, Friesen, WV (1976). Pictures of Facial Affect. Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Fusar-Poli, P, Placentino, A, Carletti, F, Landi, P, Allen, P, Surguladze, S, Benedetti, F, Abbamonte, M, Gasparotti, R, Barale, F, Perez, J, McGuire, P, Politi, P (2009). Functional atlas of emotional faces processing: a voxel-based meta-analysis of 105 functional magnetic resonance imaging studies. Journal of Psychiatry and Neuroscience 34, 418–432.Google ScholarPubMed
Grant, BF, Chou, SP, Goldstein, RB, Huang, B, Stinson, FS, Saha, TD, Smith, SM, Dawson, DA, Pulay, AJ, Pickering, RP, Ruan, WJ (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 69, 533–545.CrossRefGoogle ScholarPubMed
Gratz, KL, Rosenthal, MZ, Tull, MT, Lejuez, CW, Gunderson, JG (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology 115, 850–855.CrossRefGoogle ScholarPubMed
Gray, J, Venn, H, Montagne, B, Murray, L, Burt, M, Frigerio, E, Perrett, D, Young, AH (2006). Bipolar patients show mood-congruent biases in sensitivity to facial expressions of emotion when exhibiting depressed symptoms, but not when exhibiting manic symptoms. Cognitive Neuropsychiatry 11, 505–520.CrossRefGoogle Scholar
Gunderson, JG (2007). Disturbed relationships as a phenotype for borderline personality disorder. American Journal of Psychiatry 164, 1637–1640.CrossRefGoogle ScholarPubMed
Gur, RC, Sara, R, Hagendoorn, M, Marom, O, Hughett, P, Macy, L, Turner, T, Bajcsy, R, Posner, A, Gur, RE (2002). A method for obtaining 3-dimensional facial expressions and its standardization for use in neurocognitive studies. Journal of Neuroscience Methods 115, 137–143.CrossRefGoogle ScholarPubMed
Hariri, AR, Bookheimer, SY, Mazziotta, JC (2000). Modulating emotional responses: effects of a neocortical network on the limbic system. Neuroreport 11, 43–48.CrossRefGoogle ScholarPubMed
Hedges, LV, Olkin, I (1985). Statistical Methods for Meta-Analysis. Academic Press: New York, NY.Google Scholar
Heinrichs, RW, Zakzanis, KK (1998). Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology 12, 426–445.CrossRefGoogle ScholarPubMed
Henry, C, Mitropoulou, V, New, AS, Koenigsberg, HW, Silverman, J, Siever, LJ (2001). Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. Journal of Psychiatric Research 35, 307–312.CrossRefGoogle ScholarPubMed
Hunter, JE, Schmidt, FL (1990). Methods of Meta-Analysis. Sage Publications: Newbury Park, CA.Google Scholar
Jovev, M, Chanen, A, Green, M, Cotton, S, Proffitt, T, Coltheart, M, Jackson, H (2011). Emotional sensitivity in youth with borderline personality pathology. Psychiatry Research 187, 234–240.CrossRefGoogle ScholarPubMed
Koenigsberg, HW, Fan, J, Ochsner, KN, Liu, X, Guise, KG, Pizzarello, S, Dorantes, C, Guerreri, S, Tecuta, L, Goodman, M, New, A, Siever, LJ (2009). Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biological Psychiatry 66, 854–863.CrossRefGoogle ScholarPubMed
Koenigsberg, HW, Harvey, PD, Mitropoulou, V, New, AS, Goodman, M, Silverman, J, Serby, M, Schopick, F, Siever, LJ (2001). Are the interpersonal and identity disturbances in the borderline personality disorder criteria linked to the traits of affective instability and impulsivity? Journal of Personalty Disorders 15, 358–370.CrossRefGoogle Scholar
Koenigsberg, HW, Harvey, PD, Mitropoulou, V, Schmeidler, J, New, AS, Goodman, M, Silverman, JM, Serby, M, Schopick, F, Siever, LJ (2002). Characterizing affective instability in borderline personality disorder. American Journal of Psychiatry 159, 784–788.CrossRefGoogle ScholarPubMed
*Levine, D, Marziali, E, Hood, J (1997). Emotion processing in borderline personality disorders. Journal of Nervous and Mental Disease 185, 240–246.CrossRefGoogle ScholarPubMed
Linehan, MM (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. Guilford Press: New York, NY.Google Scholar
Lipsey, MW, Wilson, DB (1993). The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis. The American Psychologist 48, 1181–1209.CrossRefGoogle ScholarPubMed
*Lynch, TR, Rosenthal, MZ, Kosson, DS, Cheavens, JS, Lejuez, CW, Blair, RJ (2006). Heightened sensitivity to facial expressions of emotion in borderline personality disorder. Emotion 6, 647–655.CrossRefGoogle ScholarPubMed
Matsumoto, D, Ekman, P (1988). Japanese and Caucasian facial expressions of emotion (JACFEE). [Slides]. Intercultural and Emotion Research Laboratory, Department of Psychology, San Francisco State University: San Francisco, CA.Google Scholar
*Merkl, A, Ammelburg, N, Aust, S, Roepke, S, Reinecker, H, Trahms, L, Heuser, I, Sander, T (2010). Processing of visual stimuli in borderline personality disorder: a combined behavioural and magnetoencephalographic study. International Journal of Psychophysiology 78, 257–264.CrossRefGoogle ScholarPubMed
*Minzenberg, MJ, Poole, JH, Vinogradov, S (2006). Social-emotion recognition in borderline personality disorder. Comprehensive Psychiatry 47, 468–474.CrossRefGoogle ScholarPubMed
Montagne, B, Schutters, S, Westenberg, HG, van Honk, J, Kessels, RP, de Haan, EH (2006). Reduced sensitivity in the recognition of anger and disgust in social anxiety disorder. Cognitive Neuropsychiatry 11, 389–401.CrossRefGoogle ScholarPubMed
Narumoto, J, Yamada, H, Iidaka, T, Sadato, N, Fukui, K, Itoh, H, Yonekura, Y (2000). Brain regions involved in verbal or non-verbal aspects of facial emotion recognition. Neuroreport 11, 2571–2576.CrossRefGoogle ScholarPubMed
Orobio de Castro, B, Veerman, JW, Koops, W, Bosch, JD, Monshouwer, HJ (2002). Hostile attribution of intent and aggressive behavior: a meta-analysis. Child Development 73, 916–934.CrossRefGoogle ScholarPubMed
Orwin, RG (1983). A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics 8, 157–159.Google Scholar
Phillips, ML, Young, AW, Senior, C, Brammer, M, Andrew, C, Calder, AJ, Bullmore, ET, Perrett, DI, Rowland, D, Williams, SC, Gray, JA, David, AS (1997). A specific neural substrate for perceiving facial expressions of disgust. Nature 389, 495–498.CrossRefGoogle ScholarPubMed
Ray, JW, Shadish, WR (1996). How interchangeable are different estimators of effect size? Journal of Consulting and Clinical Psychology 64, 1316–1325.CrossRefGoogle ScholarPubMed
Rector, NA, Daros, AR, Bradbury, CL, Richter, MA (2012). Disgust recognition in obsessive-compulsive disorder: diagnostic comparisons and posttreatment effects. Canadian Journal of Psychiatry 57, 177–183.CrossRefGoogle ScholarPubMed
*Robin, M, Pham-Scottez, A, Curt, F, Dugre-Le Bigre, C, Speranza, M, Sapinho, D, Corcos, M, Berthoz, S, Kedia, G (2012). Decreased sensitivity to facial emotions in adolescents with Borderline Personality Disorder. Psychiatry Research. Published online: 3 April 2012. doi:10.1016/j.psychres.2012.03.032.CrossRefGoogle ScholarPubMed
Rosenthal, MZ, Gratz, KL, Kosson, DS, Cheavens, JS, Lejuez, CW, Lynch, TR (2008). Borderline personality disorder and emotional responding: a review of the research literature. Clinical Psychology Review 28, 75–91.CrossRefGoogle ScholarPubMed
Rosenthal, R (1995). Writing meta-analytic reviews. Psychological Bulletin 118, 183–192.CrossRefGoogle Scholar
Ruocco, AC, Amirthavasagam, S, Choi-Kain, LW, McMain, SF (2012). Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis. Biological Psychiatry. Published online: 17 August 2012. doi:10.1016/j.biopsych.2012.07.014.Google ScholarPubMed
Ruocco, AC, Medaglia, JD, Ayaz, H, Chute, DL (2010 a). Abnormal prefrontal cortical response during affective processing in borderline personality disorder. Psychiatry Research 182, 117–122.CrossRefGoogle ScholarPubMed
Ruocco, AC, Medaglia, JD, Tinker, JR, Ayaz, H, Forman, EM, Newman, CF, Williams, JM, Hillary, FG, Platek, SM, Onaral, B, Chute, DL (2010 b). Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder. Psychiatry Research 181, 233–236.CrossRefGoogle ScholarPubMed
Rusch, N, Schulz, D, Valerius, G, Steil, R, Bohus, M, Schmahl, C (2011). Disgust and implicit self-concept in women with borderline personality disorder and posttraumatic stress disorder. European Archives of Psychiatry and Clinical Neuroscience 261, 369–376.CrossRefGoogle ScholarPubMed
Santangelo, P, Bohus, M, Ebner-Priemer, UW (2012). Ecological momentary assessment in borderline personality disorder: a review of recent findings and methodological challenges. Journal of Personality Disorders. Published online: 17 September 2012. doi:10.1521/pedi_2012_26_067.Google ScholarPubMed
Simonian, SJ, Beidel, DC, Turner, SM, Berkes, JL, Long, JH (2001). Recognition of facial affect by children and adolescents diagnosed with social phobia. Child Psychiatry and Human Development 32, 137–145.CrossRefGoogle ScholarPubMed
Staebler, K, Helbing, E, Rosenbach, C, Renneberg, B (2011). Rejection sensitivity and borderline personality disorder. Clinical Psychology and Psychotherapy 18, 275–283.CrossRefGoogle ScholarPubMed
Surguladze, SA, Young, AW, Senior, C, Brebion, G, Travis, MJ, Phillips, ML (2004). Recognition accuracy and response bias to happy and sad facial expressions in patients with major depression. Neuropsychology 18, 212–218.CrossRefGoogle ScholarPubMed
Trull, TJ, Solhan, MB, Tragesser, SL, Jahng, S, Wood, PK, Piasecki, TM, Watson, D (2008). Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. Journal of Abnormal Psychology 117, 647–661.CrossRefGoogle ScholarPubMed
*Unoka, Z, Fogd, D, Fuzy, M, Csukly, G (2011). Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder. Psychiatry Research 189, 419–425.CrossRefGoogle ScholarPubMed
Van Horn, JD, McManus, IC (1992). Ventricular enlargement in schizophrenia. A meta-analysis of studies of the ventricle:brain ratio (VBR). British Journal of Psychiatry 160, 687–697.CrossRefGoogle ScholarPubMed
*von Ceumern-Lindenstjerna, IA, Brunner, R, Parzer, P, Frey, M, Fiedler, P, Resch, F (2007). Perception of emotional facial expressions in female adolescents with borderline personality disorder [in German]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 35, 333–340.Google Scholar
von Ceumern-Lindenstjerna, IA, Brunner, R, Parzer, P, Mundt, C, Fiedler, P, Resch, F (2010). Initial orienting to emotional faces in female adolescents with borderline personality disorder. Psychopathology 43, 79–87.CrossRefGoogle ScholarPubMed
*Wagner, AW, Linehan, MM (1999). Facial expression recognition ability among women with borderline personality disorder: implications for emotion regulation? Journal of Personality Disorders 13, 329–344.CrossRefGoogle ScholarPubMed
Winton, EC, Clark, DM, Edelmann, RJ (1995). Social anxiety, fear of negative evaluation and the detection of negative emotion in others. Behaviour Research and Therapy 33, 193–196.CrossRefGoogle ScholarPubMed
Zakzanis, KK (1998). Brain is related to behavior (p < .05). Journal of Clinical and Experimental Neuropsychology 20, 419–427.CrossRefGoogle ScholarPubMed
Zakzanis, KK (2001). Statistics to tell the truth, the whole truth, and nothing but the truth: formulae, illustrative numerical examples, and heuristic interpretation of effect size analyses for neuropsychological researchers. Archives of Clinical Neuropsychology 16, 653–667.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR (2007). The essential nature of borderline psychopathology. Journal of Personality Disorders 21, 518–535.CrossRefGoogle ScholarPubMed