Borderline Pathology: The Unique Reactivity to Social Rejection Seen in Patients with Borderline Personality Disorder

Research by Dixon-Gordon, Chapman, Lovasz and Walters (2011) suggests social rejection carries the strongest likelihood of negative interpersonal consequences on behavioral functioning for those suffering with BPD. In the study, Dixon-Gordon and colleagues sorted patients with the disorder into categories of high, mid, or low levels of symptoms/features of BPD. The high-BP group showed a compromised ability to find “relevant solutions to social problems” (Dixon-Gordon, et al., 2011, p. 243); whereas the low-BP group showed more appropriate solutions to the same set of social problems. The high-BP group demonstrated an increase in self-reports of negative emotions during attempts to find appropriate solutions to social problems when compared with the low-BP group. Based on the study, Dixon-Gordon and colleagues determined that clinical interventions aimed at improving social problem solving skills among the BPD population is worthy of further examination. Some of the more severe behavioral problems exhibited by BPD patients seeking psychiatric services (self-injury, suicide attempts, behavior dyscontrol) occur during times of interpersonal conflict and the resulting distress. According to Berk, Jeglic, Brown, Henriques, & Beck, 2007, suicide attempters with BPD demonstrate poor social solving skills and heightened physiological emotional reactivity. According to Kuo & Linehan (2009) patients with BPD are very likely uniquely reactive to social rejection stimuli. Findings by Dixon-Gordon and colleagues (2011) support the conceptualization of a negative emotional state leading to consequential social problem-solving deficits in patients with the disorder. Further, rather than this being simply a trait-like symptom of BPD it appears that BPD sufferers have a tendency to experience heightened negative emotional states as well as emotional stressors (Dixon-Gordon et al., 2011). Kuo & Linehan (2009) hypothesize that an increased arousal beyond the threshold of “optimal social problem-solving performance” may account for the tendency of patients with BPD to suffer from “heightened negative emotional states” in response to social-rejection. Moreover, these patients may be more “uniquely reactive” to scenarios of interpersonal distress (Kuo & Linehan, 2009). Rather than a trait-like symptom of BPD, the social problem-solving deficits may be a consequence of a negative emotional state (Bateman & Fonagy, 2008; Dixon-Gordon, et al., 2011). This is especially important for consideration as it relates to DBT (Kuo & Linehan, 2009). For instance, training aimed at reconciling the chaotic emotional states of BPD sufferers may prove to be a potent refinement of and salient therapeutic feature in treating the disorder. Additionally, DBT may allow working memory to become “freed up” by augmenting the patient’s social skills and affording the patient more self-efficacy through increased capacity to problem solve (Linehan, 1993; Linehan, et al., 2002; Lyons-Ruth, 2008; Schmahl et al., 2004; McWilliams, 2011).