Embarrassment

The Brain Science Behind Emotions in Borderline Personality

Neuroscience provides new look at the negative emotions in borderline disorder.

Posted Dec 29, 2020 |

Everyone experiences the negative emotions of shame and guilt from time to time. You’ve hurt a good friend of yours by making an insensitive joke and feel bad for days afterwards. At times, shame can be a justifiable if not productive emotion. If you felt no shame, you would be oblivious to the psychological damage you caused, and therefore unlikely to try to repair your relationship. However, what if your joke wasn’t at all insensitive? What if you are making yourself miserable over nothing?

According to University of Lübeck’s Martin Göttlich and colleagues (2020), for people with borderline personality disorder (BPD) the experience of shame is a central part of their existence. They show, the German researchers maintain, “particularly pronounced” levels of shame that, in turn, begin a destructive cycle in which these individuals become convinced of their unworthiness, ruminate over this conviction, try to deny or externalize blame for their actions, and ultimately develop a destructive form of anger. This pattern, according to Göttlich and colleagues, makes it unlikely that people with borderline personality disorder develop a healthier, “prosocial,” orientation (p. 980).

The German authors differentiate shame from guilt, viewing guilt as positively associated with a prosocial orientation. This is because, they maintain, when you feel guilty you are more likely to try to make amends with those you might have harmed. However, people with BPD don’t actually experience guilt when they feel ashamed, an emotion known as “guilt-free shame.” The fact that these individuals feel shame without guilt can help account, according to Göttlich et al., for the risky and other dysfunctional behaviors shown by people with BPD.

Where does this heightened sensitivity to shame come from in people with BPD? According to Göttlich and his fellow researchers, there may be neural underpinnings involving the amygdala, the part of the brain involved in the processing of emotional stimuli. Other brain regions also play a key role, particularly those that become activated when people engage in empathy, self-referential thinking, and social cognition, or the understanding of other people’s behavior.

To gain insight into the functioning of these regions of the brain in people with BPD, Göttlich et al. compared functional magnetic resonance imaging (fMRI) data obtained from 19 women diagnosed with this disorder with 22 healthy controls. The participants averaged 26 years of age and all had at least one other major psychological disorder with most also experiencing eating disorder.

The research team elicited the emotions of shame and guilt while the women were in the brain scanner by presenting them with short descriptions of fictitious scenarios intended to produce shame, guilt, disgust, or no particular emotion (neutral). Read each of these and think about what your reaction would be:

Shame: In a group of people someone says loudly that you have something green between your teeth.

Guilt: You are at a café with a friend making fun of another friend who coincidently listens in on your conversation.

Disgust: While cooking at a friend’s house you find mildewed bread in her kitchen cupboard.

Neutral: You meet a friend at the bus and chat with her about the nice weather.

To understand the subjective experience of participants upon reading these scenarios, the research team asked them to rate their levels of shame, guilt, disgust, anger, fear, sadness, joy, and surprise. Participants also rated their levels of tension, and vividness of imagination for the events in the scenario themselves.

As controls for the levels of negative emotions typically experienced by participants, the research team also measured general predispositions to the negative emotions of shame and guilt, as well as fear, in the two groups of participants. This measure also included brief scenarios designed to prompt these reactions. For example, in one item, the scenario was “You break something at work and then hide it.” Participants then indicated what their reactions would be such as “you would think about quitting.” As a control for the extent to which participants differed in qualities associated with BPD, Göttlich et al. also asked participants to complete a standard questionnaire measure of BPD symptoms.

The fMRI findings showed that, as predicted, the amygdala indeed played a role in the processing of shame- and guilt-inducing scenarios with higher activity for the BPD as compared to the control sample. Additionally, across the trials involving presentation of repeated scenarios evoking these emotional reactions, healthy participants showed different levels of habituation in the form of lower amygdala activity compared to those with BPD. In other words, the reactions of the healthy controls eventually settled down in a way that the reactions of BPD participants did not.

For the disgust-inducing scenarios, all participants showed habituation or a reduced emotional response across trials. For the self-conscious emotions of shame and guilt, by contrast, the women in the BPD sample remained aroused without dropping off.

In terms of their subjective reactions to the scenarios, the women with BPD showed pronounced experiences of all emotions, but particularly those of shame and guilt. Thus, at both the neural and subjective levels, there appears to be heightened sensitivity to these highly self-conscious emotion-provoking situations. People without BPD might feel some shame and guilt, but not to the extent as those who have this disorder.

The authors believe that their findings support at least some of the evidence derived from clinical studies involving psychotherapy of individuals with BPD. In their words, “the lack of amygdala habituation to shame and guilt in BPD patients might relate to the relatively slow improvement in emotional reactivity typically seen in therapy” (pp. 989-990). These findings would support a focus in future approaches to treatment on the specific aversive emotions of shame and guilt.

To sum up, in the search for an understanding of BPD, the German findings yield intriguing implications for being able to trace the dysfunctional emotional life of people with this disorder to alterations in neural processing of emotional information. If you know people with BPD, you may be very familiar with their tendency to ruminate over their perceived failings, only to then act in self-destructive ways. The Göttlich et al. findings suggest a new way of thinking about the origins of their difficult emotional lives.

References

Göttlich, M., Westermair, A. L., Beyer, F., Bußmann, M. L., Schweiger, U., & Krämer, U. M. (2020). Neural basis of shame and guilt experience in women with borderline personality disorder. European Archives of Psychiatry and Clinical Neuroscience, 270(8), 979–992. doi: 10.1007/s00406-020-01132-z