Borderline Personality Disorder: Hyper-Reactive or a High Index of Suspicion?

Source: Flickr: Suspicious by Juliana Dacoregio, CC by 2.0

One of the main themes of this blog is how researchers in psychiatry continually mix up learned or conditioned responses with disease states. These include misinterpreting fMRI findings and data derived from twin studies.

I have also discussed something called Error Management Theory, which predicts that if you come from a toxic and crazy environment as someone with borderline personality disorder (BPD) does, and have to learn how to react to it, it is in your interest to have a high index of suspicion about the people around you.

Somehow this has turned into emotional “hyper-reactivity” as some sort of brain pathology or abnormality. To my mind, it would be highly abnormal to not trust your own experience and to overly trust people who have often demonstrated that they are in fact rather unpredictable and often untrustworthy.

The labeling of behavior that may serve a useful purpose in one’s social environment as pathological can be highly damaging to the individuals involved in terms of their own self-image, and in terms of their receiving help to learn more adaptive responses from a psychotherapist. Psychotherapy clients reading these ideas might come to the conclusion that they are highly damaged and therefore getting better might be a rather hopeless goal in life. Indeed, they may decide they must have permanent brain damage.

Furthermore, they might be treated as if this were the case by mental health professionals, particularly psychiatrists, some of whom think that there is a medication or other type of physical intervention for every human problem.

It also lets other family members off the hook for the adverse childhood experiences of their progeny. Lately, they have been portrayed as “burdened” by having children with a disorder that they themselves helped create.

Now comes a study that seems to be strong evidence for the idea that the behavior of these patients is not due to innate pathology. The authors did a meta-analysis (combining the data from several studies) that addressed the question of the physiological nature of the apparently “overly” reactive person with borderline personality disorder.

Variables measured in these studies included heart rate, respiratory heart sinus arrhythmia, skin conductance, cortisol (stress hormone) levels, startle response, blood pressure, and patient self-report.

Their conclusion: The hyper-reactivity hypothesis was in general not supported. The apparent increase in reactivity in BPD could instead be attributable to their tendency to evaluate emotional stimuli more negatively than controls. This is the exact result that error management theory would predict.

The study authors go on to say that amygdala functioning (basically fight/flight/freeze reactions) concerns “several processes that go beyond emotional arousal (salience and novelty detection, reward learning, memory, attention modulation, decision making…” (p. 79).

Exactly. And Amen.