The Impact of State Shame on Theory of Mind in Individuals with Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by a marked difficulty in regulating one’s emotions, as manifested by problems in a variety of areas (APA, 2013). One such difficulty is in the area of interpersonal relationships; individuals with BPD have tumultuous relationships and trouble with social cognition, which means that they exhibit difficulty processing and applying information about other people and social situations (Roepke et al., 2013). One facet of social cognition is theory of mind, which is a multi-faceted construct that refers to the ability to attribute mental states to oneself and others, and to understand that people can have different beliefs, wants, and desires from one’s own (e.g., Wellman et al., 2001). Although the clinical consensus is that individuals with BPD exhibit difficulties with theory of mind, research findings are mixed. Therefore, it is important to explore variables that may impact theory of mind in individuals with BPD. One such construct is shame, which is typically experienced as a negative emotion that includes feelings or thoughts of being judged as inferior to others and the fear of being rejected by others (e.g., Leeming & Boyle, 2013). Broadly, shame is often associated with action urges to focus on oneself in relation to others, hide, withdraw from others, self-blame, and more (Rizvi & Linehan, 2005). Research demonstrates that shame-proneness is higher in individuals with BPD and is associated with a number of the disorder’s hallmark symptoms, such as self-injury and suicidality (Rüsch et al., 2007). Furthermore, there is evidence that the type of shame characteristic of individuals with BPD is more maladaptive and enduring than the type of shame that is experienced by individuals with a number of other disorders (Scheel et al., 2014). At present, research has not yet examined whether experiences of shame influence the social cognitive abilities of individuals with BPD. This was addressed in the present study, which aimed to experimentally assess the effects of state shame on theory of mind in individuals with BPD. The sample of 142 participants was recruited from three sources: a national online screening database of individuals who are willing to participate in research that has a focus on psychological history; Craigslist; and from a previous study on facial emotion recognition in individuals with BPD. Initial recruitment was based on participants’ scores on online screening measures; potentially eligible participants were contacted to determine whether they were interested in participating in the study. Participants’ eligibility was determined by a diagnostic interview conducted via Skype, Google Hangouts, or by phone to determine BPD diagnosis and diagnostic group assignment (BPD versus non-BPD control). Eligible participants then completed a series of measures of mood, personality, and behavior. Next, participants were randomized into one of three mood induction conditions: shame mood, sad mood, or boredom. Following the mood induction, participants completed the Reading the Mind in the Eyes Task (RMET; Baron-Cohen et al., 2001) to assess affective theory of mind and the Short Story Task (SST; Dodell-Feder et al., 2013) to assess affective and cognitive theory of mind. The results did not support the prediction that individuals with BPD who underwent the shame mood induction would exhibit greater theory of mind deficits as compared to individuals without BPD. However, exploratory analyses demonstrated that state shame predicted lower theory of mind scores across all participants when controlling for trait shame, and that trait shame slightly buffered the impact of state shame in BPD participants only. These findings provide tentative support that shame impacts theory of mind abilities in individuals with BPD.