A study of individuals seeking treatment for borderline personality disorder found that the gap between their own perceived social preferences and their expectations about the social preferences of other people might foster a vicious cycle of misunderstanding and disappointment in social relationships. In turn, this vicious cycle may lead to heightened feelings of loneliness. The paper was published in Comprehensive Psychiatry.

Borderline personality disorder is a mental health condition marked by ongoing problems with emotional regulation, self-image, behavior, and relationships. People with it frequently experience very intense emotions that can shift quickly, sometimes over hours or days.

Common features of this disorder include fear of abandonment, unstable or intense relationships, impulsive behavior, and a changing or uncertain sense of self. Some people also feel chronic emptiness, anger that is hard to control, or suspiciousness and stress-related changes in perception.

The condition often begins by late adolescence or early adulthood. Borderline personality disorder can occur together with depression, anxiety, post-traumatic stress disorder, substance use problems, eating disorders, or bipolar disorder, which can make diagnosis more complicated.

Study author Ruben Vonderlin and his colleagues investigated whether individuals with borderline personality disorder differ from non-clinical control participants in their views of social value orientations and expectations from others. They wanted to know whether misalignment between these characteristics is related to how lonely these individuals feel.

Social value orientations are people’s relatively stable preferences about how outcomes should be distributed between themselves and others. They can range from more self-focused preferences, where people value personal gain more, to more prosocial preferences that value fairness and good outcomes for everyone. Expectations from others are beliefs about the social value preferences of others.

The authors believed that people with borderline personality disorder may see themselves as holding fairly prosocial values but at the same time expect other people to be much more selfish and unfair. This gap in how individuals with this disorder perceive themselves and how they perceive others might foster feelings of loneliness.

Study participants were 60 individuals diagnosed with borderline personality disorder, and 60 healthy individuals matched with them on education and sex. Each group of participants consisted of 8 men and 52 women. Participants with borderline personality disorder had more severe symptoms of this disorder and stronger feelings of loneliness compared to the group of healthy participants.

Study participants completed assessments of their own social value orientations and their expectations about the social values of others (using a slider task in which they had to allocate resources between themselves and a stranger), and of justice sensitivity, both of their own and of their expectations about the justice sensitivity of others (the Justice Sensitivity Inventory). Justice sensitivity is a tendency to perceive and react strongly to injustice experienced as a victim, an observer, a beneficiary, or a perpetrator.

Results showed that the differences between participants’ own social values and their expectations about the social values of others were higher among participants with borderline personality disorder than among healthy participants. As expected, participants with borderline personality disorder saw themselves as more prosocial compared to the control group. The two groups did not differ in their perceptions of the social values of others.

Similarly, participants with borderline personality disorder differed more than healthy controls in how they perceived their own justice sensitivity and how they perceived the justice sensitivity of other people—specifically regarding injustice that happens to others. These participants tended to see themselves as more concerned with injustice (particularly when observing it or benefiting from it) than they expected others to be.

Further analyses revealed that participants with borderline personality disorder who perceived themselves as more prosocial tended to feel lonelier. This association was absent in the control group. Loneliness was also associated with the size of the difference between the perception of one’s own justice sensitivity and the justice sensitivity of others, but only in the group of participants with borderline personality disorder, and specifically in scenarios where they observed or benefited from injustice.

“The results of this study indicate that individuals generally perceive themselves as more prosocial and more concerned about injustice than they expect others to be. This misalignment is particularly pronounced in BPD [borderline personality disorder]. Heightened prosocial preferences and JS [justice sensitivity] may predispose individuals with BPD to become especially attuned to perceiving injustices in social interactions, potentially eliciting more intense emotional responses such as anger, moral outrage, or guilt.

Strongly held ideals of prosocial behaviors and justice may place excessive demands on the social behaviors individuals strive for. This self-other misalignment may leave individuals with BPD vulnerable to feelings of loneliness, since their heightened social ideals collide with pessimistic expectations about others’ moral behavior,” the study authors concluded.

The study contributes to the scientific knowledge about borderline personality disorder. However, the authors noted some limitations. Because the sample consisted of treatment-seeking individuals and was predominantly female, the external validity of the findings may be limited. Additionally, the lack of a clinical control group (such as patients with other personality disorders) means it is unclear if these mechanisms are unique to borderline personality disorder or shared across other mental health conditions. Finally, the cross-sectional, laboratory-based design of the study does not allow any causal inferences to be derived from the results.

The paper, “Loneliness in borderline personality disorder: The role of misalignments between self-view and social expectations in social value orientation and justice sensitivity,” was authored by R. Vonderlin, C. Claus, S. Hanraths, A.S. Lerchl, B. Senyüz, N. Kleindienst, T. Boritz, S. McMain, T. Teismann, P. Kirsch, M. Bohus, and S. Lis.