High Index of Suspicion vs. Hyper-reactivity in Borderline Personality Disorder

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 like 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 others around you. Somehow this has turned into emotional “hyper-reactivity” as some of sort of brain pathology or abnormality.

Now comes a study that seems to be strong evidence for my point of view. (Borrolla, B., Cavicchioli, C,., Fossati, A., and Maffei, C. “Emotional Reactivity Borderline Personality Disorder: Theoretical Considerations based on Meta-Analytic Review of Laboratory Studies.” Journal of Personality Disorders 34[1], 64-87, 2020). 

The authors did a meta-analysis (combining the data from several studies) which addressed the question.

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. Exactly what error management theory would predict!

The study authors go on to say that amygada 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.