DSM  5: Impairment 7 – Interpersonal hypersensitivity (i.e., prone to feel slighted or insulted)

  Research seems to suggest that borderline personality disorder may be characterized by emotional hypersensitivity with increased stress levels, anger proneness, and hostile, impulsive behaviours. As a result we may tend to view facial expressions as being angry or threatening and respond with prolonged emotional (amygdala) feelings.

                Frick et al (2012) examined the behavioural and fMRI responses of 21 female BPD patients and 20 healthy controls during performance of the ‘Reading the Mind in the Eyes’ test (RMET). This task involved describing the emotional/mental state of a person based on only an image of their eyes. BPD patients’ discrimination was significantly better and faster along with greater activity in the amygdala, the medial frontal gyrus, the left temporal pole, and the middle temporal gyrus (aside: we have met all these fellows before; you may want to look back at those sections… or not). In contrast, HC subjects showed a greater activation in the insula and the superior temporal gyri.  Bertsch et al (2013), asked 40 nonmedicted female BPD patients and 41 healthy women, to complete an emotion classification task involving angry, fearful, and happy faces after administrating intranasal oxytocin or placebo. They monitored the number of reflexive eye movements and manual responses while monitoring the fMRI responses in the amygdala. Their results indicated that Borderline patients exhibited more and faster initial eye fixation changes on angry faces combined with increased amygdala activation. They concluded that Borderline patients exhibit a hypersensitivity to social threat and that oxytocin may decrease social threat hypersensitivity and thus reduce anger and aggressive behavior.

                So what does this men in plain English? Well, we have a problem. It would appear that we tend to overreact when reading emotions, especially when it comes to looking at peoples’ faces and especially when looking them in the eye. We appear to be good at it but it seems to require a lot of emotional energy. This may again be related to difficulties in learning emotional patterns during childhood (baby smiles, mommy smiles, baby smiles, I must be special). Babies are great at studying facial expression, usually focusing on the eyes as they try to connect with loving adults. If their searching is met with a loving smile that goes right into mommy’s eyes, baby learns that smiles and eye contact are great things that give pleasure and acceptance. However, if there is no smile behind the eyes, baby gets confused and will tend to keep searching for a sign of acceptance. If it does not happen baby will feel rejection and will eventually avoid eye contact, all of this happening at the subconscious level.

                As we grow older, we continue to lack this subconscious skill, so we have to do everything consciously, and this takes time and energy. In addition, we have now been conditioned subconsciously to believe that eye contact is an unpleasant happening that will probably be painful, loaded with anger or rejection. Therefore, we make multiple scans and fixations as we are trying to figure things mentally, and we usually find what we are looking for. We interpret anything short of a heart based smile as potentially harmful and dangerous. When in social situations, we will be super vigilant in looking for that smile in the eyes before we trust whomever we are communicating with. We will tend to protect ourselves at the slightest indication that the person may be hostile thus reacting either with withdrawal or with aggression.

                The oxytocin experiment is really interesting. This hormone secreted by the pituitary gland also serves as a neuromodulator thus affecting the flow of neurotransmitters in the brain. It is often referred to as the love hormone. It is usually associated with bonding, most notably with the mother, and later with the life partner. It is this family bond that gives the child a sense of emotional security. The study by Bertsch et al indicates that this flow may be absent with us borderliners, thereby creating an emotional hypersensitivity predisposition. Once oxytocin is applied artificially through a nasal spray, low and behold, we no longer react to imagined fearful or angry faces. We suddenly seem to have the ability to read the emotions of others in a nonthreatening manner, perhaps expecting love or acceptance rather than rejection (aside: perhaps we should have one of those sprays available like they have for asthma. Whenever we feel a tingle by looking at someone’s eyes, we simply pull out the nasal spray and voila!  Just joking).

                Seriously though, all we have to do is become aware of our negative subconscious tendencies, monitor our emotional reaction, take control of them consciously, and allow our higher self to soothe our mind. Perhaps conscious control of the mind coupled with this bonding between the mind self and the higher self will be enough to create or replace the missing oxytocin response.