Individuals with Borderline Personality Disorder show larger preferred social distance in live dyadic interactions
Introduction
Personal space refers to “the area individuals maintain around themselves into which others cannot intrude without arousing discomfort” and governs each person's preferred interpersonal distance from others (Hayduk, 1983). Personal space has been theorized to serve a protective function by regulating one's distance from potential emotional and physical threats while also allowing for an appropriate level of intimacy and trust in social contexts (Lloyd, 2009). Preferred interpersonal distance is one way to describe personal space in a measurement task (e.g. the stop-distance paradigm described in detail below). For each individual, preferred interpersonal distance varies according to psychological state and situational circumstances, for example, degree of familiarity with one's interaction partner (Hayduk, 1983), gender roles (Uzzell and Horne, 2006), and emotional valence of the interaction (Tajadura-Jiménez et al., 2011). However, there is also evidence that personal space is a stable trait (Perry et al., 2016), varying between individuals according to such factors as attachment style (Yukawa et al., 2007b) and varying levels of social anxiety in adults with Autism Spectrum Disorder (Perry et al., 2013).
Personal space regulation is understudied in borderline personality disorder (BPD), a severe personality disorder characterized by problems with mood, impulse control, and interpersonal functioning (Lieb et al., 2004) as well as altered amygdala function (Schulze et al., 2016), disordered attachment (Levy et al., 2015) and impairments in mentalization (see discussion of mentalization below) (Bateman and Fonagy, 2004; Fonagy, 2003).
Disturbed social relationships have been considered central to the phenotype of BPD (Gunderson, 2007) and empirical studies of interpersonal functioning in BPD have found widespread alterations in perceptual biases, social cognition, theory of mind, trust and cooperation (for review see (Lazarus et al., 2014)).
Two recent studies of imagined social experiences have suggested that personal space may be altered in BPD. In a study of implicit and explicit behavioral activation, BPD patients and controls were asked how many steps they imagined they would take toward or away from faces shown to them in photographs. BPD patients imagined more steps away from both the happy and fearful faces than controls (Kobeleva et al., 2014). More recently, a neuroimaging study found that simulating personal space intrusion by zooming in on pictures of emotional faces activated fronto-parietal regions and the amygdala in BPD patients and controls (Schienle et al., 2015). BPD patients endorsed a larger preferred interpersonal distance in a pen and paper task. They also had increased activation of both amygdala and fronto-parietal cortex in the fMRI task, but only towards looming disgusted faces (not faces expressing other emotions). It is important to note, however, that neither of these studies involved live interpersonal interactions – only imagined ones.
Personal space regulation is an essential component of social interaction. However, these dynamic aspects of social exchange have been difficult to capture in traditional experimental probes of social cognition. Typically, studies of preferred interpersonal distance have relied on derivate stimuli (e.g. disembodied faces) abstracted from social context (Adolphs, 2006, McCall, 2016). When looking at individuals with BPD, utilizing methods such as drawing circles around figures (e.g. Schienle et al., 2015) is likely less reliable than observing live interaction (Harrigan, 2008, Hayduk, 1983, McCall, 2016). Some researchers have argued that individuals with BPD may struggle to accurately describe their emotions in response to hypothetical situations, particularly when they are emotionally aroused (Bateman, 2004). If this is the case, direct observation of behavior may be essential to accurately measuring differences in preferred interpersonal distance (and other social behaviors) among people with BPD.
To overcome the limitations of previous studies in BPD, we employed a more ecologically valid method: the stop-distance paradigm. This is a highly reliable measure of preferred interpersonal distance that is performed in a live 2-person interaction in the lab (Aiello, 1987, Hayduk, 1983, Perry et al., 2016). Study participants are asked to indicate when an approaching confederate has stepped into their personal space.
The study included only female subjects. The approaching strangers (confederates) were also all young women. We selected the single-gender experimental design given expected differences in BPD presentation by gender which we predicted might markedly increase heterogeneity of preferred interpersonal distance. Men with BPD are less likely to present for clinical care, though the condition has been found in some studies to be equally prevalent in men and women in community samples, and men with BPD are more likely to have substance use disorders and to exhibit externalizing behavior (Bayes and Parker, 2017). Proxemic behavior in the stop-distance task has been shown to differ between women and men: female research subjects show a larger difference between distance preferences from men (larger) and women (shorter) than do male subjects (Miller et al., 2013; Holt et al., 2014).
To our knowledge, this is the first study of personal space regulation in BPD in a live dyadic context, involving face to face interaction with another individual. We used the stop-distance paradigm to test the hypothesis that disrupted interpersonal functioning in BPD manifests in increased preferred interpersonal distance in an encounter with a stranger.
Section snippets
Subjects
Women aged 18–60 were recruited from the community via posters and online advertisements. This study was approved by the Yale Institutional Review Board and all subjects gave informed consent. Initial screen was done over the phone; subjects were then screened by a psychiatrist (SKF) using semi-structured interviews (Structured Interview for DSM-IV: controls had no psychiatric conditions, BPD subjects had no current substance dependence and no primary psychotic disorder; Revised Diagnostic
Results
We enrolled 30 women in the control group and 23 women in the BPD group. The two groups were matched on age, years of education, current work status, current relationship status, and reading ability (Table 1). In the control group, 10% were Asian, 26.7% were Black, 10% Hispanic, 36.7% White. In the BPD group, 4.3% were Asian, 13% Black, 4.3% South Asian, 4.3% Latina, 56.5% White. Women in the BPD group were significantly more symptomatic on a dimensional measure of BPD symptoms (BSL) as well as
Enlarged preferred interpersonal distance in the context of known behavior in BPD
In this study, we found that people with BPD prefer a significantly larger interpersonal distance from a stranger than do non-BPD controls. This finding is consistent with our hypothesis, and fits with a growing literature describing the interpersonal perceptions and behavior of people with BPD, and specifically the intolerance of sustained social closeness (though fluctuating states can include profound idealization of others and avoidance of separation as well). One recent study reports
Acknowledgements
We would like to thank Kristin Budde, Sasha Deutsch-Link, Erin Feeney, Carol Gianessi, Megan Ichinose, Taylor McGuiness, Margot Reed, and for their help as confederates, and Albert Goclowski for his help with preparing and maintaining our testing station at the Connecticut Mental Health Center.
This work was supported by the Connecticut State Department of Mental Health and Addiction Services. Sarah K. Fineberg was supported by NIMH Grant no. 5T32MH019961, “Clinical Neuroscience Research
References (66)
How do we know the minds of others? Domain-specificity, simulation, and enactive social cognition
Brain Res.
(2006)- et al.
Borderline personality disorder in men: a literature review and illustrative case vignettes
Psychiatry Res.
(2017) - et al.
Rejection sensitivity and disruption of attention by social threat cues
J. Res. Personal.
(2009) - et al.
Altered default mode and fronto-parietal network subsystems in patients with schizophrenia and their unaffected siblings
Brain Res.
(2014) - et al.
Reliability and validity of the Beck anxiety inventory
J. Anxiety Disord.
(1992) - et al.
Abnormalities in personal space and parietal–frontal function in schizophrenia
NeuroImage: Clin.
(2015) - et al.
Dissociation of explicit and implicit measures of the behavioral inhibition and activation system in borderline personality disorder
Psychiatry Res.
(2014) - et al.
Interpersonal functioning in borderline personality disorder: a systematic review of behavioral and laboratory-based assessments
Clin. Psychol. Rev.
(2014) - et al.
Borderline personality disorder
Lancet
(2004) The space between us: a neurophilosophical framework for the investigation of human interpersonal space
Neurosci. Biobehav. Rev.
(2009)