Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face

Miriam Biermann; Anna Schulze; Ruben Vonderlin; Martin Bohus; Lisa Lyssenko; Stefanie Lis

doi:10.3389/fpsyt.2023.1082785

Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face

Front Psychiatry. 2023 Mar 8:14:1082785. doi: 10.3389/fpsyt.2023.1082785. eCollection 2023.

Authors

Miriam Biermann^{1

2}, Anna Schulze², Ruben Vonderlin¹, Martin Bohus^{1

3

4}, Lisa Lyssenko⁵, Stefanie Lis^{1

2}

Affiliations

¹ Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
² Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
³ Department of Clinical Psychology, Ruhr University Bochum, Bochum, Germany.
⁴ McLean Hospital, Harvard Medical School, Boston, MA, United States.
⁵ Department of Public Health, Freiburg University of Education, Freiburg, Germany.

Abstract

Background: A markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.

Methods: A sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).

Results: Individuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.

Conclusion: Our study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.

Keywords: borderline personality disorder; disgust; envy; experiment; self-conscious emotions; self-referential processing; shame.