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The Lonely Road of People with Borderline Personality

A new study reveals the social isolation of people with borderline personality.

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Close relationships provide the framework for everyday life, structuring the way you spend your time while contributing to the ebb and flow of your emotions. It feels good to be with people you care about, and even though you might not always get along, there is an unmistakable bond with your significant other, family, and friends. Relationships also serve the function of providing you with concrete forms of help and for giving you the opportunity to help others, which further can promote your happiness and well-being. Even if you don’t see the people you consider your friends every day, there’s comfort in knowing they exist, and that you can touch base with them at any time.

Social isolation, in which you see yourself as separate and independent from other people, should therefore carry with it negative consequences for your mental health. Even if you feel that you like your solitude and would rather not have the entanglements and obligations that social relationships involve, there are still times when it feels good to share a tender moment or two. There are practical reasons to maintain connections with other people as well. Your physical health benefits when you have people in your life to whom you feel you can relate. Research on health and relationships shows definite advantages to being involved with at least one or two people on an intimate level.

For people with borderline personality disorder, according to a new study by McLean Hospital (Belmont, Massachusetts) psychologist Hannah Parker et al., (2019), social isolation may become a chronic condition that poses significant mental as well as physical health risks. Correlational studies may reveal that people with this disorder have fewer close relationships, but it is difficult to determine the causal direction when people are tested at one point in time. The McLean researchers were able to overcome this limitation by accessing 20 years' worth of long-term data from former inpatients. Over a 20-year period, Pucker et al. were able to follow their 269 participants 10 times every two years, providing unique longitudinal data on their psychosocial functioning. Predictor variables measured at the start of the study further helped to reduce the problem of one-shot correlational studies in determining what factors lead to isolation over time.

In the Parker et al. study, social isolation was defined “as having no emotionally sustaining relationships outside of the family” (p. 1). To measure social isolation, the research team asked participants to state whether they had any friends, intimate partners, and mentors. For each of these relationships that they named, participants answered questions about the amount of confiding, emotional support, conflict, and distance or coolness they experienced. Then participants were asked to rate how helpful the relationship was to their functioning and/or self-esteem. Individuals who reported that they had no relationships outside the family that were very helpful were classified as socially isolated.

Again, taking advantage of the longitudinal method and extensive data available on participants, both from their initial entry into the study and across the 10 years, the McLean researchers were able to evaluate the role of personality and early life experiences. The predictor measures included the personality traits of neuroticism, extraversion, agreeableness, pathological experiences in childhood of abuse and neglect, protective childhood experiences with ratings of competence and positive relationships, as well as age, gender, race, and the experience of depression, anxiety, PTSD, and substance abuse. These very comprehensive measures then became part of a statistical model to predict social isolation at the end of the 20 years of the study. Additionally, the authors were able to compare the individuals with borderline personality disorder and 72 people who met the diagnostic criteria for other personality disorders. This comparison group provided an important control for the role of personality disorders in general as influences on long-term outcomes.

The findings revealed that, as expected, people with borderline personality disorder indeed had higher rates of social isolation than the comparison sample. Across the 20 years of the study, the rates of social isolation in the borderline participants ranged from 22 percent to 32 percent, with 26 percent remaining isolated at the end of the study period. Those with other personality disorders showed a similar pattern over time, but their rates were far lower, so that at the 20-year mark, 10 percent reported themselves as being socially isolated.

Moving on to the predictors of social isolation, Pucker et al. narrowed the significant factors down to three: fewer childhood strengths (competence and positive relationships), lower scores on extraversion, and lower scores on agreeableness. As the authors note, extraversion involves positive emotions and an interest in social relationships; agreeableness reflects an individual’s willingness to cooperate and the ability to feel compassion. In their words, “It makes clinical sense that people who lack these qualities would have fewer emotionally sustaining relationships” (p. 4). The authors go on to suggest that these personality qualities are hard-wired into people and therefore can’t be changed. On this point, however, it is important to note that longitudinal studies on extraversion and agreeableness (not cited by the authors) do show that personality traits can modulate over time (Roberts et al., 2006). Perhaps if these personality measures had been obtained over the course of the McLean study, their stability could have been assessed.

Nevertheless, the findings provide important insights into the life experiences of people with borderline personality disorder and what factors may contribute to their poorer adjustment over time. Their social isolation, as the authors describe, can have a series of other negative consequences including “smoking and lack of exercise . . . and higher blood pressure and inflammation, coronary heart disease, colds, falls, cognitive decline, suicide, and premature mortality” (p. 4). Treatment, therefore, should focus on reducing social isolation and attempting to work on the underlying personality dimensions that also play a role. Only targeting the acute symptoms of people with borderline personality disorder will fail to address these underlying contributors to their psychological and physical health.

To sum up, social isolation is a risk factor for everyone throughout the adult years. This study of people with borderline personality disorder shows just how difficult it can be to overcome the early life experiences that affect the ability to form close relationships. However, if it’s true that personality can change, then fulfillment may yet be possible even in these very challenging conditions.

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Pucker, H. E., Temes, C. M., & Zanarini, M. C. (2019). Description and prediction of social isolation in borderline patients over 20 years of prospective follow-up. Personality Disorders: Theory, Research, and Treatment. doi: 10.1037/per0000337

Roberts, B. W., Walton, K. E., & Viechtbauer, W. (2006). Patterns of mean-level change in personality traits across the life course: A meta-analysis of longitudinal studies. Psychological Bulletin, 132(1), 1-25. doi: 10.1037/0033-2909.132.1.1

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