The relationship between exaggeration attitudes and perceptual appraisal processes in borderline personality disorder

Introduction Borderline Personality Disorder (BPD) is characterized by hypersensitivity to rejection and fear of abandonment, heightened emotional experiences, poor self-image and impulsivity. There is a large area of research arguing that emotion dysregulation is one of the main responsible factors in the psychopathology of BPD. In the literature, it has been shown that perceptual disturbances occur in the context of different sensory modalities in BPD. Clinical observations and knowledge from the literature emphasize the tendency to exaggeration in BPD. In our study, we aimed to investigate the relationship between the tendency to exaggeration and perceptual processes. Method In our study, a backward masking paradigm was applied to assess participants' perceptual performance (perception duration and accuracy). Further, we developed and applied a paradigm that allows the assessment of perceptual exaggeration. In this paradigm, participants evaluated both verbal and numerical differences of the identical images. Response times were recorded during the evaluations. Interpretation time was calculated based on the difference in reaction times of verbal and numerical evaluations and "deviation" value was calculated as a measure of exaggeration based on the quantitative differences of the evaluations from 1 to 4 according to Likert scale. In addition, scales were applied to determine impulsivity, primitive defense mechanisms including splitting, mentalization assessment, anxiety and depression scores. Self-report and clinician assessments of anxiety and depression were made and "clinical exaggeration coefficients" (CAC) were calculated. Comparisons were made between groups consisting of 22 BPD and 24 healthy controls. The data obtained from the study were analyzed using MATLAB and SPSS 23 (IBM, USA). Results Student's t-test results showed that in the backward masking paradigm, the BPD group needed a longer time to perceive the correct answer (p=0.007) and reached a lower number of correct answers (p=0.043) compared to the control group. In terms of CAC scores for anxiety and depression, according to Student's t test, the BPD group had significantly higher scores (p<0.001). There was no significant difference between the groups in terms of "deviation" values in Student's t test, and there was no correlation between CAC values and "deviation" in Pearson correlation analysis. Linear regression analysis showed that impulsivity had no effect on "deviation", interpretation time (p=0.014) and anxiety had a significant effect (p=0.014), and primitive defense mechanism values had an almost significant effect (p=0.054). Discussion It has been shown that the perceptual speed of BPD patients is lower than that of controls. Although our findings do not show a direct relationship between impulsivity and perceptual exaggeration, they do indicate that anxiety and primitive defenses are related. To the best of our knowledge, this is the first study that aims to reveal the relationship of exaggeration tendency with splitting and anxiety in BPD as reported in the literature. Keywords: borderline personality disorder, perceptual processes, exaggeration, backward masking, reaction time, anxiety, splitting