Mechanisms of vulnerability in borderline personality psychopathology: The role of childhood maltreatment, social cognition, and emotion dysregulation.

Childhood maltreatment (CM), impaired social cognition, emotion dysregulation, and clinical outcomes (e.g., aggression, suicidal ideation, non-suicidal self-injury) frequently co-occur in borderline personality disorder (BPD). However, the precise associations between individual CM facets, cumulative CM severity, and social cognition (e.g., theory of mind (ToM) and facial emotion recognition) remain underexplored. Furthermore, the collective role of depression, CM, emotion dysregulation, and social cognition in BPD-related outcomes has not been investigated. A sample of 183 patients with BPD and 178 non-clinical participants completed a battery of scales (e.g., Reading the Mind in the Eyes Test and Faux Pas Task). In the BPD group, individuals with a history of sexual abuse, physical abuse, or physical neglect demonstrated poorer facial emotion recognition than those without such histories, though ToM facets remained comparable. However, patients with greater cumulative CM severity reported more impairments in both facial emotion recognition and affective ToM. In the non-clinical sample, physical neglect was associated with deficits in both cognitive ToM and positive emotion recognition. Across both samples, BPD-related outcomes were associated with a constellation of factors, including depression, BPD symptom severity, emotion dysregulation, specific CM facets, impaired negative emotion recognition, and diminished cognitive ToM. The study underscores that specific CM facets and CM severity can be linked to impaired social cognition, even in the absence of a formal BPD diagnosis. Moreover, the findings highlight the role of clinical severity, specific CM aspects, emotion dysregulation, and poor social cognition in the psychopathology of BPD and its associated consequences.