Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.

Psychiatry Research 255 (2017) 347354

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Facial emotion recognition and borderline personality pathology MARK

a,d, b a c b
Kevin B. Meehan , Chiara De Panlis , Nicole M. Cain , Camilla Antonucci , Antonio Soliani ,
John F. Clarkind, Fabio Sambataroe
a
Department of Psychology, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
b
Unit of Psychiatry, Department of Neuroscience, University of Parma, c/o Ospedale Maggiore, pad. 21 Braga, viale Gramsci 14, 43126 Parma, Italy
c
Service of Hospital-based Psychiatry, Department of Mental Health, Parma Local Health Agency, c/o Ospedale Maggiore, pad. 21 Braga, viale Gramsci 14, 43126 Parma,
Italy
d
Department of Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY 10605, USA
e
Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy

A R T I C L E I N F O A B S T R A C T

Keywords: The impact of borderline personality pathology on facial emotion recognition has been in dispute; with impaired,
Facial emotion recognition comparable, and enhanced accuracy found in high borderline personality groups. Discrepancies are likely driven
Borderline personality by variations in facial emotion recognition tasks across studies (stimuli type/intensity) and heterogeneity in
Eortful control borderline personality pathology. This study evaluates facial emotion recognition for neutral and negative
Social cognition
emotions (fear/sadness/disgust/anger) presented at varying intensities. Eortful control was evaluated as a
Self-regulation
moderator of facial emotion recognition in borderline personality. Non-clinical multicultural undergraduates (n
Negative aect
= 132) completed a morphed facial emotion recognition task of neutral and negative emotional expressions
across dierent intensities (100% Neutral; 25%/50%/75% Emotion) and self-reported borderline personality
features and eortful control. Greater borderline personality features related to decreased accuracy in detecting
neutral faces, but increased accuracy in detecting negative emotion faces, particularly at low-intensity thresh-
olds. This pattern was moderated by eortful control; for individuals with low but not high eortful control,
greater borderline personality features related to misattributions of emotion to neutral expressions, and en-
hanced detection of low-intensity emotional expressions. Individuals with high borderline personality features
may therefore exhibit a bias toward detecting negative emotions that are not or barely present; however, good
self-regulatory skills may protect against this potential social-cognitive vulnerability.

1. Introduction been associated with, respectively, an under-attention to emotional

Borderline Personality Disorder (BPD) is characterized by sig-
nicant interpersonal dysregulation that may be fostered by biased
perceptions of social cues (Lieb et al., 2004). Decoding facial expres-
sions is an important aspect of social communication that inuences
how individuals respond to interpersonal contexts (Wagner and
Linehan, 1999). However, studies evaluating facial emotion recognition
(FER) in BPD have collectively yielded inconsistent ndings. Studies
have variously reported either impaired (Levine et al., 1997; Bland
et al., 2004; Guitart-Masip et al., 2009; Unoka et al., 2011) or increased
facial emotion recognition accuracy (Lynch et al., 2006; Minzenberg
et al., 2006; Domes et al., 2008; Dyck et al., 2009; Merkl et al., 2010;
Schulze et al., 2013; Veague and Hooley, 2014) in BPD, while other
studies indicated a tendency of those with BPD to misattribute negative
emotions to neutral faces (Wagner and Linehan, 1999; Dyck et al.,
2009; Daros et al., 2014). Therefore, BPD interpersonal dysfunction has
cues in faces; an empathy paradox in which those with BPD are hy-
persensitive to others emotions; and a negativity bias toward inter-
preting neutral faces as emotional. We identied two areas in prior
research that can be addressed to clarify these seeming contradictions.
1.1. Detection versus labeling of facial emotions
Facial emotion recognition is a multifaceted process, involving both
the detection of whether an emotion is present and the labeling/iden-
tication of that emotion (Daros et al., 2014). It has been proposed that
the former assessment i.e., discerning an emotion's presence in facial
expressions: is that an emotion? can be intact or even more accurate
in BPD, thus explaining the clinical observation of an empathy
paradox in BPD (i.e., those with BPD may be attending to and over-
interpreting eeting emotions best left ignored). Conversely, the latter
process i.e., distinguishing among negative emotion labels: what

Correspondence to: Long Island University - Brooklyn Campus, 1 University Plaza, Brooklyn, NY 11201, United States.
E-mail address: kevin.meehan@liu.edu (K.B. Meehan).

http://dx.doi.org/10.1016/j.psychres.2017.05.042

Available online 30 May 2017

Received 21 November 2016; Received in revised form 23 May 2017; Accepted 28 May 2017

0165-1781/ 2017 Elsevier B.V. All rights reserved.

Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.
K.B. Meehan et al.
emotion is that? might be disrupted, thus accounting for BPD mis-
reading of social stimuli and emotional instability in interpersonal
contexts (Daros et al., 2013, 2014; Schulze et al., 2013; Mitchell et al.,
2014). However, some caveats apply to previous research in this area.
First, research on pure facial emotion detection in BPD is still
limited. In fact, most studies used dynamically morphing tasks asking to
identify when an emotion is recognizable as it unfolds from neutral to
full emotional intensity, and then label that emotion (Lynch et al.,
2006; Domes et al., 2008; Robin et al., 2012;), or still morphing tasks
prompting for emotion labeling (i.e., Veague and Hooley, 2014). In this
way, the two processes of facial emotion detection and identication
are conated, leaving unclear whether impairments in accuracy are
driven by altered detection or altered labeling of emotional cues. In
order to address this confound, Schulze et al. (2013) asked participants
to indicate the presence of an emotional stimulus within a stream of
neutral faces without the need to label the emotional state, and found
increased detection of emotional expressions in BPD. However, that
study employed only two FEs (100% intensity anger and happiness),
leaving it unclear whether BPD is associated with over-attending to
subtle (i.e., less than 100% intensity) expressions of facial emotions, as
the empathy paradox seems to imply. Therefore, the present study
evaluated facial emotion detection separately from labeling using two
dierent tasks to ensure that detection is not biased by expectancies of
subsequently being asked to label the emotion that has just been de-
tected. Further, the present detection task required discrimination of
neutral vs. emotion when viewing still images presented at varying
emotional intensities (100% neutral and 25%/50%/75% emotion in-
tensities) to clarify whether BPD is related to a decreased threshold
for detecting facial emotions.
Second, studies evaluating labeling of full-intensity still facial
emotions in BPD reported decreased accuracy for negative emotions,
especially for rejection-related emotions such as anger and disgust
(Daros et al., 2013; Mitchell et al., 2014). Conversely, studies that used
dynamic facial morphs reported that those with BPD or high BPD fea-
tures correctly identied facial emotions either at an earlier (Lynch
et al., 2006), at a later (Robin et al., 2012), or at a comparable stage of a
dynamic morph than controls (Domes et al., 2008). Importantly, a dy-
namic morph may actually limit the ability to inform about facial
emotion recognition at very low intensities, because in practice re-
sponses tend to occur as the emotion has moved to the higher intensity
range (broadly in the 4575% diusion range across studies) when the
emotion has become clear enough to be accurately labeled. Only one
study (Daros et al., 2014) evaluated the lower intensity range with still
images at low diusion (as well as medium/high), and found no dif-
ferences in terms of BPD status, but only sadness and happiness were
evaluated, and the percent intensity of these low diusion images were
not specied. Thus, the present study evaluated labeling accuracy for
still images of neutral and low-intensity (25%) negative emotional ex-
pressions; with no full (100%) intensity emotions presented.
1.2. The role of self-regulatory skills
Discrepancies in past facial emotion recognition ndings may not be
explained by BPD alone, but through its interaction with other per-
sonality variables that can inuence social-cognitive functioning.
Eortful Control (EC) is the self-regulatory aspect of temperament that
allows individuals to strategically regulate contingent emotions, im-
pulses and thoughts for the sake of valued goals, thereby promoting
social adjustment (Rothbart et al., 2011; De Panlis et al., 2013). Ef-
fortful control buers the link between relational vulnerabilities and
BPD features (Ayduk et al., 2008; De Panlis et al., 2016) and dier-
entiates between high and low functioning subgroups of BPD patients
(Hoermann et al., 2005). Notably, eortful control reects the e-
ciency of executive attention (Posner and Rothbart, 2009), and execu-
tive/attentional control has been proposed as an inuential determi-
nant of facial emotion recognition in BPD (e.g., Domes et al., 2009;
348
Psychiatry Research 255 (2017) 347354
Robin et al., 2012; Lowyck et al., 2016). For instance, the nding of
lower facial emotion recognition accuracy for full intensity negative
emotions in BPD may be explained by bottom-up impairments in cog-
nitive control: the hyperarousal evoked by highly salient emotional
stimuli deplete cognitive resources and interfere with facial emotion
identication (Daros et al., 2013). Consistently, the studies (Gardner
et al., 2010; Preti et al., 2016) that explicitly evaluated the interaction
between eortful control, BPD features, and accuracy in labeling full-
intensity or dynamically morphed facial emotions found that, in those
with high BPD traits, good eortful control favors while low eortful
control reduces facial emotion recognition accuracy. However, to date
eortful control has not been directly investigated as a putative mod-
erator in the association between BPD features and response accuracy
in both facial emotion detection and identication for low-intensity
emotions.
1.3. The present study
The present study examined facial emotion recognition accuracy
using two separate tasks for evaluating emotion detection and labeling
in a nonclinical sample with varying BPD traits. In the present tasks, all
faces depict neutral and negative emotions. First, the detection task
requires a rapid forced choice between neutral and emotion in faces
presented across of range of emotional intensities (100% neutral and
25%/50%/75% emotion intensity) and valences (anger, fear, sadness,
disgust). Second, the labeling task allows for a more deliberative forced
choice among valences (neutral, anger, fear, sadness, disgust), with the
emotions only presented at a very low (25%) intensity. Self-reported
eortful control and borderline personality features then predicted
detection and labeling accuracy.
In keeping with the negativity bias and empathy paradox hy-
potheses of facial emotion recognition in BPD, for both tasks we hy-
pothesized a bias towards over-attributing negative emotions to neutral
or ambiguous facial expressions in those with high borderline person-
ality features, particularly in those who also reported low eortful
control. In other words, we expected those with borderline personality
features to show a reduced detection and labeling accuracy for neutral
faces, suggesting that they interpret neutral expressions as emotional,
and an enhanced detection and labeling accuracy for emotional faces
presented at very low (25%) intensity, suggesting that they are hy-
persensitive to subtle expressions of negative emotions in others (pos-
sibly with stronger eects for emotions that connote rejection, such as
anger and disgust). We further expected that both of these patterns (i.e.,
the tendency to misinterpret neutral stimuli as emotional coupled with
an increased ability to detect and label ambiguous, low-intensity ne-
gative facial emotions) would be buered by high eortful control.
2. Methods
2.1. Participants and procedures
In total, 186 undergraduates from a multicultural U.S. university
participated in a study approved by the university's institutional review
board. Prior to the study, the Benton Facial Recognition Test short-form
(BFRT) was administered to exclude facial emotion recognition decits
due to impaired recognition of facial identity (prosopagnosia); scores
39 were classied as normal (Benton et al., 1994). One participant was
excluded for BFRT performance; the sample mean was 46.09 (SD =
3.70). Participants then completed the facial emotion recognition tasks
and self-report measures, and were compensated with course credit.
Fifty-four participants (32 females) were removed prior to analyses
because they failed multiple attention checks embedded in the protocol
(i.e., questionnaire items that ask for a specic response based on a
close read of the item; see Goodman et al., 2013). The analyses pre-
sented here are based on the remaining (n = 132) participants. How-
ever, participants could skip items they did not feel comfortable
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.
K.B. Meehan et al.
responding to, resulting in missing data on some measures (see below).
Participants (76.5% female) ranged in age from 18 to 53 years
(mean age 21.39 6.38), with 80% between 18 and 22 years of age.
The ethnic composition of the sample was 33.3% African-American,
18.5% Asian, 17.8% Latino, 17.8% Caucasian, 7.4% Middle Eastern,
and 4.4% Other.
2.2. Measures
2.2.1. Facial emotion recognition tasks
2.2.1.1. Stimuli preparation. Both the facial emotion detection and
labeling tasks included neutral and negative (sadness, fear, anger,
disgust) facial stimuli taken from Ekman's Japanese and Caucasian
Facial Expressions of Emotion (JACFEE) and Neutral Faces (JACNeuF)
series (Ekman and Friesen, 1976; Matsumoto and Ekman, 1988) and
NimStim (Tottenham et al., 2009). Face morphs of both sexes were
created with Abrosoft Fantamorph 5.4 by blending negative and neutral
expressions of the same identity in 25% increments (LaBar et al., 2003)
to obtain four levels of emotional intensity (100% neutral and 25%/
50%/75% emotion intensity).
2.2.1.2. Detection task. This task evaluated detection of neutral and
negative facial emotions (anger, disgust, fear, sadness) across dierent
levels of intensity (25%/50%/75% emotion intensity). Subjects were
required to indicate, as quickly and accurately as possible, whether the
face displayed an emotion or not. Two labels, neutral and emotion,
were presented under a morphed face, prompting a forced choice by
pressing the left or right mouse button (Fig. 1). Each trial lasted for 2 s
Fig. 1. Screenshots illustrating the facial emotion recognition detection (A) and labeling
(B) tasks. Both tasks were presented on a Windows computer, using E-Prime 2.0 software,
and were preceded by detailed instructions.
349
Psychiatry Research 255 (2017) 347354
with an inter-trial interval of 1 s. Stimuli were pseudo-randomized by
emotion valence (neutral, anger, disgust, fear, sadness) and emotion
intensity (25/50/75%) to reduce habituation and expectancy eects. A
total of 450 trials were presented, lasting 20 min. Accuracy and
reaction time were recorded.
2.2.1.3. Labeling task. In order to clarify accuracy of recognition of
low-intensity emotions, the detection task was followed by a labeling
task evaluating neutral and negative facial emotions (anger, disgust,
fear, sadness) at a low level (25%) of intensity. Subjects determined by
multiple choice which expression among ve valences (i.e. neutral,
sadness, fear, anger, disgust) is portrayed by the face (Fig. 1). The total
number of trials was 70 (30 neutral stimuli, 40 emotion stimuli, i.e., 10
stimuli for each emotion). Stimuli were pseudorandomized by emotion
type. There were no response time limit: the next stimulus would
appear only when the subject had made a choice on the preceding one.
Again, the performance measures were accuracy and reaction time.
2.2.2. Questionnaires
2.2.2.1. SCID-II screener for personality disorders: BPD scale. The SCID-II
questionnaire (First et al., 1997) was constructed as a screener that
precedes the full SCID-II semi-structured interview, with Yes/No
statements referring to the presence/absence of DSM-IV personality
disorder symptoms. Using the SCID-II Interview as gold standard, the
SCID-II questionnaire has demonstrated good psychometrics as a
measure of personality disorder pathology in its own right, with good
criterion validity (Germans et al., 2010) construct validity (Piedmont
et al., 2003) and clinical utility in assessing BPD (Chanen et al., 2008).
In this study we administered only the BPD scale, which consists of 15
questions covering the nine DSM-IV BPD criteria. The total number of
BPD items endorsed is the index of severity of borderline personality
features, which was found to have high internal validity ( = .85).
2.2.2.2. Eortful control (EC). Eortful control was assessed with the
19-item EC scale of the Adult Temperament Questionnaire (ATQ; Evans
and Rothbart, 2007). Items on a 7-point Likert-scale (1 = extremely
untrue of you, to 7 = extremely true of you) refer to inhibitory control,
activation control, and eortful attention. The internal consistency of
the EC scale in the present sample was = .68, which is only adequate
but closely compares to other studies using a larger sample of a similar
cohort ( = .71; Cain et al., 2013) and to the validation study among
undergraduates ( = .78).
2.3. Statistical analysis
Reaction time (RT) was evaluated as a potential covariate for la-
beling, but not for detection given that not responding within 2 s is a
ceiling past which the response is deemed inaccurate, there was an
expected negative relationship between accuracy and RT (rneutral =
.27; remotion = .31) that indicates no speed-accuracy trade-o.
Potential covariates were evaluated with Pearson correlations (age) and
t-tests (sex). The relationship between borderline personality features
and both detection and labeling accuracy were evaluated with Pearson
correlations and linear regression models (SPSS.20), with the latter
meeting the assumption of independent errors (Durbin-Watson, all d's
= 1.68 2.14). Further, the interaction of eortful control in the re-
lationship between borderline personality features and accuracy was
probed with moderation analysis using PROCESS for SPSS (Hayes,
2013). Because emotion detection accuracy varied by intensity per-
centage, multilevel linear modeling (MLM) was utilized (in STATA.14)
with a restricted maximum-likelihood random-eects model. For these
models emotion detection accuracy scores (Level 1) that varied across
intensity percentage were nested within individuals, and eortful
control and borderline personality features were evaluated as (Level 2)
moderators.
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.

K.B. Meehan et al. Psychiatry Research 255 (2017) 347354

Table 1
Descriptive statistics and pearson correlations between accuracy, borderline personality
features, and eortful control.

BP EC

Detection: % Accurate M (SD) r r

Neutral 78.18 (16.80) .21* .06
Emotion 73.14 (10.56) .24* .09
25% Emotion 46.37 (18.20) .24* .09
50% Emotion 82.61 (10.31) .21* .09
75% Emotion 90.43 (7.09) .14 .05
Anger 71.60 (11.91) .19* .08
Disgust 85.43 (7.73) .24* .11
Fear 68.00 (13.67) .30* .09
Sadness 67.52 (13.28) .15 .06
Labeling: % Accurate
+
Neutral 89.22 (9.93) .28* +
.14
+
Anger 38.64 (24.11) .21* +
.14
+ +
Disgust 34.55 (17.62) .14 .31*
+
Fear 33.64 (19.51) .21* +
.19*
+ +
Sadness 31.44 (21.05) .04 .05
Reaction Time (ms) 2268.38 (885.26) .17 .02
M (SD) M (SD)
5.13 (3.74) 4.45 (.72)

Note. Responses were obtained from 132 participants. On the EC scale, 11 subjects had
partially missing data, mean-replacement was used on those with less than 10% missing
Fig. 2. Detection accuracy for neutral faces predicted by borderline personality features
data, resulting in n = 129. On the SCID-II borderline personality scale, 19 subjects had
in interaction with eortful control. Note. The moderator (eortful control) is continuous,
partially missing data; because symptoms are discrete mean replacement is not appro-
with its conditional eect depicted at one standard deviation above (high = 5.17), below
priate, resulting in n = 113. BP = Borderline Personality features on the SCID-II ques-
(low = 3.76), and at the mean (medium = 4.46). The moderator value dening the
tionnaire; EC = Eortful Control on the Adult Temperament Questionnaire; +partial
Johnson-Neyman signicance region is below 4.33, which encompasses the region of low
correlation controlling for Reaction Time.
to medium eortful control.
* p < .05.

neutral faces was found with high borderline personality features for
3. Results
those with low but not high eortful control ( = 1.22, p = .03),
though the eect was small (F[3,108] = 3.31, p = .02, R2 = .08). The
Responses were obtained from 132 participants. On the EC scale, 11
Johnson-Neyman technique indicated that for individuals scoring
subjects had partially missing data, mean-replacement was used for
higher than 4.33 on the EC scale (i.e., just below the mean; 56% of the
those with less than 10% missing data, resulting in n = 129. On the
sample) borderline personality features had no signicant eect on
SCID-II borderline personality scale, 19 subjects had partially missing
neutral detection accuracy (Fig. 2). Therefore, only those with high
data; as symptoms are discrete mean replacement is not appropriate,
borderline personality features and low eortful control displayed re-
resulting in n = 113.
duced accuracy for neutral faces.

3.1. Detection of facial expressions 3.1.2. Emotion detection accuracy

Detection accuracy for the two response options (neutral vs.
emotion) was analyzed separately; the emotion response option
included faces that varied by valence and intensity, and thus accuracy
was probed across these variations. The relationship of demographic
variables to detection accuracy was evaluated; sex and age were not
related to emotion (tsex = 1.34, p = .18; rage = .02, p = .83) or neutral
(tsex = 1.09, p = .28; rage = .01, p = .88) accuracy. Eortful control
was not related to neutral or total emotion detection accuracy across
any valence or intensity (see Table 1). However, greater borderline
personality features was signicantly correlated with lower neutral (r
= .21, p = .03) and higher emotion (r = .24, p = .01) detection
accuracy, and this higher accuracy was observed when the emotion
depicted was anger (r = .19, p = .046), fear (r = .30, p = .001), and
disgust (r = .24, p = .01), but not sadness (r = .15, p = .12). The
positive relationship between borderline personality features and de-
tection accuracy was observed when the emotion was presented at low
(25%; r = .24, p = .01) and medium (50%; r = .21, p = .03) but not
high (75%; r = .14, p = .16) intensity. These relationships were
therefore probed with models that included eortful control as a
moderator.
3.1.1. Neutral detection accuracy
Eortful control was evaluated as a moderator of the relationship
between borderline personality features and neutral detection accuracy;
a signicant interaction was found, such that reduced accuracy for
Eortful control was also evaluated as a moderator of the re-
lationship between borderline personality features and emotion detec-
tion accuracy (across levels of intensity). A signicant interaction was
found, such that greater accuracy for emotion faces was found with
high borderline personality features for those with low but not high
eortful control ( = 1.77, p = .001), with a medium eect (F
[3,108] = 6.03, p = .001, R2 = .14). The Johnson-Neyman technique
indicated that for individuals scoring higher than 4.43 on the eortful
control scale (i.e., at the mean; 51% of the sample) borderline per-
sonality features had no signicant eect on emotion detection accu-
racy (Fig. 3). Therefore, only those with high borderline personality
features and low eortful control displayed enhanced accuracy for
emotion faces.
MLM was used to evaluate the moderating role of emotion intensity,
given that accuracy for emotion responses was evaluated across three
degrees of intensity (Level 1) as a function of interacting baseline levels
of borderline personality and eortful control (Level 2). Consistent with
above, in Model 1 there was a signicant and positive main eect of
Intensity Percentage as well as borderline personality features on
greater emotion detection accuracy, and in Model 2 there was a sig-
nicant interaction between eortful control and borderline personality
features (Table 2). In Model 3, there was an interaction between bor-
derline personality features and Intensity Percentage, such that the
impact of greater borderline personality features on greater emotion
detection accuracy is observed at low (25%) but not high (75%) in-
tensity. This interaction is further moderated by eortful control: the

350
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.

K.B. Meehan et al. Psychiatry Research 255 (2017) 347354

impact of greater borderline personality features on greater low in-

tensity detection accuracy is observed in those with low but not high
eortful control (all p < .01; Fig. 4). Therefore, only those with high
borderline personality features and low eortful control displayed en-
hanced accuracy for subtle presentations of emotion in faces.

3.2. Labeling of facial expressions

In order to clarify accuracy of recognition of low-intensity emotions,

labeling accuracy for the ve response options (neutral, anger, fear,
disgust, sadness; with emotions all at 25% intensity) were analyzed
separately. RT was evaluated as a potential covariate and found to be
negatively related to neutral labeling accuracy (r = .47, p = .001)
and positively related to anger (r = .35, p = .001), fear (r = .25, p =
.004), sadness (r = .37, p = .001), but not disgust (r = .15, p = .10).
This suggests a speed-accuracy trade-o for labeling emotions, with
accurate responses only at the expense of a longer RT, whereas for
neutral stimuli speed and accuracy are working in concert.
Demographic variables were also evaluated; age was not related to la-
beling accuracy for neutral (r = .04), anger (r = .01), disgust (r =
.14), fear (r = .07), or sadness (r = .05, all ns). Female sex was
related to labeling accuracy for neutral (t = 2.18, p = .03), anger (t
= 2.77, p = .01), and disgust (t = 2.38, p = .02), but not fear (t = .44,
Fig. 3. Detection accuracy for emotion faces predicted by borderline personality features
p = .66) and sadness (t = .53, p = .60).
in interaction with eortful control. Note. The moderator (eortful control) is continuous,
with its conditional eect depicted at one standard deviation above (high = 5.17), below Greater borderline personality features were signicantly correlated
(low = 3.76), and at the mean (medium = 4.46). The moderator value dening the with lower neutral (r = .28, p = .004) and higher emotion labeling
Johnson-Neyman signicance region is below 4.43, which encompasses the region of low accuracy for anger (r = .21, p = .02) and fear (r = .21, p = .03), but
to medium eortful control. not disgust (r = .14) and sadness (r = .04, both ns) (Table 1), con-
trolling for RT. Greater eortful control was related to less accurate
Table 2 emotion labeling of disgust (r = .30, p = .001) and fear (r = .19, p
Multilevel model of emotion detection accuracy by intensity. = .045), but was not related to sadness (r = .05) and anger (r =
.14), nor was it related to neutral labeling (r = .14, all ns). These
Model 1 Model 2 Model 3
relationships were probed with linear regression models that included
** **
Intensity% 22.63 (.80) 22.60 (.80) 39.09 (9.18)** eortful control as a moderator, controlling for RT. However, no sig-
BP .65 (.25)* 5.76 (1.59)** 12.92 (3.19)** nicant interaction terms were found in models evaluating the inter-
EC 5.55 (2.21)* 11.81 (4.46)*
action of borderline personality features and eortful control in pre-
BP EC 1.18 (.36)** 2.64 (.73)**
% BP 3.58 (1.38)* dicting the labeling accuracy of neutral ( = .18, p = .73), anger (
% EC 3.13 (1.93) = .62, p = .27), disgust ( = 1.05, p = .06), fear ( = .05, p = .93),
% BP EC .73 (.32)* or sadness ( = .42, p = .44).
Intercept 51.56 (14.11) 43.62 (12.49) 45.08 (13.23) Exploratory analyses evaluated whether there was a pattern to the
Residual 144.11 (13.59) 143.97 (13.63) 139.56 (13.30)
2LL 1362.14 1343.16 1337.93
inaccurate labeling related to greater borderline personality features.
For errors on emotion faces, those higher on borderline personality
Note. BP = Borderline Personality features on the SCID-II questionnaire; EC = Eortful were less likely to mistake faces depicting anger (r = .27, p = .01),
Control on the Adult Temperament Questionnaire. fear (r = .34, p = .00), disgust (r = .21, p = .04), and sadness (r =
* p < .01. .28, p = .00) as neutral, controlling for RT. Put dierently, those with
** p < .001.
higher borderline personality features were more likely to inaccurately
label an emotion as another valenced emotion, rather than a neutral
face, though there was no specic pattern with regard to what valenced
emotion was instead attributed. For errors on neutral faces, those with
higher borderline personality features were more likely to inaccurately
attribute sadness to neutral faces (r = .22, p = .03), but not other
valences (ranger = .02; rdisgust = .15; rfear = .02; all ns).

4. Discussion

4.1. Detection of facial expressions

The present study rst assessed the degree to which an emotion is

detected to be present at all even if too eeting to be categorized and
labeled by requiring a quick, dichotomous distinction of emotion
versus neutral, with emotions randomized across valences and in-
tensities. Those with high borderline personality features were less
accurate at detecting neutral faces, and more accurate at detecting
subtle, low-intensity negative emotions in faces.
Fig. 4. Detection accuracy for emotion faces varies by borderline personality features in
interaction with eortful control and intensity %.
With respect to the reduced detection of neutral faces, these results
extend previous ndings of inaccurate attributions of an emotional

351
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.
K.B. Meehan et al.
valence to neutral expressions in those with BPD (Daros et al., 2013)
and further clarify that this bias towards seeing emotions in neutral
faces is apparent even in the detection phase of facial emotion re-
cognition, irrespective from the potential confounds driven by the need
to choose among diverse emotion labels.
With respect to the increased detection of emotional stimuli, the
present results extend the ndings of Lynch et al. (2006), who found
that those with BPD correctly identied emotions at an earlier stage of a
dynamic morph than controls across a range of positive and negative
valences, as well as those of Schulze et al. (2013), who reported en-
hanced detection of 100% emotional facial expressions presented
among rapidly changing neutral facial stimuli. However, those studies
left unclear what kinds of preliminary impressions may have been
present at low-intensity emotion diusions, while the present facial
emotion detection specically claried that there is a bias at the lower
level intensity of emotion detection. Notably, higher borderline per-
sonality features were related to more accurate emotion detection when
the valence depicted indicated potential interpersonal rejection (i.e.,
anger and disgust) or threat/alarm around or about oneself (i.e., fear),
but not sadness. In fact, sadness potentially conveys less salient in-
formation about the high borderline personality respondent it is more
likely to elicit concern for the other person than signal danger for the
self.
Taken together, the results on the detection phase of facial emotion
recognition indicate that those high in borderline personality features
exhibit a lower detection threshold for seeing emotion in faces, either
inaccurately (e.g., misperceiving a neutral face as emotional) or accu-
rately (i.e., detecting low-intensity, ambiguous facial emotions as va-
lenced, especially if these signal threat or rejection).
4.2. Labeling of facial expressions
The labeling task subsequently claried this detection bias by
evaluating the ability to correctly identify subtle emotional expressions
across ve valenced choices (anger, fear, sadness, disgust, and neutral).
While this task is procedurally closer to past studies evaluating facial
emotion recognition with still images, it was the rst to clarify accuracy
of recognition of low-intensity (25%) emotional stimuli, which is im-
portant given that biased detection was most evident at this level
(whereas the sample was largely accurate at detecting 75% emotions).
Consistent with expectations, greater borderline personality features
predicted reduced labeling accuracy of neutral faces but greater la-
beling accuracy of low-intensity angry and fearful faces.
The nding of a decreased ability to correctly label neutral faces
extends the results of the detection phase of facial emotion recognition:
the tendency towards inaccurate attributions of negative emotions to
neutral faces exhibited by those with high borderline personality fea-
tures does not diminish when provided with greater time for reection,
nor when provided with explicit labels for emotions. Notably, the
sample overall was quite accurate in labeling neutral faces, with much
higher rates of errors occurring for low-intensity emotional stimuli;
however, high borderline personality features were specically asso-
ciated with a negativity bias toward interpreting neutral expressions
as emotional, consistent with previous studies (Daros et al., 2013).
With respect to the labeling of low-intensity emotions, those with
high borderline personality features were signicantly less likely to
mistake an emotion for a neutral face. Put dierently, those with low
borderline personality features were signicantly more likely to fail to
notice a subtle emotion and mislabel it neutral. While this response
pattern is consistent with past studies nding heightened sensitivity to
negative facial emotions in those with BPD (Domes et al., 2008), pre-
vious studies also reported a decreased accuracy in identifying full-in-
tensity (100%) negative emotions (Daros et al., 2013; Mitchell et al.,
2014). This suggests an interesting facial emotion recognition pattern in
BPD, such that an enhanced identication of subtle, ambiguous signs of
emotions is coupled with increasing diculties in correctly identifying
352
Psychiatry Research 255 (2017) 347354
full-intensity emotions.
4.3. The moderating role of eortful control
This study was the rst to evaluate eortful control as a potential
moderator of both low-intensity facial emotion detection and labeling.
With regard to the detection phase of facial emotion recognition, good
self-regulatory skills (i.e., high eortful control) buered against the
automatic response tendency of those with high borderline personality
features to see emotions in faces with no (neutral) or subtle (25%)
signs of emotions. Notably, emotion detection is regarded as an auto-
matic and reexive process (Adolphs, 2002; Phillips et al., 2008). In
those with high borderline personality features this bias toward a self-
referential and negative processing of social cues (i.e., a misattribution
of emotion to neutral faces coupled with enhanced detection of very
subtle negative emotions in faces) is buered by high eortful control.
This conrms the role of eortful control in protecting against BPD-
related social-cognitive vulnerabilities (Ayduk et al., 2008; De Panlis
et al., 2016) and in promoting interpersonal adjustment: in the service
of social bonding and functioning, it may actually be adaptive to not
over-attend to eeting negative expressions in other's faces.
Eortful control did not moderate the association between high
borderline personality traits and emotion identication through verbal
labeling, which is regarded as a more voluntary, reective process
than emotion detection (Adolphs, 2002; Phillips et al., 2008). Thus, the
moderating role of eortful control may be more evident at the more
reexive detection phase, through providing adequate top-down
control of bottom-up automatic response tendencies, rather than during
the more reective, deliberative labeling phase of neutral or low-in-
tensity facial emotions. This is consistent with the conceptualizations of
the centrality of eortful control in the modulation of reactive ten-
dencies (Rothbart and Bates, 1998). However, greater eortful control
may buer the relationship between greater borderline personality
features and less accurate labeling of angry expressions presented at
higher intensities (Gardner et al., 2010; Preti et al., 2016), which are
likely to deplete cognitive resources to a greater extent than low-in-
tensity ones. It may be that good eortful control may protect those
with high borderline personality features from the arousal evoked by
high-intensity emotional faces, thereby favoring their accurate identi-
cation. Conversely, the low-intensity emotions displayed in the cur-
rent study may attract BPD individuals attention toward salient social
stimuli in the environment without increasing one's arousal, thus fa-
voring their enhanced deliberative processing irrespective of top-down
cognitive control (Daros et al., 2013). The role of arousal evoked by
facial expressions would need to be borne out in future research.
4.4. Implications for BPD interpersonal dysfunction
Overall, these results do not indicate a general facial emotion re-
cognition decit in BPD, but are consistent with recent research sug-
gesting that while some processes may be impaired (i.e., the accurate
recognition of neutral faces), others may be intact or even amplied
(i.e., the accurate recognition of low-intensity negative emotions,
especially those signaling rejection or danger) (Hidalgo et al., 2016).
Thus, ndings are consistent with both a negativity bias, by which
those with high borderline personality features misinterpret neutral
social stimuli as negative, and an empathy paradox in which they
show an enhanced attention toward salient social stimuli (Dinsdale and
Crespi, 2013). These tendencies towards greater detection of emotions
that are either not present (neutral) or barely present (25% emotion)
may each contribute to detriments in social functioning. Inaccurately
detecting eeting negative emotions in neutral faces may be the basis of
distorted attributions that lead to interpersonal ruptures. Accurate de-
tection of subtle negative cues of anger and fear may also be mala-
daptive; a good deal of coordinated interpersonal exchange involves not
over-noticing every aect cue that signals rejection or danger in the
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.
K.B. Meehan et al.
service of keeping up positive social relatedness. It may even be
adaptive to at times mistake subtle negative expressions for neutral
ones in the context of a warm, mutual social exchange a subtle ash of
anger or disgust might not have much heuristic value but in this study
those with high borderline personality did not tend to make mistakes in
that direction. Thus, the fear of rejection may lead those with high
borderline personality features to over-attend signals of danger or
threat, even if it means disrupting the interpersonal transaction. Ir-
onically, this may be the basis of a self-fullling prophecy: these rup-
tures in the transaction may lead their interaction partner to pull away
in the very manner that was feared (Downey and Feldman, 1996).
However, eortful control protected against this response bias. The
capacity for self-regulation may be essential for translating the detec-
tion of social cues into positive, mutual relatedness. Good eortful
control could prevent those with high borderline personality features
from detecting subtle signs of emotions in ambiguous or even neutral
faces that in actual social interactions would be best left ignored. This is
consistent with the notion that the empathy paradox may be attri-
butable in part to a combination of enhanced attention/perception of
social stimuli with dysfunctional regulatory systems; in BPD a poten-
tially pathological facial emotion recognition pattern may become ap-
parent only in the absence of ecient top-down regulatory systems
(i.e., Dinsdale and Crespi, 2013). Conversely, when self-regulatory
processes work properly, those with high borderline personality fea-
tures may overcome their automatic tendencies toward amplifying
minor signs of negative aect in others, resulting in better social ad-
justment.
4.5. Limitations and future directions
This study employed a non-clinical sample mostly comprised of
female undergraduate students, thus calling for a replication of ndings
among older, male, and clinical populations. However, the ethnic di-
versity in our sample increases the generalizability of the ndings be-
yond predominately Caucasian samples, and the range of borderline
personality pathology endorsed by the current study participants (as
evidenced by a mean of 5 borderline personality features, with a range
of 013 features on the SCID-II screener) allows for the evaluation of
facial emotion recognition accuracy across a full dimension of border-
line personality features. Further, using a non-clinical sample has the
potential to illuminate specic facial emotion recognition patterns re-
lated to BPD traits rather than other illness-related variables. For in-
stance, non-clinical individuals are less likely to exhibit the inter-
personal and cognitive impairments that usually characterize patients
with BPD (i.e., due their prolonged illness duration, comorbidity and
medication use). However, the present study is limited by the absence
of data on the full range of PD symptoms on the SCID-II screener, as
well as some missing data among available subjects. The present nd-
ings should be replicated with conrmed PD symptoms on the SCID-II
Interview, both within nonclinical and clinical samples; with a cut-o
of > 12 on the SCID-II questionnaire indicating the presence of BPD
(Chanen et al., 2008), very few in this sample would likely have met full
diagnostic criteria. Utilizing the full SCID-II Interview would also allow
for an evaluation of the full spectrum of PD pathology, which may in-
teract with borderline personality features in predicting facial emotion
recognition accuracy.
We do not have information on comorbidities of our undergraduate
sample, though comorbidity has generally not been borne out as a
signicant contributor of facial emotion recognition in BPD samples
(Daros et al., 2014). However, facial recognition may be altered in
depressive disorders (Jenness et al., 2015), and trauma has been found
to relate to accuracy for full-intensity emotion in faces in those with
BPD (Lowyck et al., 2016). Trauma and dissociation have also been
found to interact with borderline personality features on the RMET
(Weinstein et al., 2016), so future research would benet from their
inclusion in the evaluation of accuracy for low intensity emotions.
353
Psychiatry Research 255 (2017) 347354
Because our primary interest was in evaluating a negativity bias in
borderline personality pathology, we only evaluated neutral and ne-
gative emotion faces. However, BPD has been associated with specic
diculties in categorizing positive, 60% intensity happy facial emo-
tions (Fenske et al., 2015); therefore future studies should also evaluate
facial emotion detection and labeling for low-intensity positive facial
stimuli, as well as whether good eortful control could buer against
the potential bias toward under-estimating cues of positive aect in
faces.
4.6. Conclusions
Borderline personality features were associated with greater emo-
tion sensitivity to facial expressions, i.e., with a greater ability to de-
tect and label facial emotions at low intensity thresholds, and a greater
propensity to misdetect and mislabel neutral faces as emotional.
However, good eortful control buered this response bias in the de-
tection phase of facial emotion recognition. Individuals with high
borderline personality features may therefore be automatically noti-
cing negative emotions in faces that are actually not or barely present,
but good self-regulatory skills may protect them against this potential
social-cognitive vulnerability.
References
Adolphs, R., 2002. Neural systems for recognizing emotion. Current opinion in neuro-
biology. 12 (2), 169177.
Ayduk, O., Zayas, V., Downey, G., Cole, A.B., Shoda, Y., Mischel, W., 2008. Rejection
sensitivity and executive control: joint predictors of borderline personality features.
J. Res. Personal. 42, 151168.
Bland, A.R., Williams, C.A., Scharer, K., Manning, S., 2004. Emotion processing in bor-
derline personality disorder. Issues Ment. Health Nurs. 24, 655672.
Benton, A.L., 1994. Contributions to Neuropsychological Assessment: A Clinical Manual.
Oxford University Press, USA.
Cain, N.M., De Panlis, C., Meehan, K.B., Clarkin, J.F., 2013. Assessing interpersonal
proles associated with varying levels of eortful control. J. Personal. Asses. 95 (6),
640644.
Chanen, A.M., Jovev, M., Djaja, D., McDougall, E., Yuen, H.P., Rawlings, D., Jackson,
H.J., 2008. Screening for borderline personality disorder in outpatient youth. J.
Personal. Dis. 22 (4), 353364.
Daros, A.R., Zakzanis, K.K., Ruocco, A.C., 2013. Facial emotion recognition in borderline
personality disorder. Psychol. Med. 43 (9), 19531963.
Daros, A.R., Uliaszek, A.A., Ruocco, A.C., 2014. Perceptual biases in facial emotion re-
cognition in borderline personality disorder. Personal. Disord. 5 (1), 7987.
De Panlis, C., Meehan, K.B., Cain, N.M., Clarkin, J.F., 2013. The relationship between
eortful control, current psychopathology, and interpersonal diculties in adult-
hood. Compr. Psychiatry 54, 454461.
De Panlis, C., Meehan, K.B., Cain, N.M., Clarkin, J.F., 2016. Eortful control, rejection
sensitivity, and borderline personality disorder features in adulthood. J. Personal.
Disord. 30 (5), 595612.
Dinsdale, N., Crespi, B.J., 2013. The borderline empathy paradox: evidence and con-
ceptual models for empathic enhancements in borderline personality disorders. J.
Personal. Disord. 27 (2), 172195.
Domes, G., Czieschneck, D., Weidler, F., Berger, C., Fast, K., Herpertz, S.C., 2008.
Recognition of facial aect in borderline personality disorder. J. Personal. Disord. 22,
135147.
Domes, G., Schulze, L., Herpertz, S.C., 2009. Emotion recognition in borderline person-
ality disorder: A review of the literature. J. Personal. Disord. 23, 619.
Downey, G., Feldman, S.I., 1996. Implications of rejection sensitivity for intimate re-
lationships. J. Personal. Soc. Psychol. 6, 13271343.
Dyck, M., Habel, U., Slodczyk, J., Schlummer, J., Backes, V., Schneider, F., Reske, M.,
2009. Negative bias in fast emotion discrimination in borderline personality disorder.
Psychol. Med. 39 (05), 855864.
Ekman, P., Friesen, W., 1976. Pictures of Facial aect. Consulting Psychologist Press, Palo
Alto, CA.
Evans, D.E., Rothbart, M.K., 2007. Developing a model for adult temperament. J. Res.
Personal. 41, 868888.
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., 1997. Structured Clinical
Interview for DSM-IV Personality Disorders, (SCID-II). American Psychiatric Press
Inc, Washington, DC.
Fenske, S., Lis, S., Liebke, L., Niedtfeld, I., Kirsch, P., Mier, D., 2015. Emotion recognition
in borderline personality disorder: eects of emotional information on negative bias.
Borderline Personal. Disord. Emot. Dysregul. 26 (2), 10.
Gardner, K.J., Qualter, P., Stylianou, M., Robinson, A.J., 2010. Facial aect recognition in
non-clinical adults with borderline personality features: The role of eortful control
and rejection sensitivity. Personal. Individual Dier. 49, 799804.
Germans, S., Van Heck, G.L., Mastho, E.D., Trompenaars, F.J., Hodiamont, P.P., 2010.
Diagnostic eciency among psychiatric outpatients of a self-report version of a
Los art?culos se proporcionan ?nicamente para uso personal y educativo. Est? prohibida la reproducci?n, distribuci?n y uso comercial.
K.B. Meehan et al.
subset of screen items of the structured clinical interview for DSMIVTR Personality
Disorders (SCID-II). Psychol. Assessment 22 (4), 945.
Goodman, J.K., Cryder, C.E., Cheema, A., 2013. Data collection in a at world: The
strengths and weaknesses of Mechanical Turk samples. J Behav. Decis. Making 26 (3),
213224.
Guitart-Masip, M., Pascual, J.C., Carmona, S., Hoekzema, E., Berg, D., Prez, V.,
Vilarroya, O., 2009. Neural correlates of impaired emotional discrimination in bor-
derline personality disorder: an fMRI study. Prog. Neuro-Psychoph. 33 (8),
15371545.
Hayes, A.F., 2013. Introduction to Mediation, Moderation and Conditional Process
Analysis. A Regression-Based Approach. Guilford Press, New York.
Hidalgo, N.A.I., Oelkers-Ax, R., Nagy, K., Mancke, F., Bohus, M., Herpertz, S.C., Bertsch,
K., 2016. Time course of facial emotion processing in women with borderline per-
sonality disorder: an ERP study. J. Psychiatry Neuroscience 41 (1), 1626.
Hoermann, S., Clarkin, J.F., Hull, J.W., Levy, K.N., 2005. The construct of eortful
control: An approach to borderline personality disorder heterogeneity.
Psychopathology 38, 8286.
Jenness, J.L., Hankin, B.L., Young, J.F., Gibb, B.E., 2015. Misclassication and identi-
cation of emotional facial expressions in depressed youth: A preliminary study. J.
Clinical Child Adol. Psychology 44 (4), 559565.
LaBar, K.S., Crupain, M.J., Voyvodic, J.T., Mccarthy, G., 2003. Dynamic perception of
facial aect and identity in the human brain. Cereb. Cortex 13 (10), 10231033.
Levine, D., Marziali, E., Hood, J., 1997. Emotion processing in borderline personality
disorders. J. Nerv. Ment. Dis. 185 (4), 240246.
Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M., Bohus, M., 2004. Borderline per-
sonality disorder. Lancet 364 (9432), 453461.
Lowyck, B., Luyten, P., Vanwalleghem, D., Vermote, R., Mayes, L.C., Crowley, M.J., 2016.
What's in a face? Mentalizing in borderline personality disorder based on dynamically
changing facial expressions. Personal. Disord 7 (1), 7279.
Lynch, T.R., Rosenthal, M.Z., Kosson, D.S., Cheavens, J.S., Lejuez, C.W., Blair, R.J., 2006.
Heightened sensitivity to facial expressions of emotions in borderline personality
disorder. Emotion 6, 647655.
Matsumoto, D., Ekman, P., 1988. Japanese and Caucasian Facial Expressions of Emotion
(JACFEE). Intercultural and Emotion Research Laboratory. Department of
Psychology, San Francisco State University, San Francisco.
Merkl, A., Ammelburg, N., Aust, S., Roepke, S., Reinecker, H., Trahms, L., Sander, T.,
2010. Processing of visual stimuli in borderline personality disorder: a combined
behavioural and magnetoencephalographic study. Int. J. Psychophysiol. 78 (3),
257264.
Minzenberg, M.J., Poole, J.H., Vinogradov, S., 2006. Social emotion recognition in
354
Psychiatry Research 255 (2017) 347354
borderline personality disorder. Compr. Psychiatry 47, 468474.
Mitchell, A.E., Dickens, G.L., Picchioni, M.M., 2014. Facial emotion processing in bor-
derline personality disorder: a systematic review and meta-analysis. Neuropsychol.
Rev. 24 (2), 166184.
Phillips, L.H., Channon, S., Tunstall, M., Hedenstrom, A., Lyons, K., 2008. The role of
working memory in decoding emotions. Emotion 8 (2), 184191.
Piedmont, R.L., Sherman, M.F., Sherman, N.C., Williams, J.E.G., 2003. A First Look at the
Structured Clinical interview for DSM-IV Personality Disorders Screening
Questionnaire: More than Just a Screener. Measurement & Evaluation in
Counseling & Development 36 (3), 150160.
Posner, M.I., Rothbart, M.K., 2009. Toward a physical basis of attention and self-reg-
ulation. Phys. Life Rev. 6, 103120.
Preti, E., Richetin, J., Suttora, C., Pisani, A., 2016. Individual dierences in components of
impulsivity and eortful control moderate the relation between borderline person-
ality disorder traits and emotion recognition in a sample of university students.
Psychiatry Res. 238, 109115.
Robin, M., Pham-Scottez, A., Curt, F., Dugre-Le Bigre, C., Speranza, M., Sapinho, D.,
Kedia, G., 2012. Decreased sensitivity to facial emotions in adolescents with bor-
derline personality disorder. Psychiatry Res. 200 (2), 417421.
Rothbart, M.K., Ellis, L.K., Posner, M.I., 2011. Temperament and Self-Regulation. In: In:
Vohs, K.D., Baumeister, R.F. (Eds.), Handbook of Self-Regulation: Research, Theory,
and Applicationspp. 441460.
Rothbart, M.K., Bates, J.E., 1998. Temperament. Handbook of Child Psychology.
Wiley, NY.
Schulze, L., Domes, G., Koppen, D., Herpertz, S.C., 2013. Enhanced detection of emotional
facial expressions in borderline personality disorder. Psychopathology 46, 217224.
Tottenham, N., Tanaka, J.W., Leon, A.C., McCarry, T., Nurse, M., Hare, T.A., Nelson, C.,
2009. The NimStim set of facial expressions: judgments from untrained research
participants. Psychiatry Res. 168 (3), 242249.
Unoka, Z., Fogd, D., Fuzy, M., Csukly, G., 2011. Misreading the facial signs: specic
impairments and error patterns in recognition of facial emotions with negative va-
lence in borderline personality disorder. Psychiatry Res. 189, 419425.
Veague, H.B., Hooley, J.M., 2014. Enhanced sensitivity and response bias for male anger
in women with borderline personality disorder. Psychiatry Res. 215 (3), 687693.
Wagner, A.W., Linehan, M.M., 1999. Facial expression recognition ability among women
with borderline personality disorder: Implications for emotion regulation? J.
Personal. Dis. 13, 329344.
Weinstein, S.R., Meehan, K.B., Cain, N.M., Ripoll, L.H., Boussi, A.R., Papouchis, N., New,
A.S., Siever, L.J., 2016. Mental state identication, borderline pathology, and the
neglected role of childhood trauma. Personal. Disord. 7 (1), 6171.