Cognitive Impairment in Borderline Personality Disorder and Its

Formation

Jing Li

WLSA Shanghai Academy, Shanghai, China

Keywords: Psychology, Borderline Personality Disorder, Schema Theory.

Abstract: This paper examines the role of cognitive schemas in the development and manifestation of symptoms of

Borderline Personality Disorder (BPD), a complex mental health condition marked by emotional instability,

intense interpersonal relationships, fear of abandonment, and impulsive, self-destructive behaviours.

Cognitive schemas are internal frameworks that influence how people perceive and interpret external

information, and in individuals with BPD, these schemas are often distorted, particularly in relation to self-

other perceptions, leading to maladaptive emotional and behavioural responses. Early life experiences, such

as childhood trauma, contribute to the formation of these distorted schemas, which in turn reinforce feelings

of worthlessness, abandonment, and unstable self-identity. The study examines how these thought patterns,

which include cognitive biases like catastrophising and all-or-nothing thinking, contribute to the persistence

of BPD symptoms. Additionally, it highlights treatment modalities that can assist people with BPD in

identifying and reshaping their maladaptive cognitive schemas, such as Cognitive Behavioural Therapy

(CBT), Dialectical Behaviour Therapy (DBT), and Schema Therapy (ST). Despite the effectiveness of these

therapies, resolving the profoundly embedded cognitive processes that define BPD still presents difficulties.

1 INTRODUCTION

Borderline Personality Disorder (BPD) is a

complex mental condition featuring emotional

instability, intense interpersonal relationships,

fear of abandonment, and impulsivity and self-

destructive behaviors (Kegerreis, 2007). These

symptoms may be related to self-other mergence

of them (Story et al., 2024). Schema, which is

internal thinking systems that influence how

individuals interpret their perceptions, plays a

critical role in shaping these symptoms.

Cognitive behavioural therapy (CBT) has

demonstrated remarkable efficacy in treating

Borderline Personality Disorder (BPD). BPD

patients frequently experience emotional

instability, impulsive behaviours, poor self-

image, and interpersonal difficulties. CBT helps

patients recognise and change negative thought

patterns and behavioural responses, especially in

the areas of emotional regulation and self-

perception. CBT for BPD usually entails

emotion management, impulse control, and the

development of interpersonal skills. During

therapy, patients learn to recognise cognitive

distortions that cause emotional reactions and

adopt more realistic, positive thought patterns to

deal with stress and conflicts. Additionally, CBT

emphasises behaviour modification by

rewarding adaptive behaviours and decreasing

maladaptive behaviours, such as substance abuse

or self-harm, thus improving overall quality of

life. According to research, cognitive

behavioural therapy (CBT) can help with BPD

symptoms, especially with emotional control,

suicidal thoughts, and self-harming behaviours.

Compared to medicine alone, cognitive

behavioural therapy (CBT) typically produces

more lasting improvements and does not result

in reliance, even if treatment may take longer.

Additionally, it promotes increased self-

awareness and long-term self-management, both

of which are essential for BPD sufferers to

continue making improvement after therapy

ends.

Li, J.

Cognitive Impairment in Borderline Personality Disorder and Its Formation.

DOI: 10.5220/0014109800004942

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 2nd International Conference on Applied Psychology and Marketing Management (APMM 2025), pages 159-165

ISBN: 978-989-758-791-7

159

Since certain schemas developed to adapt to

early-life experiences, by studying how these

cognitive schemas manifest in these negative

symptoms, this essay will discuss the critical role

of schemas in understanding and addressing

BPD symptoms.

2 UNDERSTANDING

BORDERLINE PERSONALITY

DISORDER

Borderline Personality Disorder is a mental

health condition characterized by cognition

disability and compulsory behavioral patterns of

emotional instability, intense interpersonal

relationships, impulsivity, and fear of

abandonment. It is a complex personality

disorder that can lead to malfunction on

cognitive schemas, and thus causes distorted

emotion experience for the patients and

borderline interpersonal dynamics.

2.1 Emotional Instability

To begin with, one of the most significant

features of BPD is emotional instability.

Emotional instability includes extreme emotions

and rapid mood swings, which range from deep

feelings of sadness or hopelessness to irritability

or anxiety. These moods are often in response to

perceived illusional interpersonal threats or

rejection, like the sense of abandonment. For

instance, a person with BPD might feel an

intense and overwhelming sense of fear for being

deserted, even though the stimuli may just be a

simple different feeling of others. The person

with BPD may interpret the disagreements

between people as a hint that forecasts the

coming debasement or critics from others.

Despite that this person may not specifically be

someone that really matters to the person with

BPD, he may still represent it as a rejection made

by the group, alienating the individual from

being socially connected, leading to rapid shifts

in mood and behavior. Moreover, the self-other

mergence also exists in BPD symptoms. The

fusion of self and other further weakens the ego

and makes it unable to handle frustration and

worry. Because the person with BPD is torn

between the extremes of a panicked infantile

neediness and a fear of being stuck, this adds to

their pattern of unstable and insecure attachment

(Kegerreis, 2007). The cognitive malfunction

which leads to uncontrollable intense mood is

central to the experience of BPD, making it

difficult for individuals to maintain emotional

balance in their daily life.

2.2 Intense Interpersonal Relationships

Another typical symptom of BPD is intense

interpersonal relationships. Since person

diagnosed with BPD may show a fusion of self

and other representations, as they perceive

other’s expectation as a learning signal, they

may show high dependence on building

relationships with others which provide them

with a sense of security (Story et al., 2024).

What’s more, a significant interaction of the

behavior pattern is observed between BPD

symptoms and people without BPD around

them, which indicates that this fusion may lead

to obscure self-value and adjusting to others’

value (Story et al., 2024). In this case, they tend

to oscillate between idealizing people to reduce

cognitive dissonance when they try to socialize

at the cost of adjusting to others values and then

quickly devaluing them when feelings of

abandonment or betrayal arise, which provide

them a rationalization that the disagreement is

caused by the other, indicating that they

themselves are not excluded by social groups.

This pattern, often referred to as “splitting,”

reflects a black-and-white thinking style. Since

BPD criteria includes identity diffusion, this lack

of a stable self-identity can contribute to these

fluctuations, as people with BPD often rely

heavily on others to define personal image and

values (Clarkin and Kernberg, 1992). In

addition, since it is observed that BPD symptoms

include a impairment in recognizing other’s

facial expression as well as certain level of

difficulty in identifying their own emotions,

which would lead to misinterpretations in

socializing, this provide individuals with BPD a

suitable state to assume the extreme outcome of

being abandoned, as they fail to sense the signals

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but only can guess and rationalize (Domes et al.,

2011).

2.3 Positioning

Additionally, the fear of abandonment is also

highly related to the obvious fluctuations and

mood disorders of BPD. As what has mentioned

before, the fear for being abandonment may be a

result of self-other mergence that individuals

with BPD may not be able to build up their own

self-identity but recognize it through others’

judgments, resulting in a sense of cognitive

dissonance, which refers to a discomfort that

results from having opposing ideas at the same

time, and it typically causes people to devalue

contradicting information (Sato et al., 2024;

Masataka and Perlovsky, 2012). Unresolved

cognitive dissonances may hinder the progress

of cognition because every thought connotes

some degree of contradiction to other

information. The cognitive dissonance is caused

by the perceived critics and previously relied

positive judgments from the others. This fear

leads to several reactions, such as excessive

clinging behaviors or pushing others away to

avoid the corrupt of self-identity when

individuals with BPD have already sensed a

negative judgement to them. The fear of being

deserted or excluded can lead to behaviors that

contradictorily deeply attach to people while

also keeping distance from them, making the

interpersonal relationship turbulent.

2.4 Positioning

Finally, impulsivity and self-destructive

behaviors are common among individuals

diagnosed with BPD. Since chemicals such as

Orbitofrontal Cortex(OFC) and Dorsolateral

Prefrontal Cortex (DLPFC) plays a role in the

pathophysiology of suicidality in mood disorders

by suggesting that suicidal behavior is linked to

personality factors and the activation of OFC and

DLPFC to negative emotional cognitive inputs,

showing that both personality traits and emotion

is related to self-destructive behaviors

(Kamimura et al., 2012). These behaviors may

often occur in response to overwhelming

emotions in order to alleviate feelings of

emptiness or regain control in situations where

they feel emotionally out of control. These

behaviors are believed to be efficient from the

perspective of individuals with BPD as they

provide a sense of relief that cannot be easily

found in other responses. However, due to the

negative effect of these self-destructive

behaviors on relationship, it is also believed that

these behaviors are also used as methods to

condition others, being harmful to people who

has close relationship with BPD-diagnosed

individuals.

3 SCHEMAS AND THEIR ROLE

IN PERSONALITY DISORDERS

3.1 Definition

Schemas are cognitive frameworks or concepts

that influence how individuals perceive and

interpret external information. While schema of

normal person shared basic commons on

perceiving others’ mood, attitude, and intentions

when socializing, individuals with BPD may not

interpret this information in the same way as

them. The high dependence on others evaluation

makes individual with BPD more sensitive to the

difference between people’s ideas than to the

overall reasoning. These schemas may develop

through repeated intense interactions with the

environment, particularly during childhood. This

may be because the neuroanatomical changes are

influenced by environmental factors in diagnosis

pf BPD, including trauma experiences, such as

parental loss, neglect, abuse, or reject

(Economou and Chafos, 2014). Additionally, as

numerous aspects of forgiveness of individuals

with BPD are significantly lower than in

individuals without this symptomatology, which

indicates the level of forgiveness is related to

BPD symptoms, childhood trauma is a critical

factor that can lead to the low level of

forgiveness as they may receive low level of

forgiveness during their childhood or may feel

too hard to forgive events happened in their

childhood and thus expand this behavior to other

aspects (Sansone et al., 2013). Conditioning may

exist in shaping these schemas that these people

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may be punished for building up independent

ideas or holding different points of view from the

groups. While schemas can be adaptive,

benefiting the efficiency of personal

interpretation of the world, they can also become

maladaptive and contribute to psychological

disorders when they become rigid and distorted.

3.2 Cognitive Schemas’ Role in BPD

Symptoms

Generally, schema has its significance for people

since it allows people to take shortcuts in

interpreting the vast amount of information. This

is because by using a schema, people can process

information through several fixed ways.

Moreover, since schema provides a fixed way to

help understanding the role of oneself and the

relationship between one and the environment,

cognitive schemas play a critical role in shaping

how individuals perceive themselves, others, and

the world around them. For individuals with

BPD, their schemas are distorted, particularly in

recognizing their relationship with others in the

environment. Negative beliefs, including the

sense of unworthy of love and sense of being

deserted, form the foundation of these distorted

perceptions and can lead to maladaptive

emotional and extreme behavioral responses,

since they act as filters through which people

process information. When these filters are

distorted, they lead to problematic perception

that put a person in a horrifying situation

although others in the same environment

probably will not sense it. According to

functional schema theory, schema is dynamic,

ongoing and continuously evolving (Iran-Nejad

and Winsler, 2000). This characteristic of

schema may also reinforce itself. For instance,

the distorted schema led to fear of abandonment,

while fear of abandonment may cause a

depressive social environment which drives

people away. As the schema responds to the

environmental changes, the belief of being

abandoned of the schema would be reinforced.

To be more specific, a person with BPD may

believe in a helpless situation where he is placed

into an environment that he deserves no

assistance and is also no able to do anything with

his own effort. In this case, he interprets every

socialization as a rare opportunity to solve the

predicted problems other than nothing. This

leads to the constant extreme emotions of them

despite the environment, making changes in

environment not effective unless the internal

cognitive model has changed.

To be more specific, a person with BPD may

believe in a helpless situation where he is placed

into an environment that he deserves no

assistance and is also no able to do anything with

his own effort. In this case, he interprets every

socialization as a rare opportunity to solve the

predicted problems other than nothing. This

leads to the constant extreme emotions of them

despite the environment, making changes in

environment not effective unless the internal

cognitive model has changed.

4 THE FORMATION OF

COGNITIVE SCHEMAS IN BPD

4.1 Early Life Experiences

There are quite a lot of factors that can influence

the development of schema, including

environment, events, and neuron development.

While neuron development is highly related to

neuron plasticity which help to rebuild neuron

pathways and adjust to the environment, it is

reasonable to conclude that the environment and

experiences lead to the adjustment occurred in

neuron pathways and thus contribute to the

development of schema. Focusing on

experiences lead to distortion in schema, tracing

back to early life is necessary to find the

causation relationship between events and the

outcoming distortion. Childhood trauma is an

essential type of these experiences. For instance,

parents who have a neglective parenting style

may have low expectations and provide low

levels of assistance to a child. This may lead the

child to self-identify as a person who is worth

little due to his limited ability, which is the idea

conveyed by the attitude of his parents. In

addition, children in this circumstance are easily

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exposed to events where they are not able to

improve anything with their own effort, leaving

them a necessity to rely on others. In this case,

as schema is gaining others’ appreciation

becomes a survival strategy instead of a mental

pursuit, causing them to feel an extreme sense of

helplessness when these supports are absent,

shaping the schema , since in functional schema

theory, mental functioning is believed to be

caused by ongoing awareness, as nervous system

continuously update the peripheral and focal

awareness, forming a organized self-model

which is referred to the term “schema” (Iran-

Nejad and Winsler, 2000).

These maladaptive schemas are reinforced

over time through continued negative

experiences in relationships. While individuals

with BPD struggle to maintain stable

interpersonal connections, their schemas of

reliance on others and worthlessness are

continually activated and reinforced since they

consider normal reactions in communication as

hints of being abandoned. Since disagreement

widens the distance with others, the absence of

attachment between them means that they are

less likely to gain assistance. These assistances

122 are believed not to occur among normal

social relationships. With this leading to the

helplessness, which is also a result of the

distortion in schema. These distorted schemas

thus become self-perpetuating, as individuals

with BPD interpret events through the lens of

their deep-rooted cognitive patterns.

4.2 Development of Certain Schemas in

BPD

In addition to childhood experiences, cognitive

biases also play a significant role in the

formation and reinforcement of schemas in BPD.

For instance, all-or-nothing thinking, which

refers to the belief that a person is either

completely good or completely bad. Although

this belief may have its benefits like helping the

person with BPD to avoid every people that are

believed to potentially be threatening to himself,

this belief divides the majority in an environment

into a completely bad category, leaving the

person with BPD himself in a lonely situation,

which reinforce the sense of being deserted.

Moreover, emotional reasoning is also a

critical factor. Since to some extent, people with

BPD may be able to sense internal natural

reaction to the happening events as normal

people but fail to interpret the underlying

meaning of their sense, they usually repress it

until they cannot keep ignoring it. This leads to

a situation where they express these senses just

to make them feel more self-consistent, instead

of coping with it, leaving the events themselves

unsolved, making the overall situation worse.

What’s more, if they feel abandoned, they may

assume that abandonment is truly happening

which contemporarily makes them feel better

since it proves the validity of their judgement,

however, placing them to a nonexistent situation

which thus has no solution, reinforcing their

belief in their weakness. This leads to impulsive

actions to prevent abandonment, reinforcing the

maladaptive cycles of behavior and further

entrenching negative cognitive schemas.

4.3 Cognitive Biases in BPD

Catastrophizing is another cognitive bias, which

involves anticipating the worst possible outcome

in any given situation, no matter how unlikely it

may be. This may be resulted from the frequency

of being placed into trouble in their previous

experience that they have to prevent any

possibility that they may get into them again.

However, as preventing catastrophic events has

its costs, including efforts and materials, and

even the peaceful mood since catastrophic

events are something worth being anxious about.

In this case, in physical aspect, person with BPD

may continuously stay in a situation lack of

things as they devote them into a nonexistent

problem, while in mental aspect, they are

constantly being anxious and has less chance to

realize its invalidity due to the self-fulfilling

prophecy, leading the cognitive schema to be

reinforced as the predictions are correct

compared to the consequences.

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5 THE FORMATION OF

COGNITIVE SCHEMAS IN BPD

Since cognitive schemas play a critical role in the

BPD symptoms, featuring in deep-rooted belief

systems that shape the way individuals perceive

themselves and the environment around them.

These maladaptive schemas distort thinking and

behavior, leading to the symptoms of BPD,

including fear of abandonment, unstable self-

image, and impulsive, self-destructive behaviors.

5.1 Fear of Abandonment

One critical symptom of BPD is fear of

abandonment. This symptom may be caused by

beliefs that the individual with BPD himself is

dependent on help provided by others and that it

would be safe only when the individual is deeply

connected with a group. However, individuals

with BPD also hold a pervasive belief that

relationships are unstable and will inevitably end

which are hinted by previous disagreements and

conflicts that are usually considered as normal

and inevitable in relationships of individuals

without BPD. What’s more, one of relevant

symptoms is an intense fear of being rejected,

which may lead to social exclusion and is one of

their social cognitive impairments (Sato et al.,

2018). In this case, since individuals without

BPD may not try to avoid disagreements, these

disagreements may strengthen the prediction of

being abandonment of individuals with BPD,

leading to constant sense of fear. Moreover, the

sense of fear is also related to their self-cognition

including unworthy, unlovable, and inadequate,

with which the individual deserves to be

abandoned. Their self-cognition is highly tied to

external comments and criticisms, for instance,

from parents, teachers, and peers. This may be

related to the self-other mergence of BPD that

their cognition may easily be confused with

others. In this case, faced with perceived signs of

rejection—no matter how minor or

unintentional—this schema not only triggers

intense emotional distress and desperate

attempts to prevent abandonment, such as

clinging behaviors or outbursts, but also

strengthen the negative evaluation of the

individual or confuse his previous self-cognition

with contradictory comments, leading to the

negative beliefs of themselves and causing the

fear of being abandoned. These beliefs can also

paradoxically strain relationships, reinforcing

the individual’s belief that they are destined to

be abandoned.

5.2 Unstable Self-Image

Unstable self-image complicates BPD

symptoms as well. Since individuals with BPD

do not have or be highly unconfident with their

personal perceptions, they have self-other

mergence that leads them to build their

perception of themselves and the environments

on other’ s behavior or claims. Since people’s

criticisms on a single item varies from different

dimensions and is influenced by their previous

beliefs, cognition-level, culture background, and

many other factors, the individual with BPD can

receive contradictory perceptions or variable

negative criticisms. The former ones reinforce

their lack of confidence in personal judgement as

they fail to do so when believing in all

contradicting claims, while the latter ones build

up their negative self-evaluation since they are

corresponding to their experiences. With the

self-other mergence, these two factors contribute

to the unstable image of individual with BPD.

5.3 Impulsivity and Self-Destructive

Behaviors

Finally, impulsivity and self-destructive

behaviors are caused by the temptation of

individuals with BPD to solve problems when

they experience frustration. These impulsive

behaviors serve as coping methods to escape

from overwhelming emotions or to prove

distorted beliefs which causes cognitive

dissonance. In this case, doing impulsivity

behavior is temporarily beneficial for emotions

of them as these harmful behaviors corresponded

to their negative cognition, reducing certain level

of cognitive dissonance, and distract them from

self-criticizing during the overwhelming

emotions.

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6 CONCLUSION

BPD’s certain syndromes including fear of

abandonment, unstable self-image, and

impulsivity may be resulted from early life

experiences including childhood trauma or latter

huge events that undergoing a deep doubt on

themselves. These events contribute to the

syndromes of BPD through affecting the

schemas of their way to interpretation. As

schema is a concept of the cognitive framework

that affect how people percept and interpret the

received messages from external environment,

distortion of schema may lead to unique focus on

certain information while ignoring other main

points and thus cause the syndromes. Schema

may be affected by childhood trauma by

providing unrelated negative feedback on

random behaviors, leading to abnormal level of

need for attachment and afraid of failure in

interpersonal socialization. While cognitive bias

in schema contribute to the syndrome through

the all-or-nothing thinking, as this way of

thinking leaves individuals with BPD in a lonely

situation that reinforce the sense of being

abandoned. Catastrophizing in schema lead to

self-fulfillment prophecy of the predicted

negative outcome by putting the individual

consistently in an anxious or disappointed mood.

The formations of these schema is also discussed.

While the afraid of being abandoned may be

resulted from the belief that connection with the

group brings safety, the unstable self-image may

be resulted from the self-other mergence, and the

impulsivity and self-destructive behavior be

resulted from the temptation to solve cognitive

dissonance caused by the contradictory belief

and the facts. However, since the discussion is

mainly based on the interpretation on previous

findings and reasoning, the lack of experiments

supported data may result in an incomplete

explanation of each cases. It may be reasonable

to believe that believing in an ambiguous self-

image or build their image based on others’

reaction has a temporary benefit that make

patient feel necessary to do that, and leave a

cognitive schema that strengthens certain

negative schema and then become a long-term

cognitive schema. Several cognitive therapies

are effective, including CBT, DBT, Schema

Therapy, but there are still challenges. As

cognition can be spread, leaving personality

disorders.

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