Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy

Background: In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text message interface. Methods: : The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in a text message interface. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework. Results: : Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. While HC showed a negativity bias on an implicit level, BPD perceived praising remarks less praising when explicitly asked, but no difference on critical remarks. Neither empathy, nor schizotypy explained any outcomes. Conclusions: : This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased and more neutral in implicit measurements of perceived intention, they perceived praising remarks as less positive on explicit measurements. Results stress the potential resource of non-verbal therapies to establish an appreciating therapeutical environment and contribute to difficulties in self-other distinction in BPD.