Impaired decision making and feedback evaluation in borderline personality disorder

BackgroundIncreased impulsivity is considered to be a core characteristic of borderline personality disorder (BPD) and has been shown to play a significant role in decision making and planning. Neuropsychological studies in BPD revealed impairments of executive functions, and it is assumed that these deficits are related to altered feedback processing. However, research on executive functions in BPD is still limited and the underlying deficits remain an open question. The present study, therefore, explored whether decision-making deficits are related to altered feedback evaluation in BPD.MethodA total of 18 BPD patients and 18 matched healthy controls underwent a modified version of the Iowa Gambling Task while an electroencephalogram was recorded. Feedback processing was examined by measuring the feedback-related negativity (FRN) and the P300 as electrophysiological correlates of feedback evaluation.ResultsBehavioural results revealed that BPD patients, relative to controls, made more risky choices and did not improve their performance. With regard to the FRN, amplitudes in BPD patients did not discriminate between positive and negative feedback information. Further, BPD patients showed reduced FRN amplitudes, which were associated with enhanced impulsivity and enhanced risk taking. In contrast, the P300 amplitudes following negative feedback were increased in BPD patients, relative to controls.ConclusionsThis study indicates that BPD patients are impaired in decision making, which might be related to a dysfunctional use of feedback information. Specifically, BPD patients did not learn to avoid disadvantageous selections, even though they attended to negative consequences.

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Stuck in a negative me: fMRI study on the role of disturbed self-views in social feedback processing in borderline personality disorder

Psychological Medicine ◽

10.1017/s0033291719000448 ◽

2019 ◽

Vol 50 (4) ◽

pp. 625-635 ◽

Cited By ~ 2

Author(s):

Charlotte C. van Schie ◽

Chui-De Chiu ◽

Serge A. R. B. Rombouts ◽

Willem J. Heiser ◽

Bernet M. Elzinga

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Negative Feedback ◽

Positive Feedback ◽

Borderline Personality ◽

Positive Interactions ◽

Social Feedback ◽

Feedback Processing ◽

Temporoparietal Junction ◽

Fmri Study

AbstractBackgroundInterpersonal difficulties in borderline personality disorder (BPD) could be related to the disturbed self-views of BPD patients. This study investigates affective and neural responses to positive and negative social feedback (SF) of BPD patients compared with healthy (HC) and low self-esteem (LSE) controls and how this relates to individual self-views.MethodsBPD (N = 26), HC (N = 32), and LSE (N = 22) performed a SF task in a magnetic resonance imaging scanner. Participants received 15 negative, intermediate and positive evaluative feedback words putatively given by another participant and rated their mood and applicability of the words to the self.ResultsBPD had more negative self-views than HC and felt worse after negative feedback. Applicability of feedback was a less strong determinant of mood in BPD than HC. Increased precuneus activation was observed in HC to negative compared with positive feedback, whereas in BPD, this was similarly low for both valences. HC showed increased temporoparietal junction (TPJ) activation to positive v. negative feedback, while BPD showed more TPJ activation to negative feedback. The LSE group showed a different pattern of results suggesting that LSE cannot explain these findings in BPD.ConclusionsThe negative self-views that BPD have, may obstruct critically examining negative feedback, resulting in lower mood. Moreover, where HC focus on the positive feedback (based on TPJ activation), BPD seem to focus more on negative feedback, potentially maintaining negative self-views. Better balanced self-views may make BPD better equipped to deal with potential negative feedback and more open to positive interactions.

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Disadvantageous decision-making in borderline personality disorder: Partial support from a meta-analytic review

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2016.11.019 ◽

2017 ◽

Vol 72 ◽

pp. 301-309 ◽

Cited By ~ 20

Author(s):

Christian Paret ◽

Christine Jennen-Steinmetz ◽

Christian Schmahl

Keyword(s):

Decision Making ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Partial Support ◽

Analytic Review

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P02-244 - Evaluation of cognitive-executive functions in subjects with borderline personality disorder and childhood ADHD

European Psychiatry ◽

10.1016/s0924-9338(10)70870-1 ◽

2010 ◽

Vol 25 ◽

pp. 879

Author(s):

A.E. Di Rosa ◽

R. Cambria ◽

M.C. Crescenti ◽

M. Pata

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Executive Functions ◽

Borderline Personality ◽

Childhood Adhd

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Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder

Psychological Medicine ◽

10.1017/s0033291702006657 ◽

2002 ◽

Vol 32 (8) ◽

pp. 1395-1405 ◽

Cited By ~ 109

Author(s):

E. BAZANIS ◽

R. D. ROGERS ◽

J. H. DOWSON ◽

P. TAYLOR ◽

C. MEUX ◽

...

Keyword(s):

Decision Making ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Recognition Memory ◽

Frontal Lobe ◽

Visual Recognition ◽

Borderline Personality ◽

Neurocognitive Deficits ◽

Visual Recognition Memory ◽

History Of

Background. Repeated, self-damaging behaviour occurring in the context of borderline personality disorder (BPD) may reflect impairments in decision-making and planning cognition. However, there has been no systematic neuropsychological examination of these particular cognitive functions in patients diagnosed with BPD. Such investigations may improve our understanding of the possible role of brain dysfunction in BPD and improve the characterization of the psychological difficulties associated with this disorder.Method. Forty-two psychiatric patients with a diagnosis of DSM-III-R BPD (41 of whom gave a history of self-harm), without a history of specified ‘psychoses’ or current major affective disorder, were clinically assessed before completing computerized tasks of decision-making and planning previously shown to be sensitive to frontal lobe dysfunction, and tests of spatial and pattern visual recognition memory previously shown to be sensitive to frontal lobe damage and temporal lobe damage respectively. The performance of the BPD patient group was compared with that of a non-clinical control group consisting of 42 subjects.Results. The performance of the BPD patients on the decision-making task was characterized by a pattern of delayed and maladaptive choices when choosing between competing actions, and by impulsive, disinhibited responding when gambling on the outcome of their decisions. BPD patients also showed impairments on the planning task. There was no evidence of impaired visual recognition memory. Additional analyses suggested only limited effects of current medication and history of previous substance use disorder.Conclusions. These findings suggest that BPD is associated with complex impairments in dissociable cognitive processes mediated by circuitry encompassing the frontal lobes. These impairments may mediate some of the behavioural changes evident in BPD. Further work is needed to examine the specificity of these findings.

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Social feedback processing in borderline personality disorder

Psychological Medicine ◽

10.1017/s003329171500207x ◽

2015 ◽

Vol 46 (3) ◽

pp. 575-587 ◽

Cited By ~ 13

Author(s):

C. W. Korn ◽

L. La Rosée ◽

H. R. Heekeren ◽

S. Roepke

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Character Traits ◽

Healthy Controls ◽

Healthy Individuals ◽

Social Feedback ◽

Feedback Processing ◽

Relevant Feedback ◽

Self And Other

BackgroundPatients with borderline personality disorder (BPD) show negative and unstable self- and other-evaluations compared to healthy individuals. It is unclear, however, how they process self- and other-relevant social feedback. We have previously demonstrated a positive updating bias in healthy individuals: When receiving social feedback on character traits, healthy individuals integrate desirable more than undesirable feedback. Here, our aim was to test whether BPD patients exhibit a more negative pattern of social feedback processing.MethodWe employed a character trait task in which BPD patients interacted with four healthy participants in a real-life social interaction. Afterwards, all participants rated themselves and one other participant on 80 character traits before and after receiving feedback from their interaction partners. We compared how participants updated their ratings after receiving desirable and undesirable feedback. Our analyses included 22 BPD patients and 81 healthy controls.ResultsHealthy controls showed a positivity bias for self- and other-relevant feedback as previously demonstrated. Importantly, this pattern was altered in BPD patients: They integrated undesirable feedback for themselves to a greater degree than healthy controls did. Other-relevant feedback processing was unaltered in BPD patients.ConclusionsOur study demonstrates an alteration in self-relevant feedback processing in BPD patients that might contribute to unstable and negative self-evaluations.

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Validation of a French Translation of the McLean Screening Instrument for Borderline Personality Disorder, Invariance Across Genders, and Association With Depression, Trauma Symptoms, and Substance Use Among University Students

Journal of Personality Disorders ◽

10.1521/pedi_2020_34_494 ◽

2020 ◽

pp. 1-13

Author(s):

Yann Le Corff ◽

Alexa Martin-Storey ◽

Luc Touchette ◽

Mélanie Lapalme ◽

Karine Forget

Keyword(s):

Substance Use ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

University Students ◽

Meta Analysis ◽

Screening Instrument ◽

Borderline Personality ◽

French Translation ◽

Negative Consequences ◽

Trauma Symptoms

The present study investigated psychometric properties of a French translation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD; Zanarini et al., 2003) in a large sample of university students (N = 1,350). A confirmatory factor analysis supported the single-factor structure of the MSI-BPD, and its configural, metric and scalar invariance across gender was established. Internal consistency was high (tetrachoric α = .88; Ω = .88). MSI-BPD scores were significantly correlated to depressive symptoms (r = .57), trauma symptoms (r = .40), negative consequences of substance use (r = .25), and frequency of drug use (r = .11). Finally, 9.5% of the sample reached the clinical cutoff, which is similar to the pooled prevalence for BPD reported in a recent meta-analysis of university students. The present study showed that the French translation of the MSI-BPD is a psychometrically sound screening tool for BPD in both men and women.

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