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King-Casas, B. et al. The rupture and repair of cooperation in borderline personality disorder. Science 321, 806-810

Computational Psychiatry Unit and Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
Science (Impact Factor: 31.48). 09/2008; 321(5890):806-10. DOI: 10.1126/science.1156902
Source: PubMed

ABSTRACT To sustain or repair cooperation during a social exchange, adaptive creatures must understand social gestures and the consequences when shared expectations about fair exchange are violated by accident or intent. We recruited 55 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game with healthy partners. Behaviorally, individuals with BPD showed a profound incapacity to maintain cooperation, and were impaired in their ability to repair broken cooperation on the basis of a quantitative measure of coaxing. Neurally, activity in the anterior insula, a region known to respond to norm violations across affective, interoceptive, economic, and social dimensions, strongly differentiated healthy participants from individuals with BPD. Healthy subjects showed a strong linear relation between anterior insula response and both magnitude of monetary offer received from their partner (input) and the amount of money repaid to their partner (output). In stark contrast, activity in the anterior insula of BPD participants was related only to the magnitude of repayment sent back to their partner (output), not to the magnitude of offers received (input). These neural and behavioral data suggest that norms used in perception of social gestures are pathologically perturbed or missing altogether among individuals with BPD. This game-theoretic approach to psychopathology may open doors to new ways of characterizing and studying a range of mental illnesses.

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Available from: Carla Sharp, Jan 21, 2014
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    • "Here, for concreteness, we consider the multi round trust task, which is a social exchange game that has been used with hundreds of pairs (dyads) of subjects, including both normal and clinical populations [14] [15] [16] [17] [18]. This game has been used to show that characteristics that only arise in multi-round interactions such as defection (agent A increases their cooperation between two rounds; agent B responds by decreasing theirs) have observable neural consequences that can be measured using functional magnetic resonance imaging (fMRI) [19] [14] [20] [21] [22]. "
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    ABSTRACT: Reciprocating interactions represent a central feature of all human exchanges. They have been the target of various recent experiments, with healthy participants and psychiatric populations engaging as dyads in multi-round exchanges such as a repeated trust task. Behaviour in such exchanges involves complexities related to each agent's preference for equity with their partner, beliefs about the partner's appetite for equity, beliefs about the partner's model of their partner, and so on. Agents may also plan different numbers of steps into the future. Providing a computationally precise account of the behaviour is an essential step towards understanding what underlies choices. A natural framework for this is that of an interactive partially observable Markov decision process (IPOMDP). However, the various complexities make IPOMDPs inordinately computationally challenging. Here, we show how to approximate the solution for the multi-round trust task using a variant of the Monte-Carlo tree search algorithm. We demonstrate that the algorithm is efficient and effective, and therefore can be used to invert observations of behavioural choices. We use generated behaviour to elucidate the richness and sophistication of interactive inference.
    PLoS Computational Biology 02/2015; 11(6). DOI:10.1371/journal.pcbi.1004254 · 4.83 Impact Factor
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    • "Taken together, the negative emotional state observed in CD after social exclusion (Cyberball) and the accompanying reduction in OT levels compared to HC extends previous findings in BPD patients (Jobst et al., 2014; King-Casas et al., 2008; Renneberg et al., 2012). To our knowledge, no other studies have examined this issue with a social exclusion challenge in clinical CD populations . "
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    ABSTRACT: Objective: Patients with chronic depression (CD) experience a high burden of disease, severe comorbidity, and increased mortality. Although interpersonal dysfunction is a hallmark of CD, the underlying mechanisms are largely unexplored. Oxytocin (OT) has been proposed to play a crucial role in the social deficits of mental disorders and has been found to be dysregulated after social exclusion (ostracism) in patients with borderline personality disorder. This study investigated how social exclusion affects emotions, OT levels, and cortisol (CT) levels in CD patients. Method: Twenty-one patients diagnosed with CD and 21 healthy controls (HC) matched for gender, age, and education underwent repeated neuroendocrine measurements in a standardized laboratory setting while playing Cyberball, a virtual ball-tossing game that mimics a social exclusion situation. Emotional reactions, plasma OT and cortisol levels were assessed at baseline and 5, 15, and 40 min after Cyberball. Results: At baseline, there were no group differences in OT levels. Immediately after playing Cyberball, plasma OT levels showed divergent changes in CD patients and HC; the difference in direction of change was significant with a reduction in CD patients compared to HC (p = .035*); CT levels did not differ between groups at any time point, but decreased over time. Patients showed more threatened emotional needs and increased negative emotions, especially anger and resentment, and showed higher sensitivity to ambiguous threat of social exclusion than healthy controls. Conclusions: CD patients react to ostracism with pronounced negative emotions. The reduction in OT levels in CD patients after social exclusion may contribute to their interpersonal dysfunction and their difficulty in coping adequately with aversive social cues.
    Journal of Psychiatric Research 11/2014; 60. DOI:10.1016/j.jpsychires.2014.11.001 · 4.09 Impact Factor
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    • "In particular, this sample space should be extended by investigating similarities and differences due to a variety of factors such as personality traits (Gallagher, 2000; Morin, 2009), perception of proposer's intention (Houser and Xiao, 2010), age (Bailey et al., 2013), and culture (Henrich et al., 2001). Levels of perceived fairness are known to change in certain psychiatric illnesses, such as bipolar disorder and personality disorders (Baez et al., 2013; King-Casas et al., 2008). This study with fairness related games and neuroimaging probes could provide some basis for future studies of cognitive functions and dysfunctions useful for the diagnosis and understanding of mental disorders. "
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    ABSTRACT: Human decision-making in situations of inequity has long been regarded as a competition between the sense of fairness and self-interest, primarily based on behavioral and neuroimaging studies of inequity that disfavor the actor while favoring others. Here, we use functional magnetic resonance imaging experiments to study refusals and protests using both favoring and disfavoring inequity in three economic exchange games with undercompensating, nearly equal, and overcompensating offers. Refusals of undercompensating offers recruited a heightened activity in the right dorsolateral prefrontal cortex (dlPFC). Accepting of overcompensating offers recruited significantly higher node activity in, and network activity among, the caudate, the cingulate cortex, and the thalamus. Protesting of undercompensating fixed offers activated the network consisting of the right dlPFC and the left ventrolateral prefrontal cortex and midbrain in the substantia nigra. These findings suggest that perceived fairness and social decisions are the results of coordination between evaluated fairness norms, self-interest and reward.
    08/2014; 4(8):619-630. DOI:10.1089/brain.2014.0243
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