The Rupture and Repair of Cooperation in Borderline Personality Disorder

Computational Psychiatry Unit and Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
Science (Impact Factor: 33.61). 09/2008; 321(5890):806-10. DOI: 10.1126/science.1156902
Source: PubMed


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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    • "This was interpreted as an unwillingness or inability to use 'coaxing' behaviours to repair or improve stressed or vulnerable relationships. This failure to use coaxing behaviour was associated with diminished BOLD amplitudes within the anterior cingulate cortex on receiving smaller than expected investments (King-Casas et al. 2008). Here, outcomes in which participants cooperated but their partners defected (DC) often elicited further cooperation as attempts to coax partners into cooperating again. "
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    ABSTRACT: Borderline personality disorder (BPD) and bipolar disorder (BD) have overlapping clinical presentations and symptoms - sources of persistent clinical confusion. Game-theory can characterize how social function might be sub-optimal in the two disorders and move the field beyond the anecdotal description of clinical history. Here, we tested the hypothesis that BPD and BD can be distinguished on the basis of diminished reciprocal altruism in iterated Prisoner's Dilemma (PD) games. Twenty females with BPD, 20 females with euthymic BD and 20 healthy (non-clinical) females, matched for age and cognitive ability, were assessed for Axis-I and personality disorders, and completed psychometric measures of state affect, impulsivity and hostility. Participants completed two iterated PD games and a test of gaze-cueing. In the PD games, BPD participants failed to show statistically stable preferences to cooperate with social partners (playing tit-for-tat) and made significantly fewer cooperative responses compared to BD or controls (ANOVA main effect p = 0.03, post-hoc Tukey p < 0.05 for both comparisons). BPD participants were also less likely to sustain cooperation following experiences involving mutual cooperation than the other groups. Neither BPD nor BD participants demonstrated impairments in shifting visual attention on the basis of other peoples' gaze. These data indicate that BPD is (selectively) associated with difficulties in establishing, and then maintaining, reciprocal cooperation, involving altruism. These difficulties are not seen in euthymic BD. Our data support the differentiation of BPD from BD and offer fresh insights into the social difficulties experienced by individuals with diagnoses of BPD.
    Psychological Medicine 02/2015; 45(08):1-10. DOI:10.1017/S0033291714002475 · 5.94 Impact Factor
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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 · 4.62 Impact Factor
    • "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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