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.

    • "Another line of research used multi-player economic games to investigate how trust develops over multiple economic transactions (King- Casas et al. 2008; Unoka et al. 2009; Franzen et al. 2011). Initially, BPD patients reciprocate as much trust as healthy controls, but they fail to repair breaches of trust (King-Casas et al. 2008). Thus, some evidence from the laboratory supports deficient social interactions in BPD but these results remain largely silent on how altered information processing could be related to the integration of social feedback and its subsequent effects on negative self-and other-evaluations. "
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    ABSTRACT: Background: Patients 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. Method: We 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. Results: Healthy 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. Conclusions: Our study demonstrates an alteration in self-relevant feedback processing in BPD patients that might contribute to unstable and negative self-evaluations.
    No preview · Article · Oct 2015 · Psychological Medicine
    • "For instance, depression risk is associated with signatures of increased neural threat signals (Roiser, Elliott, & Sahakian, 2012) even in the absence of any overt behavior or conscious perception. Equally, work using trust games has shown that patients with borderline personality disorder are unable to perceive and correctly interpret social approaches after a bond of trust has been partially broken (King-Casas et al., 2008). "
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    ABSTRACT: Psychiatric disorders profoundly impair many aspects of decision making. Poor choices have negative consequences in the moment and make it very hard to navigate complex social environments. Computational neuroscience provides normative, neurobiologically informed descriptions of the components of decision making that serve as a platform for a principled exploration of dysfunctions. Here, we identify and discuss three classes of failure modes arising in these formalisms. They stem from abnormalities in the framing of problems or tasks, from the mechanisms of cognition used to solve the tasks, or from the historical data available from the environment.
    No preview · Article · May 2015
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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.
    Full-text · Article · Feb 2015 · Psychological Medicine
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