Abstract
Non-suicidal self-injury (NSSI) is a symptom of borderline personality disorder (BPD). However, NSSI often occurs independently of BPD. Altered neural processing of social exclusion has been shown in adolescents with NSSI and adults with BPD with additional alterations during social inclusion in BPD patients. Aims of this study were to investigate differences in neural processing of social inclusion and exclusion situations between adolescents with NSSI and young adults with BPD and NSSI. Using fMRI, neural processing of positive and negative social situations (paradigm: "Cyberball") was explored. Participants were 14 adolescents with NSSI, but without BPD (Mage = 15.4; SD = 1.9), 15 adults with BPD and NSSI (Mage = 23.3; SD = 4.1), as well as 15 healthy adolescents (Mage = 14.5; SD = 1.7), and 16 healthy adults (Mage = 23.2; SD = 4.4). Behavioral results showed enhanced feelings of social exclusion in both patient groups as compared to healthy controls but only the NSSI group showed enhanced activation during social exclusion versus inclusion compared to the other groups. While both NSSI and BPD groups showed enhanced activation in the ventral anterior cingulate cortex during social exclusion as compared to their age-matched controls, enhanced activation during social inclusion as compared to a passive watching condition was mainly observed in the BPD group in the dorsolateral and dorsomedial prefrontal cortex, and the anterior insula. While neural processing of social exclusion was pronounced in adolescents with NSSI, BPD patients also showed increased activity in a per se positive social situation. These results might point toward a higher responsiveness to social exclusion in adolescents with NSSI, which might then develop into a generalized increased sensitivity to all kinds of social situations in adults with BPD.
Highlights
Non-suicidal self-injury (NSSI), defined as the intentional and direct damage of body tissue without suicidal intent, is described as a prominent and maybe the most noticeable symptom of borderline personality disorder (BPD) lifetime prevalence rates of BPD range around 2.7% in the general population [1], while around 18% of adolescents report to have engaged in NSSI at least once, and repetitive NSSI is seen in around 4 and 7% of adolescents [2, 3]
Adults with BPD scored significantly higher than adolescents with NSSI (p < 0.05, T = 2.76), while there were no differences between healthy adults and healthy adolescents (p > 0.05, T = 0.91)
This study is the first to compare adolescents with ongoing NSSI without BPD diagnosis against young adults with ongoing NSSI and BPD diagnosis regarding their neural processing of social situations experimentally operationalized by the Cyberball paradigm during fMRI. While both patient groups showed significantly higher ratings on the HFS relative to their agematched healthy control groups as an index of greater general sensitivity for social exclusion, task-specific ratings of distress experienced from the social exclusion condition of the Cyberball paradigm were significantly higher only in BPD patients relative to controls, but not in NSSI patients
Summary
Non-suicidal self-injury (NSSI), defined as the intentional and direct damage of body tissue without suicidal intent, is described as a prominent and maybe the most noticeable symptom of borderline personality disorder (BPD) lifetime prevalence rates of BPD range around 2.7% in the general population [1], while around 18% of adolescents report to have engaged in NSSI at least once, and repetitive NSSI is seen in around 4 and 7% of adolescents [2, 3]. Accord ing to the DSM-5, BPD is characterized by impairments of interpersonal functioning, which can be associated to “interpersonal hypersensitivity (i.e., prone to feel slighted or insulted)” and “perceptions of others selectively biased toward negative attributes or vulnerabilities” [4]. Adults with BPD have repeatedly shown an increased sensitivity for social exclusion in comparison to healthy controls [5, 6]. NSSI has been linked with impaired social interactions. Bullying has been shown to be a risk factor in longitudinal studies [7, 8] and patients with NSSI show elevated feelings of loneliness, even in comparison to clinical controls [9]. While BPD and NSSI do not match well in prevalence rates, sensitivity to social exclusion may play a role in both syndromes
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