Abstract
Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.
Highlights
Borderline Personality Disorder (BPD) is characterized by maladaptive decision-making tendencies, such as unstable relationships, self-harm behaviors, and substance use
Probability of Reward Borderline personality disorder and control participants were comparable on overall probability of reward [p(rew); Figure 2A, Table 3, p > 0.05] which was significantly lower than 0.50 in both BPD (M = 0.47, SE = 0.006; t = –3.76, p < 0.001) and control participants (M = 0.47, SE = 0.005; t = –4.74, p < 0.001), and did not differ between groups (β = 0.05, t = 0.17, p = 0.86, pBonferroni = 1.00)
We found that increased emotional dysregulation and increased impulsivity in BPD may facilitate decreased choice biases in this competitive context, future studies are required to further ascertain whether this is a deliberate process/strategy or a reflection of increased psychopathology more generally (Mukherjee and Kable, 2014)
Summary
Borderline Personality Disorder (BPD) is characterized by maladaptive decision-making tendencies, such as unstable relationships, self-harm behaviors, and substance use (for review, see Soloff et al, 2000; Dougherty et al, 2004; Rosval et al, 2006; Sebastian et al, 2014). An increased propensity for impulsivity and risk-taking behaviors in adolescents with BPD can lead to adverse health outcomes (i.e., suicide and substance use; Kaess et al, 2014), and individuals diagnosed with BPD early in development may have more severe disease burden and poorer prognosis (Chanen et al, 2007; Kaess et al, 2014) Despite these findings, the majority of experimental studies concerning decision-making in BPD have been conducted in adults [a recent meta-analysis reported mean age of 27–30 years (Jeung et al, 2016; but see Tay et al, 2017)], we know very little regarding the developmental pathways to dysfunctional decisionmaking in BPD (Kaess et al, 2014). We focus on an adolescent cohort of BPD patients, with the aim of exploring how individual differences in impulsivity (that may be beyond the normative increases observed during adolescence) confer risk for maladaptive decision-making tendences in BPD
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