Impaired decision making and feedback evaluation in borderline personality disorder

Background Increased impulsivity is considered to be a core characteristic of borderline personality disorder (BPD) and has been shown to play a significant role in decision making and planning. Neuropsychological studies in BPD revealed impairments of executive functions, and it is assumed that these deficits are related to altered feedback processing. However, research on executive functions in BPD is still limited and the underlying deficits remain an open question. The present study, therefore, explored whether decision-making deficits are related to altered feedback evaluation in BPD. Method A total of 18 BPD patients and 18 matched healthy controls underwent a modified version of the Iowa Gambling Task while an electroencephalogram was recorded. Feedback processing was examined by measuring the feedback-related negativity (FRN) and the P300 as electrophysiological correlates of feedback evaluation. Results Behavioural results revealed that BPD patients, relative to controls, made more risky choices and did not improve their performance. With regard to the FRN, amplitudes in BPD patients did not discriminate between positive and negative feedback information. Further, BPD patients showed reduced FRN amplitudes, which were associated with enhanced impulsivity and enhanced risk taking. In contrast, the P300 amplitudes following negative feedback were increased in BPD patients, relative to controls. Conclusions This study indicates that BPD patients are impaired in decision making, which might be related to a dysfunctional use of feedback information. Specifically, BPD patients did not learn to avoid disadvantageous selections, even though they attended to negative consequences.

[1]  M. Lenzenweger,et al.  Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. , 2004, Journal of personality disorders.

[2]  Joshua W. Brown,et al.  Risk prediction and aversion by anterior cingulate cortex , 2007, Cognitive, affective & behavioral neuroscience.

[3]  J. Hennen,et al.  Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. , 2004, The American journal of psychiatry.

[4]  J. Newman,et al.  Specifying the impulsivity of female inmates with borderline personality disorder. , 2002, Journal of abnormal psychology.

[5]  R. O. Friedel.  Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis , 2004, Neuropsychopharmacology.

[6]  Steven W Anderson,et al.  Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers , 2001, Neuropsychologia.

[7]  Derek W. Johnston,et al.  The relationship between cardiovascular responses in the laboratory and in the field. , 1990, Psychophysiology.

[8]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[9]  J. Bobes,et al.  Brain glucose metabolism in borderline personality disorder. , 1997, Journal of psychiatric research.

[10]  T. Robbins,et al.  Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder , 2002, Psychological Medicine.

[11]  A. Chapman,et al.  Impulsivity and emotion dysregulation in Borderline Personality Disorder. , 2008, Journal of personality disorders.

[12]  T. Dalgleish,et al.  Neuropsychological processing associated with recovery from depression after stereotactic subcaudate tractotomy. , 2004, The American journal of psychiatry.

[13]  A. Damasio,et al.  Insensitivity to future consequences following damage to human prefrontal cortex , 1994, Cognition.

[14]  C. Brunia,et al.  Psychophysiological brain research. , 1993 .

[15]  Adrian R. Willoughby,et al.  The Medial Frontal Cortex and the Rapid Processing of Monetary Gains and Losses , 2002, Science.

[16]  Rogier B. Mars,et al.  De Bruijn ERA, Mars RB, & Hulstijn W It wasn't me... or was it? How false feedback affects performance , 2004 .

[17]  Clay B. Holroyd,et al.  Medial Prefrontal Cortex and Error Potentials , 2002, Science.

[18]  H. Walter,et al.  Electrophysiological correlates of error processing in borderline personality disorder , 2006, Biological Psychology.

[19]  T. Endrass,et al.  Changes of performance monitoring with learning in older and younger adults. , 2008, Psychophysiology.

[20]  W. Schultz.  Getting Formal with Dopamine and Reward , 2002, Neuron.

[21]  W. Hulstijn,et al.  Effects of antipsychotic and antidepressant drugs on action monitoring in healthy volunteers , 2006, Brain Research.

[22]  C. Izard,et al.  Motivation, emotion, and personality , 1985 .

[23]  John C Gore,et al.  Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation , 2003, Biological Psychiatry.

[24]  Monte S. Buchsbaum,et al.  Reduced Anterior and Posterior Cingulate Gray Matter in Borderline Personality Disorder , 2005, Biological Psychiatry.

[25]  R. Rogers,et al.  Altered emotional decision-making in prisoners with borderline personality disorder. , 2007, Journal of personality disorders.

[26]  Clay B. Holroyd,et al.  It's worse than you thought: the feedback negativity and violations of reward prediction in gambling tasks. , 2007, Psychophysiology.

[27]  Giuseppe Sartori,et al.  Brain correlates of risky decision-making , 2010, NeuroImage.

[28]  K. Silk.  OVERVIEW OF BIOLOGIC FACTORS , 2000 .

[29]  Nils Inge Landrø,et al.  Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder , 2007, Journal of the International Neuropsychological Society.

[30]  A. Ohman,et al.  Emotionally controlled decision-making and a gene variant related to serotonin synthesis in women with borderline personality disorder. , 2009, Scandinavian journal of psychology.

[31]  Clay B. Holroyd,et al.  The neural basis of human error processing: reinforcement learning, dopamine, and the error-related negativity. , 2002, Psychological review.

[32]  Sidney J Segalowitz,et al.  The error-related negativity is related to risk taking and empathy in young men. , 2009, Psychophysiology.

[33]  Stacey B. Daughters,et al.  Impulsivity as a common process across borderline personality and substance use disorders. , 2005, Clinical psychology review.

[34]  A. Lawrence,et al.  The somatic marker hypothesis: A critical evaluation , 2006, Neuroscience & Biobehavioral Reviews.

[35]  Thomas A Widiger,et al.  The borderline diagnosis II: biology, genetics, and clinical course , 2002, Biological Psychiatry.

[36]  Gregory P. Lee,et al.  Different Contributions of the Human Amygdala and Ventromedial Prefrontal Cortex to Decision-Making , 1999, The Journal of Neuroscience.

[37]  Louis Lemieux,et al.  Frontolimbic brain abnormalities in patients with borderline personality disorder a volumetric magnetic resonance imaging study , 2003, Biological Psychiatry.

[38]  K. R. Ridderinkhof,et al.  The Role of the Medial Frontal Cortex in Cognitive Control , 2004, Science.

[39]  Jonathan D. Cohen,et al.  Decision making, the P3, and the locus coeruleus-norepinephrine system. , 2005, Psychological bulletin.

[40]  S. Kéri,et al.  Sensitivity to reward and punishment and the prefrontal cortex in major depression. , 2006, Journal of affective disorders.

[41]  E. Rolls,et al.  Borderline personality disorder, impulsivity, and the orbitofrontal cortex. , 2005, The American journal of psychiatry.

[42]  E. Barratt,et al.  Reduced punishment sensitivity in neural systems of behavior monitoring in impulsive individuals , 2006, Neuroscience Letters.

[43]  Clay B. Holroyd,et al.  Learning-related changes in brain activity following errors and performance feedback in schizophrenia , 2008, Schizophrenia Research.

[44]  Eric Vermetten,et al.  A positron emission tomography study of memories of childhood abuse in borderline personality disorder , 2004, Biological Psychiatry.

[45]  B. Renneberg,et al.  Response Inhibition in Borderline Personality Disorder: Performance in a Go/Nogo Task , 2007, Psychopathology.

[46]  R. Krishnan,et al.  Decision-making and risk aversion among depressive adults. , 2008, Journal of behavior therapy and experimental psychiatry.

[47]  H. Wittchen,et al.  SKID. Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Handanweisung , 1997 .

[48]  A. Sanfey,et al.  Independent Coding of Reward Magnitude and Valence in the Human Brain , 2004, The Journal of Neuroscience.

[49]  Roberto Keller,et al.  Frontal lobe dysfunction in pathological gambling patients , 2002, Biological Psychiatry.

[50]  Johannes Hewig,et al.  Decision-making in Blackjack: an electrophysiological analysis. , 2007, Cerebral cortex.

[51]  Clay B. Holroyd,et al.  Brain potentials associated with expected and unexpected good and bad outcomes. , 2005, Psychophysiology.

[52]  E. Rolls,et al.  Emotion-related learning in patients with social and emotional changes associated with frontal lobe damage. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[53]  Michael J. Frank,et al.  Error-Related Negativity Predicts Reinforcement Learning and Conflict Biases , 2005, Neuron.

[54]  A. Damasio,et al.  Emotion, decision making and the orbitofrontal cortex. , 2000, Cerebral cortex.

[55]  Atsushi Sato,et al.  Effects of value and reward magnitude on feedback negativity and P300 , 2005, Neuroreport.

[56]  P. Links,et al.  Impulsivity: core aspect of borderline personality disorder. , 1999, Journal of personality disorders.

[57]  A. Holmes,et al.  Effects of task-relevant incentives on the electrophysiological correlates of error processing in major depressive disorder , 2010, Cognitive, affective & behavioral neuroscience.

[58]  A. Engel,et al.  Trial-by-Trial Coupling of Concurrent Electroencephalogram and Functional Magnetic Resonance Imaging Identifies the Dynamics of Performance Monitoring , 2005, The Journal of Neuroscience.

[59]  R. van Reekum,et al.  The Neuropsychological Correlates of Borderline Personality Disorder and Suicidal Behaviour , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[60]  W. Hulstijn,et al.  Neural correlates of impulsive responding in borderline personality disorder: ERP evidence for reduced action monitoring. , 2006, Journal of psychiatric research.

[61]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[62]  K. Silk.  Biological and neurobehavioral studies of borderline personality disorder , 1994 .

[63]  C. Braun,et al.  Event-Related Brain Potentials Following Incorrect Feedback in a Time-Estimation Task: Evidence for a Generic Neural System for Error Detection , 1997, Journal of Cognitive Neuroscience.

[64]  Anthony C. Ruocco,et al.  The neuropsychology of borderline personality disorder: A meta-analysis and review , 2005, Psychiatry Research.

[65]  M. Farah,et al.  Different underlying impairments in decision-making following ventromedial and dorsolateral frontal lobe damage in humans. , 2004, Cerebral cortex.