Consider others better than yourself: Social decision-making and partner preference in Borderline Personality Disorder.

BACKGROUND AND OBJECTIVES: Patients with Borderline Personality Disorder (BPD) suffer from interpersonal difficulties. They have been shown to be distrustful and yet involved in abusive relationships. In this study, we want to examine whether the perception of fairness and partner preference are altered in BPD. METHODS: We employed a coalition formation game in which a participant can choose whether to interact in dyads or triads, thus exclusion or inclusion of a third potential interaction partner. Furthermore, triads get a higher endowment, such that dyads are not only unfair to one partner, but also economically inefficient, as the participant reduces the overall amount of money available for distribution. Subsequently, we compared how participants predicted another person's game strategy (inclusive, exclusive, or mixed) and rated its fairness, and which partner the participant would select. RESULTS: The majority of the BPD group (n = 26) as well as of the healthy group (n = 29) preferred triads over dyads and offered a near-to-equal split to their interaction partners in the first two rounds. In contrast to the healthy group, the BPD group did not show a drop of the average level of investment in the final round. In both groups, the inclusive strategy was perceived as the fairest strategy. Most interestingly, despite a similar perception of fairness, half of the BPD group preferred an interaction partner with an exclusive or mixed strategy while the majority of the HC group would choose an interaction partner with an inclusive strategy. LIMITATIONS: This is a preliminary study which needs further replications before strong conclusions can be drawn. CONCLUSIONS: Our study demonstrates no differences in fairness perception but an alteration in partner preference of patients with BPD which might contribute to unfavorable partner choices and impairments of interpersonal functioning in BPD.

Emotional responses to receiving peer feedback on opinions in borderline personality disorder.

Although emotional reactivity to social rejection has been examined in patients with borderline personality disorder (BPD) in several studies, the effects of other aspects of social feedback, such as evaluation of one's opinions that concern self-esteem, have not been addressed yet. The objective of this study was to examine emotional responses of BPD patients after exchanging personal opinions in a new, ecologically valid virtual peer interaction paradigm ("chatroom paradigm"). In this paradigm, 21 BPD patients and 21 healthy controls received peer feedback on their own statements and rated the intensity of their own emotional responses (happiness, sadness, anger, and shame) and the self or other affirmation in response to agreement, disagreement, and neutral statements. Across all social feedback conditions, BPD patients reported more intense negative emotions and less happiness than healthy controls. While healthy controls showed a "positivity bias" for any type of social feedback, the emotional responses of BPD patients' corresponded to the valence of the feedback; that is, they were happiest after positive than after neutral feedback and least happy after negative feedback. Disagreement resulted in more intense anger and less other affirmation in both groups but only BPD patients also experienced higher shame in this condition. This is the first study to assess emotional responses to social feedback in an ecologically valid chatroom paradigm. Our findings underline that more negative emotional reactions in everyday interactions play a central part in interpersonal difficulties of patients with BPD. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Neurobiology of Criterion A: self and interpersonal personality functioning.

The Criterion A of the DSM-5 Alternative Model of Personality Disorders follows a functional approach to personality disorders which can be effectively related to abnormalities in brain circuits that are involved in processes related to the self and others. While brain circuits related to the self and others highly overlap supporting the notion of inseparable constructs, structural and functional neuroimaging data point to rather specific deviations in brain processes among the various types of personality disorders, with a focus on borderline and antisocial personality disorders. Neurobiological data have shed light on the problem areas of individuals with personality disorders that goes beyond what we know from either patients' reports or observing their behavior and may open new perspectives on treatment.

Oxytocin improves facial emotion recognition in young adults with antisocial personality disorder.

Deficient facial emotion recognition has been suggested to underlie aggression in individuals with antisocial personality disorder (ASPD). As the neuropeptide oxytocin (OT) has been shown to improve facial emotion recognition, it might also exert beneficial effects in individuals providing so much harm to the society. In a double-blind, randomized, placebo-controlled crossover trial, 22 individuals with ASPD and 29 healthy control (HC) subjects (matched for age, sex, intelligence, and education) were intranasally administered either OT (24 IU) or a placebo 45min before participating in an emotion classification paradigm with fearful, angry, and happy faces. We assessed the number of correct classifications and reaction times as indicators of emotion recognition ability. Significant group×substance×emotion interactions were found in correct classifications and reaction times. Compared to HC, individuals with ASPD showed deficits in recognizing fearful and happy faces; these group differences were no longer observable under OT. Additionally, reaction times for angry faces differed significantly between the ASPD and HC group in the placebo condition. This effect was mainly driven by longer reaction times in HC subjects after placebo administration compared to OT administration while individuals with ASPD revealed descriptively the contrary response pattern. Our data indicate an improvement of the recognition of fearful and happy facial expressions by OT in young adults with ASPD. Particularly the increased recognition of facial fear is of high importance since the correct perception of distress signals in others is thought to inhibit aggression. Beneficial effects of OT might be further mediated by improved recognition of facial happiness probably reflecting increased social reward responsiveness.

Cortical folding patterns are associated with impulsivity in healthy young adults.

Impulsivity is associated with distinct mental disorders but is also considered as a personality trait exhibited by healthy individuals. Current studies suggest that early stressful life events might cause higher impulsivity in the adulthood. Morphological features, which reflect early brain development, could provide valuable information regarding the origin of impulsive behavior. However, none of the previous MRI studies employed a methodology specifically designed to investigate the relationship between impulsivity and markers of brain development. In this regard, we aimed to investigate the relationship between cortical folding and the three distinct factors of impulsivity (attention, motor, and non-planning) in young healthy adults. Fifty-four right-handed healthy individuals were recruited for the study and underwent magnetic resonance imaging (MRI) at 3 Tesla. A surface-based analysis was used to calculate a local gyrification index (LGI). Impulsivity was examined by the Barratt Impulsiveness Scale (BIS-11) and related to LGI. Associations between LGI and BIS-11 scores were assessed using within-group correlations (p < 0.05, "cluster-wise probability" [CWP] corr.). BIS subscores were positively correlated with cortical folding in several distinct areas: Total and attention scores were positively correlated with LGI in the left postcentral gyrus, cingulate gyrus, precentral gyrus, pars opercularis of the inferior frontal gyrus, right middle temporal gyrus, superior parietal gyrus, pericalcarine gyrus, and lateral occipital gyrus (each p < 0.05 CWP corr.). BIS motor score was positively correlated with LGI in the left superior temporal, lingual and supramarginal gyrus (each p < 0.05 CWP corr.). BIS non-planning score showed a positive correlation with LGI in the pars opercularis of the right inferior frontal gyrus and the left middle temporal, precentral and superior parietal gyrus (each p < 0.05 CWP corr.). Furthermore, we found gender-specific differences in BIS-11-LGI-correlation in the middle and inferior frontal gyrus. Our findings illustrate the advantages of cortical folding as a marker of early brain development when investigating structural brain correlates of impulsivity in young adulthood. Further, they lend additional support to the notion that alterations in early neurodevelopment comprising fronto-temporo-parietal regions might give rise to higher impulsivity in healthy individuals.

Rationality and self-interest as economic-exchange strategy in borderline personality disorder: Game theory, social preferences, and interpersonal behavior.

Borderline Personality Disorder (BPD) is characterized by severe and persistent impairments in interpersonal functioning. Given the complexity of social interactions, studying the interactive behavior of BPD patients is challenging. One way to implement both tight experimental control and realistic, externally valid settings is to use game-theoretical experiments. This review discusses findings from economic exchange studies in BPD against the background of game-theoretical literature. BPD patients do not seem to derive utility from mutual cooperation with others and appear not to "forgive" a partner's unfairness. By pursuing a strategy of negative reciprocity, BPD patients seem to act mostly "rationally" and in their own self-interest. Their "grim trigger strategy" resembles the theoretical ideal of the rational and self-interested agent homo economicus. Finally, we summarize how research findings from economics and clinical psychiatry may be mutually enriching and propose new research ideas in this fascinating field.

Social dysfunctioning and brain in borderline personality disorder.

Interpersonal dysfunction is the most prominent and best discriminating characteristic in individuals with borderline personality disorder (BPD). Data from experimental psychopathology point to emotional lability, (auto-)aggression, threat hypersensitivity, poor chance of interpersonal repair, frequent misunderstandings and self/other diffusion as the most significant factors which contribute to the interpersonal derailments typical of BPD. Neuroscientific methods are suitable to elucidate the mechanisms which mediate deficient social functioning in BPD, i.e. affective dysregulation, impulsivity/disinhibition and poor social cognition as well as their neurobiological correlates. Low prefrontoamygdalar coupling together with low activity in inhibiting prefrontal areas, high activity in the mirror neuron system, low activity in the mentalizing circuit, and low anterior insular activity in case of social norm violations are the most significant functional neuroimaging findings that have been reported from individuals with BPD, up to now. In addition, peculiarities of facial emotion processing have been detected by means of psychophysiological methodology in BPD patients. Data have led to preliminary models of social dysfunctioning in BPD that have to be experimentally tested in the future, evolving neuroscience into an important tool to better understand what distresses patients with BPD when communicating with others.

Impairments of interpersonal functioning: empathy and intimacy in borderline personality disorder.

Impairments of interpersonal functioning are central to borderline personality disorder (BPD). Patients with BPD suffer from severe psychosocial dysfunction in general and - among others - disturbed romantic relationships. Compounding the problem, the diagnosis of BPD interferes with therapeutic relationships and results in pejorative and discriminatory clinical practices. Previously, interpersonal dysfunction has been related to emotional dysregulation, behavioral dyscontrol, and impaired social cognition. However, these features may be intertwined yet separate. In this review, we will focus on disturbed empathy and intimacy as they are referred to as two discrete impairments of interpersonal functioning in the new DSM-5 Section III. The aim of this review is to contribute to a comprehensive, integral understanding of interpersonal dysfunction in BPD based on the behavioral and neurobiological studies available up to now. Despite some inconsistencies, behavioral studies in BPD patients indicate impaired cognitive and affective empathy particularly in complex and ecologically valid measurements. These findings are reflected even more consistently in functional magnet resonance imaging studies. Low quality of intimate relationships in BPD may at least partially result from lower mentalizing abilities and cognitive empathy, higher personal distress and affective empathy in the social context. Finally, the evaluation of the severity and quality of impairment of interpersonal functioning may enable clinicians and researchers to describe and to understand the mechanisms of interpersonal dysfunction better, and to improve the effectiveness of the treatment of patients with BPD.

Effects of Chronic D-Serine Elevation on Animal Models of Depression and Anxiety-Related Behavior.

NMDA receptors are activated after binding of the agonist glutamate to the NR2 subunit along with a co-agonist, either L-glycine or D-serine, to the NR1 subunit. There is substantial evidence to suggest that D-serine is the most relevant co-agonist in forebrain regions and that alterations in D-serine levels contribute to psychiatric disorders. D-serine is produced through isomerization of L-serine by serine racemase (Srr), either in neurons or in astrocytes. It is released by astrocytes by an activity-dependent mechanism involving secretory vesicles. In the present study we generated transgenic mice (SrrTg) expressing serine racemase under a human GFAP promoter. These mice were biochemically and behaviorally analyzed using paradigms of anxiety, depression and cognition. Furthermore, we investigated the behavioral effects of long-term administration of D-serine added to the drinking water. Elevated brain D-serine levels in SrrTg mice resulted in specific behavioral phenotypes in the forced swim, novelty suppression of feeding and olfactory bulbectomy paradigms that are indicative of a reduced proneness towards depression-related behavior. Chronic dietary D-serine supplement mimics the depression-related behavioral phenotype observed in SrrTg mice. Our results suggest that D-serine supplementation may improve mood disorders.

The N-methyl-D-aspartate receptor co-agonist D-cycloserine facilitates declarative learning and hippocampal activity in humans.

BACKGROUND: The N-methyl-D-aspartate receptor (NMDAR) is critical for learning-related synaptic plasticity in amygdala and hippocampus. As a consequence, there is considerable interest in drugs targeting this receptor to help enhance amygdala- and hippocampus-dependent learning. A promising candidate in this respect is the NMDAR glycine-binding site partial agonist D-cycloserine (DCS). Accumulating clinical evidence indicates the efficacy of DCS in the facilitation of amygdala-dependent fear extinction learning in patients with phobic, social anxiety, panic, and obsessive-compulsive disorder. An important unresolved question though is whether the use of DCS can also facilitate hippocampus-dependent declarative learning in healthy people as opposed to being restricted to the fear memory domain. METHODS: In the present study, we investigated whether or not DCS can facilitate hippocampus-dependent declarative learning. We have therefore combined functional magnetic resonance imaging with two different declarative learning tasks and cytoarchitectonic probabilistic mapping of the hippocampus and its major subdivisions in 40 healthy volunteers administered either a 250 mg single oral dose of DCS or a placebo. RESULTS: We found that DCS facilitates declarative learning as well as blood-oxygen level dependent activity levels in the probabilistically defined cornu ammonis region of the hippocampus. The absence of activity changes in visual control areas underscores the specific action of DCS in the hippocampal cornu ammonis region. CONCLUSIONS: Our findings highlight NMDAR glycine-binding site partial agonism as a promising pharmacological mechanism for facilitating declarative learning in healthy people.