The new issue of the American Association for the Advancement of Science* (Vol. 321. no. 5890, Aug 8) includes an article on borderline personality disorder: "PSYCHOLOGY: Trust Me on This" by Andreas Meyer-Lindenberg.
Here are some excerpts:
[begin excerpts]
Unstable interpersonal relationships, reduced impulse control, and difficulty regulating emotions characterize borderline personality disorder, a severe mental illness that accounts for up to 20% of psychiatric inpatients and exerts a tremendous toll on those afflicted, their social network, and the health-care system (1).
Close relationships of patients are often tumultuous, spiraling out of control through highly emotional and unpredictable behavior that can leave others baffled, angry, and frightened. On page 806 in this issue, King-Casas et al. (2) use an economic exchange game and neuroimaging to provide a glimpse into the neural mechanisms underlying the breakdown of cooperation in individuals with borderline personality disorder. The study also establishes a game theory paradigm that holds promise for investigating social interactions, particularly psychiatrically relevant disturbances of social behavior.
In the multiround economic trust game, money is exchanged between an investor, who decides how much money to commit, and a trustee, who decides how much of the investment (which is tripled during the transfer) to repay the investor. If both cooperate, both benefit from the exchange, much more so than if the investor keeps most of the money. However, this requires a degree of trust between the players, which is built up through repeated fair offers. An investor who does not trust will not invest much money. This is exactly what happened at the end of games with trustees who suffered from borderline personality disorder, indicating that they were less likely to establish or maintain a cooperative relationship. By contrast, healthy trustees were successful at doing so (thus, investment remained high at the end of the game). The better outcome was accomplished through a coaxing strategy, in which wary investors transferring small amounts of money were encouraged by generous returns, which signaled trustworthiness. Healthy players used this strategy twice as often as borderline personality disorder subjects. Why?
To find out, King-Casas et al. used neuroimaging to study brain activation of trustees confronted with a small investment (a signal of the investor's lack of trust). Individuals with borderline personality disorder and healthy players differed in the activity of one brain area-- the anterior insula (see the figure). In healthy trustees, small investments corresponded to large activations and large investments corresponded to small activations. By contrast, in players with borderline personality disorder, the anterior insula did not distinguish between offer sizes. As expected from previous work (3), the same brain area was also reactive to the amount trustees were about to repay the investor, but this was now found in both patients and healthy controls. In healthy controls, the anterior insula was activated in response both to distrustful offers from investors and stingy repayments they were about to make, whereas in trustees with the personality disorder, differential neural activity was observed only when they were repaying.
Thus, their impairment selectively affected representation of the other player in the pair.
The anterior insula is traditionally associated with sensing the physiological state of the body, but strongly reacts to adverse or uncomfortable occurrences in social interactions, such as unfairness (4), risky choices, frustration, or impending loss of social status (5). This brain region also responds to the intentions and emotional state of thers (6, 7), and imbues them with feeling (8). Because rewarding aspects of social interactions have been mapped to the ventral striatum in the brain (9), the present results suggest that activation of the anterior insula in a social context represents a negative/aversive evaluation of perceived or planned action, perhaps associated with a feeling of discomfort. If true, this implies that individuals with borderline personality disorder may have difficulty cooperating because they lack the "gut feeling" (corresponding to the anterior insula signal) that the relationship is in jeopardy and/or expect such behavior from the outset. The correspondence of these brain findings to current psychotherapeutic practice is remarkable. The most effective treatment of borderline personality disorder (1), dialectical behavior therapy, is based on the assumption that patients lack skills in interpersonal self- regulation, and attempts to build these abilities.
The use of a game theoretic approach to investigate personality disorders may be useful for studying other mental illnesses where social dysfunction is a prominent source of disability and distress, such as schizophrenia or autism. Game theory originated as an instrument of neuroeconomic analyses that assume perfect rationality of the players, and at first it came as a surprise that economic choices were in fact strongly impacted by emotional and reward-related brain processes. As King-Casas et al. show, it has now evolved into a tool for investigating psychopathological impairment of social interactions. Such advances are needed for patients, therapists, and researchers to grapple with social dysfunction, which is among the most impairing and least treatable components of severe illnesses such as schizophrenia.
[end excerpts]
The author note states that reprint requests may be sent to the author at Central Institute of Mental Health, J5, University of Heidelberg, 68159 Mannheim, Germany. E-mail: <a.meyerlindenberg@ zi-mannheim. de>.
"Believe nothing merely because you have been told it.... Do not believe what your teacher tells you merely out of respect for the teacher. But whatsoever, after due examination and analysis, you find to be kind, conducive to the good, the benefit, the welfare of all beings--that doctrine believe and cling to, and take it as your guide." Buddha (about 623-543 BC)
Here are some excerpts:
[begin excerpts]
Unstable interpersonal relationships, reduced impulse control, and difficulty regulating emotions characterize borderline personality disorder, a severe mental illness that accounts for up to 20% of psychiatric inpatients and exerts a tremendous toll on those afflicted, their social network, and the health-care system (1).
Close relationships of patients are often tumultuous, spiraling out of control through highly emotional and unpredictable behavior that can leave others baffled, angry, and frightened. On page 806 in this issue, King-Casas et al. (2) use an economic exchange game and neuroimaging to provide a glimpse into the neural mechanisms underlying the breakdown of cooperation in individuals with borderline personality disorder. The study also establishes a game theory paradigm that holds promise for investigating social interactions, particularly psychiatrically relevant disturbances of social behavior.
In the multiround economic trust game, money is exchanged between an investor, who decides how much money to commit, and a trustee, who decides how much of the investment (which is tripled during the transfer) to repay the investor. If both cooperate, both benefit from the exchange, much more so than if the investor keeps most of the money. However, this requires a degree of trust between the players, which is built up through repeated fair offers. An investor who does not trust will not invest much money. This is exactly what happened at the end of games with trustees who suffered from borderline personality disorder, indicating that they were less likely to establish or maintain a cooperative relationship. By contrast, healthy trustees were successful at doing so (thus, investment remained high at the end of the game). The better outcome was accomplished through a coaxing strategy, in which wary investors transferring small amounts of money were encouraged by generous returns, which signaled trustworthiness. Healthy players used this strategy twice as often as borderline personality disorder subjects. Why?
To find out, King-Casas et al. used neuroimaging to study brain activation of trustees confronted with a small investment (a signal of the investor's lack of trust). Individuals with borderline personality disorder and healthy players differed in the activity of one brain area-- the anterior insula (see the figure). In healthy trustees, small investments corresponded to large activations and large investments corresponded to small activations. By contrast, in players with borderline personality disorder, the anterior insula did not distinguish between offer sizes. As expected from previous work (3), the same brain area was also reactive to the amount trustees were about to repay the investor, but this was now found in both patients and healthy controls. In healthy controls, the anterior insula was activated in response both to distrustful offers from investors and stingy repayments they were about to make, whereas in trustees with the personality disorder, differential neural activity was observed only when they were repaying.
Thus, their impairment selectively affected representation of the other player in the pair.
The anterior insula is traditionally associated with sensing the physiological state of the body, but strongly reacts to adverse or uncomfortable occurrences in social interactions, such as unfairness (4), risky choices, frustration, or impending loss of social status (5). This brain region also responds to the intentions and emotional state of thers (6, 7), and imbues them with feeling (8). Because rewarding aspects of social interactions have been mapped to the ventral striatum in the brain (9), the present results suggest that activation of the anterior insula in a social context represents a negative/aversive evaluation of perceived or planned action, perhaps associated with a feeling of discomfort. If true, this implies that individuals with borderline personality disorder may have difficulty cooperating because they lack the "gut feeling" (corresponding to the anterior insula signal) that the relationship is in jeopardy and/or expect such behavior from the outset. The correspondence of these brain findings to current psychotherapeutic practice is remarkable. The most effective treatment of borderline personality disorder (1), dialectical behavior therapy, is based on the assumption that patients lack skills in interpersonal self- regulation, and attempts to build these abilities.
The use of a game theoretic approach to investigate personality disorders may be useful for studying other mental illnesses where social dysfunction is a prominent source of disability and distress, such as schizophrenia or autism. Game theory originated as an instrument of neuroeconomic analyses that assume perfect rationality of the players, and at first it came as a surprise that economic choices were in fact strongly impacted by emotional and reward-related brain processes. As King-Casas et al. show, it has now evolved into a tool for investigating psychopathological impairment of social interactions. Such advances are needed for patients, therapists, and researchers to grapple with social dysfunction, which is among the most impairing and least treatable components of severe illnesses such as schizophrenia.
[end excerpts]
The author note states that reprint requests may be sent to the author at Central Institute of Mental Health, J5, University of Heidelberg, 68159 Mannheim, Germany. E-mail: <a.meyerlindenberg@ zi-mannheim. de>.
"Believe nothing merely because you have been told it.... Do not believe what your teacher tells you merely out of respect for the teacher. But whatsoever, after due examination and analysis, you find to be kind, conducive to the good, the benefit, the welfare of all beings--that doctrine believe and cling to, and take it as your guide." Buddha (about 623-543 BC)
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