Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-26T17:56:24.341Z Has data issue: false hasContentIssue false
  • English
  • Français

Suboptimal Decision Making in Borderline Personality Disorder: Effect of Potential Losses

Published online by Cambridge University Press:  08 July 2014

Juan P. Sánchez-Navarro ,
Joshua A. Weller ,
Jose M. López-Navarro ,
Jose M. Martínez-Selva  and
Antoine Bechara
Juan P. Sánchez-Navarro*
Affiliation:
Universidad de Murcia (Spain)
Joshua A. Weller
Affiliation:
Idaho State University (USA)
Jose M. López-Navarro
Affiliation:
Hospital General Universitario Reina Sofía (Spain)
Jose M. Martínez-Selva
Affiliation:
Universidad de Murcia (Spain)
Antoine Bechara
Affiliation:
University of Southern California (USA)
*
*Correspondence concerning this article should be addressed to Juan P. Sánchez-Navarro. Facultad de Psicología. Universidad de Murcia. 30100. Murcia (Spain). Phone: +34–868887707. FAX: +34–868884111. E-mail: jpedro@um.es
Get access Rights & Permissions [Opens in a new window]

Abstract

This research explored the underlying processes mediating risky decisions for individuals with Borderline Personality Disorder (BPD). We tested whether BPD patients were more apt to take risks compared to a matched comparison group. We used two controlled tasks designed to assess risky decision-making, both to achieve gains and to avoid losses. Overall, BPD patients showed increased risk-taking compared to the comparison group (p = .011, η2 = .224), and were especially likely to be risk-seeking when the decision was framed as a potential loss (p < .0001, d = 1.77). When the outcome involved pure losses, BPD patients were insensitive to the relative expected value between choice options resulting in suboptimal decision making (p = .004, d = 1.24), but did not differ from the comparison group when taking risks to achieve gains (p = .603, d = 0.21). We discuss these results in the context of behavioral and neuropsychiatric research suggesting abnormalities BPD patients’ ability to effectively regulate affect.

Keywords

borderline personality disorderdecision-makingriskframing effectexpected value sensitivity
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 17 , 2014 , E38
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4 th Ed.). Washington, DC: Author.Google Scholar
Banks, S. J., Eddy, K. T., Angstadt, M., Nathan, P. J., & Phan, K. L. (2007). Amygdala-frontal connectivity during emotion regulation. Social Cognitive and Affective Neuroscience, 2, 303–312. http://dx.doi.org/10.1093/scan/nsm029 Google Scholar
Bazanis, E., Rogers, R. D., Dowson, J. H., Taylor, P., Meux, C., Staley, C., … Sahakian, J. (2002). Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychological Medicine, 32, 1395–1405. http://dx.doi.org/10.1017/S0033291702006657 Google Scholar
Bechara, A., Damasio, H., Damasio, A. R., & Lee, G. P. (1999). Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. The Journal of Neuroscience, 19, 5473–5481.Google Scholar
Bechara, A., Damasio, H., Tranel, D., & Damasio, A. R. (1997). Deciding advantageously before knowing the advantageous strategy. Science, 275, 1293–1295. http://dx.doi.org/10.1126/science.275.5304.1293 Google Scholar
Cavedini, P., Riboldi, G., Keller, R., D’Annucci, A., & Bellodi, L. (2002). Frontal lobe dysfunction in pathological gambling patients. Biological Psychiatry, 51, 334–341. http://dx.doi.org/10.1016/S0006-3223(01)01227-6 Google Scholar
Crowell, S. E., Beuchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending linehan’s theory. Psychological Bulletin, 135, 495–510. http://dx.doi.org/10.1037/a0015616 Google Scholar
Damasio, A. R. (1994). Descartes’ error: Emotion, reason, and the human brain. New York, NY: Grosset/Putnam.Google Scholar
de Martino, B., Kumaran, D., Seymour, B., & Dolan, R. (2006). Frames, biases, and rational decision-making in the human brain. Science, 313, 684–687. http://dx.doi.org/10.1126/science.1128356 Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997a). Structured clinical interview for DSM-IV personality disorders (SCID-II). Washington, DC: American Psychiatric Press, Inc.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997b). Structured clinical interview for DSM-IV-TR Axis i disorders, research version, patient edition. (SCID-I/P). NewYork, NY: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Gehring, W. J., & Willoughby, A. R. (2002). The medial frontal cortex and the rapid processing of monetary gains and losses. Science, 295, 2279–2282. http://dx.doi.org/10.1126/science.1066893 CrossRefGoogle ScholarPubMed
Haaland, V. Ø., & Landrø, N. I. (2007). Decision making as measured with the Iowa gambling task in patients with borderline personality disorder. Journal of the International Neuropsychological Society, 13, 699–703. http://dx.doi.org/10.1017/S1355617707070890 Google Scholar
Kahneman, D., & Tversky, A. (1979). Prospect theory: An analysis of decision under risk. Econometrica, 47, 263–292. http://dx.doi.org/10.2307/1914185 Google Scholar
Kirkpatrick, T., Joyce, E., Milton, J., Duggan, C., Tyrer, P., & Rogers, R. D. (2007). Altered emotional decision-making in prisoners with borderline personality disorder. Journal of Personality Disorders, 21, 243–261. http://dx.doi.org/10.1521/pedi.2007.21.3.243 Google Scholar
Koenigsberg, H. W., Siever, L. J., Lee, H., Pizzarello, S., New, A. S., Goodman, M., … Prohovnik, I. (2009). Neural correlates of emotion processing in borderline personality disorder. Psychiatry Research: Neuroimaging, 172, 192–199. http://dx.doi.org/10.1016/j.pscychresns.2008.07.010 Google Scholar
Maurex, L., Zaboli, G., Wiens, S., Asberg, M., Leopardi, R., & Öhman, A. (2009). Emotionally controlled decision-making and a gene variant related to serotonin synthesis in women with borderline personality disorder. Scandinavian Journal of Psychology, 50, 5–10. http://dx.doi.org/10.1111/j.1467-9450.2008.00689.x Google Scholar
Mohr, P. N., Biele, G., & Heekeren, H. R. (2010). Neural processing of risk. Journal of Neuroscience, 30, 6613–6619. http://dx.doi.org/10.1523/JNEUROSCI.0003-10.2010 Google Scholar
Mortensen, J. A., Rausmussen, I. A., & Håberg, A. (2010). Trait impulsivity in female patients with borderline personality disorder and matched controls. Acta Neuropsychiatrica, 22, 139–149. http://dx.doi.org/10.1111/j.1601-5215.2010.00468.x Google Scholar
Ruocco, A. C., McCloskey, M. S., Lee, R., & Coccaro, E. F. (2009). Indices of orbitofrontal and prefrontal function in Clusert B and Cluster C personality disorder. Psychiatry Research, 170, 282–285. http://dx.doi.org/10.1016/j.psychres.2008.12.003 Google Scholar
Ruocco, A. C., Medaglia, J. D., Ayaz, H., & Chute, D. L. (2010). Abnormal prefrontal cortical response during affective processing in borderline personality disorder. Psychiatry Research: Neuroimaging, 182, 117–122. http://dx.doi.org/10.1016/j.pscychresns.2010.01.011 Google Scholar
Satterthwaite, T. D., Green, L., Myerson, J., Parker, J., Ramaratnam, M., & Buckner, R. L. (2007). Dissociable but inter-related systems of cognitive control and reward during decision making: Evidence from pupillometry and event-related fMRI. Neuroimage, 37, 1017–1031. http://dx.doi.org/10.1016/j.neuroimage.2007.04.066 Google Scholar
Schmahl, C., & Bremmer, J. D. (2006). Neuroimaging in borderline personality disorder. Journal of Psychiatric Research, 40, 419–427. http://dx.doi.org/10.1016/j.jpsychires.2005.08.011 Google Scholar
Schonberg, T., Fox, C. R., & Poldrack, R. A. (2010). Mind the gap: Bridging economic and naturalistic risk-taking with cognitive neuroscience. Trends in Cognitive Sciences, 15, 11–19. http://dx.doi.org/10.1016/j.tics.2010.10.002 Google Scholar
Schulze, L., Domes, G., Krüger, A., Berger, C., Fleischer, M., Prehn, K., … Herpertz, S. C. (2011). Neuronal correlates of cognitive reappraisal in borderline patients with affective instability. Biological Psychiatry, 69, 564–573. http://dx.doi.org/10.1016/j.biopsych.2010.10.025 Google Scholar
Selby, E. A., & Joiner, T. E Jr.. (2009). Cascades of emotion: The emergence of borderline personality disorder from emotional and behavioral dysregulation. Review of General Psychology, 13, 219–229. http://dx.doi.org/10.1037/a0015687 Google Scholar
Seymour, B., & Dolan, R. (2008). Emotion, decision making, and the amygdala. Neuron, 58, 662–671. http://dx.doi.org/10.1016/j.neuron.2008.05.020 Google Scholar
Sheehan, D. V., Lecrubier, Y., Harnett-Sheehan, K., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The MINI international neuropsychiatric interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DS;-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–23.Google Scholar
Silbersweig, D., Clarkin, J. F., Goldstein, M., Kernberg, O. F., Tuescher, O., Levy, K. N., ... Stern, E. (2007). Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. American Journal of Psychiatry, 164, 1832–1841. http://dx.doi.org/10.1176/appi.ajp.2007.06010126 Google Scholar
Skodol, A. E., Gunderson, J. G., Pfohl, B., Widiger, T. A., Livesley, W. J., & Siever, L. J. (2002). The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51, 936–950. http://dx.doi.org/10.1016/S0006-3223(02)01324-0 Google Scholar
Talmi, D., Hurlemann, R., Patin, A., & Dolan, R. J. (2010). Framing effect following bilateral amygdala lesion. Neuropsychologia, 48, 1823–1827. http://dx.doi.org/10.1016/j.neuropsychologia.2010.03.005 Google Scholar
Tull, M. T., Gratz, K. L., & Weiss, N. H. (2011). Exploring associations between borderline personality disorder, crack/cocaine dependence, gender, and risky sexual behavior among substance-dependent inpatients. Personality Disorders: Theory, Research, and Treatment, 2, 209–219. http://dx.doi.org/10.1037/a0021878 Google Scholar
Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453–458. http://dx.doi.org/10.1126/science.7455683 Google Scholar
Weber, E. U., & Johnson, E. J. (2008). Decisions under uncertainty: Psychological, economic, and neuroeconomic explanations. In Glimcher, P., Camerer, C., Fehr, E., & Poldrack, R. (Eds.), Neuroeconomics: Decision making and the brain (pp. 127–144). New York, NY: Elsevier.Google Scholar
Weller, J. A., Levin, I. P., & Denburg, N. (2011). Trajectory of advantageous decision making for risky gains and losses from ages 5 to 85. Journal of Behavioral Decision Making, 24, 331–344. http://dx.doi.org/10.1002/bdm.690 Google Scholar
Weller, J. A., Levin, I. P., Shiv, B., & Bechara, A. (2007). Neural correlates of adaptive decision making for risky gains and losses. Psychological Science, 18, 958–964. http://dx.doi.org/10.1111/j.1467-9280.2007.02009.x Google Scholar
Weller, J. A., Levin, I. P., Shiv, B., & Bechara, A. (2009). The effects of insula damage on advantageous decision making for risky gains and losses. Social Neuroscience, 4, 347–358. http://dx.doi.org/10.1080/17470910902934400 Google Scholar