Dataset Information

A Computational Phenotype of Disrupted Moral Inference in Borderline Personality Disorder.

ABSTRACT: Background: Borderline personality disorder (BPD) is a serious mental disorder characterized by marked interpersonal disturbances, including difficulties trusting others and volatile impressions of others' moral character, often resulting in premature relationship termination. We tested a hypothesis that moral character inference is disrupted in BPD and sensitive to democratic therapeutic community (DTC) treatment.

Methods: Participants with BPD (n = 43; 20 untreated and 23 DTC-treated) and control participants without BPD (n = 106) completed a moral inference task where they predicted the decisions of 2 agents with distinct moral preferences: the "bad" agent was more willing than the "good" agent to harm others for money. Periodically, participants rated their subjective impressions of the agent's moral character and the certainty of those impressions. We fit a hierarchical Bayesian learning model to participants' trialwise predictions to describe how beliefs about the morality of the agents were updated by new information.

Results: The computational mechanisms of moral inference differed for patients with untreated BPD relative to matched control participants and patients with DTC-treated BPD. In patients with BPD, beliefs about harmful agents were more certain and less amenable to updating relative to both control participants and participants who were treated with DTC.

Conclusions: The findings suggest that DTC may help the maintenance of social relationships in BPD by increasing patients' openness to learning about adverse interaction partners. The results provide mechanistic insights into social deficits in BPD and demonstrate the potential for combining objective behavioral paradigms with computational modeling as a tool for assessing BPD pathology and treatment outcomes.

SUBMITTER: Siegel JZ

PROVIDER: S-EPMC7718209 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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A Computational Phenotype of Disrupted Moral Inference in Borderline Personality Disorder.

Siegel Jenifer Z JZ Curwell-Parry Owen O Pearce Steve S Saunders Kate E A KEA Crockett Molly J MJ

Biological psychiatry. Cognitive neuroscience and neuroimaging 20200729 12

<h4>Background</h4>Borderline personality disorder (BPD) is a serious mental disorder characterized by marked interpersonal disturbances, including difficulties trusting others and volatile impressions of others' moral character, often resulting in premature relationship termination. We tested a hypothesis that moral character inference is disrupted in BPD and sensitive to democratic therapeutic community (DTC) treatment.<h4>Methods</h4>Participants with BPD (n = 43; 20 untreated and 23 DTC-trea ...[more]

PMID: 33012682

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Project description:BackgroundDrugs are widely used in borderline personality disorder (BPD) treatment, chosen because of properties known from other psychiatric disorders ("off-label use"), mostly targeting affective or impulsive symptom clusters.ObjectivesTo assess the effects of drug treatment in BPD patients.Search strategyWe searched bibliographic databases according to the Cochrane Developmental, Psychosocial and Learning Problems Group strategy up to September 2009, reference lists of articles, and contacted researchers in the field.Selection criteriaRandomised studies comparing drug versus placebo, or drug versus drug(s) in BPD patients. Outcomes included total BPD severity, distinct BPD symptom facets according to DSM-IV criteria, associated psychopathology not specific to BPD, attrition and adverse effects.Data collection and analysisTwo authors selected trials, assessed quality and extracted data, independently.Main resultsTwenty-eight trials involving a total of 1742 trial participants were included. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, valproate semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin), and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Data were sparse for individual comparisons, indicating marginal effects for first-generation antipsychotics and antidepressants.The findings were suggestive in supporting the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but require replication, since most effect estimates were based on single studies. The long-term use of these drugs has not been assessed.Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition.Direct drug comparisons comprised two first-generation antipsychotics (loxapine versus chlorpromazine), first-generation antipsychotic against antidepressant (haloperidol versus amitriptyline; haloperidol versus phenelzine sulfate), and second-generation antipsychotic against antidepressant (olanzapine versus fluoxetine). Data indicated better outcomes for phenelzine sulfate but no significant differences in the other comparisons, except olanzapine which showed more weight gain and sedation than fluoxetine. The only trial testing single versus combined drug treatment (olanzapine versus olanzapine plus fluoxetine; fluoxetine versus fluoxetine plus olanzapine) yielded no significant differences in outcomes.Authors' conclusionsThe available evidence indicates some beneficial effects with second-generation antipsychotics, mood stabilisers, and dietary supplementation by omega-3 fatty acids. However, these are mostly based on single study effect estimates. Antidepressants are not widely supported for BPD treatment, but may be helpful in the presence of comorbid conditions. Total BPD severity was not significantly influenced by any drug. No promising results are available for the core BPD symptoms of chronic feelings of emptiness, identity disturbance and abandonment. Conclusions have to be drawn carefully in the light of several limitations of the RCT evidence that constrain applicability to everyday clinical settings (among others, patients' characteristics and duration of interventions and observation periods).

Project description:Psychiatric disorders are ubiquitously characterized by debilitating social impairments. These difficulties are thought to emerge from aberrant social inference. In order to elucidate the underlying computational mechanisms, patients diagnosed with major depressive disorder (N = 29), schizophrenia (N = 31), and borderline personality disorder (N = 31) as well as healthy controls (N = 34) performed a probabilistic reward learning task in which participants could learn from social and non-social information. Patients with schizophrenia and borderline personality disorder performed more poorly on the task than healthy controls and patients with major depressive disorder. Broken down by domain, borderline personality disorder patients performed better in the social compared to the non-social domain. In contrast, controls and major depressive disorder patients showed the opposite pattern and schizophrenia patients showed no difference between domains. In effect, borderline personality disorder patients gave up a possible overall performance advantage by concentrating their learning in the social at the expense of the non-social domain. We used computational modeling to assess learning and decision-making parameters estimated for each participant from their behavior. This enabled additional insights into the underlying learning and decision-making mechanisms. Patients with borderline personality disorder showed slower learning from social and non-social information and an exaggerated sensitivity to changes in environmental volatility, both in the non-social and the social domain, but more so in the latter. Regarding decision-making the modeling revealed that compared to controls and major depression patients, patients with borderline personality disorder and schizophrenia showed a stronger reliance on social relative to non-social information when making choices. Depressed patients did not differ significantly from controls in this respect. Overall, our results are consistent with the notion of a general interpersonal hypersensitivity in borderline personality disorder and schizophrenia based on a shared computational mechanism characterized by an over-reliance on beliefs about others in making decisions and by an exaggerated need to make sense of others during learning specifically in borderline personality disorder.

Dataset Information

A Computational Phenotype of Disrupted Moral Inference in Borderline Personality Disorder.

Publications

A Computational Phenotype of Disrupted Moral Inference in Borderline Personality Disorder.

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