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

Abstract

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, η 2 = .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.

Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder

“…In contrast to traditional decision-making paradigms, decreased LS biases served as adaptive during Matching Pennies. However, this reduced LS could be reflective, in part, of changes in limbic processes related to feedback processing ( Goyer et al, 1994 ; Lyoo et al, 1998 ; Tebartz Van Elst et al, 2003 ; Silbersweig et al, 2007 ; Schuermann et al, 2011 ; Svaldi et al, 2012 ; Schulze et al, 2016 ; Paret et al, 2017 ), particularly with regard to outcome evaluation when a potential loss is present ( de Bruijn et al, 2006 ; Vega et al, 2013 ; Sánchez-Navarro et al, 2014 ) and the ability to adjust behavior accordingly ( de Bruijn et al, 2006 ; Vega et al, 2013 ). The reduced LS bias in BPD observed in the current study could potentially indicate aberrant PE following negative outcomes, which may contribute to disadvantageous decision-making tendencies observed in BPD in other decision-making paradigms ( de Bruijn et al, 2006 ; Haaland and Landro, 2007 ; Schuermann et al, 2011 ; Vega et al, 2013 ), although future work is needed to support this hypothesis.…”

Altered psychophysiological correlates of risk‐taking in borderline personality disorder

“…Patients with BPD show altered abilities in effectively regulating affect and using affective information during the performance on tasks that simulate real‐life risk‐taking. For instance, they draw more cards from risky compared to safe decks on experimental gambling tasks (Haaland & Landro, ; Paret, Jennen‐Steinmetz, & Schmahl, ; Schuermann, Kathmann, Stiglmayr, Renneberg, & Endrass, ) and continue to draw cards from these decks even after losses, failing to adjust their behavior based on past experiences (Sánchez‐Navarro, Weller, López‐Navarro, Martínez‐Selva, & Bechara, ; Schuermann et al, ; Svaldi, Philipsen, & Matthies, ). Psychophysiological evidence also points to a reduced ability of patients with BPD to learn from feedback.…”

Meaning-Making Activity in the Emotional Experience of Borderline Personalities

“…Originally, something has value because it exists [34] 16 and manifests its "there-ness" for us as a necessity that converts the concreta to prominence, that is, into units acknowledged as wholes or general meanings (e.g., family). In BPD/EUPDs' affective lifeworld, the family, as a meaning, which has a very specific intersubjective and social function, has an intermittent existence for their interaffective world and its existential reality 17 . "You have never been there from me" is the typical sentence stemming from this value apprehension and its logic.…”

“…Some scholars believe that these aspects are due to large-scale cognitive deficits [14,15] that extend, at times, to affective decision-making processes. BPD/EUPDs, for example, tend to make significantly more disadvantageous decisions concerning delay-discounting tasks, wanting immediate rewards over long-term gain [16,17], discounting rewards that were less certain [17], or with problems that involve potential losses [18]. Laboratory studies showed how the high emotional reactivity is often characterized by shame [19], anger [20], and fear/anxiety [6] and accompanied by greater amygdala reactivity [21].…”

“…What Husserl would call (wertvoller Leistung)[35, p. 137-143]17 Daseinswert (existential value) is the term that Husserl uses to refer to the primordial "axiological functioning" (wertvoller leistungen)[35, p. 137-143] with which the primordial value of "being there" is brought to light 18. Normally, converting the concreta to prominence produces a Wertsein (being-value), a unit whose worth comes exactly from the fact that its concrete blurred components come into being as a perceivable prominent unit among other beings.…”