Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury
Borderline Personality Disorder (BPD) is a disabling and difficult-to-treat mental disease. One of its core features is a significant difficulty in affect regulation, which is often accompanied by Non-Suicidal Self-Injury (NSSI). It is suggested that this type of behavior elicits positive emotions and mitigates emotional distress, and therefore can ultimately be reinforced and promoted. In spite of the high prevalence of NSSI behaviors (also in non-BPD samples), their role in modulating reward-related processes has not yet been investigated in BPD patients. In the present study, this lack of research was addressed. A large sample of BPD patients (N = 40), divided into two groups depending on the presence of NSSI, and a group of matched healthy controls underwent functional Magnetic Resonance Imaging (fMRI) while performing a gambling task. Patients who committed NSSI acts exhibited enhanced activation of the orbitofrontal cortex following an unexpected reward, when compared with controls and BPD patients with no NSSI behavior. In addition, the NSSI group showed diminished functional connectivity between the left orbitofrontal cortex and the right parahippocampal gyrus. These findings might suggest impaired ability to update reward associations of potential choices when both BPD and NSSI are present. We propose that the presence of NSSI involves alterations in the reward system independently of BPD, and thus can be considered as a possible phenotype for reward-related alterations.
KeywordsBorderline personality disorder Non-suicidal self-injury Reward Neuroimaging Functional connectivity Gambling
Compliance with ethical standards
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study had been approved by the ethics committee of the Hospital de Bellvitge.
This research was funded by the “Fundació La Marató de TV3” (2009–092410), the Spanish Ministry of Science to JMP (PSI2012–37472) and ARF (PSI2011–29219), and Catalan Government to ARF (2009 SGR 93). PR was supported by a FPU grant (AP2010–4179). This work was also supported by the Catalan Government (2009SGR211) and two Miguel Servet Research Contracts (CP07/00048 to RS and CP10/00596 to EP-C) from the Plan Nacional de I + D + I, and was co-funded by the Instituto de Salud Carlos III-Subdirección General de Evaluación y Fomento de la Investigación and the European Regional Development Fund (FEDER). The funders had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
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