Atypical processing of social anticipation and feedback in borderline personality disorder

Background- Borderline personality disorder (BPD) is characterized by maladaptive social functioning, and widespread negativity biases. The neural underpinnings of these impairments remain elusive. We thus tested whether BPD patients show atypical neural activity when processing social (compared to non-social) anticipation, feedback, and particularly, how they relate to each other.
Methods- We acquired functional MRI data from 21 BPD women and 24 matched healthy controls (HCs) while they performed a task in which cues and feedbacks were either social (neutral faces for cues; happy or angry faces for positive and negative feedbacks, respectively) or non-social (dollar sign; winning or losing money for positive and negative feedbacks, respectively). This task allowed for the analysis of social anticipatory cues, performance-based feedback, and their interaction.
Results- Compared to HCs, BPD patients expressed increased activation in the superior temporal sulcus during the processing of social cues, consistent with elevated salience associated with an upcoming social event. BPD patients also showed reduced activation in the amygdala while processing evaluative social feedback. Importantly, perigenual anterior cingulate cortex (pgACC) activity during the presentation of the social cue correlated with reduced amygdala activity during the presentation of the negative social feedback in the BPD patients.
Conclusions- These neuroimaging results clarify how BPD patients express altered responses to different types of social stimuli (i.e. social anticipatory cues and evaluative feedback) and uncover an atypical relationship between frontolimbic regions (pgACC-amygdala) over the time span of a social interaction. These findings may help to explain why BPD patients suffer from pervasive difficulties adapting their behavior in the context of interpersonal relationships and should be considered while designing better-targeted interventions.

背景 - 边缘性人格障碍（BPD）以适应性不良的社会功能及普遍的消极性偏见为特征。这些障碍的神经基础仍难以捉摸。因此，本研究旨在探究BPD患者在处理社会（相对于非社会）预期、反馈，尤其是它们之间相互关系时，是否表现出非典型的神经活动。
方法 - 在受试者执行一项任务的过程中，我们获取了21名BPD女性和24名匹配的健康对照者（HCs）的功能磁共振成像（fMRI）数据。该任务中的线索和反馈要么是社会性的（线索为中性面孔；积极和消极反馈分别为快乐或愤怒的面孔），要么是非社会性的（线索为美元符号；积极和消极反馈分别为赢钱或输钱）。该任务允许分析社会预期线索、基于表现的反馈及其相互作用。
结果 - 与HCs相比，BPD患者在处理社会线索时，在颞上回（superior temporal sulcus）的激活程度增加，这与即将到来的社会事件的增强显著性一致。BPD患者在处理评价性社会反馈时，杏仁核的激活度降低。值得注意的是，在社会线索呈现期间的前扣带回皮层（pgACC）活动与BPD患者在呈现消极社会反馈时杏仁核活动减少相关。
结论 - 这些神经影像学结果阐明了BPD患者在面对不同类型的社会刺激（即社会预期线索和评价性反馈）时表现出的改变反应，并揭示了在社会互动过程中前额叶皮层与边缘叶区域（pgACC-杏仁核）之间异常的关系。这些发现有助于解释为什么BPD患者在与人际关系的背景下难以适应其行为，并在设计更具针对性的干预措施时应予以考虑。