Abstract
Background
Borderline personality disorder (BPD) is characterized by an elevated distress response
to social exclusion (i.e., rejection distress), whose neural mechanisms remain unclear.
fMRI studies of social exclusion have relied on the classic version of the Cyberball
task, which is not optimized for fMRI. Our goal was to clarify the neural substrates
of rejection distress in BPD using a modified version of Cyberball, which allowed
us to dissociate the neural response to exclusion events from its modulation by exclusionary
context.
Methods
Twenty-three women with BPD and 22 healthy controls completed a novel fMRI modification
of Cyberball with five runs of varying exclusion probability and rated their rejection
distress after each run. We tested group differences in the whole-brain response to
exclusion events and in the parametric modulation of that response by rejection distress
using mass univariate analysis.
Results
Although rejection distress was higher in participants with BPD, F(1,40)=5.25, p=0.027, η2=0.12, both groups showed similar neural responses to exclusion events. However, as
rejection distress increased, the rostro-medial prefrontal cortex (rmPFC) response
to exclusion events decreased in the BPD group but not in controls. Stronger modulation
of the rmPFC response by rejection distress was associated with higher trait rejection
expectation, r=-0.30, p=0.050.
Conclusions
Heightened rejection distress in BPD might stem from a failure to maintain or upregulate
the activity of the rmPFC, a key node of the mentalization network. Inverse coupling
between rejection distress and mentalization-related brain activity might contribute
to heightened rejection expectation in BPD.
Keywords
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Article info
Publication history
Accepted:
November 17,
2022
Received in revised form:
October 25,
2022
Received:
July 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
