Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder

Affective instability is a core dimension of borderline personality disorder. The somatic marker hypothesis suggests that emotions play a crucial role in decision making. In this preliminary study, decision making was assessed in individuals with borderline personality disorder. Patients with borderline personality disorder (n = 20) and healthy comparison subjects (n = 15) were tested with the Iowa Gambling Task (IGT). The patients showed less advantageous choices on the IGT than did the healthy comparison subjects. The results could not be explained by indicators of general cognitive function or by symptoms of depression. These findings demonstrate that deficits in decision making in borderline personality disorder may manifest themselves in an ecologically valid neuropsychological test. Future studies should address whether those deficits are related to the behavioral characteristics of affective dysregulation and/or impulsivity, to the proposed dysfunctions and reduced volume of the orbitofrontal cortex and/or the amygdala, and to other neuropsychological functions.