Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder

Area of Science:

• Neuroscience
• Psychiatry
• Psychology

Background:

• Borderline personality disorder (BPD) is marked by increased distress from social exclusion.
• Neural mechanisms underlying this rejection distress in BPD are not well understood.
• Previous functional magnetic resonance imaging (fMRI) studies used a Cyberball task not optimized for fMRI.

Purpose of the Study:

• To investigate the neural substrates of rejection distress in BPD using an fMRI-optimized Cyberball task.
• To differentiate neural responses to exclusion events from their modulation by exclusionary context in BPD.

Main Methods:

• Twenty-three women with BPD and 22 healthy controls underwent fMRI using a modified Cyberball task.
• Participants rated rejection distress after each of five runs with varying exclusion probabilities.
• Mass univariate analysis examined group differences in brain responses to exclusion and distress modulation.

Main Results:

• Participants with BPD reported higher rejection distress than controls.
• Both groups showed similar neural responses to exclusion events.
• In BPD, increased rejection distress correlated with decreased rostromedial prefrontal cortex (rmPFC) activity during exclusion.

Conclusions:

• Heightened rejection distress in BPD may involve impaired rmPFC regulation within the mentalization network.
• A potential failure to upregulate rmPFC activity during social exclusion could contribute to BPD symptoms.
• Inverse coupling between rejection distress and mentalization-related brain activity may underlie heightened rejection expectations in BPD.