Neural Correlates of Social Exclusion and Childhood Trauma in Borderline Personality Disorder

Introduction Borderline personality disorder (BPD) is a cluster B personality disorder that is characterized by altered perceptions of self-image, affect, and behavioral difficulties, especially a fear of being abandoned or rejected. Individuals with BPD engage in impulsive behaviors such as substance abuse, risky sexual behavior, self-harm, excessive spending, or binge eating. Beyond the individual level, BPD has a damaging effect on the integrity and safety of societies. Subjects with borderline personality disorder have various types of traumatic childhood experiences and social exclusion. Evaluating neural substrates of social exclusion and childhood trauma in BPD using functional magnetic resonance imaging (fMRI) can be a reliable approach to assess the regions of the brain that are affected in response to social exclusion and childhood maltreatment. Methods The study used secondary data obtained from OpenNeuro. In this study, fMRI was used to acquire task-based blood-oxygen-level-dependent (BOLD) signals in the participants' brains while they performed the Cyberball social exclusion task. Subjects were playing a virtual game of tossing with two other players. We conducted the fMRI analysis to compare voxel-wise activations in response to social exclusion while experimentally manipulating the percentages of participation (0%, 33%, 66%, and 100%) in the game with 20 patients with BPD and 16 age- and sex-matched controls. The study was aimed at determining the neural correlates of social exclusion and childhood trauma in individuals with BPD. Results The fMRI analysis revealed higher signalchanges in areas including anterior insula (AIns), middle frontal gyrus (MFG),cuneus (Cun), posterior orbital gyrus (POrG), medial orbital gyrus (MOrG),inferior temporal gyrus (ITG), fusiform gyrus (FuG), and postcentral gyrus(PoG) related to the effect of childhood trauma. Further analysis for neuralunderpinnings of the expression of social exclusion in individuals with BPDdetected areas including AIns, superior frontal gyrus (SFG), MFG, precentralgyrus (PrG), supramarginal gyrus (SMG), superior parietal lobule (SPL),inferior occipital gyrus (IOG), FuG, lingual gyrus (LiG), calcarine cortex(Calc), and Cun. Conclusion Our voxel-based analysis of the neural underpinnings of social exclusion expression detected larger signal changes for exclusion compared to inclusion in voxels involved in emotional regulation, suggesting an increased sensitivity to exclusion or a lower level of inclusion, possibly explained by the anticipation of abandonment in individuals with BPD. Hence, individuals with BPD may exhibit readiness to perceive and overreact to social abandonment, affecting their social and psychological adjustments.