How childhood maltreatment alters perception and cognition – the predictive processing account of borderline personality disorder

Abstract

Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others – leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.

Individual Differences in Computational Psychiatry: A Review of Current Challenges

“…As Bayesian framework continues to be applied to theorize about increasingly more disorders (Schwartenbeck et al, 2015;Gu and Filbey, 2017;Paulus et al, 2019;Linson et al, 2020;Richards et al, 2020;McGovern et al, 2022;Herzog et al, 2022), with a view that each disorder can be understood in terms of a certain kind of maladaptive priors (Fig. 3), sufficient validation of assays for measuring such priors could save a lot of confusion down the line.…”

The effects of childhood maltreatment on cortical thickness and gray matter volume: a coordinate-based meta-analysis

“…Childhood maltreatment, which mainly includes physical, sexual and emotional abuse and neglect, is common worldwide with pediatric prevalence rates of 13-36% (Lim, Howells, Radua, & Rubia, 2020). These adverse early-life experiences involved bio-psycho-social mediators and moderators (Sideli et al, 2020), and have been suggested to be closely related with cognitive decline, attention impairment, emotional dysregulation, and reward anticipation disorder (Hart et al, 2018;Lim et al, 2016), and may even increase the risks of suffering from mental illness, such as posttraumatic stress disorder (PTSD) (Daniels, Lamke, Gaebler, Walter, and Scheel, 2013), major depressive disorder (MDD) (Goltermann et al 2022;Guo et al 2022;Haidl et al 2021), borderline personality disorder (Herzog, Kube, & Fassbinder, 2022), schizophrenia (Cancel, Dallel, Zine, El-Hage, & Fakra, 2019;D'Andrea et al, 2022;Sideli et al, 2020), substance abuse (Hughes et al, 2017), eating disorders (Cascino et al, 2022;Luo et al, 2020), as well as functional somatic and visceral pain syndromes (Chandan et al, 2020). Neurobiology changes of the brain might underlie the occurrence of the above symptoms.…”

“…2022; Haidl et al . 2021), borderline personality disorder (Herzog, Kube, & Fassbinder, 2022), schizophrenia (Cancel, Dallel, Zine, El-Hage, & Fakra, 2019; D'Andrea et al, 2022; Sideli et al, 2020), substance abuse (Hughes et al, 2017), eating disorders (Cascino et al, 2022; Luo et al, 2020), as well as functional somatic and visceral pain syndromes (Chandan et al, 2020). Neurobiology changes of the brain might underlie the occurrence of the above symptoms.…”

A psychometric evaluation of the Inventory of Altered Self-Capacities in a trauma-exposed university sample: A replication and extension.

“…Given the implication of childhood maltreatment in the development of self-other dysfunction (Herzog et al, 2022), we ran exploratory analyses with a subgroup of our sample that endorsed having experienced childhood maltreatment. Using Bernstein et al’s (1998) cutoff scores, we identified 357 individuals who reported at least “low to moderate” severity on the CTQ.…”