Outcome Uncertainty and Brain Activity Aberrance in the Insula and Anterior Cingulate Cortex Are Associated with Dysfunctional Impulsivity in Borderline Personality Disorder

Abstract

Uncertainty is recognized as an important component in distress, which may elicit impulsive behavior in patients with borderline personality disorder (BPD). These patients are known to be both impulsive and distress intolerant. The present study explored the connection between outcome uncertainty and impulsivity in BPD. The prediction was that cue primes, which provide incomplete information of subsequent target stimuli, led BPD patients to overrate the predictive value of these cues in order to reduce distress related to outcome uncertainty. This would yield dysfunctional impulsive behavior detected as commission errors to incorrectly primed targets. We hypothesized that dysfunctional impulsivity would be accompanied by aberrant brain activity in the right insula and anterior cingulate cortex (ACC), previously described to be involved in uncertainty processing, attention-/cognitive control and BPD pathology. 14 female BPD patients and 14 healthy matched controls (HCs) for comparison completed a Posner task during fMRI at 3T. The task was modified to limit the effect of spatial orientation and enhance the effect of conscious expectations. Brain activity was monitored in the priming phase where the effects of cue primes and neutral primes were compared. As predicted, the BPD group made significantly more commission errors to incorrectly primed targets than HCs. Also, the patients had faster reaction times to correctly primed targets relative to targets preceded by neutral primes. The BPD group had decreased activity in the right mid insula and increased activity in bilateral dorsal ACC during cue primes. The results indicate that strong expectations induced by cue primes led to reduced uncertainty, increased response readiness, and ultimately, dysfunctional impulsivity in BPD patients. We suggest that outcome uncertainty may be an important component in distress related impulsivity in BPD.

The Degree of Modulation of Beta Band Activity During Motor Planning Is Related to Trait Impulsivity

“…Indeed, several studies have shown that self-reported measures of the impulsivity personality trait are associated with “commission errors” in stop-signal, go/no-go, Stroop, and other tasks that require the inhibition of a preponderant response (Enticott et al, 2006; Lansbergen et al, 2007; Saunders et al, 2008; Burle et al, 2016). However, there is also evidence that impulsivity affects action planning in general, that is, not only when a preponderant response ought to be inhibited, both in health (Tzagarakis et al, 2013; Rossi et al, 2018) and in disease (Clark et al, 2006; Kertzman et al, 2010; Mortensen et al, 2016).…”

Impulse control under emotion processing: an fMRI investigation in borderline personality disorder compared to non-patients and cluster-C personality disorder patients

“…Additional evidence is provided by previous fMRI studies using attention tasks, i.e. an emotional Stroop task (Wingenfeld et al 2009) and a Posner task (Mortensen et al 2016), in which BPD patients showed altered attentional control networks (e.g. dACC) compared to NPC.…”

Borderline Personality Disorder With Cocaine Dependence: Impulsivity, Emotional Dysregulation and Amygdala Functional Connectivity

“…The functional connectivity was negatively correlated with emotional dysregulation and impulsivity scores, especially with non-planned impulsivity, which relates to self-control and cognitive complexity ( 55 ). The insula has been linked to emotion regulation ( 56 ) and impulsivity ( 57 , 58 ), and is a key component of the salience network which is activated in sensory stimulus-guided goal-directed behaviors ( 59 ). In BPD patients, insula function has been related to emotional processing of pain ( 60 ).…”