Blog

A recently published article by Dr Liana Romaniuk and colleagues investigated the neural correlates of fears of abandonment and rejection in borderline personality disorder.  In this guest blog, Liana explains what they discovered about borderline personality disorder and the importance of open data.

What is Borderline Personality Disorder?

Borderline, or emotionally unstable personality disorder is a remarkably common condition, affecting approximately 6% of the population. Although there’s evidence to suggest that it is partly heritable, it is arguably much more a product of our environment. Adverse early life experiences such as physical, emotional and sexual abuse skew what a child learns about his or her social world, and their own place within it. Instead of being able to draw from a secure foundation, they find themselves somewhat adrift. Relationships are simultaneously craved and feared, and the feeling of being abandoned can bring on an almost existential crisis.

People with BPD have fewer positive experiences of seeing themselves through the eyes of others, their own sense of self is disturbed and remote. Their emotions can feel opaque and overwhelming, and impulsive acts of self-harm (including suicide) are common.

There are no specific medications licenced for BPD. As it appears to be the result of the brain attempting to adapt to an initially hostile environment, our current best treatments are more psychological in nature, helping people unravel prior expectations, and nurture insight and better coping strategies. However, if we can gain a better understanding of precisely how the developing brain changes in response to hardship, we may be able to augment psychological therapy with tailored medications, and improve the lives of those who have limited access to psychological therapy.

What we did in our study

In our study, we recruited 20 people with BPD from the community, and 20 matched healthy controls. After undergoing clinical assessments, they performed the Cyberball social exclusion task – a computer ball game used to research ostracism, social exclusion, or rejection – while lying in an MRI scanner. During this, we manipulated the degree to which they were included or excluded during a ball-throwing game with 2 other players. From this we could establish how particularly brain regions responded to being left out, and how this related to their previous childhood experiences, and current symptom severity.

The importance of our findings

We found that people with BPD showed generally less responses within an area called the temporoparietal junction. This is known to be engaged when considering the beliefs and intentions of yourself and others.

When we looked specifically at how this varied according to how often the computer players included them in the game, we found that those who were physically neglected as children had particularly blunted responses, providing clues as to how this disorder develops. When we looked at the symptoms they were experiencing today, we found that those who feared being abandoned showed a diminished response to being socially included in the area known as the inferior frontal cortex. Again, this region is crucial for social evaluation and being able to imagine what others are thinking. It could be that this lack of brain sensitivity to actual social inclusion may drive their feelings of abandonment.

Finally, we examined how the brain’s reward centres responded to being socially included, and a similar pattern emerged: people with BPD appeared to be less sensitive, and the degree to which their reward centres failed to anticipate social inclusion, the more severe their sense of abandonment. As the reward centres make significant use of the neurotransmitters dopamine and serotonin, it may be that drugs enhancing these pathways are of benefit in people with BPD.

Making our data available of others

We made the functional and structural MRI data available through OpenfMRI. It was our pleasure to share the data with the community: allowing as many groups as possible to approach the data from different perspectives, with different questions, increases the likelihood of real progress being made. Having open access to quality, curated data allows scientists to pool people together, increasing the chances of finding a subtle effect. We can also have more confidence in our findings, as independent data can be used to replicate existing results, preventing us from going down false paths. It’s especially important for BPD, as there have been relatively few studies of this group of people, and the distress they experience is not matched by our understanding of the neurobiology of BPD. We, of course, also take all necessary steps to maintain participant confidentiality so that none of the data is identifiable to individuals.