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Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder

Published online by Cambridge University Press:  18 May 2007

VEGARD ØKSENDAL HAALAND
Affiliation:
Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
NILS INGE LANDRØ
Affiliation:
Department of Psychology, University of Oslo, Oslo, Norway

Abstract

Affective instability is a core dimension of borderline personality disorder. The somatic marker hypothesis suggests that emotions play a crucial role in decision making. In this preliminary study, decision making was assessed in individuals with borderline personality disorder. Patients with borderline personality disorder (n = 20) and healthy comparison subjects (n = 15) were tested with the Iowa Gambling Task (IGT). The patients showed less advantageous choices on the IGT than did the healthy comparison subjects. The results could not be explained by indicators of general cognitive function or by symptoms of depression. These findings demonstrate that deficits in decision making in borderline personality disorder may manifest themselves in an ecologically valid neuropsychological test. Future studies should address whether those deficits are related to the behavioral characteristics of affective dysregulation and/or impulsivity, to the proposed dysfunctions and reduced volume of the orbitofrontal cortex and/or the amygdala, and to other neuropsychological functions. (JINS, 2007, 13, 699–703.)

Type
BRIEF COMMUNICATION
Copyright
© 2007 The International Neuropsychological Society

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References

REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th, text revision. ed.). Washington, DC: American Psychiatric Association.
Bazanis, E., Rogers, R.D., Dowson, J.H., Taylor, P., Meux, C., Staley, C., Nevinson Andrews, D., Taylor, C., Robbins, T.W., & Sahakian, B.J. (2002). Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychological Medicine, 32, 13951405.Google Scholar
Bechara, A. (2003). Risky business: Emotion, decision-making, and addiction. Journal of Gambling Studies, 19, 2351.Google Scholar
Bechara, A., Damasio, A.R., Damasio, H., & Anderson, S.W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 715.Google Scholar
Bechara, A., Damasio, H., Damasio, A.R., & Lee, G.P. (1999). Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. Journal of Neuroscience, 19, 54735481.Google Scholar
Berlin, H.A., Rolls, E.T., & Iversen, S.D. (2005). Borderline personality disorder, impulsivity, and the orbitofrontal cortex. American Journal of Psychiatry, 162, 23602373.Google Scholar
Boeka, A.G. & Lokken, K.L. (2006). The Iowa Gambling Task as a measure of decision making in women with bulimia nervosa. Journal of the International Neuropsychological Society, 12, 741745.Google Scholar
Damasio, A.R. (1996). The somatic marker hypothesis and the possible functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 351, 14131420.Google Scholar
Donegan, N.H., Sanislow, C.A., Blumberg, H.P., Fulbright, R.K., Lacadie, C., Skudlarski, P., Gore, J.C., Olson, I.R., McGlashan, T.H., & Wexler, B.E. (2003). Amygdala hyperreactivity in borderline personality disorder: Implications for emotional dysregulation. Biological Psychiatry, 54, 12841293.Google Scholar
Fellows, L.K. & Farah, M.J. (2005). Different underlying impairments in decision-making following ventromedial and dorsolateral frontal lobe damage in humans. Cerebral Cortex, 15, 5863.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (1997a). Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press, Inc.
First, M.B., Spitzer, R.L., Gibbon, M., & Williams, J.B.W. (1997b). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278296.Google Scholar
Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R., Castelnau, D., Malafosse, A., & Courtet, P. (2005). Impaired decision making in suicide attempters. American Journal of Psychiatry, 162, 304310.Google Scholar
Lenzenweger, M.F., Clarkin, J.F., Fertuck, E.A., & Kernberg, O.F. (2004). Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: A preliminary study. Journal of Personality Disorders, 18, 421438.Google Scholar
Linehan, M.M. (1996). Dialektisch-behaviorale Therapie der Borderline-Persönlichkeitsstörung. München, Germany: CIP-Medien.
Manes, F., Sahakian, B., Clark, L., Rogers, R., Antoun, N., Aitken, M., & Robbins, T. (2002). Decision-making processes following damage to the prefrontal cortex. Brain, 125, 624639.Google Scholar
Must, A., Szabó, Z., Bódi, N., Szász, A., Janka, Z., & Kéri, S. (2006). Sensitivity to reward and punishment and the prefrontal cortex in major depression. Journal of Affective Disorders, 90, 209215.Google Scholar
Skodol, A.E., Gunderson, J.G., Pfohl, B., Widiger, T.A., Livesley, W.J., & Siever, L.J. (2002). The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biological Psychiatry, 51, 936950.Google Scholar
Soloff, P.H., Meltzer, C.C., Becker, C., Greer, P.J., Kelly, T.M., & Constantine, D. (2003). Impulsivity and prefrontal hypometabolism in borderline personality disorder. Psychiatry Research, 123, 153163.Google Scholar
Tebartz van Elst, L., Hesslinger, B., Thiel, T., Geiger, E., Haegele, K., Lemieux, L., Lieb, K., Bohus, M., Hennig, J., & Ebert, D. (2003). Frontolimbic brain abnormalities in patients with borderline personality disorder: A volumetric magnetic resonance imaging study. Biological Psychiatry, 54, 163171.Google Scholar
Wechsler, D., Nyman, H., & Nordvik, H. (2003). WAIS-III: Wechsler Adult Intelligence Scale: Manual (Norwegian edition) (3rd ed.). Stockholm: Psykologiförlaget.