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Science 8 August 2008:
Vol. 321. no. 5890, pp. 806 - 810
DOI: 10.1126/science.1156902
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Research Articles

The Rupture and Repair of Cooperation in Borderline Personality Disorder

Brooks King-Casas,1,2 Carla Sharp,2 Laura Lomax-Bream,2 Terry Lohrenz,1 Peter Fonagy,2,3,4 P. Read Montague1,2*

To sustain or repair cooperation during a social exchange, adaptive creatures must understand social gestures and the consequences when shared expectations about fair exchange are violated by accident or intent. We recruited 55 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game with healthy partners. Behaviorally, individuals with BPD showed a profound incapacity to maintain cooperation, and were impaired in their ability to repair broken cooperation on the basis of a quantitative measure of coaxing. Neurally, activity in the anterior insula, a region known to respond to norm violations across affective, interoceptive, economic, and social dimensions, strongly differentiated healthy participants from individuals with BPD. Healthy subjects showed a strong linear relation between anterior insula response and both magnitude of monetary offer received from their partner (input) and the amount of money repaid to their partner (output). In stark contrast, activity in the anterior insula of BPD participants was related only to the magnitude of repayment sent back to their partner (output), not to the magnitude of offers received (input). These neural and behavioral data suggest that norms used in perception of social gestures are pathologically perturbed or missing altogether among individuals with BPD. This game-theoretic approach to psychopathology may open doors to new ways of characterizing and studying a range of mental illnesses.

1 Computational Psychiatry Unit and Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
2 Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
3 Research Department of Clinical, Educational, and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK.
4 Anna Freud Centre, London NW3 5SD, UK.

* To whom correspondence should be addressed. E-mail: rmontague{at}hnl.bcm.edu

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
Borderline Personality Disorder: Ontogeny of a Diagnosis.
J. G. Gunderson (2009)
Am J Psychiatry 166, 530-539
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What motivates repayment? Neural correlates of reciprocity in the Trust Game.
W. van den Bos, E. van Dijk, M. Westenberg, S. A.R.B. Rombouts, and E. A. Crone (2009)
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Toward a Clinically More Useful Model for Diagnosing Narcissistic Personality Disorder.
J. Kay (2008)
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Experiencing Physical Warmth Promotes Interpersonal Warmth.
L. E. Williams and J. A. Bargh (2008)
Science 322, 606-607
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Borderline Personality Disorder and Broken Cooperation.
(2008)
Journal Watch Psychiatry 2008, 4
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Science. ISSN 0036-8075 (print), 1095-9203 (online)