Social feedback and emotion regulation in borderline personality disorder

Oversensitivity to social signals of potential rejection, fragile self-esteem,
and durable preoccupations about the negative self-images are the clinical
characteristics of borderline personality disorder (BPD). Yet, few studies have
been conducted to clarify the potential socio-cognitive mechanisms and neural
underpinnings associated with this *fragile self*. The goal of this study is to
examine two mechanisms which may contribute to the dysregulation of state
self-esteem provoked by interpersonal acceptance/rejection in borderline
pathology. Our first hypothesis is that the feelings and perception of oneself
in individuals with BPD may be more vulnerable to social feedback. This may be
related to an enhanced self-referential processing during negative social
feedback. Second, we hypothesize that, once the negative self-referential
thought is activated, individuals with BPD may have difficulties to
deliberately regulate these negative thoughts by shifting to mood-incongruent
cognitions, such as engaging into positive self-imaginations.

Primary Objective: Using task fMRI to assess differences in the brain
activation during evaluative social feedback and script-driven emotional
imagination between participants with BPD and healthy controls.
Moment-to-moment self-esteem and mood states will be assessed to investigate
whether a decline in the moment-to-moment and global state self-esteem is
directly associated with changes in brain activation patterns in BPD patients
in brain regions associated with social rejection (bilateral anterior insula
and dorsal ACC) and with self-referential thoughts (mPFC).
Secondary objective: Using resting-state fMRI to assess brain functional
connectivity networks. In particular, we focus upon the changes in functional
connectivity networks between baseline and after evaluative social feedback,
which will be compared between the two groups.

A case-control design (patients with BPD versus healthy controls).

Participants will have to lie inside an MRI scanner, which may be of some
discomfort because of the loud scanner noise and being asked to move as little
as possible. Negative evaluative feedback may lower the state self-esteem after
the task, though neutral, negative, and positive feedback will be given
equally. However, the reduced self-esteem will be temporary and within the
tolerable range as more than 100 studies have applied this method to examine
the effect of social feedback. Moreover, a mood boost task by promoting
positive imagination is added to counteract the potential negative mood states.