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Using Neuroimaging to Enhance Understanding of Rejection Distress in Borderline Personality Disorder

Borderline personality disorder (BPD) is a psychiatric diagnosis characterized by several interpersonal and emotional markers, including rejection distress (i.e., increased distress response to feelings of social exclusion). Along with his colleagues, Dr. Eric Fertuck aims to understand neural mechanisms associated with rejection distress in BPD. In a recent article https://www.sciencedirect.com/science/article/abs/pii/S2451902222003226, individuals labeled with BPD were compared to a control group on neural activity via fMRI during a rejection distress task. Rejection distress was implemented using the Cyberball task. This task requires individuals to participate in a virtual ball tossing game with two other players. Participants were led to believe two confederates were playing with them; however, the other players were computerized. To invoke feelings of social exclusion, this task begins by having the computerized players interact with the participant equally—meaning they toss the ball to the participant and the other computerized players in equal proportions. Then, as the task progresses, the computerized players exclude the study participant by tossing the ball to them less frequently, with participants only being tossed the ball 10% of the time in the highest exclusion trial. Examination of fMRI data found that people in both the BPD and control groups demonstrated similar neural responses to the rejection task and both groups evinced greater responses to the task as the rate of exclusion increased. Importantly, as rejection distress increased, participants in the BPD group, but not the control group, evinced decreased responsivity in the rostro-medial prefrontal cortex (rmPFC). The rmPFC is a region of the brain associated with autobiographical information with a particular focus on events referencing social relationships. Further, this region is implicated in the ability to process others’ mental states and behaviors, also known as mentalization. As such, Fertuck and colleagues hypothesize that individuals with BPD may have greater difficulty processing others’ social behaviors when they are experiencing periods of exclusion, resulting it heightened rejection distress. In addition to undergoing fMRI, participants completed a rejection distress questionnaire and a trait rejection sensitivity questionnaire. Results found that participants with BPD endorsed greater rejection distress following the Cyberball task compared to the control group. Further, higher scores on the trait rejection expectation questionnaire were associated with greater modulations of rmPFC activity. Findings of this work suggest that difficulties in upregulating rmPFC activity could partially explain increased rejection distress among people with a BPD diagnosis from a mentalization theory framework.

Dr. Fertuck is an associate professor of psychology at The City College of New York and Director of the Social Neuroscience and Psychopathology Lab (SNAP), where he and his collaborators seek to understand facets of borderline personality disorder from an interdisciplinary perspective. Dr. Fertuck will be giving a presentation as part of the TRACC seminar series on February 9, 2023.

Source: Fertuck, E. A., Stanley, B., Kleshchova, O., Mann, J. J., Hirsch, J., Ochsner, K., … & Grinband, J. (2022, in press). Rejection distress suppresses medial prefrontal cortex in borderline personality disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. Advance Online Publication. https://doi.org/10.1016/j.bpsc.2022.11.006

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