BPD and Game Theory: Brain Differences Related to Disruptions in Cooperation in Relationships

Hello Dear Readers! You may have noticed my absence the past  couple days. We had a major snow storm here in NY (and all of the North East/New England area) which knocked out my internet. Quick Rant: New Yorkers around the NYC and LI areas cannot drive in the snow. At all. I’m from the Midwest originally. What they’re calling a freak blizzard here, we just call winter. But enough about that. I’m back now!

While researching, as I am wont to do, I came across this little gem. I’m posting this because 1. I disagree, but 2. This research was from 4.5-5 years ago, and I think it demonstrates just how far research in Borderline Personality has come in just 5 years.

Borderline Personality Disorder: Brain Differences Related to Disruptions in Cooperation in Relationships

Science Update • August 12, 2008

Brain activity during investment game

Different patterns of brain activity in people with borderline personality disorder were associated with disruptions in the ability to recognize social norms or modify behaviors that likely result in distrust and broken relationships, according to an NIMH-funded study published online in the August 8, 2008 issue of Science.

Borderline personality disorder is a serious mental illness noted by unstable moods, behavior and relationships. Each year, 1.4 percent of adults in the United States have this disorder, which is widely viewed as being difficult to treat.

Using brain imaging and game theory, a mathematical approach to studying social interactions, the researchers offer a potential new way to define and describe this mental illness. They conclude that people with borderline personality disorder either have a distorted sense of generally accepted social norms, or that they may not sense these norms at all. This may lead them to behave in a way that disrupts trust and cooperation with others. By not responding in a way that would repair the relationship, people with borderline personality disorder also impair the ability of others to cooperate with them.

A generally distorted sense of social norms? I’m going to start by saying that this study was entered into with a conservative bias that believed social norms means absolutely anything at all. Social norms, are a median view of cultural living. Culture which, in this country, varies IMMENSELY between geographic areas, political views, religious views, personal values, ethnic backgrounds, etc. The idea of a social “norm” is meaningless. Furthermore, social revolution and progress is defined by going against the norm. I realize this isn’t what they’re referring to here, but it means something to me. I have zero sense of needing to conform to social “norms” when and where they don’t suit me. This is probably more a result of being raised in a liberally politically active household than my Borderline Personality Disorder though. Social norms are mean to be progressed beyond. < ~~~ My slogan for the day. For instance, Mental Health issues are generally hushed, stigmatized, and not talked about… personally? I’d rather increase my voice, speak out, and raise awareness.   Social norms my ass. 

          

Brooks King-Casas, Ph.D., Baylor College of Medicine, and colleagues evaluated cooperation among pairs of participants playing an investment game. Each pair comprised a healthy “investor” and a “trustee,” who was either another healthy participant or a person with borderline personality disorder. In total, 55 people with borderline personality disorder participated. An additional 38 healthy trustees paired with healthy investors served as a control group. The investors and trustees interacted through linked computers, but did not meet or speak with each other at any point.

In each 10-round game, the investor started every round with 20 “dollars” and could invest any amount between 0–20. Clicking a button to send the investment offer automatically tripled the amount, at which point the trustee decided how much to return. If the amount returned was less than the amount invested, the investor was likely to offer smaller amounts in future rounds, signaling a breakdown in trust and cooperation in the relationship. Trustees could try to “coax” their investor partner by returning a large portion of the tripled investment, even when the offer was low—for example, returning all 15 dollars on a 5-dollar offer. Ultimately, coaxing resulted in generous payoffs in later rounds.

Compared with the control group, trust and cooperation faltered over time in pairs that included a person with borderline personality disorder. People with the illness tended to behave in ways that caused a breakdown in cooperation with their healthy partners. Moreover, they were half as likely as healthy trustees to try to repair the relationship through coaxing.

Because, yanno, people with a history of abuse and trauma would totally be likely to trust random, faceless, strangers, whom we have zero idea if they have our best interest in mind. Is this really a BPD problem or a “healthy” person problem?  Who in their right mind trusts someone with zero knowledge of their background or intent? What they call a breakdown in trust, I call common sense for my investment.

To determine whether a neural basis exists for this behavior, the researchers analyzed brain activity in the bilateral anterior insula. In addition to other functions, this region responds when we sense unfairness or violations of social norms.

In healthy participants, insula activity increased as offers or returned amounts decreased. For example, healthy trustees had high levels of activity if they received low offers from the investor or if they returned low amounts to the investor. If the offer or return was high, insula activity was relatively low. By comparison, in participants with borderline personality disorder, insula activity increased only in response to low amounts they sent back to the investor; insula activity remained at an average level regardless of the amount offered to them by investors.

This should come as no surprise. As I recently discussed in my Attachment Disorder studies, it was discovered that people with BPD tend to react significantly to negative experiences, but do not have a correspondingly intense reaction to positive experience. Where negative situations are experienced there is a heightened negative response. Where a positive situation is experienced, there’s almost no reaction change or response. That’s what we know now, however the conclusion of this study is….

The findings suggest that either people with borderline personality disorder are not persuaded by rewards of money in the same ways as healthy people, or that they do not regard low investment offers as a violation of social norms.

It does appear true that we are not persuaded by rewards as “healthy” people are. However, regarding low investment as a violation of social norm has nothing to do with anything. Social norms have nothing to do with our issues. The issue is a matter of attachment and heightened sensitivity to negative situations.

The researchers also found that people with borderline personality disorder reported lower levels of trust in general, compared with healthy participants. In other words, untrustworthy behavior by the investors would not be seen as a violation of social norms because the participants with borderline personality disorder had less trust in their partners to begin with.

Lower levels of trust in general. Shocking!?! People with Borderline Personality Disorder often have a history of trauma and abuse. We’re hypersensitive to the potential for future trauma and abuse and come complete with a built in developmental defense mechanisms to protect us from such. This isn’t a matter of not registering the violation of social norms. It’s a matter of self-preservation. 

Using concepts from game theory, this study offers a new way of studying and understanding interpersonal relationships and mental illnesses that impair social interactions.

My conclusion: Using game theory to study Borderline Personality Disorder makes zero sense. We do not typically act in socially predictable ways, and in the end we will always act for self-preservation…. In situations where we are dealing with complete strangers that we could have no chance of developing any kind of trusting relationship with. Who trusts a complete stranger? The whole premise is flawed if you ask me.

In addition to NIMH, the researchers also received funding from the Child and Family Program at the Menninger Clinic, National Institute of Neurological Disorders and Stroke (NINDS), and National Institute on Drug Abuse (NIDA).

Left: In healthy participants, brain imaging scans show activity in the bilateral anterior insula in response to the amount of offers in an investment-style game. The graph shows an inverse relationship between insula activity and investment amount—high levels of activity in response to low offers, perceived by this brain region as unfair; decreasing response as the investment offer increases.

Right: In participants with borderline personality disorder, activity in the bilateral anterior insula does not have a direct relationship with investment amounts.

Probably because we don’t trust strangers and don’t expect anything good to begin with so high or low the investment amounts don’t mean much. It’s been my experience that I need an emotional investment in something for it really get to me. Relationships, being on time, performing well at work… these things might get a response from me. Pretend investments depending on trust between myself and a complete stranger? Not so much. I think the whole premise is flawed. Game theory doesn’t work for us. Our personal investment and emotional history in the other person determines how we interact with them. If there’s no personal investment, there’s not much of a game.  

References

King-Casas B, Sharp C, Lomax-Bream L, Lohrenz T, Fonagy P, Montague PR. The Rupture and Repair of Cooperation in Borderline Personality Disorder. Science. 2008 Aug 8;321(5890):806-10.

1 Lenzenweger MF, Lane MC, Loranger AW, Kessler RC.DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15;62(6):553-64.

So why did I go through all of this if I’m just going to argue with the whole thing? Well, besides the fact that I just like to argue, I think it’s interesting on many levels that have very little to do with the subject of the research.

It shows how little was understood about BPD even just a few years ago. It also gives a glimpse into where some of the social stigma comes from. It was assumed that people with BPD had a disregard for social norms to explain why we were so “difficult”. Which contributes to the idea that perhaps we’re just not trying hard enough to “be normal” making our BPD our own fault. Which we now know is a different case entirely.

Just 5 years ago, researchers were looking at Borderline Personality Disorder from a perspective of social norms. Studies like this that measure neurological responses began to note the biological differences in neuro-functioning of the BPD brain.  I’m not sure if this was one of the first studies to do neuro-imaging for Borderline Personality Disorder or not, but the more imaging that was done, the more apparent it became that our brain functioning was different.

This article demonstrates just how far research has come in a handful of years. That, I find heartening. The material in this particular article may be outdated and a little ludicrous, but it was accepted at the time. Now, we know that this is outdated research and where potential issues actually lie. Comprehensive and accurate research is progressing by leaps and bounds. Accurate research leads to more accurate diagnosis, treatment, and healing.

Personally I think it’s neat to see how much progress is being made and that signs point towards better understanding and greater hope for healing.