title: Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury.
abstract: Borderline Personality Disorder (BPD) is a disabling and difficult-to-treat mental disease. One of its core features is a significant difficulty in affect regulation, which is often accompanied by Non-Suicidal Self-Injury (NSSI). It is suggested that this type of behavior elicits positive emotions and mitigates emotional distress, and therefore can ultimately be reinforced and promoted. In spite of the high prevalence of NSSI behaviors (also in non-BPD samples), their role in modulating reward-related processes has not yet been investigated in BPD patients. In the present study, this lack of research was addressed. A large sample of BPD patients (N = 40), divided into two groups depending on the presence of NSSI, and a group of matched healthy controls underwent functional Magnetic Resonance Imaging (fMRI) while performing a gambling task. Patients who committed NSSI acts exhibited enhanced activation of the orbitofrontal cortex following an unexpected reward, when compared with controls and BPD patients with no NSSI behavior. In addition, the NSSI group showed diminished functional connectivity between the left orbitofrontal cortex and the right parahippocampal gyrus. These findings might suggest impaired ability to update reward associations of potential choices when both BPD and NSSI are present. We propose that the presence of NSSI involves alterations in the reward system independently of BPD, and thus can be considered as a possible phenotype for reward-related alterations.
authors.affiliation: Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain.|Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.|Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute- IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vega
authors.affiliation: Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute- IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain.|Department of Cognition, Development and Educational Psychology, Campus Bellvitge, University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ripollés
authors.affiliation: Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain.
authors.forename: Àngel
authors.initials: À
authors.lastname: Soto
authors.affiliation: Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Torrubia
authors.affiliation: Servei de Psiquiatria i Salut Mental, Hospital d'Igualada (Consorci Sanitari de l'Anoia) Igualada, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Ribas
authors.affiliation: Corporación Sanitaria Parc Taulí, Servicio de Salud Mental, Sabadell, Barcelona, Spain.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Monreal
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.|Department of Psychiatry, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pascual
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.|FIDMAG, Germanes Hospitalaries, Barcelona, Spain.
authors.forename: Raymond
authors.initials: R
authors.lastname: Salvador
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.|FIDMAG, Germanes Hospitalaries, Barcelona, Spain.
authors.forename: Edith
authors.initials: E
authors.lastname: Pomarol-Clotet
authors.affiliation: Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute- IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain.|Department of Cognition, Development and Educational Psychology, Campus Bellvitge, University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.|Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Rodríguez-Fornells
authors.affiliation: Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute- IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain. josepmarco@gmail.com.|Department of Cognition, Development and Educational Psychology, Campus Bellvitge, University of Barcelona, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. josepmarco@gmail.com.
authors.forename: Josep
authors.initials: J
authors.lastname: Marco-Pallarés
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D005260:Female; D005715:Gambling / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012201:Reward; D016728:Self-Injurious Behavior / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult
keywords: Borderline personality disorder; Functional connectivity; Gambling; Neuroimaging; Non-suicidal self-injury; Reward