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Borderline Personality Disorder and Learning: The Influences of Emotional State and Social versus Nonsocial Feedback

Abstract
Borderline personality disorder (BPD) has been linked to impulsive behaviors, interpersonal difficulties, and emotional reactivity. Although these impairments imply underlying deficits in decision-making, theory suggests that such deficits may be context dependent. Both emotional state and social context may influence learning in BPD. Reinforcement learning models offer an avenue to parse types of impairments in learning. The current study used reinforcement learning models to examine whether the type of feedback (social vs. nonsocial) moderates the association between BPD and learning under conditions of distress. Adults with BPD (N = 37), subthreshold BPD (N = 29), and without BPD (N = 65) completed a diagnostic interview and a computerized learning task after both neutral and negative emotion inductions. We examined learning outcomes, including accuracy, learning rate, and stochasticity. We used multilevel models to examine the associations between BPD criteria, feedback type, and emotional state on several different learning outcomes. We found that elevated BPD features were associated with greater negative emotion-related increases in the loss learning rate in the training phase and increases in the gain learning rate in the test phase. Further, social feedback was associated with more normalized learning rates for participants with BPD. We discuss possible interpretations of our learning rates, as research is mixed on the implications of higher and lower learning rates. Understanding the decision-making and learning deficits associated with BPD will further explain the impulsive and reckless behaviors associated with the disorder, as well as inform new methods to teach effective skills during treatment.
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