Bajzát Bettina, Soltész Péter, Soltész-Várhelyi Klára, Lévay Evelyn Erika, Unoka Zsolt Szabolcs
Department of Psychiatry and Psychotherapy, Faculty of General Medicine, Semmelweis University, Budapest, Hungary.
Department of General Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Hungary.
Front Psychol. 2023 Aug 4;14:1109238. doi: 10.3389/fpsyg.2023.1109238. eCollection 2023.
Borderline personality disorder (BPD) is a complex mental disorder with core symptoms like interpersonal instability, emotion dysregulation, self-harm, and impulsive decision-making. Previous neuropsychological studies have found impairment in the decision-making of patients with BPD related to impulsivity. In our study, we focus on a better, more nuanced understanding of impulsive decision-making in BPD with the help of Rogers' decision-making test that simulates a gambling situation.
A novelty of our study is that we excluded from further analysis non-compliant participants based on their performance. Outlier participants on the measures proportion of good choices and average of wager choice number were filtered out to represent the population that understood the basic premise of the task and showed minimal motivation to gain rewards. Thus participants often choosing the less likely color or frequently choosing the first bet amount available (to probably speed up the test) were omitted from further analysis. Another novelty is that we assessed and reported six variables that examine Deliberation Time, Quality of Decision, Risk-taking, Overall proportion bet, Delay aversion, and Risk adjustment. Forty-three women with BPD participated in the study, and 16 non-compliant were excluded. As for the healthy control group, 42 women participated in the study, and four non-compliant were excluded. Thus, we compared the data of 27 patients with BPD with 38 healthy controls.
Our results show that there are significant differences amongst the groups regarding the Quality of Decision Making ( (1,63) = 5.801, = 0.019) and Risk Adjustment ( (1,63) = 6.522, = 0.013). We also found significant interactions between group and winning probability regarding Risk Taking ( (4,252) = 4.765 = 0.001) and Overall proportion of bets, i.e., the average proportion of bets relative to the total score of the subject ( (4,252) = 4.505, = 0.002).
Our results show that the two groups use different decision-making strategies that can have various associations with everyday life situations.
边缘型人格障碍（BPD）是一种复杂的精神障碍，具有人际不稳定、情绪调节障碍、自我伤害和冲动决策等核心症状。以往的神经心理学研究发现，BPD患者的决策与冲动性有关，存在受损情况。在我们的研究中，我们借助模拟赌博情境的罗杰斯决策测试，致力于更深入、更细致地理解BPD中的冲动决策。
我们研究的一个新颖之处在于，根据参与者的表现将不符合要求的参与者排除在进一步分析之外。筛选出在好选择比例和下注选择数量平均值测量中表现异常的参与者，以代表理解任务基本前提且获取奖励动机最小的人群。因此，那些经常选择可能性较小颜色或频繁选择首个可用下注金额（可能是为了加快测试）的参与者被排除在进一步分析之外。另一个新颖之处是，我们评估并报告了六个变量，这些变量用于考察思考时间、决策质量、冒险行为、总下注比例、延迟厌恶和风险调整。43名患有BPD的女性参与了该研究，16名不符合要求的被排除。至于健康对照组，42名女性参与了研究，4名不符合要求的被排除。因此，我们将27名BPD患者的数据与38名健康对照组的数据进行了比较。
我们的结果表明，在决策质量（（1,63）=5.801，=0.019）和风险调整（（1,63）=6.522，=0.013）方面，两组之间存在显著差异。我们还发现，在冒险行为（（4,252）=4.765，=0.001）和总下注比例（即相对于受试者总分的平均下注比例）（（4,252）=4.505，=0.002）方面，组与获胜概率之间存在显著交互作用。
我们的结果表明，两组使用不同的决策策略，这些策略可能与日常生活情境有各种关联。
