Borderline personality disorder and learning: The influences of emotional state and social versus nonsocial feedback.

Background: Borderline personality disorder (BPD) has been associated with decision-making deficits, yet such deficits may be context dependent, particularly emotional state and social context. Reinforcement learning models offer an avenue to pinpoint decision-making impairments. The current study used reinforcement learning models to examine whether feedback type (social vs. nonsocial) or emotional state (neutral vs. negative) influence the association between BPD and decision making.

Method: Adults (N = 131) with a range of BPD symptoms completed a diagnostic interview and a computerized learning task after neutral and negative emotion inductions. We examined accuracy, learning rate, and exploration.

Results: We conducted linear models to examine the association between BPD criteria, feedback type, and emotional state on learning parameters and learning accuracy. We found that the negative emotion condition was associated with greater exploration, particularly for those with elevated BPD features. Furthermore, elevated BPD features were associated with impaired accuracy when aiming to avoid loss. A 3-way interaction between BPD, emotion, and feedback indicated that, for people with higher BPD features, learning performance was further impaired when receiving social feedback in the negative emotion condition.

Limitations: Several limitations warrant mention, including a relatively homogenous sample, possible co-occurring diagnoses, and methodological consideration with the learning task.

Conclusions: The present study underscored the link between BPD and learning impairments. Amplified learning alterations under negative social contexts have important implications for identifying optimal venues to teach new skills (of relevance to treatment) for those with BPD.