Altered psychophysiological correlates of risk-taking in borderline personality disorder

Elevated levels of risk-taking behavior as well as affective instability are both cardinal features of Borderline Personality Disorder (BPD). To our knowledge, there are no studies which directly investigate underlying affective processes of risk-taking behavior in BPD, despite the centrality of affect in BPD symptomatology, and indications of affective dysregulation contributing to increased risk-taking behavior in BPD. Here, we examined risk-taking behavior in BPD and its underlying affective processes, using skin conductance responses (SCRs) as a proxy. Twenty-three individuals with BPD and 24 healthy controls performed a modified version of the Balloon Analogue Risk Task, where decisions take place over a time scale of several seconds, enabling us to investigate a continuous integral of SCRs in anticipation of decisions. We used trial-by-trial mixed model analyses to account for within- and between-participant effects, as well as large variability that are often observed in SCRs. In contrast to healthy controls, who showed elevated SCRs in response to high risk, individuals with BPD did not show differential physiological sensitivity towards different risk levels. In addition, increased SCRs––under low risk––were related to more cautious risk-taking behavior in HCs. However, increased SCRs under low risk in BPD were related to greater risk-taking behavior. Alterations in the processing of affective signals, such as SCRs in the context of risk, may impair adaptation to environmental demands and may lead to increased risk-taking behavior in BPD.