Biobehavioral mechanisms underlying reacitve aggression in BPD: Validation and pharmacological modulation

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Aggression emerges as a key feature of borderline BPD. Despite the high prevalence and individual as well as social costs caused by aggression, the neurobiological and behavioral (henceforth called biobehavioral) mechanisms of aggression in BPD remain unclear, and empirically founded, targeted, and cost-effective interventions that reduce aggression in BPD are still lacking. Based on the results of the first funding period and previous studies, we have recently proposed five biobehavioral mechanisms which mediate aggression in BPD, comprising: threat hypersensitivity, maladaptive anger regulation, approach rather than avoidance of social threat cues, deficits in cognitive empathy, and enhanced emotional contagion. The current project aims to 1) investigate the validity, i.e., the predictive power of these five previously identified biobehavioral mechanisms to predict aggression in BPD. Aggression will be experimentally provoked and measured using a new MRI-compatible modification of the wellestablished Taylor Aggression Paradigm, which mimics real-life social interactions by including video-based feedback of an interaction partner's emotional state. This "emotional" Taylor Aggression Paradigm will 2) allow us to assess the neural correlates of BPD patients- aggressive reactions in social interactions. In addition, we will 3) test the modulation of two of the proposed biobehavioral mechanisms, namely threat hypersensitivity and approach rather than avoidance of social threat cues, using a pharmacological intervention with intranasally administered oxytocin. The results of this project will provide deeper insights into biobehavioral mechanisms mediating aggression in BPD. Moreover, the findings will enable the compilation of a test battery of behavioral markers, which can easily be used in the future for the clinical assessment of individual differences on the mechanistic level in the highly heterogeneous group of BPD patients. Together with IP2, they will pave the way for an empirically founded and individualized mechanism-based, time-restricted, and cost-effective intervention for aggression in the future.