Testing a Biosocial Model of Borderline Personality Features in Youth

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Project Summary Borderline personality disorder (BPD) is a complex and debilitating disorder associated with pronounced social dysfunction, frequent suicidal behavior, and high rates of treatment utilization. Although traditionally diagnosed in adulthood, prominent models of BPD trace the developmental origins of BPD back to childhood. There is mounting evidence that features of BPD may emerge in childhood, predicting poor functional outcomes beyond more commonly diagnosed childhood mental health problems (e.g., depression, anxiety, attention- deficit/hyperactivity disorder, and conduct problems) as well as high risk for the development of BPD into adolescence and adulthood. Yet, very little work has examined neural mechanisms underlying BPD features in youth, hindering efforts to identify and target those youth at highest risk for BPD. Youth at risk for BPD demonstrate deficits in the NIMH RDoC domains of Cognitive Control and Attachment and Affiliation. At the self- report and behavioral level, youth with BPD features have been shown to display deficits in response inhibition, one aspect of Cognitive Control, which involves the ability to suppress a prepotent urge to act. Similarly, there is also some evidence, at the behavioral and self-report level, that deficits in social processing are central to the Attachment and Affiliation difficulties of individuals with BPD features. Sensitivity to social rejection is a primary clinical focus in intervention for BPD, although co-occurring mood and anxiety difficulties also contribute to rejection sensitivity. Emerging work suggests unique alterations in social acceptance processing among individuals with BPD, particularly difficulties modulating responses to acceptance cues. Deficits in response inhibition and social acceptance processing have been reliably elicited in youth at the neurophysiological level using event-related potentials (ERPs) derived from the electroencephalogram (EEG), although they have not specifically been used to examine mechanisms of BPD features. Attention to neurophysiological mechanisms underlying risk for BPD may offer critical insight into reducing the societal and personal burden of BPD. For this work, a sample of 100 girls (ages 10-13) will be recruited. The majority of girls (n=70) will be recruited from two clinically diverse outpatient psychiatry clinics, while the remaining (n=30) girls will be healthy controls without a history of psychopathology. Neurophysiological assessments of response inhibition and social acceptance processing will be administered, and response inhibition and social acceptance processing measured at the neurophysiological level will be tested as mechanisms underlying growth in BPD features 6 and 12 months after the initial assessment. Lastly, harsh parenting and peer victimization will be explored as moderators of associations between response inhibition, social acceptance processing, and growth in BPD features. Results from this work will validate the utility of assessing BPD features in youth and provide evidence on mechanisms that can be targeted in early intervention for youth at high risk for the development of BPD.