Despite the trend of poor decisional performance in BPD, the precise nature of these decisional deficits remain unclear amid growing neuro-imaging evidence of fronto-limbic irregularities and dysfunctions which are proposed to underlie negative choice behaviour. Of the 30 or more DM studies undertaken in BPD, few have reported normal performance. The decisional conflicts of those with BPD may be congruent with their disadvantageous choices on decision making performance tasks. Many individuals with Borderline Personality Disorder (BPD) manifest poor decisions and risky impulsive behaviours in their daily lives and do not appear to readily learn from their prior experiences. Findings support the Somatic Marker Hypothesis of IGT DM and may reflect the affective dysregulation that characterizes the disorder. This is the 1st evidence of an emotive type of impulsivity, representing a type of affective instability that is linked to poor IGT DM in BPD. Of these 3 variables, the emotive subscale, representing a rapid emotional response, was the only significant predictor contributing 49% to the variance in poor DM. Three subscales of attention, behaviour/ disorganized and emotive were significantly associated with poor IGT performance in 26 women with BPD. BPD women did not meet the threshold indicative of moderate to severe ADHD. Net decision making performance and all ADHD subscale ratings differed significantly among BPD women and healthy controls. No group differences in inhibitory control were present. Iowa Gambling Task (IGT) decision making, 2 tasks of inhibitory control and a self report of ADHD symptoms consisting of 9 subscales were administered to 41 BPD women and 41 healthy controls. Decision making in BPD may be compromised by different domains of impulsivity, affective dysregulatory processes or unknown co-morbid ADHD which is considered a developmental precursor to BPD. Poor decision making is often assumed to be due to impulsive behaviour or weak inhibitory control despite inconsistent evidences of these relationships, leaving questions about the specific nature of these decisional deficits. Adults with Borderline Personality Disorder (BPD) manifest poor performance on tasks of decision making which may be congruent with their decisional and interpersonal conflicts in real life.
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