The rewarding nature of provocation-focused rumination in women with borderline personality disorder: A preliminary fMRI investigation

Jessica R. Peters, David S. Chester, Erin C. Walsh, C. Nathan DeWall, Ruth A. Baer

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Understanding why individuals with borderline personality disorder (BPD) ruminate on prior provocations, despite its negative outcomes, is crucial to improving interventions. Provocation-focused rumination may be rewarding in the short term by amplifying anger and producing feelings of justification, validation, and increased energy, while reducing self-directed negative affect. If provocation-focused rumination is utilized regularly as a rewarding emotion regulation strategy, it could result in increased activation in reward-related neural regions. The present pilot study examined neural correlates of provocation-focused rumination, relative to other forms of thought, in BPD. Method: Functional magnetic resonance imaging (fMRI) was utilized to examine this theory in a pilot study of women diagnosed with BPD (n = 13) and healthy controls (n = 16). All participants received highly critical feedback on a previously written essay in the scanner, followed by prompts to engage in provocation-focused, self-focused, and neutral thought. Results: Whole-brain analyses showed that in response to the provocation, participants with BPD (compared to controls) demonstrated increased activation in the ventrolateral prefrontal cortex (PFC). BPD participants also showed greater activation in the dorsomedial PFC during provocation-focused rumination (relative to neutral-focus). Subsequent ROI analyses revealed that provocation-focused rumination (compared to neutral-focus) increased activation in the nucleus accumbens for the BPD group only. Conclusions: These findings, while preliminary due to the small sample size and limitations of the protocol, provide initial data consistent with the proposed neurobiological mechanism promoting provocation-focused rumination in BPD. Directions for further research are discussed.

Original languageEnglish
Article number1
JournalBorderline Personality Disorder and Emotion Dysregulation
Issue number1
StatePublished - Jan 16 2018

Bibliographical note

Publisher Copyright:
© 2018 The Author(s).


  • Anger
  • Borderline personality disorder
  • Criticism
  • FMRI
  • Insula
  • Nucleus accumbens
  • Provocation
  • Reward
  • Rumination

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health
  • Biological Psychiatry


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