Disrupted response inhibition in borderline personality disorder: Insights from a gamified stop-signal task

Borderline personality disorder (BPD) is characterized by pervasive difficulties with self-image, interpersonal relationships, emotion regulation and impulse control. Impulsive behaviors can be assessed using tasks such as the stop-signal task (SST). Traditional SSTs are repetitive and cognitively demanding, requiring sustained attention and effort over extended periods. This can be challenging, particularly for clinical populations who often experience difficulties with attention, emotional regulation, and frustration tolerance. In this study, we examined whether a gamified version of the SST (gSST) could effectively differentiate inhibitory control in patients with BPD compared to healthy controls (HC), and explored associations between behavioral performance and self-reported impulsivity. Fifty participants (25 BPD, 25 HC) completed the gSST and the UPPS-P impulsivity questionnaire. Patients with BPD showed significantly faster reaction times, more choice errors, and shorter stop-signal delays, indicating impairments in both proactive and reactive inhibition. However, no significant group difference emerged for the primary measure, the stop-signal reaction time (SSRT). The SSRT correlated positively with self-reported positive urgency across the sample, suggesting a link between emotionally driven impulsivity and inhibitory control as assessed with a gSST. These findings highlight the potential of gamified cognitive tasks to provide sensitive, engaging, and ecologically valid measures of impulsivity, with implications for both clinical assessment and personalized intervention strategies in BPD.