Executive neurocognition, memory systems, and borderline personality disorder

Cognition in adults with borderline personality disorder

OBJECTIVE

Borderline personality disorder (BPD) is a common and disabling mental health disorder and has detrimental effects on affected individuals across multiple domains. We aimed to investigate whether individuals with BPD differ from control subjects in terms of cognitive functions, and to see if there is a relationship between cognitive functions, impulsivity, and BPD symptom severity.

METHODS

BPD individuals (n = 26; mean age = 26.7; 69.2% female) and controls (n = 58; mean age = 25.3; 51.7% female) were enrolled. Intra/Extra-Dimensional Set Shift (IED) and One Touch Stockings of Cambridge (OTS) tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were used to assess cognitive functions. Barratt Impulsivity Scale-version 11 (BIS-11) was administered to measure impulsivity and both the Zanarini Scale for Borderline Personality Disorder self-report and the clinician-administered versions were used to assess BPD symptom severity.

RESULTS

BPD group showed significantly impaired cognitive performance on the IED task versus controls, but there was not a significant difference in the OTS task. BPD symptom severity was positively correlated with trait (BIS-11) impulsivity and no correlation was found between BPD symptom severity and cognitive functions.

CONCLUSIONS

This study suggests people with BPD experience impaired cognitive flexibility and heightened impulsivity. Only impulsivity appeared to be directly related to symptom severity, perhaps indicating that cognitive inflexibility could be a vulnerability marker. Future research should focus on a longitudinal approach to extend clinical and theoretical knowledge in this area.

Predictors of psychotherapy dropout in patients with borderline personality disorder: A systematic review

INTRODUCTION

Borderline personality disorder (BPD) is a highly debilitating psychiatric condition. Despite the expansion of new BPD specific forms of psychotherapy in the last few decades, high dropout rates have been reported in these treatments. Treatment discontinuation is associated with poor patient outcomes, inefficient resource utilization and the demoralization of healthcare providers.

METHODS

In order to identify predictors of psychotherapy dropout among patients with BPD, a systematic search of Medline, the Cochrane Library, PsycInfo and PsycArticles was conducted. Studies included were randomized-controlled trials in which patients diagnosed with BPD were exposed to a therapeutic intervention consisted of an evidence-based psychotherapy. The quality of evidence in the studies was assessed through the use of revised Cochrane risk of bias tool.

RESULTS

Six articles, incorporating four types of psychotherapy programmes, were included. Overall, the studies present low risk of attrition and reporting bias and unclear risk of selection, performance and detection bias. Patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates. In contrast, better mindfulness skills and greater performance in specific neuropsychological domains, such as memory and executive control, were identified as predictive of lower risk of dropout. Sociodemographic variables and treatment history did not influence treatment retention.

CONCLUSIONS

Factors that influence discontinuation should be taken into consideration in future treatment programmes, in an effort to optimize retention. Qualitative assessments of patients' reasons for dropping out may also help guide adjustments.

Neurocognition of females with substance use disorder and comorbid personality disorder: Divergence in subjective and objective cognition

At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.

Identifying Splitting Through Sentiment Analysis

In Kernerg's Object Relations Theory model of personality pathology, splitting, the mutual polarization of aspects of experience, is thought to result in a failure of identity integration. The authors sought to identify a clinician-independent, automated measure of splitting by examining 54 subjects' natural speech. Splitting in these individuals, recruited from the community, was investigated and evaluated with a shortened version of the Structured Interview of Personality Organization (STIPO-R). A type of automated sentiment textual analysis called VADER was applied to transcripts from the section of the STIPO-R that probes identity integration. Higher variability in speech valence, more negative minimum valence, and more frequent shifts in valence polarity were associated with more severe identity disturbance. The authors concluded that the degree of splitting elicited during the description of self and others is related to the degree of identity disturbance, and to the degree of negativity and instability of these descriptions of self and others.

Emotional working memory training improves cognitive inhibitory abilities in individuals with borderline personality trait: A randomized parallel-group trial

BACKGROUND

Cognitive inhibition impairment is one of the causes of impulsive behaviors in individuals with borderline personality disorder (BPD). This study aimed to investigate the effect of emotional working memory training (EWMT) on cognitive inhibition in individuals with a clinically significant borderline personality trait.

METHODS

In a randomized, parallel-group trial, 40 individuals with borderline personality trait, were selected out of 1000 screened individuals and were randomly assigned to the experimental (N = 20) and waiting-list control (N = 20) groups based on the score on the Borderline Personality Scale and the follow-up Structured Clinical Interview for DSM-IV Personality Disorders. The experimental group underwent 10 sessions of EWMT and the control group did not receive any intervention (waiting list). Participants completed the Stroop Color and Word Test (SCWT) and Go/No-Go task Before and after the intervention.

RESULTS

EWMT significantly reduced reaction time of incongruent trials in the SCWT and commission errors in the Go/No-Go task after the intervention only in the experimental group. Furthermore, the interference score in SCWT and commission error rate at the post-intervention time were significantly lower for the experimental vs the waitlist group.

LIMITATIONS

The single-blind design and absence of follow-up measures.

CONCLUSIONS

EWMT can improve cognitive inhibition in individuals with borderline personality trait and could be used for therapeutic purposes of impulsivity behavior in BPD.

Efficacy and tolerability of Brain Stimulation interventions in Borderline Personality Disorder: state of the art and future perspectives - A systematic review

Treating Borderline Personality Disorder (BPD) is a major challenge for psychiatrists. As Brain Stimulation represents an alternative approach to treat psychiatric disorders, our systematic review is the first to focus on both invasive and Non-Invasive Brain Stimulation (NIBS) interventions in people living with BPD, examining clinical effects over core features and comorbid conditions. Following PRISMA guidelines, out of 422 original records, 24 papers were included regarding Deep Brain Stimulation (n = 1), Electroconvulsive therapy (n = 5), Transcranial Magnetic Stimulation (n = 13) and transcranial Direct Current Stimulation (n = 5). According to impulsivity and emotional dysregulated domain improvements, NIBS in BPD appears to restore frontolimbic network deficiencies. NIBS seems also to modulate depressive features. Safety and tolerability profiles for each technique are discussed. Despite encouraging results, definitive recommendations on Brain Stimulation in BPD are mitigated by protocols heterogeneity, lack of randomized controlled trials and poor quality of included studies, including high risk of methodological biases. To serve as guide for future systematic investigations, protocols optimization proposals are provided, focusing on alternative stimulation sites and suggesting a NIBS symptom-based approach.

Item method directed forgetting occurs independently of borderline personality traits, even for borderline-salient items

Clinical populations sometimes demonstrate difficulties forgetting stimuli related to their trauma-related disorder, perhaps because their intense personal connection to these stimuli produce deficits in the inhibitory control abilities necessary for forgetting. The present work examined this possibility for people who have high levels of traits implicated in borderline personality disorder (BPD). In two well-powered studies, we found no evidence for deficits in forgetting specific to BPD traits, even for people with clinically significant levels of the traits, contrary to previous studies. The present experiments updated the designs from earlier experiments to employ the most contemporary methods to examine directed forgetting recommended by recent reviews. With these improved methods, Study 1 found that participants showed significant directed forgetting for BPD-related words independent of their level of BPD traits, perhaps because the BPD-related words were so strongly associated with one another. Study 2 found that when we removed the strong relatedness between the stimuli, forgetting of BPD-relevant words was significant and did not interact with BPD symptomology. We concluded that in contrast to people with PTSD who show specific inhibitory deficits for trauma-related works, people with BPD show normal, intact inhibitory control even for words that they should find threatening.

Emotional working memory updating in individuals with borderline personality features

BACKGROUND AND OBJECTIVES

Individuals with features of borderline personality disorder (BPD) are highly sensitive to social rejection. Working memory (WM) may play a critical role in processing emotional interpersonal information in BPD. Yet, little is known about how emotional WM operations are related to sensitivity to rejection cues and BPD features. Therefore, this study examined relationships among emotional WM operations, rejection sensitivity, and BPD features.

METHODS

Participants with BPD features (n = 39 with non-suicidal self-injury history; n = 47 without non-suicidal self-injury history) and healthy participants (n = 46) completed an emotional two-back task before and after a social exclusion induction (the Cyberball game).

RESULTS

Results showed that participants with BPD features were slower at discarding faces expressing anger and pain from WM compared to healthy individuals before the social exclusion induction. Participants with BPD features and a history of self-injury were also slower at entering happy faces into WM compared to the other participants. Moreover, across participants, slower WM discarding of angry and pain faces was associated with higher levels of rejection sensitivity. Finally, no group differences emerged with respect to WM entering and discarding operations for emotional faces in response to social exclusion.

LIMITATIONS

This study was conducted in a sample of undergraduate students and did not consider comorbidity with other forms of psychopathology.

CONCLUSIONS

These findings cast light on how emotional WM difficulties may be involved in how individuals with BPD process emotional interpersonal information.

Impaired set-shifting in drug-naïve patients with borderline personality disorder: an event-related potentials study

BACKGROUND

Neurocognitive impairments might play a key role in the development of Borderline Personality Disorder (BPD), however, the pathophysiological mechanism underlying cognitive impairment of BPD is largely unknown. This study was aimed to examine the electrophysiological mechanism of deficits in set-shifting processing in patients with BPD.

METHODS

Twenty-seven drug-naïve patients with BPD and twenty-four healthy controls were recruited. Demographic variables and clinical characteristics of all subjects were collected. Behavioral data and event-related potentials (ERPs) were recorded when subjects were performing the task-switching paradigm, which was applied to investigate the set-shifting function. The P2, N2 and P3 components in the task-switching paradigm would be analyzed.

RESULTS

Patients with BPD had significantly higher level of impulsivity, depression and anxiety than healthy controls. When performing the switching task, the BPD group had lower P2 amplitude and higher N2 amplitude than the control group. In the BPD group, the P2 latency at Fz electrode in repeat task was correlated positively with the level of depression, and P2 latency at Pz electrode in repeat task and switch task both had significantly negative relationships with the the level of anxiety.

LIMITATIONS

This cross-sectional designed study did not clarify the causal relationship of the electrophysiological characteristics and the development of BPD.

CONCLUSIONS

Patients with BPD might have abnormal brain activities when overcoming the inhibition of current task and inhibiting the effects of prior task, and their top-down control function might be impaired. These findings provide some useful clues for the underlying pathophysiological mechanism of BPD.

Meaning-Making Activity in the Emotional Experience of Borderline Personalities

This article describes the mereological constitution of contents in the intentional acts of people affected by borderline personality disorder (BPD) or emotionally unstable personality disorder (EUPD) in order to shed light on the origin of the emotional instability characterizing this disorder. The article will first discuss the emotional cycle of people affected by this disorder; second, it will focus on the mereological aspect of the meaning-making<A51_FootRef>1</A51_FootRef> experience in the intentional act; third, it will show how this meaning-making experience usually interacts with axiological<A51_FootRef>2</A51_FootRef> qualities that affect the continuity of their sense of reality. From the investigation, it emerges that the mereological constitution of contents occurs in a way that is disruptive of the continuity of BPD/EUPDs' interaffective lifeworld as it generates intersubjective disturbances on the axiological, logical, and ontological levels. On this basis, as a concluding suggestion, the paper will propose an alternative way to approach the problem, soothe the disturbance, and encourage integration.

Neuropsychological deficits correlate with symptoms severity and cortical thickness in Borderline Personality Disorder

BACKGROUND

Neuropsychological abnormalities have been proposed to contribute to the development and maintenance of Borderline Personality Disorder (BPD). Previous meta-analyses and reviews confirmed deficits in a broad range of cognitive domains, including attention, cognitive flexibility, memory, executive functions, planning, information processing, and visuospatial abilities, often suggested to underlie brain abnormalities. However, no study directly explored the structural neural correlates of these deficits in BPD, also accounting for the possible confounding effect of pharmacological treatments, often used as adjunctive symptom-targeted therapy in clinical setting.

METHODS

In this study we compared the performance of 24 BPD patients to 24 healthy controls obtained at the neuropsychological battery "Brief Assessment and Cognition in Schizophrenia", exploring the relationship between the cognitive impairments and current symptomatology, brain grey matter volumes and cortical thickness, controlling for medications load.

RESULTS

Data revealed deficits in verbal memory and fluency, working memory, attention and speed of information processing and psychomotor speed and coordination when medication load was not in the model. Correcting for this variable, only the impairment in psychomotor abilities remained significant. A multiple regression confirmed the effect of this neuropsychological domain on the severity of BPD symptomatology (Borderline Evaluation of Severity Over Time). In BPD, the performance at psychomotor speed and coordination was also directly associated to cortical thickness in postcentral gyrus.

LIMITATIONS

Relatively small sample size, especially for neuroimaging.

CONCLUSIONS

Our study highlighted an influence of BPD neuropsychological impairments on symptomatology, and cortical thickness, prompting the potential clinical utility of a cognitive remediation program in BPD.

Evidence for Altered Neural Processing in Patients With Borderline Personality Disorder

Abstract. Borderline personality disorder (BPD) is characterized by difficulties in emotion regulation, self-identity disturbances, self-injurious behavior, and reduced inhibitory control. Event-related potential (ERP) studies have sought to reveal the neural correlates of cognitive distortions and behavioral alterations in BPD. The article presents an overview of the existing ERP literature pertaining to BPD and discusses whether any one of the electrophysiological findings could serve as a reliable and specific marker for BPD. In short, ERP studies investigating P300 tentatively suggest impaired inhibitory control. Moreover, reduced error- and feedback-related processing and impaired response inhibition seem to be associated with impulsivity and risk-taking behavior in BPD patients. However, these findings are not specific for BPD. Regarding emotional and self-referential information processing, individuals with BPD display heightened vigilance toward social threat impacting their cognitive performance in various social-cognitive tasks demonstrating alterations of early negative and late positive potentials. These multifaceted electrophysiological alterations may be attributed to dysfunctional activity and connectivity of frontal brain regions and the limbic system.

Cognitive correlates of borderline intellectual functioning in borderline personality disorder

Borderline intellectual functioning (BIF) is highly prevalent in patients with borderline personality disorder (BPD), but their relationship remains poorly understood. This retrospective study aimed to investigate the cognitive profile of BIF among people diagnosed with BPD. Clinical, demographic, and neuropsychological data of fifty-five outpatients with BPD were analyzed. The sample split into two groups: BPD with BIF (BIF+: n = 25; intelligence quotient - IQ - range: 71-84) and BPD without BIF (BIF-: n = 30; IQ range: 86-124). Between-group comparisons employed either parametric and non-parametric descriptive statistics, as necessary. Neuropsychological measures (Wechsler Adult Intelligence Scale-Revised - WAIS-R IQ, factor index, subtest scores) and cognitive performance deficits in the two groups were likewise compared aside, followed by Spearman's correlation test conducted on relevant metrics. The cognitive, but not the clinical and demographic profiles differed significantly between the two groups. BIF+ was associated with a specific pattern of verbal, attentive, and planning dysfunctions. The verbal comprehension index had the highest discriminative value for the presence of BIF in patients with BPD, and it was tightly associated with adaptive and social functioning. The neuropsychological assessment of BPD may be relevant to plan targeted interventions based on measures of cognitive functioning which could also serve to evaluate treatment efficacy and outcomes. Clinical implications and future directions are discussed.

Empathy, Alexithymia, and Theory of Mind in Borderline Personality Disorder

The purpose of this research was to determine the differences in empathy, alexithymia features, and theory of mind between healthy controls and patients with borderline personality disorder (BPD). Thirty-five patients with BPD and 35 healthy controls were included in the study. To measure the clinical variables, the Empathy Quotient (EQ), Reading the Mind in the Eyes Test (RMET), Toronto Alexithymia Scale (TAS-20), Barratt Impulsivity Scale-11 (BIS-11), and Beck Depression Inventory (BDI) were applied. We found that the BPD group had significantly worse total RMET and neutral RMET scores than the control group. There were no differences in the EQ scores between the BPD and control groups. The patients with BPD were more alexithymic than the controls, and alexithymia and depression scores predicted BPD status. Patients with BPD who have difficulty identifying their own emotions tend to display deficits in perceptions of facial emotions, which, in turn, may lead to misperceptions of social signals and thus contribute to excessive emotional intensity and tension in social situations. The study results reveal that alexithymia and depression are important variables in predicting BPD traits.

Repeated transcranial direct current stimulation of dorsolateral-prefrontal cortex improves executive functions, cognitive reappraisal emotion regulation, and control over emotional processing in borderline personality disorder: A randomized, sham-controlled, parallel-group study

BACKGROUND

Borderline personality disorder (BPD) is primarily characterized by deficient emotion regulation. Impaired cognitive control over negative emotions is central to emotion dysregulation in BPD. Respective executive dysfunctions are associated with hypoactivation of prefrontal regions, and consecutive alterations of fronto-limbic network functionality. Here, we investigated the effect of increasing activity of the dorsolateral prefrontal cortex (DLPFC) with repeated transcranial direct current stimulation (tDCS) on (1) executive dysfunctions and (2) whether improving cognitive control affects emotion dysregulation and emotional processing in BPD.

METHODS

Thirty-two patients diagnosed with BPD were randomly assigned to active stimulation (N = 16) or sham stimulation (N = 16) group in a randomized, sham-controlled, parallel-group design. They received 10 sessions of active (2 mA, 20 min, anodal left- cathodal right DLPFC) or sham tDCS over 10 days. Major executive functions, emotion regulation strategies, and emotional processing of the patients were assessed before and immediately after the intervention.

RESULTS

The active stimulation group showed a significant improvement in major executive function domains. Importantly, cognitive reappraisal strategy of emotion regulation and several factors of emotional processing involved in the control of emotion significantly improved in the active stimulation group after the intervention. Factors related to emotional expression were, however, not affected.

LIMITATIONS

The single-blind design, absence of follow-up measures, and the intrinsically limited focality of tDCS are limitations of this study.

CONCLUSIONS

Increasing activity of the DLPFC improves executive functioning in BPD and improves ´cognitive control over negative emotions. Cognitive control interventions could be a potential, symptom-driven therapeutic approach in BPD.

Identity pathology and borderline personality disorder: an empirical overview

Pathological identity-related functioning is a core feature of borderline personality disorder (BPD) that is grievously underrepresented in the empirical literature. Burgeoning evidence indicates that identity pathology is multifaceted, influenced by transactions between social and endogenous processes, and associated with a wide variety of maladaptive outcomes. Although historically defined by patterns of instability (e.g. frequent and rapid changes to career goals, religious beliefs, core values, friend groups, etc.), accumulating research indicates that identity pathology also manifests as distress and functional impairment related to excessive rigidity (i.e. unrelenting negative self-evaluations; overidentification with a restricted role or group membership) and/or incongruous behavior (i.e. simultaneously holding discordant beliefs/values/attitudes, actions that are grossly contradictory with values, incoherent sense of self, etc.). Despite the complex nature of this construct, and its centrality to BPD, researchers often assess identity pathology indirectly, inadequately, or fail to measure it entirely. In this article, we briefly describe how identity pathology may fit into etiological models of BPD, highlight emerging themes from recent research, and identify important gaps in our knowledge. We also discuss limitations associated with current assessment practices, recommend alternatives, and articulate a research agenda for the future.

Examining the Relationship Between Executive Functions and Mentalizing Abilities of Patients With Borderline Personality Disorder

Patients with borderline personality disorder (BPD) experience interpersonal dysfunctions; therefore, it is important to understand their social functioning and the confounding factors. We aimed to investigate the mentalizing abilities and executive functioning (EF) of BPD patients and healthy subjects and to determine the relative importance of BPD diagnosis and EF in predicting mentalizing abilities while controlling for general IQ and comorbid symptom severity. Self-oriented mentalizing (operationalized as emotional self-awareness/alexithymia), other-oriented mentalizing [defined as theory of mind (ToM)], and several EF domains were examined in 18 patients with BPD and 18 healthy individuals. Decoding and reasoning subprocesses of ToM were assessed by standard tasks (Reading the Mind in the Eyes Test and Faux Pas Test, respectively). Relative to controls, BPD patients exhibited significant impairments in emotional self-awareness and ToM reasoning; however, their ToM decoding did not differ. Multivariate regression analyses revealed that comorbid psychiatric symptoms were negative predictors of alexithymia and ToM decoding. Remarkably, the diagnosis of BPD was a positive predictor of ToM decoding but negatively influenced reasoning. Moreover, EF had no impact on alexithymia, while better IQ, and EF predicted superior ToM reasoning. Despite the small sample size, our results provide evidence that there is a dissociation between mental state decoding and reasoning in BPD. Comorbid psychiatric symptoms could be considered as significant negative confounds of self-awareness and ToM decoding in BPD patients. Conversely, the impairment of ToM reasoning was closely related to the diagnosis of BPD itself but not to the severity of the psychopathology.

Brain structure and symptom dimensions in borderline personality disorder

BACKGROUND

Borderline personality disorder (BPD) presents with symptoms across different domains, whose neurobiology is poorly understood.

METHODS

We applied voxel-based morphometry on high-resolution magnetic resonance imaging scans of 19 female BPD patients and 50 matched female controls.

RESULTS

Group comparison showed bilateral orbitofrontal gray matter loss in patients, but no significant changes in the hippocampus. Voxel-wise correlation of gray matter with symptom severity scores from the Borderline Symptom List (BSL-95) showed overall negative correlation in bilateral prefrontal, right inferior temporal/fusiform and occipital cortices, and left thalamus. Significant (negative) correlations with BSL-95 subscores within the patient cohort linked autoaggression to left lateral prefrontal and insular cortices, right inferior temporal/temporal pole, and right orbital cortex; dysthymia/dysphoria to right orbitofrontal cortex; self-perception to left postcentral, bilateral inferior/middle temporal, right orbitofrontal, and occipital cortices. Schema therapy-based Young Schema Questionnaire (YSQ-S2) scores of early maladaptive schemas on emotional deprivation were linked to left medial temporal lobe gray matter reductions.

CONCLUSIONS

Our results confirm orbitofrontal structural deficits in BPD, while providing a framework and preliminary findings on identifying structural correlates of symptom dimensions in BPD, especially with dorsolateral and orbitofrontal cortices.

Decisional Capacity and Personality Disorders: Substantially Unable or Substantially Unwilling?

Capacity assessments are performed when there is suspicion that a person is unable to adequately care for their physical, medical, or financial well-being. The purpose of these assessments is to inform the legal system as to whether or not guardianship may be necessary. It is well established that certain mental illnesses, such as neurocognitive disorders (dementia) or psychotic disorders (like schizophrenia), may diminish capacity and, in some cases, lead to the need for establishment of a legal guardian. However, personality disorders are another common category of mental illness which may impair decision-making. There is very little information in the literature about how or why these disorders could impair capacity, and thus, it can often be difficult to discern whether clients with personality disorders are substantially unable to care for themselves-versus unwilling to act in a way contrary to their ingrained habits. We present a series of three cases in which clients are determined to lack capacity primarily mediated by a personality disorder diagnosis. They are demonstrated to have mild deficits in cognitive functioning, but they show impaired decision-making out of proportion to these deficits. In all three cases, it is apparent that the personality disorder is substantially impairing their ability to care for themselves. Discussion includes consideration for ways to incorporate evaluations of cognitive function, activities of daily living, and personality considerations into capacity assessments, and how to approach recommendations (such as guardianship vs. less restrictive option) based on both level and scope of impairment.

You ≠ me: individual differences in the structure of social cognition

This study investigated the structure of social cognition, and how it is influenced by personality; specifically, how various socio-cognitive capabilities, and the pattern of inter-relationships and co-dependencies among them differ between divergent personality styles. To measure social cognition, a large non-clinical sample (n = 290) undertook an extensive battery of self-report and performance-based measures of visual perspective taking, imitative tendencies, affective empathy, interoceptive accuracy, emotion regulation, and state affectivity. These same individuals then completed the Personality Styles and Disorders Inventory. Latent Profile Analysis revealed two dissociable personality profiles that exhibited contrasting cognitive and affective dispositions, and multivariate analyses indicated further that these profiles differed on measures of social cognition; individuals characterised by a flexible and adaptive personality profile expressed higher action orientation (emotion regulation) compared to those showing more inflexible tendencies, along with better visual perspective taking, superior interoceptive accuracy, less imitative tendencies, and lower personal distress and negativity. These characteristics point towards more efficient self-other distinction, and to higher cognitive control more generally. Moreover, low-level cognitive mechanisms served to mediate other higher level socio-emotional capabilities. Together, these findings elucidate the cognitive and affective underpinnings of individual differences in social behaviour, providing a data-driven model that should guide future research in this area.

Neural and Behavioral Correlates of Attentional Inhibition Training and Perceptual Discrimination Training in a Visual Flanker Task

Two groups of healthy young adults were exposed to 3 weeks of cognitive training in a modified version of the visual flanker task, one group trained to discriminate the target (discrimination training) and the other group to ignore the flankers (inhibition training). Inhibition training, but not discrimination training, led to significant reductions in both Garner interference, indicating improved selective attention, and in Stroop interference, indicating more efficient resolution of stimulus conflict. The behavioral gains from training were greatest in participants who showed the poorest selective attention at pretest. Electrophysiological recordings revealed that inhibition training increased the magnitude of Rejection Positivity (RP) to incongruent distractors, an event-related potential (ERP) component associated with inhibitory control. Source modeling of RP uncovered a dipole in the medial frontal gyrus for those participants receiving inhibition training, but in the cingulate gyrus for those participants receiving discrimination training. Results suggest that inhibitory control is plastic; inhibition training improves conflict resolution, particularly in individuals with poor attention skills.

The Impact of Social Exclusion on "Reading the Mind in the Eyes" Performance in Relation to Borderline Personality Disorder Features

In this study we used the Reading the Mind in the Eyes Test (RMET) to explore facial emotion recognition in borderline personality disorder (BPD). We also used Cyberball, a computerized task designed to mimic social ostracism, to examine the response of BPD-feature participants to social exclusion. Seventeen individuals with BPD features were compared to 16 healthy controls on RMET performance pre- and post-exclusion via Cyberball. Our results revealed a significant interaction between BPD-feature status and RMET performance in relation to neutral stimuli following a social exclusion experience. BPD participants' ability to correctly identify neutral faces significantly decreased following exclusion. This finding suggests that once an individual with BPD features experiences a social exclusion event, his or her objectivity decreases and affective valence is ascribed to stimuli previously perceived as neutral. Our results may help to explain, in part, the social instability seen in BPD.

Episodic memory and consciousness in antisocial personality disorder and conduct disorder

Episodic memory is one of the most significant sources of information of humans. It entails cooperative and linguistic skills and, as Mahr & Csibra (M&C) note, the capacity to ground veridical beliefs about the past. In some psychiatric disorders (antisocial personality disorder and conduct disorder), it was found that the habit of lying is associated with episodic memory and consciousness deficits.

Cognitive remediation improves executive functions, self-regulation and quality of life in residents of a substance use disorder therapeutic community

BACKGROUND

Executive dysfunction is common in substance use disorder (SUD) populations and hinders treatment. We previously found that 50% of residents in SUD therapeutic communities had been hospitalized for head injuries; this was a significant determinant of cognitive impairment. The current study aimed to establish whether cognitive remediation improves executive functions (EFs) and self-regulation in an ecologically valid sample of female residents attending SUD therapeutic community treatment, including those with past head injuries and psychiatric comorbidities.

METHODS

Controlled sequential groups design with residents (N=33, all female) receiving treatment as usual (TAU). The intervention group (n=16) completed four weeks of cognitive remediation (CR) and the control, TAU only (n=17). Outcome measures assessed pre- and post-intervention included both performance- and inventory-based measures of EFs, and self-reported self-regulation and quality of life.

RESULTS

CR relative to TAU significantly improved performance-based assessment of inhibition (Color-Word Interference Test; F=4.29, p=0.047), inventory-based assessment of EFs (Behavior Rating Inventory of Executive Function - Adult Version: Global Executive Composite; F=6.38, p=0.017), impulsivity (Barratt Impulsiveness Scale; F=4.61, p=0.040), self-control (Brief Self-Control Scale; F=5.53, p=0.026), and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form; F=7.68, p=0.010).

CONCLUSIONS

Findings suggest that CR improves EFs in a heterogeneous sample of female residents in therapeutic community SUD treatment. Future research may explore the possibility of tailoring CR interventions for various SUD subgroups.

Neurocognitive Deficits in Borderline Personality Disorder: Associations With Childhood Trauma and Dimensions of Personality Psychopathology

The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.

Event-Related Potentials Altered in Patients with Borderline Personality Disorder during Working Memory Tasks

Whereas some studies have demonstrated impaired working memory (WM) among patients with borderline personality disorder (BPD), these findings have not been consistent. Furthermore, there is a lack of neurophysiological evidence about WM function in patients with BPD. The goal of this study was to examine WM function in patients with BPD by using event-related potentials (ERPs). An additional goal was to explore whether characteristics of BPD (i.e., impulsiveness and emotional instability) are associated with WM impairment. A modified version of the N-back task (0- and 2-back) was used to measure WM. ERPs were recorded in 22 BPD patients and 21 age-, handedness-, and sex-matched healthy controls (HCs) while they performed the WM task. The results revealed that there were no significant group differences for behavioral variables (reaction time and accuracy rate) or for latencies and amplitudes of P1 and N1 (all p > 0.05). BPD patients had lower P3 amplitudes and longer N2 latencies than HC, independent of WM load (low load: 0-back; high load: 2-back). Impulsiveness was not correlated with N2 latency or P3 amplitude, and no correlations were found between N2 latency or P3 amplitude and affect intensity scores in any WM load (all p > 0.05). In conclusion, the lower P3 amplitudes and longer N2 latencies in BPD patients suggested that they might have some dysfunction of neural activities in sub-processing in WM, while impulsiveness and negative affect might not have a close relationship with these deficits.

Impulsivity and aggression mediate regional brain responses in Borderline Personality Disorder: An fMRI study

Fronto-limbic brain networks involved in regulation of impulsivity and aggression are abnormal in Borderline Personality Disorder (BPD). However, it is unclear whether, or to what extent, these personality traits actually modulate brain responses during cognitive processing. Using fMRI, we examined the effects of trait impulsivity, aggression, and depressed mood on regional brain responses in 31 female BPD and 25 control subjects during a Go No-Go task using Ekman faces as targets. First-level contrasts modeled effects of negative emotional context. Second-level regression models used trait impulsivity, aggression and depressed mood as predictor variables of regional brain activations. In BPD, trait impulsivity was positively correlated with activation in the dorsal anterior cingulate cortex, orbital frontal cortex (OFC), basal ganglia (BG), and dorsolateral prefrontal cortex, with no areas of negative correlation. In contrast, aggression was negatively correlated with activation in OFC, hippocampus, and BG, with no areas of positive correlation. Depressed mood had a generally dampening effect on activations. Effects of trait impulsivity on healthy controls differed from effects in BPD, suggesting a disorder-specific response. Negative emotional context and trait impulsivity, but not aggression or depression, diminished task performance across both groups. Negative emotional context may interfere with cognitive functioning in BPD through interaction with the neurobiology of personality traits.

Development, Administration, and Structural Validity of a Brief, Computerized Neurocognitive Battery: Results From the Army Study to Assess Risk and Resilience in Servicemembers

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a research project aimed at identifying risk and protective factors for suicide and related mental health outcomes among Army Soldiers. The New Soldier Study component of Army STARRS included the assessment of a range of cognitive- and emotion-processing domains linked to brain systems related to suicidal behavior including posttraumatic stress disorder, mood disorders, substance use disorders, and impulsivity. We describe the design and application of the Army STARRS neurocognitive test battery to a sample of 56,824 soldiers. We investigate its structural and concurrent validity through factor analysis and correlation of scores with demographics. We conclude that, in addition to being composed of previously well-validated measures, the Army STARRS neurocognitive battery as a whole demonstrates good psychometric properties. Correlations of scores with age and sex differences mostly replicate previously published findings, highlighting moderate to large effect sizes even within this restricted age range. Factor structures of scores conform to theoretical expectations. This neurocognitive battery provides a brief, valid measurement of neurocognition that may be helpful in predicting mental health and military performance. These measures can be integrated with neuroimaging to offer a powerful tool for assessing neurocognition in Servicemembers.

Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice

Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.

Executive functioning in people with personality disorders

PURPOSE OF REVIEW

This review summarizes recent executive functions research to better delineate the nosology of personality disorders.

RECENT FINDINGS

This review indicates that there are consistent impairments in executive functioning in people with personality disorders as compared with matched controls. Only five disorders were considered: borderline, obsessive-compulsive, antisocial, narcissistic, and schizotypal. Significant deficits are observed in decision-making, working memory, inhibition, and flexibility. Relevant data for the remaining personality disorders have not yet been published in relation to the executive functions.

SUMMARY

People with personality disorders could present a pattern of neurocognitive alterations that suggest a specific impairment of the prefrontal areas. The executive dysfunctions could partially explain the behavioral alterations in people with personality disorders.Further research should adopt broader considerations of effects of comorbidity and clinical heterogeneity, include community samples and, possibly, longitudinal designs with samples of youth.

Poor self-control and harsh punishment in childhood prospectively predict borderline personality symptoms in adolescent girls

Developmental theories of borderline personality disorder (BPD) propose that harsh, invalidating parenting of a child with poor self-control and heightened negative emotionality often leads to a coercive cycle of parent-child transactions that increase risk for BPD symptoms such as emotion dysregulation. Although parenting practices and child temperament have previously been linked with BPD, less is known about the prospective influences of caregiver and child characteristics. Using annual longitudinal data from the Pittsburgh Girls Study (n = 2,450), our study examined how reciprocal influences among harsh parenting, self-control, and negative emotionality between ages 5 and 14 predicted the development of BPD symptoms in adolescent girls ages 14 to 17. Consistent with developmental theories, we found that harsh punishment, poor self-control, and negative emotionality predicted BPD symptom severity at age 14. Only worsening self-control between ages 12 and 14, however, predicted growth in BPD symptoms from 14 to 17. Furthermore, the effects of harsh punishment and poor self-control on age 14 BPD symptoms were partially mediated by their earlier reciprocal effects on each other between ages 5 and 14. Our findings underscore the need to address both child and parental contributions to dysfunctional transactions in order to stem the development of BPD symptoms. Moreover, problems with self-regulation in early adolescence may indicate heightened risk for subsequent BPD. Altogether, these results increase our understanding of developmental trajectories associated with BPD symptoms in adolescent girls.

Dual-task performance under acute stress in female adolescents with borderline personality disorder

Research to elucidate early alterations of higher cognitive processes in adolescents with BPD is rare. This study investigated differences in dual-task performance in adolescents with BPD during stress and non-stress conditions. The study sample comprised 30 female adolescents with BPD and 34 healthy controls. The impact of stress on dual-task performance was measured using a standardized stressor. Self-reports of distress and measures of heart rate (HR) were obtained to measure stress reactivity. There were no group differences in task performance. Under stress conditions, the performance on the auditory task decreased in both groups but without significant group differences. Healthy controls showed an increase of mean HR after stress induction compared to no change in the BPD group. The finding of attenuated HR response to acute stress in adolescent patients with BPD may contradict current theories that the affective hyperresponsivity in BPD is based on a biologically determined mechanism.

Borderline personality disorder and neuropsychological measures of executive function: A systematic review

The notion that neurocognitive deficits may be core to the development of borderline personality disorder (BPD) has received considerable attention in recent years, with growing evidence pointing to cognitive deficits in executive function (EF). A relationship between EF and BPD has long been suggested by evidence of high comorbidity between BPD and disorders characterized by poor EF (e.g. attention-deficit/hyperactivity disorder); however, despite a marked increase in studies of EF and BPD in recent years, the precise nature of this relationship remains unclear. We provide a systematic review of this emerging evidence base, with respect to (1) studies of participants diagnosed with BPD in which EF has been indexed in isolation from broader cognitive processes; (2) the specific domains of EF that have been most robustly associated with BPD; and (3) whether deficits in EF are uniquely associated with BPD, independent of comorbid psychopathology. Key directions for future research are discussed with respect to strategies for measuring EF and the need for research designs that control for phenotypic overlap between BPD and related forms of psychopathology.

Executive dysfunction in bipolar disorder and borderline personality disorder

Objective

The boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients.

Method

Executive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n= 30) and BPD outpatients (n= 32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls.

Results

BD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving.

Conclusions

Differences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.

Autobiographical memory in borderline personality disorder-A systematic review

Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events. One of the main functions of these memories is to enable us to understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although a number of studies have been published results remain inconsistent. Furthermore, we find that many of the studies suffer from inadequate designs particularly regarding the reported measures of autobiographical memory. We discuss potential links between personality functioning, identity diffusion, autobiographical memory and borderline personality disorder.

Neurobiological Findings in Youth with Borderline Personality Disorder

This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processing—particularly involving negative stimuli—may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamic–pituitary–adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.

Impulsivity, aggression and brain structure in high and low lethality suicide attempters with borderline personality disorder

Impulsivity and aggressiveness are trait dispositions associated with the vulnerability to suicidal behavior across diagnoses. They are associated with structural and functional abnormalities in brain networks involved in regulation of mood, impulse and behavior. They are also core characteristics of borderline personality disorder (BPD), a disorder defined, in part, by recurrent suicidal behavior. We assessed the relationships between personality traits, brain structure and lethality of suicide attempts in 51 BPD attempters using multiple regression analyses on structural MRI data. BPD was diagnosed by the Diagnostic Interview for Borderline Patients-revised, impulsivity by the Barratt Impulsiveness Scale (BIS), aggression by the Brown-Goodwin Lifetime History of Aggression (LHA), and high lethality by a score of 4 or more on the Lethality Rating Scale (LRS). Sixteen High Lethality attempters were compared to 35 Low Lethality attempters, with no significant differences noted in gender, co-morbidity, childhood abuse, BIS or LHA scores. Degree of medical lethality (LRS) was negatively related to gray matter volumes across multiple fronto-temporal-limbic regions. Effects of impulsivity and aggression on gray matter volumes discriminated High from Low Lethality attempters and differed markedly within lethality groups. Lethality of suicide attempts in BPD may be related to the mediation of these personality traits by specific neural networks.

Executive functions and psychiatric symptoms in drug-refractory juvenile myoclonic epilepsy

PURPOSE

The pattern of executive dysfunction reported in juvenile myoclonic epilepsy (JME) resembles that of patients with cluster B personality disorders. This study examined whether executive dysfunction and maladaptive behavior reported in patients with JME are related.

METHOD

Sixty patients with drug-refractory JME were administered tests of intellect, memory, and executive dysfunction. Anxiety, depression, personality traits, impact of epilepsy, and perceived cognitive effects of antiepileptic drugs were measured.

RESULTS

Half of the cohort exhibited moderate to severe anxiety symptoms. The patients performed most poorly on naming ability and inhibition switching. Duration of epilepsy exacerbated poor performance on inhibition switching. Females presented with pathological scores for neurotic and introvert traits and males for introvert traits. Abnormal personality traits and psychiatric disorders were associated with worse intellectual and executive functioning. People with extreme Eysenck Personality Scale - Brief Version (EPQ-BV) scores demonstrated the greatest level of executive impairment. Furthermore, the same degree of dysfunction was not seen in any individual with unremarkable EPQ-BV scores.

CONCLUSION

This study indicates that specific patterns of executive dysfunction are related to maladaptive behavior in JME. Distinct behavioral patterns may be used to identify functional and anatomical differences between people with JME and for stratification to enable gene discovery.

The latest neuroimaging findings in borderline personality disorder

Borderline personality disorder (BPD) is a severe mental disorder, characterized by pronounced deficits in emotion regulation, cognitive disturbances including dissociation, impulsivity, and interpersonal disturbances. Over the last decades, neuroimaging has become one of the most important methods to investigate neurobiological alterations possibly underlying core features of BPD. The aim of our article is to provide an overview of the latest neuroimaging research in BPD focusing on functional and structural MRI studies published since 2010. Findings of these studies are depicted and discussed referring to central domains of BPD psychopathology. On a neurochemical level, altered function in neurotransmitter systems including the serotonin, glutamate, and GABA systems was observed in patients with BPD. On a neural level, individuals with BPD showed structural and functional abnormalities in a fronto-limbic network including regions involved in emotion processing (e.g., amygdala, insula) and frontal brain regions implicated in regulatory control processes (e.g., anterior cingulate cortex, medial frontal cortex, orbitofrontal cortex, and dorsolateral prefrontal cortex). Limbic hyperreactivity and diminished recruitment of frontal brain regions may yield a link between disturbed emotion processing and other core features of BPD such as impulsivity and interpersonal disturbances. To clarify whether findings are specific to BPD, comparisons with other clinical groups are needed.

Emotions and memory in borderline personality disorder

Memory processes such as encoding, storage, and retrieval of information are influenced by emotional content. Because patients with borderline personality disorder (BPD) are particularly susceptible to emotional information, it is relevant to understand whether such memory processes are altered in this patient group. This systematic literature review collects current evidence on this issue. Research suggests that emotional information interferes more strongly with information processing and learning in BPD patients than in healthy controls. In general, BPD patients do not seem to differ from healthy control subjects in their ability to memorize emotional information, but they tend to have specific difficulties forgetting negative information. Also, BPD patients seem to recall autobiographical, particularly negative events with stronger arousal than healthy controls, while BPD patients also show specific temporo-prefrontal alterations in neural correlates. No substantial evidence was found that the current affective state influences learning and memory in BPD patients any differently than in healthy control subjects. In general, a depressive mood seems to both deteriorate and negatively bias information processing and memories, while there is evidence that dissociative symptoms impair learning and memory independently of stimulus valence. This review discusses methodological challenges of studies on memory and emotions in BPD and makes suggestions for future research and clinical implications.

Susceptibility to distraction by social cues in borderline personality disorder

BACKGROUND/AIMS

Individuals with borderline personality disorder (BPD) are highly sensitive to social rejection and show alterations in social perception. Increased susceptibility to social cues in patients with BPD might interfere with executive functions that play an important role in goal-directed behavior. The aim of this study was to investigate the influence of task-irrelevant (neutral vs. negatively arousing) social cues on working memory performance in BPD patients compared to healthy controls (HC).

METHODS

28 unmedicated female BPD patients and 28 female HC (matched for age and education) performed a Sternberg item recognition task, while being distracted by neutral versus negatively arousing pictures from the International Affective Picture System (interpersonal scenes) and the Karolinska Directed Emotional Faces Set (faces). Additionally, self-ratings of aversive inner tension were assessed and correlated with task performance.

RESULTS

Compared to HC, BPD patients showed significantly impaired accuracy after distraction by negatively arousing stimuli (both scenes and faces) and neutral faces (but not neutral scenes). Significant negative correlations between overall accuracy and self-reported aversive inner tension were observed in BPD patients.

CONCLUSIONS

Findings of the present study suggest increased susceptibility to distracting (negatively arousing) social cues in individuals with BPD, which might interfere with cognitive functioning.

Dissociative amnesia in dissociative disorders and borderline personality disorder: self-rating assessment in a college population

Dissociative amnesia (DA) among subjects with a dissociative disorder and/or borderline personality disorder (BPD) recruited from a nonclinical population was examined. The Steinberg Dissociative Amnesia Questionnaire (SDAQ), the Childhood Trauma Questionnaire, and the self-report screening tool of the BPD section of the Structured Clinical Interview for DSM-IV(SCID-BPD) were administered to 1,301 college students. A total of 80 participants who were diagnosed with BPD according to the clinician-administered SCID-BPD and 111 nonborderline controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) by a psychiatrist blind to diagnosis and scale scores. Internal consistency analyses and test-retest evaluations suggested that the SDAQ is a reliable instrument for the population studied. Of the participants, 20.6% reported an SDAQ score of 20 or above and impairment by DA. Those who had both dissociative disorder and BPD (n = 78) had the highest SDAQ scores. Both disorders had significant effects on the SCID-D total and amnesia scores in the variance analysis. On SDAQ scores, however, only BPD had this effect. There was a significant interaction between the 2 disorders for the SCID-D total but not for the SDAQ or SCID-D amnesia scores. BPD represented the severity of dissociation and childhood trauma in this study group. However, in contrast to the dissociative disorders, BPD was characterized by better awareness of DA in self-report. The discrepancies between self-report and clinical interview associated with BPD and dissociative disorders are discussed in the context of betrayal theory (J. J. Freyd, 1994) of BPD and perceptual theory (D. B. Beere, 2009) of dissociative disorders.

False memories and memory confidence in borderline patients

BACKGROUND AND OBJECTIVES

Mixed results have been obtained regarding memory in patients with borderline personality disorder (BPD). Prior reports and anecdotal evidence suggests that patients with BPD are prone to false memories but this assumption has to been put to firm empirical test, yet.

METHODS

Memory accuracy and confidence was assessed in 20 BPD patients and 22 healthy controls using a visual variant of the false memory (Deese-Roediger-McDermott) paradigm which involved a negative and a positive-valenced picture.

RESULTS

Groups did not differ regarding veridical item recognition. Importantly, patients did not display more false memories than controls. At trend level, borderline patients rated more items as new with high confidence compared to healthy controls.

CONCLUSIONS

The results tentatively suggest that borderline patients show uncompromised visual memory functions and display no increased susceptibility for distorted memories.

Executive functions in borderline personality disorder

Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning.

Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity disorder: an exploratory study

Impulsivity is regarded as a key feature in borderline personality disorder (BPD). However, discrepancies in previous research indicate that the role of impulsivity in BPD is not yet fully understood. For example, state-dependent impulsivity in individuals with BPD may be related to co-occurring psychiatric conditions such as attention-deficit/hyperactivity disorder (ADHD) and to emotional states. We assessed self-reports of trait and state impulsivity and response inhibition before and after an experimental stress induction in 15 patients with BPD without ADHD, 15 patients with BPD and ADHD, 15 patients with ADHD, and 15 healthy participants. The patients in both BPD subgroups reported a stress-dependent increase of state impulsivity, which was not observed in the other groups. Response inhibition was impaired in the patients with BPD and ADHD but not in those without ADHD compared with the healthy participants. We suggest that stress levels and co-occurring ADHD should receive attention in future studies on impulsivity in BPD.

Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation?

Impulsivity is regarded as a clinical, diagnostic and pathophysiological hallmark of borderline personality disorder (BPD). Self-report measures of impulsivity consistently support the notion of higher impulsive traits in BPD patients as compared to healthy control subjects. Laboratory tests of impulsivity, i.e. neuropsychological tests of impulse control render weak and inconsistent results both across different cognitive components of impulse control and within the same cognitive component of impulse control. One important factor worsening impulsive behaviors and impulse control deficits in BPD is comorbid attention-deficit/hyperactivity disorder (ADHD). In addition, emotional dysregulation interacts with impulse control especially for BPD salient emotions. In sum, although basic mechanisms of impulse control seem not to be disturbed in BPD, clinically well observed impulsive behaviors may be explained by comorbid ADHD or may be the consequence of dysregulation of BPD salient emotions.