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Traynor JM, McMain S, Chapman AL, Kuo J, Labrish C, Ruocco AC. Pretreatment cognitive performance is associated with differential self-harm outcomes in 6 v. 12-months of dialectical behavior therapy for borderline personality disorder. Psychol Med 2024; 54:1350-1360. [PMID: 37997387 DOI: 10.1017/s0033291723003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Recent findings suggest that brief dialectical behavior therapy (DBT) for borderline personality disorder is effective for reducing self-harm, but it remains unknown which patients are likely to improve in brief v. 12 months of DBT. Research is needed to identify patient characteristics that moderate outcomes. Here, we characterized changes in cognition across brief DBT (DBT-6) v. a standard 12-month course (DBT-12) and examined whether cognition predicted self-harm outcomes in each arm. METHODS In this secondary analysis of 240 participants in the FASTER study (NCT02387736), cognitive measures were administered at pre-treatment, after 6 months, and at 12 months. Self-harm was assessed from pre-treatment to 2-year follow-up. Multilevel models characterized changes in cognition across treatment. Generalized estimating equations examined whether pre-treatment cognitive performance predicted self-harm outcomes in each arm. RESULTS Cognitive performance improved in both arms after 6 months of treatment, with no between-arm differences at 12-months. Pre-treatment inhibitory control was associated with different self-harm outcomes in DBT-6 v. DBT-12. For participants with average inhibitory control, self-harm outcomes were significantly better when assigned to DBT-12, relative to DBT-6, at 9-18 months after initiating treatment. In contrast, participants with poor inhibitory control showed better self-harm outcomes when assigned to brief DBT-6 v. DBT-12, at 12-24 months after initiating treatment. CONCLUSIONS This work represents an initial step toward an improved understanding of patient profiles that are best suited to briefer v. standard 12 months of DBT, but observed effects should be replicated in a waitlist-controlled study to confirm that they were treatment-specific.
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Affiliation(s)
- Jenna M Traynor
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shelley McMain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Janice Kuo
- Department of Psychology, PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, USA
| | - Cathy Labrish
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony C Ruocco
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
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2
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Abstract
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.
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Affiliation(s)
- Ibrahim H Aslan
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Samuel R Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
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3
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Vijayapriya CV, Tamarana R. Effectiveness of internet-delivered dialectical behavior therapy skills training on executive functions among college students with borderline personality traits: a non-randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:694. [PMID: 37905964 PMCID: PMC10690726 DOI: 10.4081/ripppo.2023.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023]
Abstract
Given the enormous influence of emotions on cognitive processes, individuals with borderline personality disorder (BPD) suffer from marked deficits in higher-order thinking abilities. Considering the prevalence of BPD among college students, this study aimed to investigate the changes in perceived executive functioning among college students with traits/presence of BPD undergoing internet-delivered dialectical behavior therapy skills training (DBT-ST) that included the mindfulness and emotion regulation modules. An internet-delivered version of DBT-ST was opted for, as technological advancements in the present era promote the use of online platforms for psychotherapy. This non-randomized controlled trial consisted of 36 college students with traits/presence of BPD. The intervention group attended 13 sessions of DBT-ST, and the control group attended 13 sessions of behavioral activation. Perceived executive functioning was assessed using the Behavior Rating Inventory of Executive Functions for Adults. A 2-way repeated measures analysis of variance was used to evaluate the treatment impact on the outcome variable. Results showed that the DBT-ST group had larger improvements in their abilities to initiate, plan, and organize current and future-oriented task demands and to organize their everyday environment, compared to the control group. Both, the DBT-ST group and the control group demonstrated improvements in emotional control, working memory, and their abilities to shift and task monitor. Findings suggest that the internet-delivered version of DBT-ST, consisting of the mindfulness and emotion regulation modules, can foster notable improvements in executive functions among college students with traits/presence of BPD. Improved executive functioning is one of the several multifaceted outcomes of dialectical behavior therapy.
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4
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Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD. BMC Psychiatry 2023; 23:106. [PMID: 36793031 PMCID: PMC9930262 DOI: 10.1186/s12888-023-04515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Research on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains. METHODS We examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD). RESULTS After adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status. CONCLUSIONS Given our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.
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5
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Veerapandian KD, Tan GXD, Majeed NM, Hartanto A. Executive Function Deficits and Borderline Personality Disorder Symptomatology in a Nonclinical Adult Sample: A Latent Variable Analysis. Brain Sci 2023; 13:brainsci13020206. [PMID: 36831751 PMCID: PMC9953861 DOI: 10.3390/brainsci13020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
While borderline personality disorder (BPD) symptomatology has been studied extensively in clinical populations, the mechanisms underlying its manifestation in nonclinical populations remain largely understudied. One aspect of BPD symptomatology in nonclinical populations that has not been well studied is cognitive mechanisms, especially in relation to executive functions. To explore the cognitive mechanisms underlying BPD symptomatology in nonclinical populations, we analysed a large-scale dataset of 233 young adults that were administered with nine executive function tasks and BPD symptomatology assessments. Our structural equation modelling did not find any significant relations between latent factors of executive functions and the severity of BPD symptomatology. Contrary to our hypothesis, our result suggests that deficits in executive functions were not a risk factor for BPD symptomatology in the nonclinical young adult sample.
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Affiliation(s)
| | - Gabriel X. D. Tan
- School of Social Sciences, Singapore Management University, Singapore 179873, Singapore
| | - Nadyanna M. Majeed
- Department of Psychology, Faculty of Arts & Social Sciences, National University of Singapore, Singapore 119077, Singapore
| | - Andree Hartanto
- School of Social Sciences, Singapore Management University, Singapore 179873, Singapore
- Correspondence:
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6
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An exploratory study of functional brain activation underlying response inhibition in major depressive disorder and borderline personality disorder. PLoS One 2023; 18:e0280215. [PMID: 36608051 PMCID: PMC9821521 DOI: 10.1371/journal.pone.0280215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
Cognitive control is associated with impulsive and harmful behaviours, such as substance abuse and suicidal behaviours, as well as major depressive disorder (MDD) and borderline personality disorder (BPD). The association between MDD and BPD is partially explained by shared pathological personality traits, which may be underpinned by aspects of cognitive control, such as response inhibition. The neural basis of response inhibition in MDD and BPD is not fully understood and could illuminate factors that differentiate between the disorders and that underlie individual differences in cross-cutting pathological traits. In this study, we sought to explore the neural correlates of response inhibition in MDD and BPD, as well as the pathological personality trait domains contained in the ICD-11 personality disorder model. We measured functional brain activity underlying response inhibition on a Go/No-Go task using functional magnetic resonance imaging in 55 female participants recruited into three groups: MDD without comorbid BPD (n = 16), MDD and comorbid BPD (n = 18), and controls with neither disorder (n = 21). Whereas response-inhibition-related activation was observed bilaterally in frontoparietal cognitive control regions across groups, there were no group differences in activation or significant associations between activation in regions-of-interest and pathological personality traits. The findings highlight potential shared neurobiological substrates across diagnoses and suggest that the associations between individual differences in neural activation and pathological personality traits may be small in magnitude. Sufficiently powered studies are needed to elucidate the associations between the functional neural correlates of response inhibition and pathological personality trait domains.
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7
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Koudys JW, Ruocco AC. Executive functioning in adults with borderline personality disorder and first-degree biological relatives. World J Biol Psychiatry 2022; 23:387-400. [PMID: 34913833 DOI: 10.1080/15622975.2021.2012396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Behavioural dysregulation is a heritable core symptom domain in borderline personality disorder (BPD) that is likely influenced by the integrity of executive functions (EFs). However, the extent to which familial risk for BPD confers decrement to EFs has yet to be comprehensively studied. METHODS In this family study, probands with BPD (n = 73), first-degree biological relatives (n = 65), and healthy controls without psychiatric diagnoses (n = 77) were assessed in abstraction, attentional vigilance, working memory, cognitive flexibility, interference resolution, planning, problem solving, and response inhibition. RESULTS In univariate analyses, probands demonstrated lower response inhibition than relatives. Comparatively, discriminant function analyses revealed that lower interference resolution and response inhibition jointly discriminated probands from relatives and controls, whereas a combination of less efficient problem solving and difficulty manipulating mental information discriminated probands and relatives from controls. Moreover, the subset of psychiatrically non-affected relatives demonstrated a pattern of resilience to psychiatric morbidity substantiated by stronger response inhibition and abstraction abilities despite less efficient problem solving. CONCLUSIONS Familial risk for BPD is represented predominantly by a pattern of problem-solving and working memory deficits. Resilience to a psychiatric disorder in non-affected relatives reflects both EF weaknesses and strengths, highlighting potential protective factors that should be considered in future neurocognitive research on BPD families.
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Affiliation(s)
- Jacob W Koudys
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada
| | - Anthony C Ruocco
- Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Canada.,Department of Psychology, University of Toronto Scarborough, Toronto, Canada
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8
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Choenni V, Kok R, Verhulst FC, van Lier MHM, Lambregtse-van den Berg MP. The Dutch Infant Caregiving Assessment Scales: Psychometric properties in mothers with and without a severe psychiatric disorder. Int J Methods Psychiatr Res 2022; 31:e1902. [PMID: 35088917 PMCID: PMC9159692 DOI: 10.1002/mpr.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/02/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study examines the psychometric properties of the Dutch adaptation of the Infant Caregiving Assessment Scales (INCAS). This standardized observation procedure is the first to assess both emotional and instrumental caregiving skills of mothers with a severe psychiatric disorder, during the postpartum period. METHODS Mothers with and without a severe psychiatric disorder (N = 123) were observed at home at the infant age of 6 weeks during daily caregiving; changing a diaper, bathing, dressing, and feeding. Recordings of observations were coded independently by trained coders, blind for group membership. Subsequently, the component structure, internal consistency, interrater reliability, and concurrent validity of the INCAS were examined. RESULTS Principal component analysis largely confirmed the two a priori defined caregiving domains. The internal consistencies of the emotional and instrumental domains were deemed excellent and good, respectively. The interrater reliability was substantial for the emotional domain and moderate for the instrumental domain. Furthermore, evidence for good concurrent validity of the emotional domain was found. Lastly, significant correlations were found between specific instrumental caregiving skills and maternal neuropsychological functioning. CONCLUSION Psychometric findings support the INCAS as a comprehensive and reliable instrument for standardized assessment of caregiving by mothers with a severe psychiatric disorder.
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Affiliation(s)
- Vandhana Choenni
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Rianne Kok
- Department of Psychology, Education, & Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monique H M van Lier
- Department of the Parnassia Psychiatric Institute, Youz, Center for Youth Mental Healthcare, The Hague, The Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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9
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Emotional working memory updating in individuals with borderline personality features. J Behav Ther Exp Psychiatry 2021; 71:101636. [PMID: 33476888 DOI: 10.1016/j.jbtep.2021.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/23/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
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.
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10
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Wrege JS, Carcone D, Lee ACH, Cane C, Lang UE, Borgwardt S, Walter M, Ruocco AC. Attentional salience and the neural substrates of response inhibition in borderline personality disorder. Psychol Med 2021; 52:1-9. [PMID: 33722320 PMCID: PMC9772916 DOI: 10.1017/s0033291721000118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Impulsivity is a central symptom of borderline personality disorder (BPD) and its neural basis may be instantiated in a frontoparietal network involved in response inhibition. However, research has yet to determine whether neural activation differences in BPD associated with response inhibition are attributed to attentional saliency, which is subserved by a partially overlapping network of brain regions. METHODS Patients with BPD (n = 45) and 29 healthy controls (HCs; n = 29) underwent functional magnetic resonance imaging while completing a novel go/no-go task with infrequent odd-ball trials to control for attentional saliency. Contrasts reflecting a combination of response inhibition and attentional saliency (no-go > go), saliency processing alone (oddball > go), and response inhibition controlling for attentional saliency (no-go > oddball) were compared between BPD and HC. RESULTS Compared to HC, BPD showed less activation in the combined no-go > go contrast in the right posterior inferior and middle-frontal gyri, and less activation for oddball > go in left-hemispheric inferior frontal junction, frontal pole, superior parietal lobe, and supramarginal gyri. Crucially, BPD and HC showed no activation differences for the no-go > oddball contrast. In BPD, higher vlPFC activation for no-go > go was correlated with greater self-rated BPD symptoms, whereas lower vlPFC activation for oddball > go was associated with greater self-rated attentional impulsivity. CONCLUSIONS Patients with BPD show frontoparietal disruptions related to the combination of response inhibition and attentional saliency or saliency alone, but no specific response inhibition neural activation difference when attentional saliency is controlled. The findings suggest a neural dysfunction in BPD underlying attention to salient or infrequent stimuli, which is supported by a negative correlation with self-rated impulsiveness.
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Affiliation(s)
- J. S. Wrege
- Department of Psychiatry, University Psychiatric Clinics of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - D. Carcone
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - A. C. H. Lee
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - C. Cane
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - U. E. Lang
- Department of Psychiatry, University Psychiatric Clinics of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | | | - M. Walter
- Department of Psychiatry, University Psychiatric Clinics of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - A. C. Ruocco
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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11
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Linhartová P, Širůček J, Ejova A, Barteček R, Theiner P, Kašpárek T. Dimensions of Impulsivity in Healthy People, Patients with Borderline Personality Disorder, and Patients with Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2021; 25:584-595. [PMID: 30628513 DOI: 10.1177/1087054718822121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Impulsivity, observed in patients with various psychiatric disorders, is a heterogeneous construct with different behavioral manifestations. Through confirmatory factor analysis (CFA), this study tests hypotheses about relationships between dimensions of impulsivity measured using personality questionnaires and behavioral tests. Method: The study included 200 healthy people, 40 patients with borderline personality disorder, and 26 patients with attention-deficit/hyperactivity disorder (ADHD) who underwent a comprehensive impulsivity test battery including the Barratt Impulsiveness Scale (BIS), UPPS-P Impulsive Behavior Scale, a Go-NoGo task, a stop-signal task, and a delay discounting task. Results: A CFA model comprising three self-reported and three behavioral latent variables reached a good fit. Both patient groups scored higher in the self-reported dimensions and impulsive choice; only the ADHD patients displayed impaired waiting and stopping impulsivity. Conclusions: Using the developed CFA model, it is possible to describe relations between impulsivity dimensions and show different impulsivity patterns in patient populations.
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Affiliation(s)
- Pavla Linhartová
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | | | | | - Richard Barteček
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Pavel Theiner
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Tomáš Kašpárek
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
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12
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Michopoulos I, Tournikioti K, Paraschakis A, Karavia A, Gournellis R, Smyrnis N, Ferentinos P. Similar or Different Neuropsychological Profiles? Only Set Shifting Differentiates Women With Bipolar vs. Borderline Personality Disorder. Front Psychiatry 2021; 12:690808. [PMID: 34393854 PMCID: PMC8355351 DOI: 10.3389/fpsyt.2021.690808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
There is ongoing debate about the similarities and differences between bipolar disorder (BD) and borderline personality disorder (BPD). Very few studies have concurrently assessed their neuropsychological profile and only on a narrow array of neuropsychological tests. We aimed to investigate the differences of these two patient groups on visual memory, executive function, and response inhibition. Twenty-nine BD patients, 27 BPD patients and 22 controls (all female) were directly compared on paired associates learning (PAL), set shifting (ID/ED), problem solving (SOC), and response inhibition (SSRT) using Cambridge Neuropsychological Test Automated Battery (CANTAB). Rank-normalized outcomes were contrasted in one-way ANOVA tests. Discriminant analysis was finally performed to predict BD or BPD patient status. BD patients performed significantly worse than controls on all tasks. BPD patients performed significantly worse than HC on all tests except SST. Significant differences between the two patient groups were recorded only on ID/ED, where BPD patients performed worse (p = 0.044). A forward stepwise discriminant analysis model based on ID/ED and SOC predicted correctly patients' group at 67.9% of cases. In conclusion, BD and BPD female patients appear to be more similar than different as regards their neuropsychological functions. This study is the first to show that BPD patients display more deficits than BD patients when directly compared on the set shifting executive function test, a marker of cognitive flexibility. Discerning BD from BPD patients through neuropsychological performance is promising but would improve by using additional subtler tests and psychometric evaluation.
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Affiliation(s)
- Ioannis Michopoulos
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Kalliopi Tournikioti
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | | | - Anna Karavia
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Rossetos Gournellis
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
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13
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Hamzeloo M, Mashhadi A, Fadardi JS, Ghahremanzadeh M. Adult attention deficit/hyperactivity disorder among the prison inmates: An investigation of the executive function differences and comorbidity effects. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ali Mashhadi
- Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran,
| | - Javad S. Fadardi
- Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran,
- School of Psychology, Bangor University, Bangor, Wales, UK,
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA,
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14
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Linhartová P, Látalová A, Barteček R, Širůček J, Theiner P, Ejova A, Hlavatá P, Kóša B, Jeřábková B, Bareš M, Kašpárek T. Impulsivity in patients with borderline personality disorder: a comprehensive profile compared with healthy people and patients with ADHD. Psychol Med 2020; 50:1829-1838. [PMID: 31439062 DOI: 10.1017/s0033291719001892] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impulsivity is a core symptom of borderline personality disorder (BPD). Impulsivity is a heterogeneous concept, and a comprehensive evaluation of impulsivity dimensions is lacking in the literature. Moreover, it is unclear whether BPD patients manifest impaired cognitive functioning that might be associated with impulsivity in another patient group, such as ADHD, a frequent comorbidity of BPD. METHODS We tested 39 patients with BPD without major psychiatric comorbidities and ADHD, 25 patients with ADHD, and 55 healthy controls (HC) using a test battery consisting of a self-report measure of impulsivity (UPPS-P questionnaire), behavioral measures of impulsivity - impulsive action (Go/NoGo task, stop signal task) and impulsive choice (delay discounting task, Iowa gambling task), and standardized measures of attention (d2 test), working memory (digit span), and executive functioning (Tower of London). RESULTS Patients with BPD and ADHD, as compared with HC, manifested increased self-reported impulsivity except sensation seeking and increased impulsive choice; patients with ADHD but not BPD showed increased impulsive action and deficits in cognitive functioning. Negative urgency was increased in BPD as compared to both HC and ADHD groups and correlated with BPD severity. CONCLUSIONS Patients with BPD without ADHD comorbidity had increased self-reported impulsivity and impulsive choice, but intact impulsive action and cognitive functioning. Controlling for ADHD comorbidity in BPD samples is necessary. Negative urgency is the most diagnostically specific impulsivity dimension in BPD.
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Affiliation(s)
- Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Richard Barteček
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Širůček
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anastasia Ejova
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Pavlína Hlavatá
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Barbora Kóša
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Jeřábková
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, St. Anne's Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tomáš Kašpárek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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15
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Aguilar-Ortiz S, Salgado-Pineda P, Vega D, Pascual JC, Marco-Pallarés J, Soler J, Brunel C, Martin-Blanco A, Soto A, Ribas J, Maristany T, Sarró S, Rodríguez-Fornells A, Salvador R, McKenna PJ, Pomarol-Clotet E. Evidence for default mode network dysfunction in borderline personality disorder. Psychol Med 2020; 50:1746-1754. [PMID: 31456534 DOI: 10.1017/s0033291719001880] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder. METHODS Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups. RESULTS On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample. CONCLUSIONS In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
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Affiliation(s)
- Salvatore Aguilar-Ortiz
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
- Departament de Psiquiatria i Medicina Legal, PhD Programme, Doctorat en Psiquiatria, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Daniel Vega
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Juan C Pascual
- CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Marco-Pallarés
- Faculty of Psychology, University of Barcelona, Bellvitge Hospital, Barcelona, Spain
| | - Joaquim Soler
- CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Brunel
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | - Ana Martin-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Angel Soto
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Joan Ribas
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Teresa Maristany
- Hospital Sant Joan de Déu, Esplugues de Llobregrat, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | | | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
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16
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López-Villatoro JM, Diaz-Marsá M, Mellor-Marsá B, De la Vega I, Carrasco JL. Executive Dysfunction Associated With the Primary Psychopathic Features of Borderline Personality Disorder. Front Psychiatry 2020; 11:514905. [PMID: 33362588 PMCID: PMC7758395 DOI: 10.3389/fpsyt.2020.514905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the present study is to investigate whether the presence of psychopathic features in BPD is related to dysfunction in executive functions and other neuropsychological functions in these patients. Methods: 82 patients diagnosed with borderline personality disorder and 54 control subjects were studied through clinical and neuropsychological evaluation protocols and the Levenson Psychopathy Inventory. Results: BPD patients showed significantly higher scores on both primary (F1) and secondary (F2) global rates of psychopathy, than controls. The results for these patients also showed a statistically significant association between high scores in primary psychopathy and deficits in executive functions. However, no associations were found between the scores of secondary psychopathy and executive dysfunction. Conclusion: Primary psychopathic features present in patients with BPD are associated with patterns of executive dysfunction. It would therefore be interesting to investigate the role of cognitive rehabilitation in the empathy dysfunctions within these disorders.
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Affiliation(s)
| | - Marina Diaz-Marsá
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Research Networking Consortium for Mental Health (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - Blanca Mellor-Marsá
- Sanitary Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Irene De la Vega
- Sanitary Research Institute, Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José L Carrasco
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Research Networking Consortium for Mental Health (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
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17
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Baliousis M, Duggan C, McCarthy L, Huband N, Völlm B. Executive function, attention, and memory deficits in antisocial personality disorder and psychopathy. Psychiatry Res 2019; 278:151-161. [PMID: 31200194 DOI: 10.1016/j.psychres.2019.05.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022]
Abstract
Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogeneity in operationalizations has led to diverse findings without clear understanding of what characterizes this broader population. This study sought to clarify the neuropsychological profiles of ASPD and psychopathy. The Cambridge Neuropsychological Test Assessment Battery was administered to 85 adult male offenders in a personality disorder secure service and to 20 healthy controls. Of patients with ASPD, 46% met criteria for psychopathy. Of those with psychopathy, 89% met criteria for ASPD. There were two sets of comparisons: ASPD versus other personality disorders versus controls and psychopathy versus other personality disorders versus controls. ASPD showed deficits across executive functions, visual short-term and working memory, and attention (compared with controls). Psychopathy showed deficits limited to attention, complex planning, inhibitory control, and response reversal. Response reversal and visual search deficits appeared specific to ASPD and psychopathy versus other personality disorders and may underpin antisocial traits. Additional deficits in inhibitory control and working memory appeared to distinguish ASPD from other personality disorders.
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Affiliation(s)
- Michael Baliousis
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK; Arnold Lodge RSU, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK.
| | - Conor Duggan
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK; Arnold Lodge RSU, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Lucy McCarthy
- Arnold Lodge RSU, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Nick Huband
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Birgit Völlm
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
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18
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Quattrini G, Marizzoni M, Magni LR, Magnaldi S, Lanfredi M, Rossi G, Frisoni GB, Pievani M, Rossi R. Whole-brain microstructural white matter alterations in borderline personality disorder patients. Personal Ment Health 2019; 13:96-106. [PMID: 30989833 DOI: 10.1002/pmh.1441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/27/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a psychiatric condition associated with the impairment of the frontolimbic network. However, a growing body of studies suggests that brain dysfunction underling BPD could involve other brain areas. We explored the whole-brain white matter (WM) organization in BPD patients to clarify the structural pattern underlying the disease and its relationship with clinical features. METHODS Fourteen BPD patients and 14 healthy controls underwent a multidimensional clinical assessment and diffusion tensor imaging acquisition. Measures of fractional anisotropy (FA) and mean, axial and radial (RD) diffusivity were collected, and alterations in the WM were assessed using the voxelwise approach, including substance and alcohol abuse as covariates. Voxelwise regression analysis was performed to identify associations between microstructural changes and clinical feature in BPD. RESULTS Group comparisons showed alterations only for FA and RD: FA decreased in the right posterior hemisphere, while RD increased bilaterally and widespread in anterior and posterior areas (p < 0.05, threshold-free cluster enhancement corrected). Moreover, WM alterations of the corpus callosum were related to anxiety in BPD group. DISCUSSION Our data support the idea that structural alterations underling BPD also involve cortico-cortical pathways, corticothalamic and corticostriatal tracts, suggesting that the frontolimbic model should be reinterpreted. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Giulia Quattrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura R Magni
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Magnaldi
- Department of Neuroradiology, Poliambulanza Hospital, Brescia, Italy
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Psychiatry, LANVIE-Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - Michela Pievani
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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19
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Albert J, López-Martín S, Arza R, Palomares N, Hoyos S, Carretié L, Díaz-Marsá M, Carrasco JL. Response inhibition in borderline personality disorder: Neural and behavioral correlates. Biol Psychol 2019; 143:32-40. [PMID: 30772405 DOI: 10.1016/j.biopsycho.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/18/2018] [Accepted: 02/09/2019] [Indexed: 11/16/2022]
Abstract
Although response inhibition is thought to be important in borderline personality disorder (BPD), little is known about its neurophysiological basis. This study aimed to provide insight into this issue by capitalizaing on the high temporal resolution of electroencephalography and information provided by source localization methods. To this end, twenty unmedicated patients with BPD and 20 healthy control subjects performed a modified go/no-go task designed to better isolate the brain activity specifically associated with response inhibition. Event-related potentials (ERP) were measured and further analyzed at the scalp and source levels. Patients with BPD made more commission errors (failed inhibitions) than control subjects. Scalp ERP data showed that both groups displayed greater frontocentral P3 amplitude for no-go (response inhbition) than for go trials (response execution). However, source reconstruction data revealed that patients with BPD activated posterior parietal regions (precuneus) to inhibit their responses, whereas controls activated prefrontal regions (presupplementary motor area, preSMA). This dissociation was supported by a significant Region (precuneus, preSMA) x Trial Type (no-go, go) x Group (BPD, control) interaction. These findings extend our understanding of the neurophysiological basis of abnormal response inhibition in BPD, suggesting that patients with BPD recruit different brain regions for inhibiting prepotent responses compared to controls. Future research in larger, medication-naïve samples of patients with BPD is required to confirm and extend these findings.
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Affiliation(s)
- Jacobo Albert
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain.
| | - Sara López-Martín
- Centro Neuromottiva, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Rocío Arza
- Hospital Clínico San Carlos, Cibersam, Madrid, Spain
| | | | - Sandra Hoyos
- Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Luis Carretié
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
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20
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Tzagarakis C, Thompson A, Rogers RD, Pellizzer G. The Degree of Modulation of Beta Band Activity During Motor Planning Is Related to Trait Impulsivity. Front Integr Neurosci 2019; 13:1. [PMID: 30705624 PMCID: PMC6344424 DOI: 10.3389/fnint.2019.00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Impulsivity is a prominent personality trait, and a key modulating component of neurologic and psychiatric disorders. How impulsivity is related to the brain mechanisms associated with action planning is poorly understood. Here, we investigated the relation between impulsivity and the modulation of beta band oscillatory activity associated with action planning and execution. Given that beta power decreases during action planning and decreases further during action execution, we hypothesized that during planning the level of beta band power of more impulsive individuals would be closer to the level reached during execution than that of less impulsive individuals. This could explain the tendency to "jump the gun" (commission errors) in high impulsivity. To test this hypothesis, we recruited healthy volunteers (50 participants analyzed) and used the Barratt Impulsiveness Scale questionnaire to evaluate their impulsivity as high or low. We then recorded their brain neuromagnetic signals while they performed an instructed-delay task that induced different levels of action planning by varying the number of spatial cues, hence the uncertainty, about the location of the upcoming target. During the early cue period of the task, we found a posterior (source localized in the occipito-parietal areas) and a left fronto-central group of channels (source localized in the left sensorimotor areas) where beta power was modulated by number of cues, whereas during the late cue period only the left fronto-central group was modulated. We found that the decrease of relative beta band power during action planning in the left fronto-central group of channels was more pronounced in the high impulsivity group than in the low impulsivity group. In addition, we found that the beta band-mediated functional connectivity between the posterior and the left fronto-central groups of channels was weaker in the high impulsivity group than in the low impulsivity group during the early cue period. Furthermore, high impulsives made more commission and movement errors in the task than low impulsives. These results reveal neural mechanisms through which impulsivity affects action planning and open the way for further study of the role of beta band activity in impulsivity, especially in the context of disease and therapeutics.
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Affiliation(s)
- Charidimos Tzagarakis
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Brain Sciences Center, Minneapolis VA Health Care System, Minneapolis, MN, United States
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Andrew Thompson
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Robert D. Rogers
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- School of Psychology, Bangor University, Bangor, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pellizzer
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Brain Sciences Center, Minneapolis VA Health Care System, Minneapolis, MN, United States
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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21
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Blasiman RN, Was CA. Why Is Working Memory Performance Unstable? A Review of 21 Factors. EUROPES JOURNAL OF PSYCHOLOGY 2018; 14:188-231. [PMID: 29899806 PMCID: PMC5973525 DOI: 10.5964/ejop.v14i1.1472] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/25/2017] [Indexed: 01/05/2023]
Abstract
In this paper, we systematically reviewed twenty-one factors that have been shown to either vary with or influence performance on working memory (WM) tasks. Specifically, we review previous work on the influence of intelligence, gender, age, personality, mental illnesses/medical conditions, dieting, craving, stress/anxiety, emotion/motivation, stereotype threat, temperature, mindfulness training, practice, bilingualism, musical training, altitude/hypoxia, sleep, exercise, diet, psychoactive substances, and brain stimulation on WM performance. In addition to a review of the literature, we suggest several frameworks for classifying these factors, identify shared mechanisms between several variables, and suggest areas requiring further investigation. This review critically examines the breadth of research investigating WM while synthesizing the results across related subfields in psychology.
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22
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23
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Sinke C, Wollmer MA, Kneer J, Kahl KG, Kruger THC. Interaction between behavioral inhibition and emotional processing in borderline personality disorder using a pictorial emotional go/no-go paradigm. Psychiatry Res 2017; 256:286-289. [PMID: 28654876 DOI: 10.1016/j.psychres.2017.06.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by difficulties in emotional regulation and impulse control. In this study, we presented a novel picture-based emotional go/no-go task with distracting emotional faces in the background, which was administered to 16 patients with BPD and 16 age-matched healthy controls. The faces displayed different emotional content (angry, neutral, or happy). Results showed differences in sensitivity between patients and the control group, with patients exhibiting less sensitivity in the task, and also showed influences of emotional content represented in the distracting faces in both groups. Specifically, happy faces decreased sensitivity compared to angry faces. It seemed as though processing of a positive emotional stimulus led to a more relaxed state and thereby to decreased sensitivity, while a negative emotional stimulus induced more alertness and tension, leading to higher sensitivity. Thus, this paradigm is suitable to investigate the interplay between emotion processing and impulse control in patients with BPD.
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Affiliation(s)
- Christopher Sinke
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - M Axel Wollmer
- Asklepios Clinic North - Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany
| | - Jonas Kneer
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - Kai G Kahl
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - Tillmann H C Kruger
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany.
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24
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Liu Y, Zhong M, Xi C, Jin X, Zhu X, Yao S, Yi J. Event-Related Potentials Altered in Patients with Borderline Personality Disorder during Working Memory Tasks. Front Behav Neurosci 2017; 11:67. [PMID: 28458633 PMCID: PMC5394125 DOI: 10.3389/fnbeh.2017.00067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ying Liu
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal UniversityGuangzhou, China
| | - Chang Xi
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Xinhu Jin
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China
| | - Xiongzhao Zhu
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
| | - Shuqiao Yao
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
| | - Jinyao Yi
- Medical Psychological Center, Second Xiangya Hospital, Central South UniversityChangsha, China.,Medical Psychological Institute, Central South UniversityChangsha, China
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25
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Baltacioglu M, Kosger F, Essizoglu A, Gulec G, Ozlem Akarsu F, Yenilmez C. Comparison of cognitive functions in bipolar disorder patients with and without comorbid borderline personality disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1293247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Abstract
PURPOSE OF REVIEW Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. RECENT FINDINGS All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
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Abstract
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.
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Paret C, Jennen-Steinmetz C, Schmahl C. Disadvantageous decision-making in borderline personality disorder: Partial support from a meta-analytic review. Neurosci Biobehav Rev 2016; 72:301-309. [PMID: 27914943 DOI: 10.1016/j.neubiorev.2016.11.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 01/27/2023]
Abstract
To achieve long-term goals, organisms evaluate outcomes and expected consequences of their behaviors. Unfavorable decisions maintain many symptoms of borderline personality disorder (BPD); therefore, a better understanding of the mechanisms underlying decision-making in BPD is needed. In this review, the current literature comparing decision-making in patients with BPD versus healthy controls is analyzed. Twenty-eight empirical studies were identified through a structured literature search. The effect sizes from studies applying comparable experimental tasks were analyzed. It was found that (1) BPD patients discounted delayed rewards more strongly; (2) reversal learning was not significantly altered in BPD; and (3) BPD patients achieved lower net gains in the Iowa Gambling Task (IGT). Current psychotropic medication, sex and differences in age between the patient and control group moderated the IGT outcome. Altered decision-making in a variety of other tasks was supported by a qualitative review. In summary, current evidence supports the altered valuation of outcomes in BPD. A multifaceted influence on decision-making and adaptive learning is reflected in this literature.
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Affiliation(s)
- Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany.
| | - Christine Jennen-Steinmetz
- Department of Biostatistics, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
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McClure G, Hawes DJ, Dadds MR. Borderline personality disorder and neuropsychological measures of executive function: A systematic review. Personal Ment Health 2016; 10:43-57. [PMID: 26381859 DOI: 10.1002/pmh.1320] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/27/2015] [Accepted: 08/20/2015] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Georgia McClure
- School of Psychology, University of Sydney, Sydney, Australia
| | - David J Hawes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Mark R Dadds
- School of Psychology, University of New South Wales, Sydney, Australia
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30
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van Eijk J, Sebastian A, Krause-Utz A, Cackowski S, Demirakca T, Biedermann SV, Lieb K, Bohus M, Schmahl C, Ende G, Tüscher O. Women with borderline personality disorder do not show altered BOLD responses during response inhibition. Psychiatry Res 2015; 234:378-89. [PMID: 26483213 DOI: 10.1016/j.pscychresns.2015.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 01/18/2023]
Abstract
Impulsivity is central to borderline personality disorder (BPD). Response inhibition, addressing the ability to suppress or stop actions, is one aspect of behavioral impulse control which is frequently used to assess impulsivity. BPD patients display deficits in response inhibition under stress condition or negative emotions. We assessed whether response inhibition and its neural underpinnings are impaired in BPD when tested in an emotionally neutral setting and when co-morbid attention-deficit/hyperactivity disorder (ADHD) is excluded. To this end, we studied response inhibition in unmedicated BPD patients and healthy controls (HC) in two independent samples using functional magnetic resonance imaging during Simon-, Go/nogo-, and Stopsignal tasks. BPD patients and HC did not differ significantly in their performance in the Go/nogo and the Stopsignal tasks. Response interference in the Simon task was increased in BPD patients in one sample, but this could not be replicated in the second sample. In both samples, no significant differences in brain activation patterns during any of the tasks were present while the neural impulse control network was robustly activated during the inhibition tasks in both groups. Our results provide evidence that under emotionally neutral conditions response inhibition is not impaired in patients with BPD without co-occurring ADHD.
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Affiliation(s)
- Julia van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexandra Sebastian
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany.
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany; Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioral Science, Leiden University, Leiden, The Netherlands
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Sarah V Biedermann
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Klaus Lieb
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Oliver Tüscher
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany; Departments of Neurology and Psychiatry, Albert-Ludwigs-University Medical Center, Freiburg, Germany
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31
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Lozano V, Soriano MF, Aznarte JI, Gómez-Ariza CJ, Bajo MT. Interference control commonalities in patients with schizophrenia, bipolar disorder, and borderline personality disorder. J Clin Exp Neuropsychol 2015; 38:238-50. [DOI: 10.1080/13803395.2015.1102870] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vega D, Vilà-Balló A, Soto À, Amengual J, Ribas J, Torrubia R, Rodríguez-Fornells A, Marco-Pallarés J. Preserved Error-Monitoring in Borderline Personality Disorder Patients with and without Non-Suicidal Self-Injury Behaviors. PLoS One 2015; 10:e0143994. [PMID: 26636971 PMCID: PMC4670111 DOI: 10.1371/journal.pone.0143994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control. Method We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants. Results The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors. Conclusions This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms.
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Affiliation(s)
- Daniel Vega
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Adrià Vilà-Balló
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Àngel Soto
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Julià Amengual
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Ribas
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Rafael Torrubia
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Josep Marco-Pallarés
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Institut de Recerca en Cervell, Cognició i Conducta, IR3C, University of Barcelona, Barcelona, Spain
- * E-mail:
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Gvirts H, Braw Y, Harari H, Lozin M, Bloch Y, Fefer K, Levkovitz Y. Executive dysfunction in bipolar disorder and borderline personality disorder. Eur Psychiatry 2015; 30:959-64. [DOI: 10.1016/j.eurpsy.2014.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 10/22/2022] Open
Abstract
AbstractObjectiveThe 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.MethodExecutive 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.ResultsBD 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.ConclusionsDifferences 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.
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Skrzypińska D, Szmigielska B. Dream-reality confusion in borderline personality disorder: a theoretical analysis. Front Psychol 2015; 6:1393. [PMID: 26441768 PMCID: PMC4569816 DOI: 10.3389/fpsyg.2015.01393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.
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Affiliation(s)
- Dagna Skrzypińska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
| | - Barbara Szmigielska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
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35
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Israel M, Klein M, Pruessner J, Thaler L, Spilka M, Efanov S, Ouellette AS, Berlim M, Ali N, Beaudry T, Van den Eynde F, Walker CD, Steiger H. n-back task performance and corresponding brain-activation patterns in women with restrictive and bulimic eating-disorder variants: preliminary findings. Psychiatry Res 2015; 232:84-91. [PMID: 25707581 DOI: 10.1016/j.pscychresns.2015.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 09/28/2014] [Accepted: 01/27/2015] [Indexed: 01/08/2023]
Abstract
Eating disorder (ED) variants characterized by "binge-eating/purging" symptoms differ from "restricting-only" variants along diverse clinical dimensions, but few studies have compared people with these different eating-disorder phenotypes on measures of neurocognitive function and brain activation. We tested the performances of 19 women with "restricting-only" eating syndromes and 27 with "binge-eating/purging" variants on a modified n-back task, and used functional magnetic resonance imaging (fMRI) to examine task-induced brain activations in frontal regions of interest. When compared with "binge-eating/purging" participants, "restricting-only" participants showed superior performance. Furthermore, in an intermediate-demand condition, "binge-eating/purging" participants showed significantly less event-related activation than did "restricting-only" participants in a right posterior prefrontal region spanning Brodmann areas 6-8-a region that has been linked to planning of motor responses, working memory for sequential information, and management of uncertainty. Our findings suggest that working memory is poorer in eating-disordered individuals with binge-eating/purging behaviors than in those who solely restrict food intake, and that observed performance differences coincide with interpretable group-based activation differences in a frontal region thought to subserve planning and decision making.
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Affiliation(s)
- Mimi Israel
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada.
| | - Michael Klein
- McGill University, Department of Psychology, Montreal, Quebec, Canada; Montreal Neurological Institute, Cognitive Neuroscience Unit, Montreal, Quebec, Canada
| | - Jens Pruessner
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Michael Spilka
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Simona Efanov
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Anne-Sophie Ouellette
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Marcelo Berlim
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Nida Ali
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Thomas Beaudry
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Frederique Van den Eynde
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Claire-Dominique Walker
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
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Sebastian A, Jung P, Krause-Utz A, Lieb K, Schmahl C, Tüscher O. Frontal dysfunctions of impulse control - a systematic review in borderline personality disorder and attention-deficit/hyperactivity disorder. Front Hum Neurosci 2014; 8:698. [PMID: 25232313 PMCID: PMC4153044 DOI: 10.3389/fnhum.2014.00698] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/20/2014] [Indexed: 12/20/2022] Open
Abstract
Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control, and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive vs. reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, patients with BPD exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial, and dorsolateral prefrontal regions, whereas patients with ADHD displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders.
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Affiliation(s)
- Alexandra Sebastian
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, Johannes Gutenberg-University , Mainz , Germany
| | - Patrick Jung
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, Johannes Gutenberg-University , Mainz , Germany
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - Klaus Lieb
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, Johannes Gutenberg-University , Mainz , Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - Oliver Tüscher
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, Johannes Gutenberg-University , Mainz , Germany ; Department of Neurology, Albert-Ludwigs-University Medical Center , Freiburg , Germany
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Sadeh N, Londahl-Shaller EA, Piatigorsky A, Fordwood S, Stuart BK, McNiel DE, Klonsky ED, Ozer EM, Yaeger AM. Functions of non-suicidal self-injury in adolescents and young adults with Borderline Personality Disorder symptoms. Psychiatry Res 2014; 216:217-22. [PMID: 24594204 DOI: 10.1016/j.psychres.2014.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 02/03/2014] [Accepted: 02/09/2014] [Indexed: 12/28/2022]
Abstract
Rates of deliberate non-suicidal self-injury (NSSI) increase during adolescence and young adulthood, particularly in clinical samples, making these important developmental stages for understanding the functions of NSSI. Borderline Personality Disorder (BPD) symptoms also begin to emerge in adolescence, though little research has examined relationships between BPD symptoms and the functions of NSSI in youth, the primary goal of the present study. Adolescents and young adults recruited from an outpatient psychotherapy clinic (N=36) endorsed a range of NSSI functions on the Inventory of Statements about Self-Injury (Klonsky and Glenn, 2009). Participants engaged in NSSI to serve intrapersonal functions (e.g., regulate affect, punish oneself) more frequently than interpersonal functions (e.g., bond with peers, establish autonomy). As predicted, linear regression analyses indicated that BPD affective dysregulation symptoms were associated with the intrapersonal but not the interpersonal functions of NSSI. In contrast, BPD interpersonal dysfunction symptoms were differentially associated with the interpersonal rather than intrapersonal functions of NSSI. These preliminary data indicate that clusters of BPD symptoms show unique relationships with functions of NSSI in treatment-seeking adolescents and young adults, relationships that can be used to target specific functions of NSSI in treatment planning.
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Affiliation(s)
- Naomi Sadeh
- Department of Psychiatry, University of California, San Francisco, CA, USA.
| | | | - Auran Piatigorsky
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Samantha Fordwood
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Barbara K Stuart
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA; Office of Diversity and Outreach, University of California, San Francisco, CA, USA
| | - Alison M Yaeger
- Department of Psychiatry, University of California, San Francisco, CA, USA
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van Dijk F, Schellekens A, van den Broek P, Kan C, Verkes RJ, Buitelaar J. Do cognitive measures of response inhibition differentiate between attention deficit/hyperactivity disorder and borderline personality disorder? Psychiatry Res 2014; 215:733-9. [PMID: 24418050 DOI: 10.1016/j.psychres.2013.12.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 10/29/2013] [Accepted: 12/18/2013] [Indexed: 11/28/2022]
Abstract
This study examined whether cognitive measures of response inhibition derived from the AX-CPT are able to differentiate between adult attention deficit/hyperactivity disorder (ADHD), borderline personality disorder (BPD), and healthy controls (HC). Current DSM-IV-TR symptoms of ADHD and BPD were assessed by structured diagnostic interviews, and parent developmental interviews were used to assess childhood ADHD symptoms. Patients (14 ADHD, 12 BPD, 7 ADHD and BPD, and 37 HC) performed the AX-CPT. Seventy percent of AX-CPT trials were target (AX) trials, creating a bias to respond with a target response to X probes in the nontarget (AY, BX, BY) trials. On BX trials, context, i.e. the non-'A' letter, must be used to inhibit this prepotent response tendency. On AY trials context actually causes individuals to false alarm. The effects of ADHD and BPD on AX-CPT outcome were tested using two-way ANOVA. BPD was associated with higher percentage of errors across the task and more errors and slower responses on BX trials, whereas ADHD was associated with slower responses on AY trials. The findings suggest response inhibition problems to be present in both ADHD and BPD, and patients with BPD to be particularly impaired due to poor context processing.
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Affiliation(s)
- Fiona van Dijk
- Radboud University Nijmegen Medical Centre, Department of Psychiatry (961), P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Arnt Schellekens
- Radboud University Nijmegen Medical Centre, Department of Psychiatry (961), P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Pieter van den Broek
- Radboud University Nijmegen Medical Centre, Department of Psychiatry (961), P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Cornelis Kan
- Radboud University Nijmegen Medical Centre, Department of Psychiatry (961), P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Robbert-Jan Verkes
- Radboud University Nijmegen Medical Centre, Department of Psychiatry (961), P.O.Box 9101, 6500 HB, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Radboud University Nijmegen Medical Centre, Departments of Cognitive Neuroscience, Nijmegen, The Netherlands
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39
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Winter D, Elzinga B, Schmahl C. Emotions and memory in borderline personality disorder. Psychopathology 2014; 47:71-85. [PMID: 24355827 DOI: 10.1159/000356360] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 10/06/2013] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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