1
|
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.
Collapse
|
2
|
The Role of Cognitive Deficits in Borderline Personality Disorder with Early Traumas: A Mediation Analysis. J Clin Med 2023; 12:jcm12030787. [PMID: 36769436 PMCID: PMC9917894 DOI: 10.3390/jcm12030787] [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: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: although studies of cognitive functions are still limited in borderline personality disorder (BPD), the initial evidence suggested that BPD patients have deficits of executive functions and social cognition. In addition, patients who report physical and psychic traumatic experiences in childhood and adolescence show considerable neurocognitive impairment and severe BPD symptoms. The present study has a twofold aim: (1) to evaluate the differences in neurocognitive performances between BPD patients and healthy controls and (2) to verify in the BPD patients group whether neurocognitive deficits have the role of mediating the effect of early traumas on BPD psychopathology. (2) Methods: 69 subjects were enrolled: 38 outpatients with a diagnosis of BPD (DSM-5) and 31 healthy controls. BPD patients were tested with the Borderline Personality Disorder Severity Index (BPDSI), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). All subjects were evaluated with the Iowa Gambling task (IGT), the Berg card sorting test (BCST), the Tower of London task (ToL), and the Reading-the-mind-in-the-eyes-test (RMET). Statistical analysis was performed with the analysis of variance to compare the cognitive performances between BPD patients and controls. A mediation analysis was conducted with the Sobel Test in the BPD patients group. The significance level was p ≤ 0.05. (3) Results: significant differences between the two groups were found for several parameters of all the cognitive tests examined: BCST, IGT, ToL, and RMET. Mediation analysis with the Sobel test demonstrated that the percentage of correct answers in the BCST (BCSTc) and the RMET score significantly mediated the relation between the CTQ total score and BPDSI total score. (4) Conclusions: BPD patients showed an impairment of the following executive functions: set shifting, decision making, planning and problem solving, and social cognition abilities, in comparison with controls. Our results suggested that the effect of early trauma on BPD psychopathology was mediated by a deficit in two cognitive domains: cognitive flexibility and social cognition.
Collapse
|
3
|
Roye S, Calamia M, Castagna PJ, Aita SL, Hill BD. Normative and Maladaptive Personality Traits and Self-Reported Executive Functioning. Assessment 2020; 29:499-507. [PMID: 33372559 DOI: 10.1177/1073191120981762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on self-reported executive functioning (EF) and personality has largely focused on normative personality traits. While previous research has demonstrated that maladaptive personality traits are associated with performance-based EF, the literature examining the relationship between these traits and self-reported EF is limited. The current study examined the relationship between multiple domains of self-reported EF (Barkley Deficits in Executive Functioning Scale) and both normative (The International Personality Item Pool-NEO-120 Item [IPIP-120]) and maladaptive (Personality Inventory for DSM-5-Short Form [PID-5-SF]) personality traits in an undergraduate student sample (n = 354). Similar to past research, relationships were largest across EF domains for both measures related to neuroticism (i.e., IPIP-120 neuroticism and PID-5-SF negative affectivity) and conscientiousness (i.e., IPIP-120 conscientiousness and PID-5-SF disinhibition). Normative personality traits generally accounted for greater variance in EF when examined alone and were also generally associated with greater incremental validity when compared with maladaptive personality traits. However, multiple regression analyses indicated that maladaptive personality traits added unique predictive variance above and beyond normative personality traits in their association with multiple domains of EF. These results highlight the utility of assessing both normative and maladaptive personality traits as well as multiple domains of EF to more fully understand the relationship between personality and EF.
Collapse
Affiliation(s)
- Scott Roye
- Louisiana State University, Baton Rouge, LA, USA
| | | | | | | | | |
Collapse
|
4
|
Flasbeck V, Juckel G, Brüne M. Evidence for Altered Neural Processing in Patients With Borderline Personality Disorder. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Borderline personality disorder (BPD) is characterized by difficulties in emotion regulation, self-identity disturbances, self-injurious behavior, and reduced inhibitory control. Event-related potential (ERP) studies have sought to reveal the neural correlates of cognitive distortions and behavioral alterations in BPD. The article presents an overview of the existing ERP literature pertaining to BPD and discusses whether any one of the electrophysiological findings could serve as a reliable and specific marker for BPD. In short, ERP studies investigating P300 tentatively suggest impaired inhibitory control. Moreover, reduced error- and feedback-related processing and impaired response inhibition seem to be associated with impulsivity and risk-taking behavior in BPD patients. However, these findings are not specific for BPD. Regarding emotional and self-referential information processing, individuals with BPD display heightened vigilance toward social threat impacting their cognitive performance in various social-cognitive tasks demonstrating alterations of early negative and late positive potentials. These multifaceted electrophysiological alterations may be attributed to dysfunctional activity and connectivity of frontal brain regions and the limbic system.
Collapse
Affiliation(s)
- Vera Flasbeck
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Germany
| | - Georg Juckel
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, Germany
| | - Martin Brüne
- LWL University Hospital, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Germany
| |
Collapse
|
5
|
Galletta D, Califano AI, Micanti F, Santangelo G, Santoriello C, de Bartolomeis A. Cognitive correlates of borderline intellectual functioning in borderline personality disorder. J Psychiatr Res 2020; 130:372-380. [PMID: 32882579 DOI: 10.1016/j.jpsychires.2020.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022]
Abstract
Borderline intellectual functioning (BIF) is highly prevalent in patients with borderline personality disorder (BPD), but their relationship remains poorly understood. This retrospective study aimed to investigate the cognitive profile of BIF among people diagnosed with BPD. Clinical, demographic, and neuropsychological data of fifty-five outpatients with BPD were analyzed. The sample split into two groups: BPD with BIF (BIF+: n = 25; intelligence quotient - IQ - range: 71-84) and BPD without BIF (BIF-: n = 30; IQ range: 86-124). Between-group comparisons employed either parametric and non-parametric descriptive statistics, as necessary. Neuropsychological measures (Wechsler Adult Intelligence Scale-Revised - WAIS-R IQ, factor index, subtest scores) and cognitive performance deficits in the two groups were likewise compared aside, followed by Spearman's correlation test conducted on relevant metrics. The cognitive, but not the clinical and demographic profiles differed significantly between the two groups. BIF+ was associated with a specific pattern of verbal, attentive, and planning dysfunctions. The verbal comprehension index had the highest discriminative value for the presence of BIF in patients with BPD, and it was tightly associated with adaptive and social functioning. The neuropsychological assessment of BPD may be relevant to plan targeted interventions based on measures of cognitive functioning which could also serve to evaluate treatment efficacy and outcomes. Clinical implications and future directions are discussed.
Collapse
Affiliation(s)
- Diana Galletta
- Department of Head-Neck Care Unit of Psychiatry and Psychology "Federico II", University Hospital Naples, Italy.
| | | | - Fausta Micanti
- Department of Head-Neck Care Unit of Psychiatry and Psychology "Federico II", University Hospital Naples, Italy
| | | | - Carmen Santoriello
- Department of Head-Neck Care Unit of Psychiatry and Psychology "Federico II", University Hospital Naples, Italy
| | - Andrea de Bartolomeis
- Department of Head-Neck Care Unit of Psychiatry and Psychology "Federico II", University Hospital Naples, Italy
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Malivoire BL, Stewart KE, Tallon K, Ovanessian MM, Pawluk EJ, Koerner N. Negative urgency and generalized anxiety disorder symptom severity: The role of self-reported cognitive processes. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
8
|
Yang P, Tao R, He C, Liu S, Wang Y, Zhang X. The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities. Front Neurosci 2018; 12:303. [PMID: 29867316 PMCID: PMC5958183 DOI: 10.3389/fnins.2018.00303] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
Alcohol use disorders (AUDs) represent a severe, world-wide problem, and are usually comorbid with psychiatric disorders, comorbidity increases the risks associated with AUDs, and results in more serious consequences for patients. However, currently the underlying mechanisms of comorbid psychiatric disorders in AUDs are not clear. Studies investigating comorbidity could help us understand the neural mechanisms of AUDs. In this review, we explore three comorbidities in AUDs, including schizophrenia, major depressive disorder (MDD), and personality disorders (PDs). They are all co-morbidities of AUDs with rate of 33.7, 28, and 50–70%, respectively. The rate is significantly higher than other diseases. Therefore we review and analyze relevant literature to explore whether these three diseases are the risk factors of AUDs, focusing on studies assessing cognitive function and those using neural imaging. We found that memory deficits, impairment of cognitive control, negative emotion, and impulsivity may increase an individual's vulnerability to AUDs. This comorbidity may indicate the neural basis of AUDs and reveal characteristics associated with different types of comorbidity, leading to further development of new treatment approaches for AUDs.
Collapse
Affiliation(s)
- Ping Yang
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Rui Tao
- Department of Substance-Related Disorders, Anhui Mental Health Center, Hefei, China
| | - Chengsen He
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Shen Liu
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
| | - Ying Wang
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
| | - Xiaochu Zhang
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
| |
Collapse
|
9
|
|
10
|
Unoka Z, Vizin G, Bjelik A, Radics D, Nemeth D, Janacsek K. Intact implicit statistical learning in borderline personality disorder. Psychiatry Res 2017; 255:373-381. [PMID: 28662479 DOI: 10.1016/j.psychres.2017.06.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 05/14/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Wide-spread neuropsychological deficits have been identified in borderline personality disorder (BPD). Previous research found impairments in decision making, declarative memory, working memory and executive functions; however, no studies have focused on implicit learning in BPD yet. The aim of our study was to investigate implicit statistical learning by comparing learning performance of 19 BPD patients and 19 healthy, age-, education- and gender-matched controls on a probabilistic sequence learning task. Moreover, we also tested whether participants retain the acquired knowledge after a delay period. To this end, participants were retested on a shorter version of the same task 24h after the learning phase. We found intact implicit statistical learning as well as retention of the acquired knowledge in this personality disorder. BPD patients seem to be able to extract and represent regularities implicitly, which is in line with the notion that implicit learning is less susceptible to illness compared to the more explicit processes.
Collapse
Affiliation(s)
- Zsolt Unoka
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Gabriella Vizin
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Anna Bjelik
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Dóra Radics
- Department of Psychotherapy and Psychiatry, Semmelweis University, Budapest, Hungary
| | - Dezso Nemeth
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46., H-1064 Budapest, Hungary; MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary.
| | - Karolina Janacsek
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46., H-1064 Budapest, Hungary; MTA-ELTE NAP B Brain, Memory and Language Research Group, Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Magyar tudósok körútja 2., H-1117 Budapest, Hungary
| |
Collapse
|
11
|
Thomsen MS, Ruocco AC, Carcone D, Mathiesen BB, Simonsen E. Neurocognitive Deficits in Borderline Personality Disorder: Associations With Childhood Trauma and Dimensions of Personality Psychopathology. J Pers Disord 2017; 31:503-521. [PMID: 27617651 DOI: 10.1521/pedi_2016_30_265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.
Collapse
Affiliation(s)
- Marianne S Thomsen
- Department of Psychology, University of Copenhagen, Denmark.,Psychiatric Clinic, Psychiatry Roskilde, Region Zealand, Denmark
| | - Anthony C Ruocco
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | - Dean Carcone
- Department of Psychology, University of Toronto Scarborough, Toronto, Canada
| | | | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW We review the literature on the use and potential use of computational psychiatry methods in Borderline Personality Disorder. RECENT FINDINGS Computational approaches have been used in psychiatry to increase our understanding of the molecular, circuit, and behavioral basis of mental illness. This is of particular interest in BPD, where the collection of ecologically valid data, especially in interpersonal settings, is becoming more common and more often subject to quantification. Methods that test learning and memory in social contexts, collect data from real-world settings, and relate behavior to molecular and circuit networks are yielding data of particular interest. SUMMARY Research in BPD should focus on collaborative efforts to design and interpret experiments with direct relevance to core BPD symptoms and potential for translation to the clinic.
Collapse
Affiliation(s)
| | - Dylan Stahl
- Yale University Department of Psychiatry
- Knox College
| | | |
Collapse
|
13
|
Kogan-Goloborodko O, Brügmann E, Repple J, Habel U, Clemens B. Experimentally Assessed Reactive Aggression in Borderline Personality Disorder. PLoS One 2016; 11:e0166737. [PMID: 27851804 PMCID: PMC5112922 DOI: 10.1371/journal.pone.0166737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
Approximately 73% of patients suffering from Borderline personality disorder (BPD) exhibit aggressive behaviour, which severely hinders therapeutic work and clinical improvement. Because the underlying mechanisms of aggression in BPD are not yet completely understood, additional research in this domain has a high clinical and scientific relevance. We employed a modified version of the Taylor Aggression Paradigm (mTAP), in order to examine for the first time whether this task can be used to differentiate between BPD patients and healthy controls with regard to reactive aggression. In the mTAP, the amount of money subtracted by a virtual opponent was categorized into 'low' (10-20 cents) and 'high' (80-100 cents) provocations, enabling us to compare how much money BPD patients and healthy controls subtracted (i.e., how aggressively participants responded) following high and low provocation trials. Our results showed that, compared to healthy controls, BPD patients showed higher overall aggression, higher aggression after high provocation trials, as well as a larger difference between high and low provocation trials. This finding was corroborated by a neuropsychological assessment, demonstrating higher levels of aggression and impulsivity in BPD patients. Interestingly, reactive aggression in the mTAP was positively correlated with symptom severity and impulsivity in BPD patients. We suggest that the mTAP provides a valuable tool allowing psychiatrists to quantify reactive aggression in BPD. Therefore, clinicians and researchers might consider this task, as a short experimental measure of reactive aggression, either in future studies or to aid diagnostic assessment during clinical practice.
Collapse
Affiliation(s)
- Olga Kogan-Goloborodko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Elisabeth Brügmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- JARA – BRAIN Institute I, Aachen, Germany
| | - Benjamin Clemens
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
14
|
|
15
|
Vita A, Deste G, Barlati S, Poli R, Cacciani P, De Peri L, Sacchetti E. Feasibility and effectiveness of cognitive remediation in the treatment of borderline personality disorder. Neuropsychol Rehabil 2016; 28:416-428. [DOI: 10.1080/09602011.2016.1148054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Giacomo Deste
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Stefano Barlati
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Roberto Poli
- Department of Psychiatry, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Paolo Cacciani
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| | - Luca De Peri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emilio Sacchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Psychiatry, Spedali Civili Hospital, Brescia, Italy
| |
Collapse
|
16
|
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.
Collapse
|
17
|
Koven NS, Collins LR. Urinary brain-derived neurotrophic factor as a biomarker of executive functioning. Neuropsychobiology 2015; 69:227-34. [PMID: 24942240 DOI: 10.1159/000362242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Neurotrophins such as brain-derived neurotrophic factor (BDNF) are vital for neuronal survival and adaptive plasticity. With high BDNF gene expression in the prefrontal cortex, BDNF is a potential regulatory factor for building and maintaining cognitive reserves. Recent studies suggest that individual differences in executive functioning, a broad cognitive domain reliant upon frontal lobe structure and function, are governed in part by variance in BDNF polymorphisms. However, as neurogenetic data are not necessarily indicative of in vivo neurochemistry, this study examines the relationship between executive functioning and the neurotransmitter by measuring peripheral BDNF levels. METHODS Fifty-two healthy young adults completed a battery of standardized executive function tests. BDNF levels, adjusted for creatinine, were quantified with enzyme-linked immunosorbent assay of urine samples taken at the time of testing. RESULTS BDNF concentration was positively associated with cognitive flexibility but had no relationship with working memory, abstract reasoning/planning, self-monitoring/response inhibition, or fluency. CONCLUSIONS These results individuate cognitive flexibility as the specific facet of executive functioning associated with in vivo BDNF levels. This study also validates urinary BDNF as a peripheral biomarker of cognition in healthy adults.
Collapse
Affiliation(s)
- Nancy S Koven
- Program in Neuroscience, Department of Psychology, Bates College, Lewiston, Maine, USA
| | | |
Collapse
|
18
|
Frías Á, Palma C. Comorbidity between post-traumatic stress disorder and borderline personality disorder: a review. Psychopathology 2015; 48:1-10. [PMID: 25227722 DOI: 10.1159/000363145] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Traditionally, the presence of post-traumatic stress disorder (PTSD) in subjects diagnosed with borderline personality disorder (BPD) has been the object of scant empirical research. The clarification of issues related to the different areas of study for this comorbidity is not only significant from a theoretical point of view but also relevant for clinical practice. The aim of this review is to describe the main theoretical findings and research conclusions about the comorbidity between PTSD and BPD. METHODS A literature review was carried out via PubMed and PsycINFO for the period between 1990 and September 2013. The descriptors used were 'post-traumatic stress disorder', 'borderline personality disorder', 'PTSD', 'complex PTSD' and 'BPD'. RESULTS Epidemiological studies show that the risk of PTSD among BPD subjects is not regularly higher than in subjects with other personality disorders. Furthermore, there is no conclusive evidence about the main aetiopathogenic mechanism of this comorbidity, either of one disorder being a risk factor for the other one or of common underlying variables. Concerning comparative studies, several studies with PTSD-BPD subjects have found a higher severity of psychopathology and psychosocial impairment than in BPD subjects. With regard to nosological status, the main focus of controversy is the validation of 'complex PTSD', a clinical entity which may comprise a subgroup of PTSD-BPD subjects. With regard to treatment, there are preliminary evidences for the efficient treatment of psychopathology in both PTSD and BPD. CONCLUSIONS These findings are remarkable for furthering the understanding of the link between PTSD and BPD and their implications for treatment. The results of this review are discussed, including methodological constraints that hinder external validity and consistency of referred findings.
Collapse
Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Barcelona, Spain
| | | |
Collapse
|
19
|
Brunner R, Henze R, Richter J, Kaess M. Neurobiological Findings in Youth with Borderline Personality Disorder. Scand J Child Adolesc Psychiatr Psychol 2014. [DOI: 10.21307/sjcapp-2015-003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processing—particularly involving negative stimuli—may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamic–pituitary–adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.
Collapse
Affiliation(s)
- Romuald Brunner
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Romy Henze
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Julia Richter
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
- Department of Radiology, German Cancer Research Center , Heidelberg , Germany
| | - Michael Kaess
- Section for Disorders of Personality Development, Clinic for Child and Adolescent Psychiatry, University of Heidelberg , Heidelberg , Germany
| |
Collapse
|
20
|
Albein-Urios N, Martinez-González JM, Lozano Ó, Verdejo-Garcia A. Monetary delay discounting in gambling and cocaine dependence with personality comorbidities. Addict Behav 2014; 39:1658-1662. [PMID: 25047890 DOI: 10.1016/j.addbeh.2014.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 04/10/2014] [Accepted: 06/05/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cocaine addiction and pathological gambling are commonly associated with steeper (impulsive) discounting of delayed rewards, which promotes ongoing drug and gambling behaviors. However, it is yet unclear whether impulsive delay discounting is a stable trait in cocaine and gambling disorders during abstinence, and whether it is significantly impacted by dysfunctional personality beliefs. METHODS The aim of this study was to compare the delay discounting rates of four groups: 47 cocaine users with comorbid personality disorders, 41 cocaine users without psychiatric comorbidities, 28 pathological gamblers without psychiatric comorbidities, and 36 healthy comparison individuals. We also examined the association between dysfunctional personality beliefs and delay discounting rates. Participants completed the Kirby Delay Discounting Questionnaire and the Beck Personality Belief Questionnaire as part of a larger battery. RESULTS We used non-parametric tests to compare discounting rates between the groups, and bivariate correlation analyses to examine the association between beliefs and discounting rates within each of the groups. We found that discounting rates were significantly higher in individuals with disordered gambling compared to controls. Specifically in cocaine users with Cluster B personality disorders, higher discounting rates were associated with the intensity of "dependent" dysfunctional beliefs (e.g., "I am needy and weak"). Conclusion:We conclude that impulsive delay discounting is increased in gambling relative to controls and linked to personality beliefs in cocaine users with Cluster B personality disorders.
Collapse
Affiliation(s)
- Natalia Albein-Urios
- Department of Clinical Psychology, Universidad de Granada, 18071 Granada, Spain; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Building BC, Burwood Campus, 221 Burwood Hwy, VIC 3125, Australia.
| | - José M Martinez-González
- Red de Trastornos Adictivos, Universidad de Granada, Spain; Centro Provincial de Drogodependencias, Calle San Juan de Dios, 11. Hospital de San Juan de Dios, 18001 Granada, Spain.
| | - Óscar Lozano
- Red de Trastornos Adictivos, Universidad de Granada, Spain; Department of Psychology, Universidad de Huelva, Facultad de Ciencias de la Educación Campus de El Carmen, Avenida de las Fuerzas Armadas, S/N, 21071 Huelva, Spain.
| | - Antonio Verdejo-Garcia
- Department of Clinical Psychology, Universidad de Granada, 18071 Granada, Spain; Red de Trastornos Adictivos, Universidad de Granada, Spain; School of Psychological Sciences, Monash University, 3800 Wellington Road, Melbourne, Australia.
| |
Collapse
|
21
|
Beblo T, Mensebach C, Wingenfeld K, Rullkoetter N, Schlosser N, Driessen M. Subjective memory complaints and memory performance in patients with borderline personality disorder. BMC Psychiatry 2014; 14:255. [PMID: 25214199 PMCID: PMC4172827 DOI: 10.1186/s12888-014-0255-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is still a matter of debate as to whether patients with Borderline Personality Disorder (BPD) suffer from memory deficits. Existing studies indicate no or small impairments in memory test performance. However, it was shown in patients with related disorders, such as depression, that self-reported impairment exceeds test malfunction. In the present study we assessed memory performance of BPD patients through the use of memory tests and a questionnaire for subjective memory complaints (SMC) in everyday life. METHODS Thirty-two patients with BPD and 32 healthy control subjects were included in the study. The groups of subjects were comparable with respect to age, education, and gender. Subjects completed verbal and nonverbal memory tests, as well as the everyday memory questionnaire (EMQ). RESULTS BPD patients reported severe SMC but did not show memory test impairment. The results remained stable even when all BPD patients with acute or lifetime depression comorbidity were excluded from analyses. In both groups, SMC and test performances were not related but in BPD patients SMC were related to BPD symptoms. CONCLUSIONS Our data indicate memory impairment of BPD patients in everyday life. However, it cannot be ruled out that increased memory complaints result from patients' negative self-perception. Future research needs to clarify the reasons for memory complaints of BPD patients.
Collapse
Affiliation(s)
- Thomas Beblo
- Department of Research, Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany ,Department of Psychology, University of Bielefeld, Bielefeld, Germany
| | - Christoph Mensebach
- Department of Psychosomatic Medicine and Psychotherapy, University Duisburg-Essen, Essen, Germany
| | - Katja Wingenfeld
- Department of Psychiatry, Charité University Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Nina Rullkoetter
- Department of Research, Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany
| | - Nicole Schlosser
- Department of Research, Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany
| | - Martin Driessen
- Department of Research, Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld, Remterweg 69-71, 33617 Bielefeld, Germany
| |
Collapse
|
22
|
Mathiesen BB, Simonsen E, Soegaard U, Kvist K. Similarities and differences in borderline and organic personality disorder. Cogn Neuropsychiatry 2014; 19:1-16. [PMID: 23710758 DOI: 10.1080/13546805.2013.776494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Previous research has shown that brain injury patients with Organic Personality Disorder (OPD) may display "borderline" traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients. METHODS Twenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery. RESULTS Very few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation. CONCLUSIONS These results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.
Collapse
Affiliation(s)
- Birgit B Mathiesen
- a Department of Psychology , University of Copenhagen , Copenhagen , Denmark
| | | | | | | |
Collapse
|
23
|
Fernando SC, Griepenstroh J, Urban S, Driessen M, Beblo T. [Attentional bias and emotional suppression in borderline personality disorder]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2014; 28:121-129. [PMID: 25037993 DOI: 10.1007/s40211-014-0112-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/17/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Emotion regulation dysfunctions marked by negative affectivity are a core feature of borderline personality disorder (BPD). In addition, patients with BPD show disturbed attentional processes which become particularly apparent in the domain of selective attention when emotional stimuli are presented (negative attentional bias). Assuming that emotion regulation is linked to attentional deployment processes, this study aimed (1) to determine whether a negative attentional bias is established by using film clips of fearful faces and (2) to investigate the association between dysfunctional emotion regulation strategies (emotional suppression) and negative attention bias in BPD. METHODS We investigated 18 inpatients with BPD and 18 healthy control participants using the modified version of the fearful face-paradigm to assess the inhibition of emotional stimuli. We also administered self-report emotion regulation questionnaires. RESULTS Compared to the healthy controls, patients with BPD showed significant longer reaction times during the emotional versus the neutral film stimuli in the modified fearful face-paradigm. With regard to the second hypothesis, we failed to find an association between the negative attentional bias and the habitual use of emotional suppression in BPD. CONCLUSIONS In this study, we could confirm an attentional bias for negative stimuli, using complex, dynamic material. Future studies need to address the impact of confounding variables (e. g. comorbid disorders) on the relationship between maladaptive emotion regulation and selective attentional bias.
Collapse
Affiliation(s)
- Silvia Carvalho Fernando
- Klinik für Psychiatrie und Psychotherapie Bethel, Evangelisches Krankenhaus Bielefeld, Remterweg 69-71, 33617, Bielefeld, Deutschland,
| | | | | | | | | |
Collapse
|
24
|
Barker V, Pope M, Smith S, Brown V, Hall J. Set shifting and reversal learning in borderline personality disorder. Personal Ment Health 2014; 8:1-13. [PMID: 24532550 DOI: 10.1002/pmh.1235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 03/06/2013] [Accepted: 03/30/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND People with BPD have been shown in some studies to have structural deficits in regions of the prefrontal cortex. A sensitive test of prefrontal cortex function is the intra-dimensional/extra-dimensional (IDED) set shifting task. This study sought to examine whether people with BPD demonstrate impaired performances on extra-dimensional shift (EDS) and reversal learning aspects of this task similar to those seen in conditions such as schizophrenia and bipolar affective disorder. METHOD Twenty subjects with BPD and 21 healthy control subjects were administered the IDED task from the Cambridge Neuropsychological Test Automated Battery cognitive test battery. EDS and reversal learning errors were compared between the groups using repeated measures ANOVAs. RESULTS There was no significant difference between the BPD and control participants in EDS or reversal learning on the IDED task or in stage of the task completed. There was a medium effect size difference (Cohen's d = 0.4) for simple reversal learning and small effect sizes for reversal learning (Cohen' d = 0.17) and IDED shift stages (Cohen's d = 0.2 and -0.3 respectively). CONCLUSIONS Participants with BPD in this study did not show statistically significant deficits in EDS or reversal learning, although small to medium effect sizes were found. These findings distinguish them from sufferers of schizophrenia and bipolar affective disorder and are in keeping with the idea that BPD is a distinct condition with discrete neuropathological processes.
Collapse
Affiliation(s)
- Victoria Barker
- Division of Psychiatry, Centre for Brain Sciences, School of Clinical Sciences, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | | | | | | | | |
Collapse
|
25
|
Hagenhoff M, Franzen N, Koppe G, Baer N, Scheibel N, Sammer G, Gallhofer B, Lis S. Executive functions in borderline personality disorder. Psychiatry Res 2013; 210:224-31. [PMID: 23764434 DOI: 10.1016/j.psychres.2013.05.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 12/31/2022]
Abstract
Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning.
Collapse
Affiliation(s)
- Meike Hagenhoff
- Centre for Psychiatry, Justus Liebig University Giessen, Giessen, Germany
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Albein-Urios N, Martinez-Gonzalez JM, Lozano Ó, Moreno-López L, Soriano-Mas C, Verdejo-Garcia A. Negative urgency, disinhibition and reduced temporal pole gray matter characterize the comorbidity of cocaine dependence and personality disorders. Drug Alcohol Depend 2013; 132:231-7. [PMID: 23466222 DOI: 10.1016/j.drugalcdep.2013.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 02/03/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals with cocaine dependence and co-occurring personality disorders are more likely to have increased impulsivity, dysfunctional beliefs, executive dysfunction and brain structural abnormalities by virtue of the conjoint impact of both pathologies. METHODS We recruited 32 cocaine dependent patients with comorbid Cluster B personality disorders, 44 cocaine dependent patients without comorbidities and 34 non-drug-using controls. They completed the UPPS-P impulsivity scale, the Personality Belief Questionnaire, and executive function tests of working memory, attention/response inhibition and shifting. A subsample (n=61) was also scanned using Magnetic Resonance Imaging. We used univariate ANOVAs for group comparisons, and tested the association between impulsivity, executive control and personality dysfunction and diagnoses using correlation and multivariate logistic regression analyses. RESULTS Cocaine dependent patients with personality disorders had elevated negative urgency and borderline beliefs, decreased inhibition and attention regulation, and reduced temporal pole gray matter with respect to the rest of the sample. Trait and cognitive measures correctly classified 73% of comorbid patients (60% sensitivity and 82% specificity). CONCLUSION The co-occurrence of cocaine dependence and personality disorders is associated with negative-mood impulsivity and beliefs, executive dysfunction and temporal pole attrition.
Collapse
|
27
|
Frontal systems related symptoms in cocaine dependent patients with comorbid personality disorders. Psychopharmacology (Berl) 2013; 228:367-73. [PMID: 23483199 DOI: 10.1007/s00213-013-3040-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
Abstract
RATIONALE The co-occurrence of cocaine dependence and personality disorders may contribute to frontal systems-related behavioral symptoms in cocaine users. OBJECTIVE This study aims to characterize apathy, disinhibition, and dysexecutive symptoms in cocaine users with comorbid personality disorders. METHODS Thirty-nine participants meeting criteria for cocaine dependence and personality disorders, 35 participants meeting criteria for cocaine dependence without comorbidities, and 29 controls matched for age, education, and IQ completed the Frontal Systems Behavior Scale (FrSBe), which provides present and retrospective assessments (of the period preceding cocaine use) about apathy, disinhibition, and dysexecutive symptoms. Additionally, relatives of cocaine patients (34 relatives from comorbid patients and 31 relatives from noncomorbid patients) completed the informant version of the FrSBe. We used one-way ANOVAs to investigate present-moment differences between the groups and related samples t tests to quantify changes between pre-disorder and present-moment symptoms. RESULTS Cocaine users with personality disorders self-reported higher present-moment apathy and disinhibition symptoms than noncomorbid users and controls. Informant ratings showed that comorbid users exhibited pre-disorder elevations in apathy, disinhibition and dysexecutive symptoms, and that these symptoms did not significantly change between the pre-disorder and the present-moment assessments. In contrast, noncomorbid users exhibited increased apathy, disinhibition, and dysexecutive symptoms at present-moment compared with pre-disorder measures. CONCLUSIONS The co-occurrence of cocaine dependence and personality disorders is associated with elevated frontal systems-related behavioral symptoms. Comorbid and noncomorbid users differ in frontal symptoms' trajectories, with the former showing pre-disorder stable elevations and the latter showing lower baseline symptoms but greater addiction-related elevations.
Collapse
|
28
|
Schönfeld S, Renneberg B. Introduction to the special issue autobiographical memory and psychopathology. J Behav Ther Exp Psychiatry 2012; 43 Suppl 1:S1-3. [PMID: 23092652 DOI: 10.1016/j.jbtep.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Krawitz R. Behavioural treatment of chronic, severe self-loathing in people with borderline personality disorder. Part 1: interrupting the self-loathing cycle. Australas Psychiatry 2012; 20:419-24. [PMID: 23014120 DOI: 10.1177/1039856212459584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this article is to briefly outline difficulties in the standard behavioural treatment of severe chronic self-loathing in people with borderline personality disorder, and to follow with a fuller discussion on interrupting the self-loathing cycle. This is the first of a series of two articles on this topic. The second article focuses on the specific intervention of self-compassion and briefly mentions a range of other behavioural interventions. CONCLUSIONS Treating severe chronic self-loathing in people with borderline personality disorder can be challenging for client and clinician alike, with standard approaches often being ineffective. Assessment of reinforcers of the locked-in downward spiral of self-loathing will guide interventions for clients to interrupt this vicious cycle.
Collapse
Affiliation(s)
- Roy Krawitz
- Waikato District Health Board, and Auckland University, Auckland, New Zealand.
| |
Collapse
|
30
|
Svaldi J, Philipsen A, Matthies S. Risky decision-making in borderline personality disorder. Psychiatry Res 2012; 197:112-8. [PMID: 22421066 DOI: 10.1016/j.psychres.2012.01.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 01/11/2012] [Accepted: 01/11/2012] [Indexed: 11/19/2022]
Abstract
Impulsivity is a core feature of borderline personality disorder (BPD). Thereby, individuals with BPD are most often explicitly aware of the deleterious long-term consequences of their impulsive behaviors, but still engage in them. Therefore, the aim of the present study was to test decision-making in BPD. Female individuals with BPD (n=21) and female controls without BPD (CG; n=29) were compared on the Game of Dice Task (GDT) with regard to disadvantageous decision-making and feedback processing. In the GDT rules for reinforcement and punishment are explicitly clear and the outcome is defined by probabilities. By providing feedback about the outcome of previous decisions, the GDT is a valid measure to simulate decision-making in real life situations. Main results revealed that women with BPD make risky decisions significantly more often than the CG. Moreover, they show reduced capacities to advantageously utilize feedback. As deficits in decision-making were correlated with BPD symptom severity and impulsivity, risky decision-making may be a relevant maintenance factor for the disorder.
Collapse
Affiliation(s)
- Jennifer Svaldi
- University of Freiburg, Department of Clinical Psychology and Psychotherapy, Germany.
| | | | | |
Collapse
|
31
|
Neuromagnetic indication of dysfunctional emotion regulation in affective disorders. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:156529. [PMID: 22649719 PMCID: PMC3357925 DOI: 10.1155/2012/156529] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/10/2012] [Accepted: 01/24/2012] [Indexed: 11/18/2022]
Abstract
Dysfunctional emotion regulation is often reported in affective disorders, but it is unclear whether this dysfunction concerns initial processing of emotional input or regulation of resulting emotion. The present study addressed these aspects in 27 depressive and 15 borderline personality disorder patients and 28 healthy controls who were instructed to either passively view unpleasant and neutral pictures or downregulate emotional responses by reappraisal, while neuromagnetic brain activity was measured. All three groups showed more early response to unpleasant than to neutral pictures, whereas patients failed to show subsequent activity suppression under instructions to down-regulate. This deficient emotion regulation was evident primarily in those subjects reporting high childhood adversity. Results support intact emotional input processing but impaired emotion regulation in affective disorders and indicate a moderating influence of early life stress.
Collapse
|
32
|
Self-reported emotional dysregulation but no impairment of emotional intelligence in borderline personality disorder: an explorative study. J Nerv Ment Dis 2010; 198:385-8. [PMID: 20458204 DOI: 10.1097/nmd.0b013e3181da4b4f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emotional dysfunction is a key feature of patients with borderline personality disorder (BPD) but emotional intelligence (EI) has rarely been investigated in this sample. This study aimed at an investigation of ability EI, general intelligence, and self-reported emotion regulation in BPD. We included 19 patients with BPD and 20 healthy control subjects in the study. EI was assessed by means of the Mayer-Salovey-Caruso emotional intelligence test and the test of emotional intelligence. For the assessment of general intelligence, we administered the multidimensional "Leistungsprüfsystem-Kurzversion." The emotion regulation questionnaire and the difficulties in Emotion Regulation Scale were used to assess emotion regulation. The patients with BPD did not exhibit impairments of ability EI and general intelligence but reported severe impairments in emotion regulation. Ability EI was related both to general intelligence (patients and controls) and to self-reported emotion regulation (patients). In conclusion, emotional dysfunction in BPD might primarily affect self-perceived behavior rather than abilities. Intense negative emotions in everyday life may trigger dysfunctional emotion regulation strategies in BPD although patients possess sufficient theoretical knowledge about optimal regulation strategies.
Collapse
|