Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings

A meta-analysis on the neuropsychological correlates of Borderline Personality Disorder: An update

Previous research on Borderline Personality Disorder (BPD) demonstrated dysfunction across a broad range of cognitive domains. However, the limited number of neuropsychological studies on BPD and their occasionally conflicting results have precluded a clear characterization of the neuropsychological features associated with this personality disorder. Therefore, the main aim of the present study is to provide an updated overview of neuropsychological functions related to BPD. A meta-analysis of 36 studies was performed, comparing the performance of BPD patients and healthy controls (HCs) across several cognitive domains. Significant differences between BPD patients and HCs in multiple cognitive domains were found. The smallest effect size was observed for general executive function, while the largest effect sizes were found in the long-term spatial memory and inhibition domains. In conclusion, the neuropsychological profile of BPD, characterized by deficits in inhibition as well as attention, memory, and executive functions, can result in difficulties in performing everyday activities. Accordingly, assessing neuropsychological functions could assist clinicians in developing more targeted non-pharmacological treatments.

Impairment of Visual Fixation and Preparatory Saccade Control in Borderline Personality Disorder With and Without Comorbid Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Borderline personality disorder (BPD) is associated with heightened impulsivity, evidenced by increased substance abuse, self-harm, and suicide attempts. Addressing impulsivity in individuals with BPD is a therapeutic objective, but its underlying neural basis in this clinical population remains unclear, partly due to its frequent comorbidity with attention-deficit/hyperactivity disorder (ADHD).

METHODS

We used a response inhibition paradigm-the interleaved pro-/antisaccade task-among adolescents diagnosed with BPD with and without comorbid ADHD (n = 25 and n = 24, respectively) during concomitant video-based eye tracking. We quantified various eye movement response parameters reflective of impulsive action during the task, including delay to fixation acquisition, fixation breaks, anticipatory saccades, and direction errors with express saccade (saccade reaction time: 90-140 ms) and regular saccade latencies (saccade reaction time > 140 ms).

RESULTS

Individuals with BPD exhibited deficient response preparation, as evidenced by reduced visual fixation on task cues and greater variability of saccade responses (i.e., saccade reaction time and peak velocity). The ADHD/BPD group shared these traits and made more anticipatory responses and direction errors with express saccade latencies and reduced error correction.

CONCLUSIONS

Saccadic deficits in BPD and ADHD/BPD stemmed not from an inability to execute antisaccades but rather from inadequate preparation for the upcoming task set. These distinctions may arise due to abnormal signaling in cortical areas like the frontal eye fields, posterior parietal cortex, and anterior cingulate cortex. Understanding these mechanisms could provide insights into targeted interventions focusing on task set preparation to manage response inhibition deficits in BPD and ADHD/BPD.

Cognition in adults with borderline personality disorder

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

False memory in posttraumatic stress disorder and borderline personality disorder

Post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) have been associated with an increased generation of false memories. We aimed to disentangle disorder-specific false memory in individuals with PTSD and BPD using the Deese-Roediger-McDermott (DRM) paradigm. It measures the tendency to mistakenly remember stimuli that are associated with actually presented material, but have not been presented. Participants with BPD without comorbid PTSD (n = 32), participants with PTSD without comorbid BPD (n = 28), and mentally healthy controls (HC, n = 30) were given a word recognition test after hearing neutral, emotionally negative, BPD-related and PTSD-related word lists. Compared to HC, participants with PTSD showed fewer false memories for neutral word material and no other differences. Participants with BPD showed no differences in false memory formation compared to HC, only more false memories for a BPD-related and a PTSD-related word list compared to PTSD. Our results indicate, that in the absence of BPD, increased false memory in PTSD cannot be observed. In addition, our findings do not suggest that individuals with BPD and HC differ in their false memory formation. More trauma-individualized material should be used in future studies on false memory in PTSD.

Negativity in delayed affective recall is related to the borderline personality trait

The present study assessed selected factors that contribute to the recollection of emotional memories over time. Participants with high-trait borderline personality disorder (BPD) watched a randomly selected positive, negative, or neutral character in a video clip (stimulus) and were asked to recall the content immediately, then 2, 4, and 6 days later. In the final sample (N = 558, average age: 33 years, 65% female), general impression had the strongest effect on recall after accounting for the effect of current mood, extremity of the responses, and level of BPD, regardless of stimulus valence. The level of BPD had an effect only when negative evaluative wording (e.g., “guilty”) was used. In conclusion, people with high-trait BPD tend to remember negative stimuli more negatively over time (unlike neutral or positive stimuli), and this effect is mostly related to general impression.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

Relatively small sample size, especially for neuroimaging.

CONCLUSIONS

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

Inhibitory control under emotional contexts in women with borderline personality disorder: An electrophysiological study

Borderline personality disorder (BPD) is characterized by emotional dysregulation and difficulties in cognitive control. Inhibitory control, meanwhile, is modulated by the presence of emotional stimuli. The objective of the present study was to examine the effects of implicit emotional contexts on response inhibition in BPD patients. Participants performed a response inhibition task (Go-NoGo) under 3 background context conditions: neutral, pleasant and unpleasant. Behavioral performance did not differed between groups. Significantly higher P3NoGo amplitudes, shorter N2 latencies and lower global connectivity were observed in the patients regardless of the emotional valence of the background images compared to controls. In addition, higher P3NoGo amplitudes were correlated with more pronounced psychopathological symptoms. Emotional contexts enhanced N2 amplitudes compared to neutral ones in both groups. Results indicate that BPD required greater neural effort to successfully perform the inhibitory task. Finally, BPD showed lower synchronization between cortical regions, which may indicate a disruption in the effective temporal coupling of distributed areas associated with emotional stimuli-processing during both response and response inhibition.

Cognitive correlates of borderline intellectual functioning in borderline personality disorder

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

The association between neurocognitive functioning and clinical features of borderline personality disorder

OBJECTIVE

To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD).

METHODS

Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups.

RESULTS

BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity.

CONCLUSION

Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.

Differential relations of executive functioning to borderline personality disorder presentations in adolescents

Borderline personality disorder (BPD) in adolescents is highly complex and heterogeneous. Within the disorder, research has suggested the existence of at least two subgroups: one with predominantly internalizing psychopathology features and one with predominantly externalizing psychopathology features. One process that may differentiate these groups is executive functioning (EF), given that poor EF is linked to externalizing psychopathology. Against this background, the current study used a multi-informant approach to examine whether adolescent patients with predominantly externalizing BPD presentations experience greater deficits in EF than adolescent patients with predominantly internalizing presentations. The sample included inpatient adolescents ages 12-17 (M = 15.26; SD = 1.51). Analyses revealed that multiple EF domains distinguished the BPD subgroups. More specifically, adolescents with externalizing presentations exhibited greater difficulties in broad domains related to global executive functioning, metacognition and behavioural regulation and specific domains related to inhibitory control, working memory, planning/organizing, monitoring and organization of materials. While this study is the first to examine EF and adolescent BPD in the context of internalizing and externalizing psychopathology, alternative approaches to examining this question are discussed. Copyright © 2018 John Wiley & Sons, Ltd.

The effects of social exclusion on response inhibition in borderline personality disorder and major depression

It is a prevalent notion that borderline personality disorder (BPD) is characterized by deficits in executive functions (EF) like inhibition. Yet experimental studies yield inconsistent results. However, despite emotional dysregulation being a core feature of BPD, most paradigms did not control for emotional state or comorbid mental disorders. In the present study, subjects with BPD and comorbid MDD (BPD+MDD), with major depression (MDD) and healthy controls (HC) partook in a social exclusion paradigm combined with an inhibition task. We expected inhibition to be more strongly impaired in BPD+MDD than in depression and HC when experiencing negative emotions. Respecting inhibition, depressed patients performed best while (BPD+MDD) patients performed worst. Surprisingly, MDD & HC participants' performance improved during social exclusion, but this was not the case for BPD+MDD. Inhibition deficits were correlated with childhood trauma. These results challenge the hypothesis that an induction of negative emotion results in inferior inhibition in (BPD+MDD). Instead, patients with (BPD+MDD) seem to suffer from a more general inhibitory dysfunction. Importantly, (BPD+MDD) patients were not able to improve their performance during social exclusion like HC and MDD patients did. These findings need to be investigated further, particularly regarding the efficiency of neural networks regulating inhibition and effects of trauma.

A negative relationship between ventral striatal loss anticipation response and impulsivity in borderline personality disorder

Patients with borderline personality disorder (BPD) frequently exhibit impulsive behavior, and self-reported impulsivity is typically higher in BPD patients when compared to healthy controls. Previous functional neuroimaging studies have suggested a link between impulsivity, the ventral striatal response to reward anticipation, and prediction errors. Here we investigated the striatal neural response to monetary gain and loss anticipation and their relationship with impulsivity in 21 female BPD patients and 23 age-matched female healthy controls using functional magnetic resonance imaging (fMRI). Participants performed a delayed monetary incentive task in which three categories of objects predicted a potential gain, loss, or neutral outcome. Impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11). Compared to healthy controls, BPD patients exhibited significantly reduced fMRI responses of the ventral striatum/nucleus accumbens (VS/NAcc) to both reward-predicting and loss-predicting cues. BIS-11 scores showed a significant positive correlation with the VS/NAcc reward anticipation responses in healthy controls, and this correlation, while also nominally positive, failed to reach significance in BPD patients. BPD patients, on the other hand, exhibited a significantly negative correlation between ventral striatal loss anticipation responses and BIS-11 scores, whereas this correlation was significantly positive in healthy controls. Our results suggest that patients with BPD show attenuated anticipation responses in the VS/NAcc and, furthermore, that higher impulsivity in BPD patients might be related to impaired prediction of aversive outcomes.

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We investigated striatal reward and loss anticipation in patients with Borderline Personality Disorder (BPD) and controls

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BPD patients relative to controls exhibited reduced ventral striatal / nucleus accumbens (VS/NAcc) anticipation responses

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In healthy controls, VS responses to gains and losses correlated positively with impulsivity

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BPD patients exhibited a negative correlation between loss responses and impulsivity.

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Our results suggest that impulsivity in BPD patients may in part result from impaired anticipation of aversive outcomes.

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

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

Possible role of a dysregulation of the endogenous opioid system in antisocial personality disorder

Around half the inmates in prison institutions have antisocial personality disorder (ASPD). A recent theory has proposed that a dysfunction of the endogenous opioid system (EOS) underlies the neurobiology of borderline personality disorder (BPD). In the present theoretical paper, based on a comprehensive database and hand search of the relevant literature, this hypothesis is extended to ASPD, which may be the predominant expression of EOS dysfunction in men, while the same pathology underlies BPD in women. According to evidence from human and animal studies, the problematic behaviours of persons with antisocial, callous, or psychopathic traits may be seen as desperate, unconscious attempts to stimulate their deficient EOS, which plays a key role in brain reward circuits. If the needs of this system are not being met, the affected persons experience dysphoric mood, discomfort, or irritability, and strive to increase binding of endogenous opioids to receptors by using the rewarding effects of aggression by exertion of physical or manipulative power on others, by abusing alcohol or substances that have the reward system as target, by creating an "endorphin rush" by self-harm, by increasing the frequency of their sexual contacts, or by impulsive actions and sensation seeking. Symptoms associated with ASPD can be treated with opioid antagonists like naltrexone, naloxone, or nalmefene.

Executive dysfunction in bipolar disorder and borderline personality disorder

Objective

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

Method

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

Results

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

Conclusions

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

Time Left for Intervention in the Suicidal Process in Borderline Personality Disorder

The objective of this study was to measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. A total of 63 patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the β coefficient of impulsivity scales in women with a suicidal process ≤10 minutes was lower compared to those observed in women with >10 min (β = -0.03, 95% CI = -0.06 = -0.01, p < 0.01). Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.

Impact of stress on different components of impulsivity in borderline personality disorder

BACKGROUND

Previous research on impulsivity in borderline personality disorder (BPD) has revealed inconsistent findings. Impulsive behaviour is often observed during states of emotional distress and might be exaggerated by current attention deficit hyperactivity disorder (ADHD) symptoms in individuals with BPD. We aimed to investigate different components of impulsivity dependent on stress induction controlling for self-reported ADHD symptoms in BPD. METHOD. A total of 31 unmedicated women with BPD and 30 healthy women (healthy controls; HCs), matched for age, education and intelligence, completed self-reports and behavioural tasks measuring response inhibition (go/stop task) and feedback-driven decision making (Iowa Gambling Task) under resting conditions and after experimental stress induction. ADHD symptoms were included as a covariate in the analyses of behavioural impulsivity. Additionally, self-reported emotion-regulation capacities were assessed.

RESULTS

BPD patients reported higher impulsive traits than HCs. During stress conditions - compared with resting conditions - self-reported impulsivity was elevated in both groups. Patients with BPD reported higher state impulsivity under both conditions and a significantly stronger stress-dependent increase in state impulsivity. On the behavioural level, BPD patients showed significantly impaired performance on the go/stop task under stress conditions, even when considering ADHD symptoms as a covariate, but not under resting conditions. No group differences on the Iowa Gambling Task were observed. Correlations between impulsivity measures and emotion-regulation capacities were observed in BPD patients.

CONCLUSIONS

Findings suggest a significant impact of stress on self-perceived state impulsivity and on response disinhibition (even when considering current ADHD symptoms) in females with BPD.

Similarities and differences in borderline and organic personality disorder

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.

Set shifting and reversal learning in borderline personality disorder

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.

False memories and memory confidence in borderline patients

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Executive functions in borderline personality disorder

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

Acute glucocorticoid effects on response inhibition in borderline personality disorder

INTRODUCTION

Growing evidence suggests inhibition dysfunctions in borderline personality disorder (BPD). Moreover, abnormalities in hypothalamic-pituitary-adrenal (HPA) axis functioning have also been found in BPD patients. In healthy individuals, response inhibition has been sensitive to acute stress, and previous research indicates that effects mediated by the HPA axis become particularly apparent when emotional stimuli are processed. This study aimed to explore the influence of acute hydrocortisone administration on response inhibition of emotional stimuli in BPD patients compared to healthy control participants.

METHODS

After a single administration of 10mg hydrocortisone or placebo, 32 female BPD patients and 32 healthy female participants performed an adapted emotional go/no-go paradigm to assess response inhibition for emotional face stimuli in a cross-over study.

RESULTS

Acute cortisol elevations decreased the reaction times to target stimuli in both BPD patients and healthy controls. Patients and controls did not differ in task performance; however, BPD patients with comorbid posttraumatic stress disorder (PTSD) displayed longer reaction times than patients without PTSD. In contrast, the occurrence of comorbid eating disorder had no significant impact on go/no-go performance. No significant interaction effect between the treatment condition and the emotional valence of the face stimuli was found.

CONCLUSIONS

Acute hydrocortisone administration enhances response inhibition of face stimuli in BPD patients and healthy controls, regardless of their emotional valence. Our results agree with the suggestion that moderate cortisol enhancement increases the inhibition of task-irrelevant distracters.

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

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

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

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

Executive functioning among patients with borderline personality disorder (BPD) and their relatives

BACKGROUND

Studies focusing on executive functioning in patients with borderline personality disorder (BPD) have shown divergent results. Moreover, little attention has been paid to the potential role of deficits in executive functions as markers of familial vulnerability to BPD. Thus, the aim of the present study was to investigate executive functions in both patients BPD and their unaffected first-degree relatives (parents).

METHOD

We examined executive functions in four groups: patients with BPD (n=27), age-matched healthy controls (n=29), healthy unaffected parents of patients in the BPD group (n=20) and their respective age-matched controls (n=22). We administered tests that tapped three domains of executive functions: cognitive planning, sustained attention, and spatial working memory. All tests form part of the Cambridge Neuropsychological Test Automated Battery (CANTAB) battery.

RESULTS

BPD patients displayed deficient executive functioning as compared to healthy controls in the domains of cognitive planning, sustained attention and working memory. Both BPD patients and their parents showed reduced latency to initiate the first move on the planning task [CANTAB's Tower of London]. All other measurements of executive functions did not differ significantly between parents of BPD patients and their respective healthy controls.

LIMITATION

Results should be replicated with a larger sample size.

CONCLUSIONS

BPD patients demonstrate a generalized profile of executive dysfunction. In the group comprising their parents, however, we found a lack of evidence for executive dysfunctions. Hence, executive dysfunctions do not appear to be markers of familial vulnerability for BPD.

Impaired working memory and normal sustained attention in borderline personality disorder

Lazzaretti M, Morandotti N, Sala M, Isola M, Frangou S, De Vidovich G, Marraffini E, Gambini F, Barale F, Zappoli F, Caverzasi E, Brambilla P. Impaired working memory and normal sustained attention in borderline personality disorder.

Objective: Although reports in the literature describe deficits in working memory in borderline personality disorder (BPD), the evidence is limited and inconsistent. The aim of this study was to evaluate further this cognitive dimension and its clinical correlates in BPD.

Method: We compared the performance of 15 BPD patients to 1:1 matched healthy controls on verbal working memory as determined by the sequential letter N-back test and sustained attention as measured using the continuous performance test (CPT).

Results: BPD patients performed significantly worse on the N-back test compared to healthy controls (p < 0.05), but not on the CPT. The N-back deficit was more pronounced and significant in the 3-back condition and inversely correlated with impulsivity.

Conclusions: These results suggest the presence of working memory deficits in BPD that may be linked to greater impulsivity and sustained by impairment in the dorsolateral prefrontal cortex.

Patients with borderline personality disorder and major depressive disorder are not distinguishable by their neuropsychological performance: a case-control study

OBJECTIVE

Patients with borderline personality disorder (BPD) and patients with major depressive disorder (MDD) exhibit a broad range of neuropsychological deficits. Studies in both groups of patients point to differences but also similarities. However, studies that compare both patient groups are missing from the literature. The present study aimed to compare neuropsychological functioning in BPD and MDD patients.

METHOD

Eighteen patients with BPD, 27 patients with MDD, 17 patients with BPD and MDD, and 76 healthy control subjects were included in the case-control study. Patients were treated for their disorders as inpatients of the Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld (Bielefeld, Germany). All patients met DSM-IV diagnoses as assessed by trained psychotherapists within the first week of their admission. In addition to a comprehensive neuropsychological test battery, the inhibitory control of emotional stimuli was assessed. Data were collected between June 2004 and June 2007.

RESULTS

Patients showed only a few impairments and no increased distractibility toward emotionally negative stimuli. Patients with BPD and patients with MDD were not distinguishable by the neuropsychological test results.

CONCLUSIONS

These data did not support the notion of specific neuropsychological profiles in BPD and MDD. Future research needs to clarify the overlap of symptoms between both disorders.

Expressive language disturbance in borderline personality disorder in response to emotional autobiographical stimuli

Clinicians recognize expressive language disturbances in borderline personality disorder (BPD) as a feature attenuating psychiatric history-taking. Neuroimaging studies demonstrate activation of key differentiating neural networks characterizing a traumatic memory system in BPD patients. Yet there are few BPD studies evaluating expressive language disturbances in response to emotionally salient, clinically relevant stimuli and no controlled studies. The aim was to examine expressive language disturbances in response to a clinically relevant emotional stimulus, the Adult Attachment Interview (AAI). Twenty BPD participants and 20 age-, sex-, and education-matched controls were administered the AAI. Verbatim transcripts were analyzed by four computerized measures designed to evaluate various linguistic components of speech (i.e., overall expressive language impairment, lexical complexity, syntactic complexity, and semantic complexity). BPD participants evidenced significantly greater levels of overall expressive language impairment and reduced syntactic and lexical complexity, but not semantic complexity scores. Detailed linguistic profiles demonstrated specific deficits linked to BPD.

A feasibility study of mindfulness-based cognitive therapy for individuals with borderline personality disorder

OBJECTIVES

Mindfulness-based cognitive therapy (MBCT) was originally developed to prevent relapse in recurrent depression. More recently it has been applied to individuals at high risk of suicide or currently suffering with anxiety and depression. The aim of this study was to consider the feasibility of MBCT for individuals with a diagnosis of borderline personality disorder (BPD).

DESIGN

The design of the study was a repeated measures, quasi-experimental design employing within-subject and between-subject comparisons of a sample of participants with BPD. Based on previous studies and theoretical models of the effect of mindfulness and of cognitive therapy, pre- and post-group measures of mindfulness, depression, anxiety, dissociation, impulsivity, experiential avoidance, and attention were obtained.

METHOD

Participants attended an 8-week adapted MBCT (MBCT-a) group intervention. A total of 22 participants were assessed pre- and post-intervention and were subsequently divided for analysis into two groups: treatment completers (N= 16) and non-completers (number of sessions attended < 4; N= 6).

RESULTS

The study found that MBCT-a is acceptable to individuals with BPD. Using intention to treat analyses, only attentional control improved. However, post hoc analyses of treatment improvers (N= 9) identified changes in mindfulness and somatoform dissociation. A dose-effect analysis suggested a weak improvement in mindfulness, experiential avoidance, state anxiety, and somatoform dissociation.

CONCLUSIONS

This study suggests that further exploration of MBCT for use with individuals with BPD is merited. The study lends tentative support for attentional and avoidance models of the effects of mindfulness.

Intérêt clinique d’une conception neuroscientifique du trouble de personnalité limite : dysfonctionnements du système exécutif et de la théorie de l’esprit

Le trouble de personnalité limite (TPL) est un problème psychopathologique complexe et les données récentes issues des neurosciences permettent une compréhension plus précise des bases neurobiologiques de ses manifestations. Cet article vise à étayer la proposition que le TPL dépend en partie d’un dysfonctionnement frontal et exécutif qui perturbe les mécanismes nécessaires au fonctionnement optimal des inférences propres à l’utilisation d’une « théorie de l’esprit ». Pour soutenir ce propos, quatre ensembles d’observations sont examinés : les parallèles entre la personnalité dite frontale et le TPL, la présence de déficits cognitifs de type frontal chez le TPL, les conséquences sur le développement cérébral d’une enfance marquée par l’abus et la négligence et enfin, les résultats des études d’imagerie cérébrale. Cet article s’inscrit dans un courant de pensée qui vise l’intégration de la perspective neuroscientifique du TPL aux conceptualisations psychopathologiques actuelles. L’objectif étant d’offrir une conceptualisation du TPL qui évite la traditionnelle dichotomie esprit/cerveau, psychologie/biologie et de dégager des points de convergence entre la psychologie clinique et la neurobiologie.

Dorso- and ventro-lateral prefrontal volume and spatial working memory in schizotypal personality disorder

Schizotypal personality disorder (SPD) individuals and borderline personality disorder (BPD) individuals have been reported to show neuropsychological impairments and abnormalities in brain structure. However, relationships between neuropsychological function and brain structure in these groups are not well understood. This study compared visual-spatial working memory (SWM) and its associations with dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) gray matter volume in 18 unmedicated SPD patients with no BPD traits, 18 unmedicated BPD patients with no SPD traits, and 16 healthy controls (HC). Results showed impaired SWM in SPD but not BPD, compared with HC. Moreover, among the HC group, but not SPD patients, better SWM performance was associated with larger VLPFC (BA44/45) gray matter volume (Fisher's Z p-values <0.05). Findings suggest spatial working memory impairments may be a core neuropsychological deficit specific to SPD patients and highlight the role of VLPFC subcomponents in normal and dysfunctional memory performance.

Planning in borderline personality disorder: evidence for distinct subpopulations

OBJECTIVE

Borderline personality disorder is a severe mental disorder, whereas previous studies suggest executive functions may be impaired. The aim of this study was to evaluate executive planning in a sample of 85 individuals.

METHODS

Planning was assessed by means of the Tower of London (Drexel University version) task. Latent class cluster analysis models were adjusted to the data.

RESULTS

We identified two different subpopulations of borderline personality disorder patients, one of them with significantly reduced performance. CONCLUSION;. Neuropsychological mechanisms may be involved in borderline personality disorder, at least in a subgroup of patients.

Quetiapine treatment and improved cognitive functioning in borderline personality disorder

OBJECTIVE

We aimed to assess whether executive functioning improved over time in a sample of borderline personality disorder (BPD) subjects that took part in a quetiapine treatment trial.

METHODS

Performance on the following neurocognitive tasks was assessed at enrolment and at the end of the 12 weeks quetiapine treatment: Trail Making Task, Word Fluency Task and Tower of London Task. Forty-one BPD patients were recruited, of whom 32 completed the trial. An intention-to-treat analysis with a mixed linear model was applied.

RESULTS

The data show that participants significantly improved on most executive functioning measures. Patients' scores decreased significantly (mean [SD] difference; p-value) on the Trail Making Task Part A (11.7 [2.3]; p < 0.0001), Part B (51.8 [9.2]; p < 0.0001) and 'B minus A' (40.1 [8.2]; p < 0.0001), on a Phonological (15.9 [1.6]; p < 0.0001) and Semantic (9.8 [1.1]; p < 0.0001) Verbal Fluency tasks, and on the Tower of London total correct score (2.5 [0.4]; p < 0.0001), total move score (29.5 [4.5]; p < 0.0001) and total time (172.9 [35.8]; p < 0.0001).

CONCLUSIONS

In this study we have demonstrated that executive functioning in BPD is improved after treatment with quetiapine. Neurocognitive measures of executive functioning should be considered as valuable outcomes in the study of treatment efficacy in BPD.

Emotion-induced memory dysfunction in borderline personality disorder

INTRODUCTION

Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference.

METHODS

47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency.

RESULTS

Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder.

DISCUSSION

The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.

Selective deficit in executive functioning among patients with borderline personality disorder

BACKGROUND

The aim of this study was to investigate the functioning of patients with borderline personality disorder (BPD) compared to healthy controls on five neuropsychological domains, with regard to the possible effect of differences in IQ.MethodOut-patients and in-patients with BPD (n=35) and healthy comparison subjects (n=35) were tested with an extensive neuropsychological battery, where most cognitive domains were covered by several tests.

RESULTS

When controlling for the effect of IQ, patients were found to have reduced executive functioning as compared to healthy controls. With regard to the other neuropsychological domains (working memory, attention, long-term verbal memory, and long-term non-verbal memory), no differences were found between the two groups. Within-subject analyses also identified executive functioning as a selective deficit among patients whereas long-term verbal memory was identified as a relative strength. An association was identified between the covariate general intellectual functioning and every neuropsychological domain. No statistically significant differences were found between the subgroups of patients with and without co-morbid post-traumatic stress disorder (PTSD) or between those with and without co-morbid major depression, or between the medicated and unmedicated subgroups on any of the neuropsychological domains.

CONCLUSIONS

Patients with BPD demonstrate a selective deficit in executive functioning. This corroborates studies that have identified frontal regions as potential neurobiological substrates of the BPD syndrome. The relative strength of the verbal long-term memory function raises pertinent questions regarding the presumed importance of hippocampal structures.

Pathological dissociation and neuropsychological functioning in borderline personality disorder

OBJECTIVE

Transient, stress-related severe dissociative symptoms or paranoid ideation is one of the criteria defining the borderline personality disorder (BPD). Examinations of the neuropsychological correlates of BPD reveal various findings. The purpose of this study was to investigate the association between dissociation and neuropsychological functioning in patients with BPD.

METHOD

The performance on an extensive neuropsychological battery of patients with BPD with (n=10) and without (n=20) pathological dissociation was compared with that of healthy controls (n=30).

RESULTS

Patients with pathological dissociation were found to have reduced functioning on every neuropsychological domain when compared with healthy controls. Patients without pathological dissociation were found to have reduced executive functioning, but no other differences were found.

CONCLUSION

Pathological dissociation is a clinical variable that differentiates patients with BPD with regard to cognitive functioning.

Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: an fMRI study

Verbal memory impairment in borderline personality disorder (BPD) is still a matter of debate. In this study we combine investigations of both, memory retrieval as well as underlying neural circuits in BPD. Functional magnetic resonance imaging (fMRI) was used to study regional brain activation in 18 right-handed female patients with BPD and 18 matched controls during the retrieval of an episodic memory retrieval (EMR) task (free recall of a word list) and a semantic memory retrieval (SMR) task (verbal fluency). Despite unaffected performance in EMR and SMR, patients with BPD showed task-specific increased activation compared with controls. During EMR, the increased activation encompassed the posterior cingulate cortex bilaterally, the left middle and superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus. SMR was associated with increased activation of the posterior cingulate cortex, of the right fusiform gyrus, of the left anterior cingulate cortex, and of the left postcentral gyrus. Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.

A neurocognitive model of borderline personality disorder: effects of childhood sexual abuse and relationship to adult social attachment disturbance

Borderline personality disorder (BPD) is a paradigmatic disorder of adult attachment, with high rates of antecedent childhood maltreatment. The neurocognitive correlates of both attachment disturbance and maltreatment are both presently unknown in BPD. This study evaluated whether dimensional adult attachment disturbance in BPD is related to specific neurocognitive deficits, and whether childhood maltreatment is related to these dysfunctions. An outpatient BPD group (n=43) performed nearly 1 SD below a control group (n=26) on short-term recall, executive, and intelligence functions. These deficits were not affected by emotionally charged stimuli. In the BPD group, impaired recall was related to attachment-anxiety, whereas executive dysfunction was related to attachment-avoidance. Abuse history was correlated significantly with executive dysfunction and at a trend level with impaired recall. Neurocognitive deficits and abuse history exhibited both independent and interactive effects on adult attachment disturbance. These results suggest that (a) BPD patients' reactivity in attachment relationships is related to temporal-limbic dysfunction, irrespective of the emotional content of stimuli, (b) BPD patients' avoidance within attachment relationships may be a relational strategy to compensate for the emotional consequences of frontal-executive dysregulation, and (c) childhood abuse may contribute to these neurocognitive deficits but may also exert effects on adult attachment disturbance that is both independent and interacting with neurocognitive dysfunction.

Intra-individual reaction time variability in schizophrenia, depression and borderline personality disorder

Intra-individual reaction time variability (IIV) in neuropsychological task performance reflects short term fluctuations in performance. Increased IIV has been reported in patients with schizophrenia and could be related to a deficient neural timing mechanism, but the role of IIV in adult patients with other psychiatric disorders has not been established. Therefore, we compared IIV measures obtained in a Go/Nogo task from patients with schizophrenia, major depression and borderline personality disorder. IIV was increased for patients with schizophrenia. When correcting for differences in mean reaction time, depressive and borderline patients also showed increased IIV. Importantly, all groups showed a strong association between IIV and accuracy of task performance. This suggests that increased IIV might be a sensitive marker for the efficiency of top-down attentional control in all diagnostic groups. Aside from these similarities, the complete results including measures of IIV, mean reaction time and accuracy show differential patterns for patients with schizophrenia compared to those with borderline personality disorder or depression. These results are discussed with respect to common versus disorder-specific neural mechanisms underlying increased IIV.

Inhibition errors in borderline personality disorder with psychotic-like symptoms

BACKGROUND

The aim of this study was to examine whether patients with borderline personality disorder (BPD) have deficits in cognitive inhibition as measured with an anti-saccade eye task similar to patients with schizophrenia (Sz). Furthermore, we investigated whether these inhibition errors were more prominent among BPD patients with psychotic-like symptoms than among BPD patients without these symptoms.

METHODS

An anti-saccade task was administered in 32 BPD patients (among them, 20 had with psychotic-like symptoms), 21 patients with recent onset schizophrenia (Sz), and 25 healthy controls (HC). The percentage inhibition errors in the anti-saccade task were the primary outcome variable, in addition, the percentage of anticipatory errors was measured.

RESULTS

Sz patients showed more inhibition errors than HC and BPD (p<.001 and p<.05 resp.), whereas BPD patients scored in between Sz and HC. The difference with HC was significant as well (p<.05). BPD patients with psychotic-like symptoms showed more inhibition errors than BPD patients without these symptoms (p<.05). BPD patients showed more anticipatory errors than HC (p<.001), whereas Sz patients did not (p<.26).

CONCLUSION

The data demonstrate that inhibition deficits, as measured with anti-saccadic eye movement task, may be characteristic among BPD patients and in a larger extent in patients with psychotic-like symptoms. This inhibition deficit was distinct from a general predisposition to response impulsively as measured by anticipatory errors, which was found in the whole group of BPD patients. Psychotic-like symptoms may be an important target dimension for future BPD research and treatment.

Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder

BACKGROUND

Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.

METHOD

The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.

RESULTS

ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.

CONCLUSIONS

Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.

Enhanced emotion-induced amnesia in borderline personality disorder

BACKGROUND

Current biological concepts of borderline personality disorder (BPD) emphasize the interference of emotional hyperarousal and cognitive functions. A prototypical example is episodic memory. Pre-clinical investigations of emotion-episodic memory interactions have shown specific retrograde and anterograde episodic memory changes in response to emotional stimuli. These changes are amygdala dependent and vary as a function of emotional arousal and valence.

METHOD

To determine whether there is amygdala hyper-responsiveness to emotional stimuli as the underlying pathological substrate of cognitive dysfunction in BPD, 16 unmedicated female patients with BPD were tested on the behavioural indices of emotion-induced amnesia and hypermnesia established in 16 healthy controls.

RESULTS

BPD patients displayed enhanced retrograde and anterograde amnesia in response to presentation of negative stimuli, while positive stimuli elicited no episodic memory-modulating effects.

CONCLUSION

These findings suggest that an amygdala hyper-responsiveness to negative stimuli may serve as a crucial aetiological contributor to emotion-induced cognitive dysfunction in BPD.

Deficits in visual functions and neuropsychological inconsistency in Borderline Personality Disorder

For Borderline Personality Disorder (BPD) cognitive and perceptual impairments were reported in some but not all studies. The aim of the present study was to analyze the neuropsychological performance of BPD patients in different domains. Predominant impairments of visual functions and an increased intra-individual variation of test performances within neuropsychological domains were expected. We investigated 22 patients with BPD and a matched sample of 22 healthy control subjects. A comprehensive clinical and neuropsychological test battery was administered. Effect sizes indicate primarily deficits of visual functions such as visual memory (Wechsler Memory Scale-Revised, WMS-R: Visual pair associates and visual reproduction, Complex Figure Test: Recall) and visuo-spatial abilities (Leistungspruefsystem, LPS 9 and 10: Spatial imagination and embedded figures), but also of executive functions (Tower of Hanoi, Trail Making Test-B, semantic and figural fluency, LPS 4: Reasoning). In addition, the intra-individual ranges of neuropsychological test results in BPD patients were increased compared to those of healthy subjects. This finding might be due to a high degree of temporary stress that interferes with effective cognitive processing. Further research is needed to confirm the present results and to control for stress during the test procedure.

The psychodynamics of borderline personality disorder: a view from developmental psychopathology

This article provides a contemporary view of the psychodynamics of borderline personality disorder (BPD) from a developmental psychopathology perspective. We first briefly describe the evolution of the borderline construct in psychoanalysis and psychiatry. Then we provide clinically and empirically informed model of domains of personality function and dysfunction that provides a roadmap for thinking about personality pathology from a developmental psychopathology standpoint and examine the nature and phenomenology of BPD in terms of these domains of functioning. Next, we describe prominent dynamic theories of etiology of BPD and examine these in relation to the available research. Finally, we describe psychodynamic conceptions of treatment and the way BPD phenomena manifest in treatment, followed again by consideration of relevant research, particularly on transference-countertransference constellations empirically identified in the treatment of patients with BPD.