Neuropsychological function in borderline personality disorder

To evaluate the possibility of an underlying dimension of organicity in borderline personality disorder (BPD), a carefully diagnosed group of borderline patients was assessed across a wide range of neuropsychological functions and then was compared to an age-and education-matched non-patient control group. The BPD group had significantly lower Verbal, Performance, and Full Scale IQ scores on the WAIS-R. The BPD group also was impaired significantly on motor skills, figural memory, complex visuo-motor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients.     

Disinhibition and borderline personality disorder

We review different conceptions of inhibitory control that may be relevant to the regulatory problems featured in borderline personality disorder (BPD). These conceptions have often been framed with regard to personality traits of inhibitory control, but can also be related to cognitive measures of response suppression as well as affect regulation. Reactive behavioral inhibition is relatively unstudied in relation to BPD. A substantial amount of literature links executive function problems with BPD, but that literature has not isolated executive response inhibition nor been controlled for other personality disorder symptoms of antisociality, attention-deficit/hyperactivity disorder (ADHD), or depression, anxiety, or posttraumatic symptoms. We therefore conducted a study of this question looking at BPD symptoms in an adult sample with a small number of BPD subjects and other disorders. Results indicated that symptoms of BPD were correlated with response inhibition (measured by stop signal reaction time) even after controlling for the overlap of stop inhibition with ADHD, antisociality, and other Axis II disorder symptoms. We conclude by hypothesizing discrete developmental routes to BPD, based on different mechanism breakdowns, which would be amenable to empirical investigation at the cognitive or trait level of analysis.     

Interpersonal psychotherapy for borderline personality disorder

This paper outlines an approach to the treatment of borderline personality disorder (BPD) based on principles of interpersonal psychotherapy. The rationale for using a modified version of interpersonal psychotherapy (IPT) is described-BPD is a disorder of attachment, depression is commonly associated with BPD and the primary symptoms of BPD such as rapid mood fluctuations, impulsivity and cognitive distortions are manifested within interpersonal relationships. A focus on interpersonal dysfunction between self and others may improve the quality of relationships for these patients and improve their capacity to manage the instability engendered by depressed mood. It is argued that the normal structure of IPT meets the basic requirements of any psychotherapy for BPD but that the current four foci of IPT are inadequate to address the complexity of the problems of the person with BPD. A case is made to extend the focal areas of IPT to increase the specificity of treatment tailoring it to the core pathology of the disorder. It is suggested that consideration of regulation of the self within interpersonal interactions becomes the primary focus for treatment. KEY PRACTITIONER MESSAGE: Borderline personality disorder is manifested through problems on interpersonal relationships. Interpersonal psychotherapy may be a useful treatment for BPD. Interpersonal psychotherapy uses a focus for treatment. A new focus of problems of self/other regulation is suggested. Further research is needed to determine if this approach is effective.     

Rejection sensitivity and borderline personality disorder

Rejection sensitivity (RS) is defined as a cognitive-affective processing disposition of anxious expectation, ready perception and overreaction to rejection cues. RS is widely investigated in social psychology, but research on RS in clinical samples is scarce. Focus of the present study was to examine the role of RS in patients with borderline personality disorder (BPD) compared to other clinical disorders. The Rejection Sensitivity Questionnaire (RSQ) was adapted for application in clinical and non-clinical samples and proved to be a methodologically sound measure. High correlations between the RSQ and borderline-specific cognitions (Questionnaire of Thoughts and Feelings) were observed. Compared to several clinical samples as well as healthy controls, BPD patients indicated the highest scores on both measures and differed significantly from all other groups, even from patients with social anxiety disorders.     

Possible selves and borderline personality disorder

Although clinical theories suggest that people with Borderline Personality Disorder (BPD) experience a confused sense of self, little empirical research has directly examined the self in BPD (Heard & Linehan, 1993; Westen & Cohen, 1993). In this study, 43 female participants, 15 with BPD and 28 without BPD, completed the closed-ended version of Markus and Wurf's (1987) Possible Selves Questionnaire (PSQ). Participants with BPD were less likely than controls to endorse positive possible selves as current, but more likely to endorse negative possible selves as current, probable, desired, and important. Participants with BPD linked negative and positive selves to their desired selves, which is consistent with the unstable sense of self characteristic of BPD.     

Developmental precipitants of borderline personality disorder

Traditional theories regarding the etiology of borderline personality disorder have focused on poor attachment figures and/or traumatic experience. The present review posits an additional pathogenic course for this disorder. Specifically, the proposed mechanism involves a basic disruption of the neural hardware that supports the formation and maintenance of unconscious emotional memory, hardware essential for the formation of early attachments. It is further theorized that this early disruption has ongoing effects on both behavioral and concomitant neural development. Within this model, adolescence is described as a period of intense change that serves as the tipping point for the onset of borderline personality disorder.     

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.     

Schema therapy for borderline personality disorder

This article presents the Schema Therapy (Young, Klosko, & Weishaar, 2003) approach to the treatment of borderline personality disorder. Schema therapy draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have borderline personality disorder as being under the sway of five modes or aspects of the self. The goal of the therapy is to reorganize this inner structure. To this end, there are four core mechanisms of change that are used in this therapy: (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking. These interventions are used during the three phases of treatment: (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy.     

Neuropsychological functioning in patients with borderline personality disorder

Although results have been variable, studies suggest that individuals with borderline personality disorder (BPD) exhibit cognitive deficits suggestive of frontal- and temporal-lobe dysfunction. Patients diagnosed with BPD (n = 18) using two structured interviews, and who were carefully screened for neurological and substance-use disorders, were compared to depressed patients (n = 18) and a nonpsychiatric control group (n = 18) on a series of neuropsychological tasks. The role of emotion on cognitive functioning was assessed by including emotional stimuli and interference on several of the tasks. Little support was found for the neurobehavioral hypothesis of BPD. The BPD group performance did not differ from the normal group on most tasks of executive functioning or memory, and the introduction of emotional stimuli did not impair performance. The depressed group performed less effectively than the other groups. Reasons for variable findings and factors affecting the cognitive functioning of patients with BPD are discussed. There may be considerable heterogeneity in the cognitive functioning of BPD patients, with those exhibiting significant cognitive deficits comprising only a subgroup.     

Autobiographical memory and dissociation in borderline personality disorder

BACKGROUND: This study investigated whether individuals with borderline personality disorder (BPD) tend to be overgeneral in their autobiographical recall and whether the extent of their overgeneral recall covaries with their susceptibilities to dissociative experiences, as expected on theoretical grounds. METHODS: Twenty-three patients with BPD and 23 matched controls completed the Autobiographical Memory Test (AMT) and self-report measures of depression, anxiety, trait anger and dissociative experiences. RESULTS: Participants with BPD scored significantly higher than the control group on the measures of depression, anxiety, trait anger, and dissociative experiences and also retrieved significantly more general memories on the AMT. The number of general memories retrieved by the BPD group correlated significantly with their dissociation scores but not with their scores on mood measures. CONCLUSIONS: Patients with BPD have difficulties in recalling specific autobiographical memories. These difficulties are related to their tendency to dissociate and may help them to avoid episodic information that would evoke acutely negative affect.     

Brain structure and function in borderline personality disorder

The spotlight on borderline personality disorder (BPD) has been growing in recent years, with the number of papers discussing potential causes and triggers of the disorder rapidly on the increase. Also on the increase, though still lacking sufficient numbers to produce well-supported hypotheses, are studies employing neuroimaging techniques as investigative tools in BPD. In this review, we investigate the current state and findings of neuroimaging studies in BPD, focusing in particular, on the studies examining structural, functional, and neurometabolic abnormalities in the disorder. Some suspected trends in the data are highlighted, including reductions in the hippocampi and amygdalae of BPD patients compared to healthy controls, exaggerated amygdala activity in BPD patients when confronted with emotion-related stimulus, and negative correlations between increases in left amygdalar creatine and reductions in amygdalar volume, reductions in absolute N-acetylaspartate concentration in the dorsolateral prefrontal cortex of BPD patients, and increases in glutamate concentration in the anterior cingulate cortices of BPD patients. We also discuss the limitations of some of the current studies including hindrances due to sample effects and techniques used and the potential of future neuroimaging research in BPD.     

5-HT1A dysfunction in borderline personality disorder

BACKGROUND: A number of challenge studies have reported abnormalities of serotonergic function in borderline personality disorder (BPD). There are, however, problems with the pharmacological probes used in these studies since fenfluramine and m-CPP are not only serotonergic agents but also induce release of catecholamines, particularly dopamine. Therefore, we tested whether subjects with BPD showed a blunted prolactin (PRL) response to flesinoxan, a highly potent and selective 5-HT1A agonist. METHODS: Flesinoxan challenge test was carried out in 20 BPD in-patients and 20 healthy controls matched for gender but not for age. Since 16 BPD in-patients exhibited major depressive co-morbidity, a group of 20 depressed in-patients matched for gender but not for age was also included. RESULTS: BPD in-patients exhibited blunted PRL responses as compared to controls, whereas depressed in-patients did not differ from controls. Moreover, PRL responses were lower among BPD in-patients than among depressed in-patients. Among the BPD in-patients, PRL responses to flesinoxan were lower in patients with past history of suicide attempts (N = 8) than in those with a negative history. CONCLUSIONS: The results show major involvement of serotonergic function in BPD and are consistent with previous studies linking lower serotonergic activity with impulsivity. More particularly, our data suggest that BPD is characterized by lower 5-HT1A receptor sensitivity. Moreover, the data support the involvement of 5-HT1A activity in suicidal behaviour. However, this conclusion is limited because other hormonal responses such as ACTH and cortisol were not assessed, and because BPD was assessed by a self-report questionnaire and not a structured clinical interview.     

Altered psychophysiological correlates of risk-taking in borderline personality disorder

Elevated levels of risk-taking behavior as well as affective instability are both cardinal features of Borderline Personality Disorder (BPD). To our knowledge, there are no studies which directly investigate underlying affective processes of risk-taking behavior in BPD, despite the centrality of affect in BPD symptomatology, and indications of affective dysregulation contributing to increased risk-taking behavior in BPD. Here, we examined risk-taking behavior in BPD and its underlying affective processes, using skin conductance responses (SCRs) as a proxy. Twenty-three individuals with BPD and 24 healthy controls performed a modified version of the Balloon Analogue Risk Task, where decisions take place over a time scale of several seconds, enabling us to investigate a continuous integral of SCRs in anticipation of decisions. We used trial-by-trial mixed model analyses to account for within- and between-participant effects, as well as large variability that are often observed in SCRs. In contrast to healthy controls, who showed elevated SCRs in response to high risk, individuals with BPD did not show differential physiological sensitivity towards different risk levels. In addition, increased SCRs––under low risk––were related to more cautious risk-taking behavior in HCs. However, increased SCRs under low risk in BPD were related to greater risk-taking behavior. Alterations in the processing of affective signals, such as SCRs in the context of risk, may impair adaptation to environmental demands and may lead to increased risk-taking behavior in BPD.     

边缘型人格障碍大学生的潜在防御机制

目的:通过防御机制评定系统(Defense Mechanism Manual for the TAT,DMM)探索边缘型人格障碍患者无意识内容的防御机制特点。方法:用人格诊断问卷(Personality Diagnostic Questionnaire,PDQ-4+)进行筛查,从边缘型得分≥7的254名大学生中,用人格障碍定式临床检查确诊边缘型人格障碍者(borderline personality disorder)62人,从中按边缘型得分由高到低选取30名为BPD组;从边缘型得分2的学生中按边缘型得分选取30名为对照组。施测主题统觉测验,运用DMM系统评定两组被试的防御机制类型得分。结果:(1)BPD组不成熟集合得分高于对照组[(7.50±2.13)vs.(2.97±1.43),P0.01];BPD组不成熟否认得分高于对照组[(2.47±1.54)vs.(1.03±0.91),P0.01],BPD组不成熟投射得分高于对照组[(4.97±1.73)vs.(2.31±1.50),P0.01];BPD组成熟否认得分显著低于对照组[(0.17±0.38)vs.(0.90±0.94),P0.01]。(2)回归分析得到边缘得分与防御机制的逐步回归方程:边缘得分=-1.066+1.061×不成熟投射+0.851×不成熟否认。结论:边缘型人格障碍患者多使用不成熟防御机制,主要表现在不成熟否认和不成熟投射两个方面。     

Social domain dysfunction and disorganization in borderline personality disorder

BACKGROUND: Social dysfunction in personality disorder is commonly ascribed to abnormal temperamental traits but may also reflect deficits in social processing. In this study, we examined whether borderline and avoidant personality disorders (BPD, APD) may be differentiated by deficits in different social domains and whether disorganization of social domain functioning uniquely characterizes BPD. METHOD: Patients were recruited from psychiatric clinics in Pittsburgh, USA, to provide a sample with BPD, APD and a no-personality disorder (no-PD) comparison group. Standardized assessments of Axis I and Axis II disorders and social domain dysfunction were conducted, including a new scale of 'domain disorganization' (DD). RESULTS: Pervasive social dysfunction was associated with a 16-fold increase in the odds of an Axis II disorder. Both APD and BPD were associated with elevated social dysfunction. Romantic relationship dysfunction was associated specifically with BPD symptoms and diagnosis. DD was associated specifically with a categorical BPD diagnosis and with a dimensional BPD symptom count. CONCLUSIONS: A focus on the inherently interpersonal properties of personality disorders suggests specific mechanisms (within and across interpersonal domains) that may help to account for the origins and maintenance of some disorders. In particular, BPD reflects disturbances in romantic relationships, consistent with a role for attachment processes, and in the organization of functioning across social domains.     

Cortical inhibition in alexithymic patients with borderline personality disorder

High levels of alexithymia, a personality trait closely associated with emotion dysregulation, have been found in several psychiatric disorders including borderline personality disorder (BPD). Both BPD and alexithymia have been related to impaired cortical inhibition; however, this relationship has not been tested directly. The aim of the present study was, therefore, to investigate whether cortical inhibition is modulated by alexithymia in BPD. Fifteen BPD patients with Toronto-Alexithymia Scale (TAS-20) scores ≥61, 14 BPD patients with TAS-20 <61, and 16 healthy controls were examined using different TMS paradigms. High-alexithymia patients showed a shortened cortical silent period (CSP) compared to low-alexithymia patients and controls. Additionally, a significant inverse correlation was found between the TAS-20, the left CSP and the left transcallosal conduction time. These findings indicate that alexithymia is associated with changes in GABAergic neurotransmission and facilitated transcallosal inhibition. The results highlight the importance of considering alexithymia in BPD.     

Electrophysiological correlates of error processing in borderline personality disorder

The electrophysiological correlates of error processing were investigated in patients with borderline personality disorder (BPD) using event-related potentials (ERP). Twelve patients with BPD and 12 healthy controls were additionally rated with the Barratt impulsiveness scale (BIS-10). Participants performed a Go/Nogo task while a 64 channel EEG was recorded. Three ERP components were of special interest: error-related negativity (ERN)/error negativity (Ne), early error positivity (early Pe) reflecting automatic error processing, and the late Pe component which is thought to mirror the awareness of erroneous responses. We found smaller amplitudes of the ERN/Ne in patients with BPD compared to controls. Moreover, significant correlations with the BIS-10 non-planning sub-score could be demonstrated for both the entire group and the patient group. No between-group differences were observed for the early and late Pe components. ERP measures appear to be a suitable tool to study clinical time courses in BPD.