Neurobehavioral study of borderline personality disorder.

The existence of an "organic" subgroup of borderline personality disorder (BPD) has been postulated. This report is of a case-controlled, chart-review study of BPD. The control sample consisted of patients with a variety of psychiatric diagnoses. The study found that 81% of the patients with BPD and 22% of the control patients had a history of brain injury, either developmental (44%), acquired (58%) or both. Furthermore, there was a positive correlation between the summed number of developmental and acquired brain injuries and the score on the retro-Diagnostic Interview for Borderline. A pilot neuropsychological study showed that seven of nine subjects with BPD had evidence of frontal system dysfunction. These results help to support the hypothesized existence of an organic BPD subgroup.     

Neural correlates of impaired emotional discrimination in borderline personality disorder: An fMRI study

A common approach to study neuronal aspects of emotional reactivity of borderline personality disorder (BPD) is to study the brain response to emotional faces with functional magnetic resonance imaging (fMRI). 10 BPD patients and 10 matched controls were submitted to an emotional discrimination task in which subjects had to identify an emotional face from a neutral face while fMRI data was acquired. BPD patients made more mistakes than controls in the discrimination task when negative faces were involved. The emotional discrimination task activated brain areas that are known to participate in processing of emotional faces (fusiform gyrus, insula and amygdala) regardless of the psychiatric condition. Additionally, BPD showed higher activation than controls in the middle and inferior temporal cortical areas, brain areas that participate in the processing of face features that carry emotional value. Furthermore, activity at this site correlated with impulsivity score in the Zuckerman–Kuhlman Personality Questionnaire. Our findings may be related to cognitive impairment that may be characteristic of the disorder.     

Borderline personality traits in hysterical neurosis

The objective of the present study is to demonstrate the traits of the psychopathology of Borderline Personality Disorder (BPD) compared with hysterical neurosis. A total of 48 subjects with BPD and 40 subjects with hysterical neurosis both defined by DSM-III-R were assessed by Diagnostic Interview for Borderlines (DIB). Statistical analysis was done by quantification of the second type, a multivariate data analysis. The total scores of DIB were BPD group, 6.13 +/- 1.52; hysterical neurosis group, 4.9 +/- 2.12 (t = 3.05, P = 0.0016). The correlation ratio (index of to what extent the two groups are discriminated) was 0.2442. Among the four parameters of: (i) affect, (ii) cognition, (iii) impulse-action pattern, (iv), and interpersonal relationships, the partial coefficient correlations of (iii) and (iv) were significantly high (0.342, 0.287, P < 0.01). The question items with high independent coefficients were manipulation (0.4416), intolerance of aloneness (0.3797), demanding nature (0.3768), self-mutilation (0.3609), visual hallucination (0.3395). Those with low score of independent coefficients were counterdependency (0.0533), identity disturbance (0.1010), depression (0.1551), loneliness (0.1752), hypomanic episode (0.1936). Both of BPD and hysterical neurosis groups were not so fairly well discriminated. However, these results suggested that impulse-action pattern and disorder of interpersonal relationships were traits of borderline personality disorder. We could admit manipulation, intolerance of aloneness as its symptoms. In addition, counterdependency, identity disturbance were comparatively common to both. There were some borderline personality traits symptomatically in hysterical neurosis.     

The 10‐year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects

Zanarini MC, Frankenburg FR, Bradford Reich D, Fitzmaurice G. The 10‐year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Objective: The purpose of this study was to determine the 10‐year course of the psychosocial functioning of patients with borderline personality disorder (BPD). Method: The social and vocational functioning of 290 inpatients meeting both the Revised Diagnostic Interview for Borderlines (DIB‐R) and DSM‐III‐R criteria for BPD and 72 axis II comparison subjects were carefully assessed during their index admission. Psychosocial functioning was reassessed using similar methods at five contiguous 2‐year time periods. Results: Borderline patients without good psychosocial functioning at baseline reported difficulty attaining it for the first time. Those who had such functioning at baseline reported difficulty retaining and then regaining it. In addition, over 90% of their poor psychosocial functioning was due to poor vocational but not social performance. Conclusion: Good psychosocial functioning that involves both social and vocational competence is difficult for borderline patients to achieve and maintain over time. In addition, their vocational functioning is substantially more compromised than their social functioning.     

"Missing links" in borderline personality disorder: loss of neural synchrony relates to lack of emotion regulation and impulse control

OBJECTIVE: Symptoms of borderline personality disorder (BPD) may reflect distinct breakdowns in the integration of posterior and frontal brain networks. We used a high temporal resolution measure (40-Hz gamma phase synchrony) of brain activity to examine the connectivity of brain function in BPD. METHODS: Unmedicated patients with BPD (n = 15) and age-and sex-matched healthy control subjects (n = 15) undertook a task requiring discrimination of salient from background tones. In response to salient stimuli, the magnitude and latency of peak gamma phase synchrony for early (0-150 ms post stimulus) and late (250-500 ms post stimulus) phases were calculated for frontal and posterior regions and for left and right hemispheres. We recorded skin conductance responses (SCRs) and reaction time (RT) simultaneously to examine the contribution of arousal and performance. RESULTS: Compared with controls, patients with BPD had a significant delay in early posterior gamma synchrony and a reduction in right hemisphere late gamma synchrony in response to salient stimuli. Both SCR onset and RT were also delayed in BPD, but independently from differences in synchrony. The delay in posterior synchrony was associated with cognitive symptoms, and reduced right hemisphere synchrony was associated with impulsivity. CONCLUSIONS: These findings suggest that distinct impairments in the functional connectivity of neural systems for orienting to salient input underlie core dimensions of cognitive disturbance and poor impulse control in BPD.     

Predicting outcome for borderline personality disorder

The purpose of this study is to identify variables predictive of the psychosocial outcomes of borderline patients 2 years following an acute psychiatric hospitalization. Of the initial 88 inpatients scoring positive for the Diagnostic Interview for Borderlines (DIB), 65 (73.8%) were reinterviewed, 14 (15.9%) refused, five (5.7%) were unable to be located, and four (4.6%) suicided. The dropouts (n = 19) were significantly more likely to be single, separated, or divorced, to be male, and to be diagnosed as having co-existing antisocial personality disorder than the followed-up probands (n = 69). In terms of global functioning, over the 2-year follow-up period, 61 (87.7%) of the 69 probands were judged to be functioning normally less than 50% of the follow-up interval. Using logistic regression, two variables, initial impulse action scores and poor premorbid functioning, predicted poor versus good outcome. This study supports the literature, which indicates that the early course of borderline personality disorder (BPD) is stormy. Impulsivity and poor premorbid functioning may be predictive of poor short-term outcome in borderline patients.     

Executive function following child stroke: the impact of lesion location

Child stroke is a major cause of death in children, although limited information exists on neurobehavioral functioning of stroke survivors. Executive function (important for goal-directed behavior) is thought to be vulnerable to early insults such as stroke because of its widespread representation in the immature brain. This study investigated the impact of lesion location on executive skills. Twenty-eight children diagnosed with stroke at least 18 months before assessment were recruited. Lesion characteristics were coded from magnetic resonance imaging (MRI) scans. Neurobehavioral assessment focused on cognitive and everyday executive skills. Deficits were found in the context of overall normal intellectual functioning (M = 91.60; SD = 19.40). Generally, insults involving frontal and extra-frontal regions impacted equally on cognitive performance. Everyday deficits were marginally more prominent following frontal insult. Subcortical frontal lesions were associated with impairments in everyday executive skills. Results provide further support for the diffuse representation of executive function in the immature brain.     

A comparison of four measures to diagnose DSM-III-R borderline personality disorder in outpatients

After three decades of clinical controversy and research, a clinical consensus has formed that borderline personality disorder (BPD) exists as a unique entity which can be defined by DSM-III-R diagnostic criteria. The purpose of this study was to evaluate the relative abilities of four different approaches to the identification of borderlines and to differentiate a DSM-III-R BPD group from a control group of other diagnoses. The approaches were the Kernberg's Structural Interview, the Diagnostic Interview for Borderline Personality Disorders (DIB), the Borderline Syndrome Index (BSI), and the Million Clinical Multiaxial Inventory (MCMI). Sixty outpatient volunteers (27 men and 33 women) from a community mental health center served as subjects. The volunteers included 30 BPDs and 30 other diagnoses, including 11 non-BPD personality disorders. Point biserial correlations indicated that the best method for identifying DSM-III-R BPD was the DIB, and the second best was the Kernberg Structural Interview, although all four identified DSM-III-R BPDs at better than chance levels. Multiple regression results showed that the DIB accounted for 61.5% of the BPD variance, while the Kernberg approach added 4.9% more unique variance prediction. MCMI dimensions and personal history characteristics were used to identify differentiators of BPD from all other diagnoses and from other personality disorders.     

Increased frontal white matter diffusion is associated with glial metabolites and psychomotor slowing in HIV

Diffusion-weighted imaging (DWI) measures brain water diffusion that is sensitive to microscopic brain injury. A total of 11 HIV seropositive patients were compared to 14 seronegative subjects using DWI, proton magnetic resonance spectroscopy (1H MRS), and neuropsychological tests. The apparent diffusion coefficient (ADC) was significantly increased in the HIV patients, primarily in the frontal white matter (FWM; +5%, p=0.01). Diffusivity correlated positively with the glial marker myo-inositol (r=0.5, p=0.008) and negatively with cognitive performance (NPZ-8 composite score; r=-0.43, p=0.05). These findings suggest increased brain water diffusion may reflect increased glial activation or inflammation, which in turn, may contribute to the cognitive deficits in HIV patients.     

Medial prefrontal cortex hyperactivation during social exclusion in borderline personality disorder

Frontal systems dysfunction and abandonment fears represent central features of borderline personality disorder (BPD). BPD subjects (n = 10) and matched non-psychiatric comparison subjects (n = 10) completed a social–cognitive task with two confederates instructed to either include or exclude subjects from a circumscribed interaction. Evoked cerebral blood oxygenation in frontal cortex was measured using 16-channel functional near infrared spectroscopy. BPD subjects showed left medial prefrontal cortex hyperactivation during social exclusion suggesting potential dysfunction of frontolimbic circuitry.     

The prevalence of borderline personality among primary care patients with chronic pain.

This study was designed to explore the prevalence of borderline personality disorder among primary care patients (N=17) with various pain syndromes. All participants completed two self-report measures [Personality Diagnostic Questionnaire-Revised (PDQ-R); Self-Harm Inventory (SHI)] and a semi-structured interview [Diagnostic Interview for Borderlines (DIB)] for the assessment of borderline personality disorder. According to study measures, 8 (47.1%), 5 (29.4%), and 8 (47.1%) participants scored positively on the PDQ-R, SHI, and DIB, respectively. Nearly 25% of the sample scored positively on two measures, and 18% scored positively on all three measures. In this sample, the prevalence of BPD was substantial. Chronic pain may be a manifestation of a self-regulatory disturbance among some patients with BPD.     

Interactions between depression and borderline personality disorder. A pilot study

Although many nosologists advocate the autonomy of borderline personality disorder (BPD), its heterogeneity led to demands that it be absorbed into the affective disorder spectrum. This study attempted to determine if (a) BPD and affective disorders overlapped and (b) if BPD characteristics were differentially associated with specific Axis I, DSM-III diagnoses. Forty-three BPD inpatients were rated retrospectively on 29 variables, including BPD characteristics from Gunderson's diagnostic interview for borderlines (DIB). chi 2 analyses were performed for each of 28 variables in 56 contingency tables whose independent variables were dysthymia/other Axis I diagnoses or depression/no depression. BPD inpatients with dysthymia had more impaired occupational functioning and greater use of splitting. Also, depressed BPDs were in general more dependent, empty and bored, and suicidal.     

Psychotic-like cognitive biases in borderline personality disorder

Whereas a large body of research has linked borderline personality disorder (BPD) with affective rather than psychotic disorders, BPD patients frequently display psychotic and psychosis-prone symptoms, respectively. The present study investigated whether cognitive biases implicated in the pathogenesis of psychotic symptoms, especially delusions, are also evident in BPD. A total of 20 patients diagnosed with BPD and 20 healthy controls were administered tasks measuring neuropsychological deficits (psychomotor speed, executive functioning) and cognitive biases (e.g., one-sided reasoning, jumping to conclusions, problems with intentionalizing). Whereas BPD patients performed similar to controls on standard neuropsychological tests, they showed markedly increased scores on four out of five subscales of the Cognitive Biases Questionnaire for Psychosis (CBQp) and displayed a one-sided attributional style on the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) with a marked tendency to attribute events to themselves. The study awaits replication with larger samples, but we tentatively suggest that the investigation of psychosis-related cognitive biases may prove useful for the understanding and treatment of BPD.     

脑小血管病总负荷与记忆力下降老年患者认知功能、脑萎缩及脑灌注的相关性

目的 探索脑小血管病（cerebral small vessel disease,CSVD）总负荷与记忆力下降老年患者认知功能、 脑萎缩及脑灌注的关系。 方法 回顾性纳入2015年12月-2017年12月同济医院神经内科门诊及记忆减退专病门诊主诉记忆力 下降患者,收集一般资料及影像学信息,进行认知评估、CSVD总负荷评分、全脑及各脑叶脑萎缩评分, 计算脑血流（cerebral blood flow,CBF）值。采用Spearman相关分析CSVD总负荷评分与认知功能、脑萎 缩及CBF的关系。 结果 共纳入200例,平均年龄69.16±9.44岁,男性99例（49.5%）。CSVD总负荷与MoCA评分呈负相 关（r =-0.202,P =0.004）;与全脑（r =-0.234,P =0.001）、额叶（r =-0.252,P <0.001）、顶叶（r =- 0.253,P <0.001）、枕叶（r =-0.224,P =0.001）CBF呈负相关;CSVD负荷与全脑（r =0.313,P <0.001）、 额叶（r =0.393,P＜0.001）及顶叶（r =0.237,P =0.001）的脑萎缩评分呈正相关。 结论 CSVD总负荷越高,认知功能越差、脑灌注越低、脑萎缩越严重。     

Improvement in borderline personality disorder in relationship to age

Objective: It is commonly believed that some features of borderline personality disorder (BPD) improve as individuals reach their late 30s and 40s. This study examined age‐related change in borderline criteria and functional impairment, testing the hypothesis that older age would be associated with relatively more improvement than younger age. Method: A total of 216 male and female participants with BPD were followed prospectively with yearly assessments over 6 years. Results: Participants showed similar rates of improvement in borderline features regardless of age. A significant age by study year interaction showed functioning in older subjects to reverse direction and begin to decline in the latter part of the follow‐up, in contrast to younger subjects who maintained or continued improvement over the 6 years. Despite the decline, functioning for the older subjects was comparable with or slightly better at year 6 than at year 1. Conclusion: Improvement in borderline features is not specific to the late 30s and 40s. There may be a reversal of improvement in functioning in some borderline patients in this older‐age range.     

Borderline personality disorder: impaired visual perception and working memory

The neurobiology of borderline personality disorder (BPD) is still elusive. There are a few studies on neuropsychological performance in BPD, which report a broad spectrum of abnormalities. The present study evaluates perception and working memory as instances of basic cognitive functions. Female subjects diagnosed with DSM-IV borderline personality disorder (n=22) were compared with age- and education-matched controls (n=25). Perception speed was assessed by a backward masking paradigm. Working memory was tested by a series of delayed matching-to-sample paradigms involving varying subsidiary functions like mental rotation, retrieval from memory, ignoring distracters, and cross-modal performance. In backward masking, BPD subjects required significantly longer stimulus onset asynchrony (SOA) than controls to identify the visual target, and there was an additional slowing of the motor response. Working memory accuracy was impaired in BPD subjects, but did not worsen when the cognitive load was increased. With increasing task difficulty, they traded off speed for accuracy similarly as the controls. Impulsivity and dissociation ratings were not correlated with performance. It is concluded that perceptional speed and working memory are impaired in BPD, but that the deficits are not augmented by increasing cognitive load.     

Is bulimia associated with borderline personality disorder? A controlled study

To test the hypothesis that bulimia may be associated with borderline personality traits or frank borderline personality disorder, the authors administered the Diagnostic Interview for Borderlines (DIB) under blind conditions to 52 bulimic subjects, 22 outpatient controls with a history of major depression but no history of an eating disorder, and 13 nonpsychiatric controls. Only 1.9% of bulimic subjects met revised DIB criteria for borderline personality disorder, and mean DIB scores were almost identical in bulimic subjects and controls with major depression. These results argue against a relationship between bulimia per se and borderline personality disorder or traits.     

Cognition in bipolar disorder.

BPD is often associated with cognitive deficits that tend to be present regardless of mood state. Greater impairments tend to be seen in BPD patients who are older, have an early onset of the disease, and suffer a more severe course of illness. The literature also suggests that cognitive deficits are present early in patients with BPD and may be cumulative, showing an association with the number of affective (particularly depressed) episodes over time. Cognitive deficits in BPD may share some common characteristics with those seen in patients with schizophrenia, although the latter tend to show much greater and generalized cognitive impairment. For example, unlike patients with schizophrenia, patients with BPD typically do not score lower than normal persons on measures of global intellectual ability. There also is not overwhelming evidence of laterality or localization of cognitive deficits in BPD, although debate in the literature continues. More visuospatial deficits tend to be found in BPD and UPD than in schizophrenia, thereby raising the possibility of greater involvement of right hemisphere systems in mood disorders. In general, despite variability across investigations, deficits in executive functioning, episodic memory,sustained concentration, and, to a lesser extent, visuospatial skills seem to be the most consistent areas of impairment in BPD. Just as neuroimaging anomalies have been well documented in schizophrenia, structural brain abnormalities have been noted in BPD,most commonly involving the basal ganglia or white matter. Specific comparisons of cerebral atrophy and ventricular size between patients with schizophrenia and BPD have not been definitive, making it difficult to draw conclusions about structural brain abnormalities that might be specific to BPD. Nonetheless, there is enough evidence to suggest that white-matter abnormalities are reported with a greater frequency in BPD patients than in patients with UPD or schizophrenia. Functional neuro-imaging studies of mood disorders have indicated that the frontal cortex,basal ganglia, and temporal lobes are involved. The relationships between neuroimaging and neurocognitive abnormalities in BPD are worthy of additional investigation. Clearly, efforts directed toward phenotyping neuropsychiatric disorders using such measures, in addition to other clinical, neuroimaging, neurophysiologic, and genotypic information, may yield important insights into the development, nature, and course of illness. It is hoped that this understanding will lead to better identification of individuals who may be prone to greater cognitive impairment or decline and those who might be more responsive to specific treatments.     

Cognitive impairment and the brain dopaminergic system in Parkinson disease: [18F]fluorodopa positron emission tomographic study

OBJECTIVE: To investigate the role of the brain dopaminergic system in cognitive impairment in patients with Parkinson disease (PD). DESIGN: We studied 28 patients with PD and 16 age-matched healthy control subjects using [18F] fluorodopa (fluorodopa F 18) positron emission tomography. Patients with PD showed a variable degree of cognitive impairment, which was assessed using the Mini-Mental State Examination and detailed neuropsychologic assessment, including tests sensitive for frontal lobe function. RESULTS: [18F] Fluorodopa uptake was reduced in the putamen (to 36% of the control mean; P<.001), the caudate nucleus (to 61% of the control mean; P<.001), and the frontal cortex (to 45% of the control mean; P<.001) in patients with PD compared with controls. There was no significant association between the degree of overall cognitive impairment of patients and [18F] fluorodopa uptake values. The influx constant (Ki(occ)) in the caudate nucleus had a negative association with performance in the attention-demanding Stroop interference task, especially with the interference time. The Ki(occ) in the frontal cortex had a positive correlation with performance in the digit span (backwards), verbal fluency, and verbal immediate recall tests. Thus, the better the patient performed in tasks demanding immediate and working memory and executive strategies, the better the [18F] fluorodopa uptake in the frontal cortex. In the putamen, no significant correlation was seen between the Ki(occ) value and any of the cognitive tests. The severity of the motor symptoms of PD and [18F]fluorodopa uptake showed a negative correlation in the putamen (r = -0.38; P = .04), and in the caudate nucleus a similar trend was seen (r = -0.36; P = .06). CONCLUSIONS: Reduced [18F]fluorodopa uptake in PD in the caudate nucleus (and frontal cortex) is related to impairment in neuropsychologic tests measuring verbal fluency, working memory, and attentional functioning reflecting frontal lobe function. This indicates that dysfunction of the dopamine system has an impact on the cognitive impairment of patients with PD. However, our results do not exclude the possibility of more generalized cognitive impairment in PD, the pathophysiology of which is probably different and more generalized.     

Frontal white matter integrity in borderline personality disorder with self-injurious behavior

Self-injurious behavior in borderline personality disorder is a frequent cause of morbidity and mortality, but neurobiological studies examining this behavior are few. Nine women with borderline personality disorder self-injurious behavior and seven comparison subjects underwent diffusion tensor imaging (DTI). Trace and fractional anisotropy (FA) were calculated for frontal and posterior regions. Borderline personality disorder-self-injurious behavior subjects also underwent a battery of neuropsychological tests that emphasized executive functions. They had significantly higher trace and lower FA in inferior frontal but not posterior regions. Correlational analyses between DTI and cognitive variables showed a pattern of results that was contrary to expectations with posterior white matter integrity correlating with isolated measures of executive function and anterior white matter integrity correlating with a component of verbal memory test performance. Women with borderline personality disorder-self-injurious behavior exhibit decreased white matter microstructural integrity in inferior frontal brain regions that may include components of orbito-frontal circuitry.