Neurocognitive profiles of people with borderline personality disorder

Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR.
Current opinion in psychiatry (Impact Factor: 3.94). 01/2013; 26(1):90-6. DOI: 10.1097/YCO.0b013e32835b57a9
Source: PubMed


This review summarizes recent neurocognitive research to better delineate the nosology, prognostication and cause underlying borderline personality disorder (BPD).
BPD had marked clinical heterogeneity with high comorbidity. Executive dysfunction in this disorder was linked to suicidality and treatment adherence, and may serve as an endophenotype. BPD was also characterized by cognitive distortions such as risky decision-making, deficient feedback processing, dichotomous thinking, jumping to conclusion, monocausal attribution and paranoid cognitive style. Social cognition deficits recently described in BPD include altered social inference and emotional empathy, hypermentalization, poorer facial emotional recognition and facial expressions. In electrophysiological studies, BPD was found to have predominantly right hemispheric deficit in high-order cortical inhibition. Reduced left orbitofrontal activity by visual evoked potential and magnetoencephalography correlated with depressive symptoms and functional deterioration. Brain structures implicated in BPD include the hippocampus, dorsolateral prefrontal cortex and anterior cingulate cortex. Abnormal anatomy and functioning of frontolimbic circuitry appear to correlate with cognitive deficits.
Frontolimbic structural and functional abnormalities underlie the broad array of cognitive abnormalities in BPD. Further research should espouse broader considerations of effects of comorbidity and clinical heterogeneity, and include community samples and, possibly, longitudinal designs.

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    • "Studies that relied on self-reports consistently demonstrated higher levels of impulsivity in BPD patients compared with healthy controls (HCs) and patients with other psychiatric disorders (Dougherty et al. 1999; Henry et al. 2001; Berlin et al. 2005; Bornovalova et al. 2005; McCloskey et al. 2009; Jacob et al. 2010; Lynam et al. 2011; Sebastian et al. 2013a). Studies that applied laboratory tasks in part revealed impaired response inhibition (Leyton et al. 2001; Hochhausen et al. 2002; Rentrop et al. 2008), difficulties in feedback-directed decision making (Haaland & Landrø, 2007; Kirkpatrick et al. 2007; Maurex et al. 2009; Schuermann et al. 2011; Svaldi et al. 2012; Mak & Lam, 2013), a stronger tendency to discount delayed reward (Dougherty et al. 1999; Lawrence et al. 2010) and more impulsive aggression * Address for correspondence: S. "
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    ABSTRACT: 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.
    Full-text · Article · Feb 2014 · Psychological Medicine
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    ABSTRACT: Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning.
    No preview · Article · Jun 2013
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    ABSTRACT: Background/aims: Individuals with borderline personality disorder (BPD) are highly sensitive to social rejection and show alterations in social perception. Increased susceptibility to social cues in patients with BPD might interfere with executive functions that play an important role in goal-directed behavior. The aim of this study was to investigate the influence of task-irrelevant (neutral vs. negatively arousing) social cues on working memory performance in BPD patients compared to healthy controls (HC). Methods: 28 unmedicated female BPD patients and 28 female HC (matched for age and education) performed a Sternberg item recognition task, while being distracted by neutral versus negatively arousing pictures from the International Affective Picture System (interpersonal scenes) and the Karolinska Directed Emotional Faces Set (faces). Additionally, self-ratings of aversive inner tension were assessed and correlated with task performance. Results: Compared to HC, BPD patients showed significantly impaired accuracy after distraction by negatively arousing stimuli (both scenes and faces) and neutral faces (but not neutral scenes). Significant negative correlations between overall accuracy and self-reported aversive inner tension were observed in BPD patients. Conclusions: Findings of the present study suggest increased susceptibility to distracting (negatively arousing) social cues in individuals with BPD, which might interfere with cognitive functioning.
    No preview · Article · Oct 2013 · Psychopathology
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