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Impulsivity and executive function in borderline personality disorder

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Impulsivity and executive function in borderline personality disorder

Abstract

The current study investigated impulsiveness and executive function in patients with borderline personality disorder (BPD) as compared to a matched control-group. Forty-five total participants were included: A psychiatrist assessed patients with the SCID-II for inclusion criteria. Twenty-two day hospital patients with BPD met eligibility criteria and were recruited into the study, along with 23 healthy matched controls attending to age and gender variables. Participants were assessed with the General Health Questionnaire (GHQ-12), the Barratt Impulsivity Scale (BIS) and the Wisconsin Card Sorting Test (WCST) in two phases. The findings suggested higher levels of impulsiveness in BPD group against the control group (t= 2.81, p= .008), but there were no differences in executive function. The total level of impulsiveness obtained an inverse correlation with results in executive function. Non-planning impulsiveness was the indicator which obtained greatest differences with failures to maintain set (r= .38, p= .012). In conclusion, people with BPD show higher levels of impulsiveness than healthy people, although this impulsiveness does not expect a deficit in executive function.
Letter to the editor
113
Actas Esp Psiquiatr 2016;44(3):113-8
Impulsivity and executive function in borderline
personality disorder
Iker Zamalloa1
Ioseba Iraurgi1
Claudio Maruottolo2,3
Andrés Mascaró2
Oscar Landeta4
Javier Malda1
1Universidad de Deusto, Bilbao, Spain
2Hospital de Día, Avances Médicos (AMSA), Bilbao, Spain
3Universidad del País Vasco (UPV/EHU), Bilbao, Spain
4Aledia Consultores, Bilbao, Spain
Correspondence:
Claudio Maruottolo
C/ Manuel Allende 19 bis, 1º
48010 Bilbao, Spain
Tel.: 944 947 071
Dear Editor,
Borderline Personality Disorder (BPD) is one of the most
controversial mental disease, because of the difficulties in
its evaluation, diagnosis and treatment, as well as its preva-
lence in the general1 (5.9%) and clinical2 (10% -25%) popu-
lation. Research in this field did not get to define a clear
etiopathogeny, although scientific community tends to
agree that both organic and environmental factors might be
involved3,4. It has been demonstrated that people with BPD
reveal difficulties in certain cognitive activities, associated
to a deficit in an organic level5. Actual studies reveal an as-
sociation between the dysfunction of the frontal lobe and
the BPD, showing lower levels in attention, cognitive flexi-
bility, learning, memory, processing speed and visual-spatial
abilities6. In fact, it has been suggested that specific neuro-
logical alterations could be present in specific brain regions
among persons with BPD7, which points towards the possi-
bility that certain functions located in these areas might be
affected, such as the executive function (EF).
The executive function involves cognitive activities that
can classified in five main groups: 1) initiative, volition and
creativity; 2) planning ability and organization; 3) fluency
and flexibility; 4) selective attention processes, concentration
and operative memory and 5) monitoring processes and
inhibitory control8. EF is responsible for establishing purposes
and objectives and for planning the actions to carry out
them9. Furthermore, previous research has suggested an
association between difficulties in attentional functions and
the EF deficits in BPD population, by the use of specific
instruments such as the Wisconsin Card Sorting Test –
WCST10. However, Biskin et al.11 conducted a research
analyzing the interaction between impulsivity and EF,
utilizing the Barratt Impulsiveness Scale (BIS) and WCST, but
found no statistically significant results.
Because impulsivity is one of the main traits associated
to BPD, the current research analyzed this variable and its
effects in persons with BPD over the executive function. In
this way, we could determinate whether there might be a
relationship between BPD and the alteration in EF, and
whether impulsivity could be responsible of this alteration.
Thus, the main hypothesis predicted that impulsivity would
be negatively correlated with the performance in executive
function tasks.
Method
Participants
The sample was constituted of 45 participants: clinical
group (22 participants with BPD) and control group (23
participants). Inclusion criteria: meet criteria for the
diagnostic of BPD utilizing the by DMS-IV TR manual and an
age over 18 years old.
Measures
Structured Clinical Interview for DSM-IV Axis II of
Personality Disorders (SCID-II)12, Spanish version13. It is an
auto administered scale, which contains 119 items with
dichotomous (true/false) answers and a semi-structured
clinical interview.
Barratt Impulsiveness Scale (BIS)14, Spanish version15.
Contains an overall impulsiveness scale and three subscales:
motor impulsiveness, cognitive impulsiveness and non-
planning impulsiveness16.
Wisconsin Card Sorting Test (WCST)17,18. Assesses the
abstraction capacity, the formation of concepts and the
change in cognitive strategy as an answer to the changes
that happened in the environmental contingencies19.
Procedures
The assessment was made in two phases. Participants
answered the BIS questionnaire and afterwards the WCST
was delivered. All of the participants signed the informed
consent form and the APA Ethics Code was respected
throughout the whole study.
Nominal variables were described using frequency and
percentages, whereas average and standard deviation were
employed to describe continuous variables. In order to
compare the differences between groups, Student´s T-test
and Chi-squared tests were applied. Moreover, to analyze
the association between variables Pearson Product-Moment
Correlation coefficients were employed.
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Actas Esp Psiquiatr 2016;44(3):113-8
114
Letter to the editor
Results
Control groups participants were matched attending to
age and gender variables (ageà t(42)=0.24, p=.815; gender à
χ2=0.07, p=.795). There were differences in the levels of
studies, portrayed by a greatest presence of persons with
high level studies in the control group (78.26%) as compared
to the clinical group (31.82%).
In the comparison between groups of impulsivity (BIS)
and executive function (WCST) variables, there were
differences in the overall impulsivity t(41)=2.81, p=.008, with
higher levels in the clinical group. Regarding the subscales
of the BIS there were significant differences in motor
impulsiveness t(41)=3.31, p=.002 and in non-planning
impulsiveness t(41)=2.05, p=.046, with higher results in the
BPD group. The results of WCST did not show differences
between both groups in no one of the indicators of the
instrument.
The total level of impulsivity showed a positive correla-
tion with the failure to maintained set (r=.39, p=.010) and
with the trials to complete first category (r=.33, p=.033; see
Table 1), and a negative correlation with the number of com-
pleted categories (r=-.32, p=.041). The non-planning impul-
sivity was the only type of impulsivity that showed significant
correlations regarding the executive function variables, ob-
taining a positive correlation with the failure to maintained
set (r=.38, p=.012). The perseverative errors showed a very low
positive correlation regarding the levels of impulsivity (r=.16,
p=.323), although the non-perseverative errors showed a
greater trend, being more evident in the case of the non-plan-
ning impulsivity (r=.30, p=.051).
Discussion
Taking into account the differences between groups,
the clinical group showed higher levels of impulsivity than
the control group, although the outputs in executive
function were similar in both groups.
Results obtained in the present study confirm one of
our main hypotheses: there seems to be an association
between impulsivity and executive function. The total score
of BIS showed the association between impulsivity and
executive function by the following indicators of WCST:
trials to complete first category, number of categories
completed and failure to maintain set. These findings
contrast with the outcomes of other authors11, who could
not find the association between those two variables. The
non-planning subscale correlated with the WCST indicator
“failure to maintain set”. These indicators are associated
with the attention capacity and the inhibitory control.
Therefore, we could suggest that between all of the cognitive
functions that the EF contains, the selective attention and
the inhibitory control are the ones potentially more affected
by the impulsivity against the cognitive flexibility and the
learning. The specificity of non-planning regarding the
WCST demonstrated that the planning of the task could be
the indicator with the most direct impact in this test.
The sample size is the limitation of the present study, not
allowing enough statistical power to detect possible differences
between groups or the associations between variables.
Our findings suggest that there are not significant
differences between both groups in EF and that the
Table 1 Association between impulsivity and executive function (Correlations between BIS and WCST scales)
Impulsivity
Total number of errors Total Cognitive Motor Non-planning
Perseverative responses 0.19 0.12 0.03 0.24
Perseverative errors 0.16 0.12 0.04 0.17
Non-perseverative errors 0.16 0.12 0.04 0.17
Percent conceptual level responses 0.21 0.11 0.02 0.30
Number of categories completed -0.23 -0.03 -0.21 -0.18
Trials to complete rst category -0.32* -0.15 -0.19 -0.28
Failure to maintain set 0.33* 0.16 0.27 0.20
Learning to learn 0.39** 0.24 0.16 0.38*
Aprender a aprender 0.05 -0.02 0.12 -0.02
*p<.05; **p<.01
BIS: Barratt Impulsiveness Scale; WCST: Wisconsin Card Sorting Test
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Letter to the editor
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Actas Esp Psiquiatr 2016;44(3):113-8
differences in impulsivity do not have a significant impact
on the EF. However, people with BPD manifest differences in
cognitive performances20,21. Thus, there is an urgent need of
further research that could shed light on the difficulty that
BPD participants seem to present in their cognitive
performance.
In conclusion, our study confirms previous literature
in that it suggests differences in impulsivity levels between
people with BPD and a control group, although it did not
allow concluding that this impulsivity was directly affecting
the performance in EF. Nonetheless, our results showed that
impulsivity could be potentially disturbing some indicators
of EF such as that non-planning impulsiveness could have a
greatest specificity with EF tasks in general population.
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course of borderline psychopathology: 6-year prospective
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neuropsychological functioning of patients with borderline
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disorder: a meta-analysis and review. Psychiatry Res. 2005;
137(3):191-202.
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HP, et al. Orbitofrontal, amygdala and hippocampal volumes
in teenagers with rst-presentation borderline personality
disorder. Psychiatry Res Neuroimaging. 2008;163(2):116-25.
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Neuropsiq Neurociencias. 2008;8(1):59-76.
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between Attentional and Executive Controls in the Expression
of Borderline Personality Disorder Features: A Preliminary Study.
Psychopathology. 2005;38(2):75-81.
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diagnosed with borderline personality disorder in adolescence. J
Can Acad Child Adolesc Psychiatry. 2011;20(3):168.
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Structured Clinical Interview for DSM-IV Axis II Personality
Disorders, (SCID-II). Washington, DC: American Psychiatric Press,
Inc; 1997.
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LS. Entrevista Clínica Estructurada para los Trastornos de
Personalidad del Eje II del DSM-IV. Barcelona: Masson; 1999.
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Steadman H, eds. Violence and mental disorder: Developments
in risk assessment. 1994;10:61-79
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Bobes J. Evaluación de la impulsividad. Barcelona: Grupo Ars XXI
de Comunicación; 2005.
16. Patton JH, Stanford MS. Factor structure of the Barratt
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reinforcement and ease of shifting to new responses in a Weigl-
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Ediciones; 2001.
19. Axelrod BN, Goldman RS, Woodard JL. Interrater reliability in
scoring the Wisconsin card sorting test. Clin Neuropsychol.
1992;6(2):143-55.
20. Sebastian A, Jung P, Krause-Utz A, Lieb K, Schmahl C, Tuscher
O. Frontal dysfunctions of impulse control - a systematic
review in borderline personality disorder and attention-decit/
hyperactivity disorder. Front Hum Neurosci. 2014;8:698.
21. Williams GE, Daros AR, Graves B, McMain SF, Links PS, Ruocco
AC. Executive functions and social cognition in highly lethal
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Between the sanitary complacency and the factitious
disorder by proxy
Isabel Sevillano-Benito1
Soraya Geijo-Uribe2
Beatriz Mongil-López2
Carlos Ímaz-Roncero3
Fernando Uribe-Ladrón De Cegama4
Francisco C Ruiz-Sanz5
Isabel Pérez-García6
Mercedes Vaquero-Casado7
1Pediatrician and 3rd year Psychiatric Trainee. Psychiatric Department,
Hospital Clínico Universitario. Valladolid
2Psychiatrist. Child and Adolescent Psychiatric Hospitalization Department,
Hospital Clínico Universitario. Valladolid
3Psychiatrist. Child and Adolescent Psychiatric Department,
Hospital Universitario Río Hortega. Valladolid
4Psychiatrist. Head of Psychiatry Service, Hospital Clínico Universitario. Valladolid
5Psychiatrist. Head of Psychiatry Service. Hospital Complex in Palencia
6Pediatrician. Jardinillos Health Center. Palencia
7Clinical Psychologist. Child and Adolescent Psychiatric Hospitalization Department,
Hospital Clínico Universitario. Valladolid
37
Actas Esp Psiquiatr 2016;44(3):113-8
116
Letter to the editor
Correspondence:
Isabel Sevillano Benito
Hospital Clínico Universitario Valladolid
C/ Avenida Ramón y Cajal s/n. 47005 Valladolid, Spain
Tel.: 657201534
E-mail: isevillano@saludcastillayleon.es; isasebe@gmail.com
Dear Editor,
The Münchausen Syndrome by Proxy (factitious disor-
der by proxy), constitutes a pathology that causes a great
morbidity1. One of the parents, generally the mother, simu-
lates or provokes the existence of symptoms in the child
with the aim of seeking medical attention. Some character-
istics exist that have to make us think about this problem
(see table 1). This diagnosis should be taken into consider-
ation in every child who has suffered multiple medical con-
sultations, examinations and hospitalizations and/or that
presents disjointed pathology, which is recurrent and has a
bad response to the usual treatment. The need of an early
diagnosis is very important to avoid severe consequences,
and the carrying out of unnecessary explorations that occa-
sionally might be invasive or involve a risk for the patient2.
Clinical Case
We present the case of an 8 year old girl who repeatedly
attends pediatric consultations and emergency services of
the hospital with multiple and non specific somatic
complaints, until during a readmission (due to digestive
problems) it is suspected that there is the possibility of a
psychological origin and the case was diverted to the Child
and Adolescent Psychiatric Hospitalization Department to
confirm the diagnosis.
The patient is a girl who resides with her mother. The
parents have been separated since 2009, they have had a
bad relationship since the patient presented with an
autoimmune disease (economic problems, not fulfilling
visiting rights, legal actions for the payment of child
support…). The mother relates that “the father does not take
care of the child properly”, and the father that “she is always
ill when she has to come with me”.
Initially she was admitted to Pediatric Service due to
abdominal pain and nauseas, she was diagnosed with a di-
gestive infection and she was readmitted 3 days after her
discharge due to the same reason. In the patient´s medical
record it can be seen: 173 applications for analysis, 87 med-
ical consultations, 37 radiological examinations, 6 hospital-
izations, 31 consultations with the general practitioner (pe-
diatrician) in 2014 and 15 consultations in 2015; without
any findings of a physical cause that justifies the symptoms
in most of the cases. In spite of being diverted to mental
health consultations, the mother asks for voluntary dis-
charge, hiding the fact to the child´s pediatrician. During
periods of hospitalization in the Pediatric Service it was not-
ed that the mother objected to examinations of the child in
her absence; while at the same time she forbade the child to
speak about her father in the presence of medical profes-
sionals.
Personal background: Normal pregnancy, labour and
psychomotor development. Up to date vaccination record
for her age. Kawasaki disease at 3 years old, with cardiac
complications (left coronary ectasia and minor mitral
insufficiency in high-pitched phase) currently in remission.
Ongoing supervision in Infant Cardiology. At 5 years of age
she was examined in the Child Digestive Service for recurrent
nauseas and abdominal pain, with normal results (including
Table 1 Indicators of Müchausen Syndrome by proxy3
IN THE CHILD IN THE PERPETRATOR
· Symptoms which do not typically fall into a specic clinical
diagnosis.
· Persistent and unexplained symptoms which lead to the
elaboration of a disordered, complex and inconsistent diagnosis.
· Family background of unexplained child death or family
members who allegedly have several serious illnesses.
· Complementary examinations that do not go inside with the
child´s state of health.
· Absence of similar cases.
· Inefcient or badly received treatments.
· Usually the mother.
· The signs and symptoms do not happen in her absence.
· The mother is less worried tan the doctors.
· She refuses to leave the child alone in the hospital.
· She tries to establish closed relationships with doctors and nurses.
· She usually has health knowledge or a history of a sanitary
profession usually unsuccessful.
· She presents with psychiatric or behavioural disorders.
· She has Münchausen Syndrome.
38
Letter to the editor
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Actas Esp Psiquiatr 2016;44(3):113-8
endoscopy). She has attended several specialists for diverse
non specific symptomatology, and has different diagnoses
of all kinds: transient synovitis of the hip, suprapubic pain,
unspecified pains, dermatological illnesses of unspecified
allergies; amongst others. Currently she is waiting upon an
adenoidectomy and a stress test.
Family background: Only child. The parents have been
separated since 2009 (coinciding with the child´s diagnosis
of Kawasaki disease). In custody of the mother. The mother
refuses permission for the father to take her during the
weekends that correspond to him, the exchanges take place
in Aprome, however there is a significant level of non
compliance. Due to this conflict and non compliance, the
father refuses to pick her up, until she follows the judicial
agreement; and they are waiting for a new evaluation by the
Judicial Psychosocial Unit.
The mother is 43 years old with higher education, but is
currently unemployed. She does not have any known medical
or psychiatric history, however she admits to having a high
level of anxiety in relation to her daughter’s state of health.
The father is 49 years old, he did an apprenticeship
(professional training) but is currently unemployed.
Orchiectomy due to Sertoli cells cancer. Positive HIV since he
was 19 years old. Former drug addict (heroin and cocaine)
from the age of 32 (he was placed in the Proyecto Hombre
Association) and presently he is drug free. Imprisoned for 15
years, until he was 37 years old. Currently, from January
2015, he has to fullfil a barring order put in place by the
child´s mother and the family for a year, because he
threatened them by phone (in relation to the unfullfilment
of the visits). Both parents have an adequate family support
structure.
Complementary examinations and tests:
Physical examination: Without significant findings at
the time of admission.
In the psychopathological examination the patient was
conscious, orientated, approachable and cooperative. Neat
and clean appearance. She relates that she does not know
the reason why she is hospitalized. She admits that she “was
ill” and that she “has been ill for many years, since she was
3 years old”, “but when she was admitted to this hospital
she got over it”. She is fidgety and tends to stand up. Correct,
spontaneous and natural language. Euthymic, no signs of
anxiety. Biological rhythms preserved. There is no alterations
in the psychotic sphere, nor autolytic ideation. Superior
cognitive functions preserved.
During the admission process the mother asks for more
examinations, specially of the digestive system and ophthal-
mologic. However it is considered that there is no clinical
justification for doing more complementary examinations
due to the results of the previous studies; therefore she was
only diverted to Dermatology for folliculitis in both gluteos
and a papilloma on the sole of the right foot (treated with
cryotherapy).
The psychological tests highlight: Children´s Depression
Inventory by Beck: 0 (no depression). Wechsler Intelligence
Scale for Children (WISC-IV): Full Scale IQ: 134 (very
superior). Verbal Comprehension: 137 (very superior).
Perceptual Reasoning: 129 (superior). Working Memory: 130
(very superior). Processing Speed: 102 (average). Children´s
Personality Questinaire CPQ-A: Average results. Projective
test HTP: Appropiate ability of comprehension. Good self
perception. It expresses a need of protection by environmental
pressures. She seems to want to separate herself from a
possible family conflict.
Due to these characteristics and the evolution of the
symptoms, during the hospitalization the following diagno-
ses were carried out: Unspecified Factitious Disorder (Facti-
tious Disorder by Proxy). High intellectual ability. Papilloma
in the right foot treated with cryotherapy. Secondary prob-
lems related to the process of the parents´ separation and
other legal aspects.
The patient initially followed the treatment as it was
prescribed during the hospitalization in the Pediatric Ser-
vice: antiemetic (Ondansetron 4mg/8h) and gastric protec-
tor (Pantoprazol 40mg/24h and Omeprazol 20 mg/24h),
which were progressively withdrawn, without presenting
any digestive symptomatology again. At no time did she
need psychofarmacological treatment. At the discharge the
results of the evaluation were communicated to the refer-
ring doctors (Mental Health and Pediatric Services). The
family (maternal grandparents) promised to take care of the
psychological and behavioral control of the mother´s anxi-
ety (who should apply for an appointment in the Mental
Health Service) and the child (appointments in the Child
Mental Health Unit), and to avoid being overdemanding and
other problems in the relationship with the father. It was
agreed to maintain supervised visits in Aprome, until a new
evaluation by the Judial Psychosocial Unit can take place.
Results
Initially the mother was opposed to the hospitalization,
and she was very upset because she experienced it like an
imposed situation under the threat of being reported to
Child Services (Juvenile Prosecution offices). The family was
very surprised by the number of complementary examina-
tions, blaming the sanitary staff for them being carried out.
On the other hand, the patient´s mother admits that “she is
worried by her daughter’s health, but has reasons for that,
due to her medical history”. With the hospitalization an en-
39
Actas Esp Psiquiatr 2016;44(3):113-8
118
Letter to the editor
vironmental separation was carried out, initially forbidding
contact with the family, afterwards supervised visits were
allowed by the medical staff of the Unit. They were appro-
priate at all times and without significant incidents.
During the hospitalization the girl stays completely
asymptomatic, well adapted and integrated in the daily
routines and activities. She does not complain about her
physical symptoms; the patient herself admits that “I got over
it after being admitted”, in spite of that the mother insists on
during the visits she sees her daughter with eye irritations,
or with digestive problems, but she does not dare to tell us”.
Interviews with the mother and the rest of the family were
carried out and confirm the mother´s excessive jealousy, her
health obsession, as well as being overprotective. In addition,
interviews with the father were carried out and he was
cooperative. It was proposed that the mother needs to receive
treatment from Mental Health Services to reduce her anxiety
levels and modify her overprotective behaviour; as well as
learning how to adequately manage any possible health
problems that the child may have. It is agreed that the
maternal grandparents will supervise these aspects.
Conclusions
The use or instrumentalisation of the illness and its
treatment in the problems of guardianship and custody of
minor between parents who are separating are a special
added complication. Münchausen Syndrome by Proxy being
a type of children abuse with a high risk and difficult
diagnosis that can be unperceived for months or even years.
Here is where the sanitary complacency dilemma
emerges; in many cases, while having doubts, health profes-
sionals applied for numerous complementary tests facing
the demanding requests of some patients or their families,
these requests being reiterated and unnecessary in most of
the cases. This is a major problem, not only economically
speaking but also health wise, which needs to be controlled.
The separation of the computers systems between Primary
Care and the hospitals, in many cases complicates even more
this supervision.
Every time we nd ourselves with the suspicion of this
disorder the need arises for an integral treatment plan, that
incorporates in all steps the physical and psychological
dimensions. Also the psychosocial context is key for the
evaluation. The multidisciplinary approach is essential3. From
the very rst moment that the patient enters the health
system (involving the doctors in the Emergency department,
general practitioners and hospital doctors, through to the
mental health professionals and the social and legal services);
to elaborate a common strategy, follow ups and adequate
intervention to guarantee the child´s security at all time.
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Síndrome de Münchausen por poderes. An Pediatr (Barc).
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2. Yalndag-Öztürk N, Erkek N, Bayram Şirinoğlu M. Think again:
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3. de la Cerda Ojeda F, Goñi González T, Gómez de Terreros I.
Münchausen Syndrome by proxy. Cuad Med Forense. 2006;
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40
... Most current studies also support the finding of higher BIS scores in BPD patients as compared to HCs and lower scores as compared to individuals with ADHD [97••, 98, 99, 100••, 101-103, 104•, 105]. Contrary to these findings though, Barker et al. [106] found no differences in the BIS total scores between BPD patients and HCs, and Zamalloa et al. [107] even observed higher BIS total scores in their HC group. However, in the latter study, BPD patients had elevated scores in the motor impulsiveness domain that is comparable to the (lack of) premeditation subscale of the UPPS, suggesting that besides acting impulsive while experiencing negative emotions (negative urgency), BPD patients are also characterized by impulsive actions that are carried out by the individuals without thinking about the consequences [107]. ...
... Contrary to these findings though, Barker et al. [106] found no differences in the BIS total scores between BPD patients and HCs, and Zamalloa et al. [107] even observed higher BIS total scores in their HC group. However, in the latter study, BPD patients had elevated scores in the motor impulsiveness domain that is comparable to the (lack of) premeditation subscale of the UPPS, suggesting that besides acting impulsive while experiencing negative emotions (negative urgency), BPD patients are also characterized by impulsive actions that are carried out by the individuals without thinking about the consequences [107]. This suggestion is in line with clinical observations: BPD patients typically show unprotected sexual activities and promiscuity, substance misuse, excessive spending of money, and disordered eating, behaviors that can be considered as impulsive in the light of not thinking about the negative consequences [13,83,106]. ...
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Purpose of Review Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. Recent Findings All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. Summary As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
... Finally, we examined in an exploratory manner whether EF performance was associated with self-reported impulsivity, a phenotype reflecting behavioural dysregulation, expecting higher self-reported impulsivity would be significantly related to lower planning and response inhibition performance in probands. This expectation is based on research linking greater selfreported impulsivity to poorer EF in samples that include participants with BPD (Hagenhoff et al. 2013;Zamalloa et al. 2016). ...
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Objectives Behavioural dysregulation is a heritable core symptom domain in borderline personality disorder (BPD) that is likely influenced by the integrity of executive functions (EFs). However, the extent to which familial risk for BPD confers decrement to EFs has yet to be comprehensively studied. Methods In this family study, probands with BPD (n = 73), first-degree biological relatives (n = 65), and healthy controls without psychiatric diagnoses (n = 77) were assessed in abstraction, attentional vigilance, working memory, cognitive flexibility, interference resolution, planning, problem solving, and response inhibition. Results In univariate analyses, probands demonstrated lower response inhibition than relatives. Comparatively, discriminant function analyses revealed that lower interference resolution and response inhibition jointly discriminated probands from relatives and controls, whereas a combination of less efficient problem solving and difficulty manipulating mental information discriminated probands and relatives from controls. Moreover, the subset of psychiatrically non-affected relatives demonstrated a pattern of resilience to psychiatric morbidity substantiated by stronger response inhibition and abstraction abilities despite less efficient problem solving. Conclusions Familial risk for BPD is represented predominantly by a pattern of problem-solving and working memory deficits. Resilience to a psychiatric disorder in non-affected relatives reflects both EF weaknesses and strengths, highlighting potential protective factors that should be considered in future neurocognitive research on BPD families.
... The statistically significant higher scores of the patients than those of the controls on all aspects of impulsivity (attentional, motor, and non-planning), as measured by BIS-11, denoted that patients had a greater tendency to accept the immediately available lesser reward rather than waiting longer for a greater reward. This was consistent with Zamalloa et al. (2016) [32] where they showed that there were differences in the overall impulsivity with higher levels in patients with BPD. ...
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... Contrary to studies supporting our findings, Barker et al. [39] found no differences between BPD patients and healthy controls in terms of the BIS total scores. Furthermore, in a study conducted by Zamalloa et al. [40], BIS total scores of the healthy controls were found to be higher than BPD patients. In sum, although most studies in the literature supported that attention deficit-hyperactivity/ impulsivity symptoms are more common in the BPD patients than in the healthy controls, there were also negative studies showing no differences between the two groups in terms of attention deficit-hyperactivity/ impulsivity symptoms or that such symptoms were more common among healthy individuals. ...
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