ArticlePDF Available

Borderline Personality Disorder: Refinements in Phenotypic and Cognitive Profiling

Authors:
Jacob W Koudys at University of Toronto
Jacob W Koudys
Tahira Gulamani at University of Toronto
Tahira Gulamani
Anthony C Ruocco at University of Toronto
Anthony C Ruocco
Download full-text PDF
Read full-text
Download citation

Abstract

Purpose of Review Advancements in taxometric and dimensional approaches to personality psychopathology have pushed for refinements to the borderline personality disorder (BPD) phenotype, but proposed revisions to the diagnosis in major nosological systems hinge in part on evidence to support their validity. We review recent phenotypic and cognitive research on BPD and consider ways that changes to the phenotype may be validated using cognitive measures. Recent Findings Phenotypic research on BPD has identified core symptom dimensions underlying the DSM diagnosis, which also aggregate in families. While a unidimensional model of the disorder has been found in some studies, latent subgroups within the diagnosis have also been uncovered. Cognitive findings reveal deficits primarily in executive functions relevant to self-regulation but also in episodic memory and attentional abilities. Summary Cognitive functioning should be considered as a potential validator of proposed changes or refinements to the BPD phenotype, including categorical and dimensional conceptualizations.
Content uploaded by Tahira Gulamani
Author content
All content in this area was uploaded by Tahira Gulamani on Mar 05, 2018
Content may be subject to copyright.
A preview of the PDF is not available
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Current Behavioral Neuroscience Reports
This content is subject to copyright. Terms and conditions apply.
... Results from earlier studies on executive functions in BPD have pointed toward broad deficits in individuals with BPD (Koudys et al., 2018). However, much of this evidence is limited to studies comparing persons with BPD to healthy ones (McClure et al., 2016). ...
... This, together with the findings from the regression analysis, makes it difficult to draw clear conclusions with regard to how cognitive flexibility may be more specifically associated with DSH and other BPD features. Furthermore, a majority of the individuals in the DSHgroup, as well as the NDSH-group, suffered from conditions associated with some cognitive deficits also in euthymic states (Cotrena et al., 2020;Koudys et al., 2018;MacQueen & Memedovich, 2017). The proportion of these conditions was not equal in the psychiatric comparison group, which constitutes a limitation for drawing conclusions from this study. ...
... Individuals with severe mental health disorders such as psychotic disorders, bipolar type 1, and ADHD were excluded due to the possible detrimental cognitive effects of these disorders. Since there is well-established evidence that deficits in EF also exist in BPD (Koudys et al., 2018;Ruocco, 2005), and to some extent bipolar type 2 (Cotrena et al., 2020), it could be argued that individuals with BPD and bipolar type 2 also should have been excluded. However, if this was done, the representativity would be negatively affected to such an extent that this study could not be considered relevant in a clinical setting. ...
Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group
Article
Full-text available
  • May 2021
Introduction: Deliberate self-harm (DSH) is a common symptom in psychiatric disorders. It is a cross-diagnostic symptom, although it has mainly been associated with borderline personality disorder (BPD). Research has suggested an association between DSH and deficits in executive functioning. The main aim of the current study was to assess three specific aspects of executive functioning (EF) (working memory, inhibition and cognitive flexibility) among psychiatric patients with DSH, compared to a clinical and a healthy comparison group. Methods: Thirty psychiatric patients with DSH, 29 psychiatric patients without DSH and 29 healthy individuals were assessed with regard to psychiatric illness, self-harming behavior, EF, general cognitive functioning level and measures of psychopathology. The results were analyzed by means of ANOVA, regression analysis, Chi-square, and correlation analysis. Results: The patients with DSH showed deficits in cognitive flexibility and inhibition as compared to healthy individuals. In addition, the patients with DSH had greater deficits in cognitive flexibility than the patients without DSH; this effect was independent of concurrent severity of depressive symptoms but not independent of borderline symptomatology. Conclusion: Psychiatric patients with DSH may have deficits in cognitive flexibility as compared to both the healthy and clinical comparison groups. The results partly differ from previous related studies in the field. It is unclear to which extent the deficits in cognitive flexibility are due to other factors. More research is needed to understand the implications of such deficits, and if the results could be used for adapting treatment services and strategies. Future studies should include more similar comparison groups.
View
... The dynamic relationship between cognitive dysfunction and SUD is well established (Y€ ucel et al., 2019), and there is an increasing focus on harnessing neuroscientific and neuropsychological research to improve assessment and treatment outcomes . Specific cognitive deficits also underpin personality disorder (Koudys et al., 2018), and the co-occurrence of SUD and personality disorder is hypothesized to reflect overlapping neurocognitive mechanisms (Koudys & Ruocco, 2020). ...
... This has marked a transition from a categorical to a dimensional view of the disorder, with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5;American Psychiatric Association, 2013) including the Alternative Model for Personality Disorders in Section III ("Emerging Measures and Models"), and a complementary version now adopted in the latest revision of the International Classification of Diseases (Grenyer, 2018). The most robust neurocognitive findings are in studies of borderline personality disorder (BPD), with a profile of deficits observed in executive functions (i.e., working memory, shifting, inhibition, planning, and decision making), attention, visual episodic learning and memory recall, visuospatial abilities, and processing speed, ranging from mild-moderate in contrast to healthy individuals (Fertuck et al., 2006;Koudys et al., 2018;Ruocco, 2005). These deficits appear to overlap with those observed in SUD. ...
Neurocognition of females with substance use disorder and comorbid personality disorder: Divergence in subjective and objective cognition
Article
Full-text available
  • Jul 2021
At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = –.91), self-reported executive function (d = –.87), processing speed (d = –.40), delayed verbal memory recall (d = –.39), premorbid functioning (d = –.51), and cognitive screening performance (d = –.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = –.67) and poorer shifting performance (d = –.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
View
... In our study, we observed an interesting finding in that participants screening positive for comorbid BPD in addition to SUD showed better cognitive functioning. BPD (Koudys et al., 2018) and SUD (Fernández-Serrano et al., 2011) are associated with unique yet overlapping profiles of neurocognitive deficits, but the effects on cognition may not necessarily be cumulative. For example, in an investigation of the impact of comorbid personality disorder on cognitive functioning in a sample of female adults with SUD, participants who screened positive for comorbid personality disorder had greater self-reported dysfunction but better performance on most assessed cognitive domains compared to participants without comorbid personality disorder (Marceau et al., 2021a). ...
Factors Associated with Treatment Response at 1-Year Follow-Up from a Residential Substance Use Disorder Programme for Young People Aged 16–24 Years
Article
Full-text available
  • Sep 2023
  • Int J Ment Health Addiction
Identifying correlates of treatment response may help to improve outcomes for adolescents and young people with substance use disorder (SUD). We assessed treatment response in an adolescent/young person-specific community-based residential SUD programme located in NSW, Australia. Participants (N = 100) were aged 16–24 years and recruited between 2018 and 2020 from a cohort study investigating treatment outcomes over time. We assessed treatment response using available data at 1-year follow-up (n = 24). Approximately one third (n = 9) of participants were classified as responders at 1-year follow-up (i.e. scoring below the clinical cut-off on the Brief Symptom Inventory Global Severity Index). At treatment entry, responders had higher levels of self-efficacy (d = 1.04), better functional status (d = 1.09), and less borderline personality disorder (BPD) symptoms (d = 1.26). Exploratory whole-sample analyses indicated over half of participants (56%) screened positively for a diagnosis of BPD at treatment entry, which was associated with more severe global psychiatric symptoms (d = .85), poorer functional status, (d = .76), lower self-efficacy (d = .73), higher substance use severity (d = .46), yet better cognitive functioning (d = .75). Findings suggest that comorbid BPD is common in this setting and may contribute to poorer outcomes for adolescents and young people with SUD.
View
... BPD patients show a range of reasoning biases [12], such as deficits in problem solving/planning [13][14][15] and decision making [16]. Additionally, comorbidity in patients with BPD is high (especially with depression [17] and PTSD [18]) which may promote additional cognitive biases and cognitive dysfunction [19,20]. ...
Can you trust this source? Advice taking in borderline personality disorder
Article
Full-text available
  • Jan 2023
  • EUR ARCH PSY CLIN N
Research suggests that patients with borderline personality disorder (BPD) share a range of cognitive biases with patients with psychosis. As the disorder often manifests in dysfunctional social interactions, we assumed associated reasoning styles would be exaggerated in a social setting. For the present study, we applied the Judge-Advisor System by asking participants to provide initial estimates of a person’s age and presumed hostility based on a portrait photo. Afterwards, we presented additional cues/advice in the form of responses by anonymous previous respondents. Participants could revise their estimate, seek additional advice, or make a decision. Contrary to our preregistered hypothesis, patients with BPD (n = 38) performed similarly to healthy controls (n = 30). Patients sought the same number of pieces of advice, were equally confident, and used advice in similar ways to revise their estimates. Thus, patients with BPD did trust advice. However, patients gave higher hostility ratings to the portrayed persons. In conclusion, patients with BPD showed no cognitive biases in seeking, evaluating, and integrating socially provided information. While the study implies emotional rather than cognitive biases in the disorder, cognitive biases may still prove to be useful treatment targets in order to encourage delaying and reflecting on extreme emotional responses in social interactions.
View
... Beyond reflecting a risk for impulsive behaviours, deficits in cognitive control are also associated with a range of psychiatric disorders, including mood disorders (such as major depressive disorder (MDD) [6]) and personality disorders (especially borderline personality disorder (BPD) [7,8]), as well as many other psychiatric diagnoses [9]. Disturbances in cognitive control are linked to both the affective regulation [10] and impulse control components of MDD and BPD. ...
An exploratory study of functional brain activation underlying response inhibition in major depressive disorder and borderline personality disorder
Article
Full-text available
Cognitive control is associated with impulsive and harmful behaviours, such as substance abuse and suicidal behaviours, as well as major depressive disorder (MDD) and borderline personality disorder (BPD). The association between MDD and BPD is partially explained by shared pathological personality traits, which may be underpinned by aspects of cognitive control, such as response inhibition. The neural basis of response inhibition in MDD and BPD is not fully understood and could illuminate factors that differentiate between the disorders and that underlie individual differences in cross-cutting pathological traits. In this study, we sought to explore the neural correlates of response inhibition in MDD and BPD, as well as the pathological personality trait domains contained in the ICD-11 personality disorder model. We measured functional brain activity underlying response inhibition on a Go/No-Go task using functional magnetic resonance imaging in 55 female participants recruited into three groups: MDD without comorbid BPD (n = 16), MDD and comorbid BPD (n = 18), and controls with neither disorder (n = 21). Whereas response-inhibition-related activation was observed bilaterally in frontoparietal cognitive control regions across groups, there were no group differences in activation or significant associations between activation in regions-of-interest and pathological personality traits. The findings highlight potential shared neurobiological substrates across diagnoses and suggest that the associations between individual differences in neural activation and pathological personality traits may be small in magnitude. Sufficiently powered studies are needed to elucidate the associations between the functional neural correlates of response inhibition and pathological personality trait domains.
View
... Firstly, as several impulsivity facets (e.g., response inhibition, cognitive flexibility, decision-making, planning, problem-solving, delay discounting and proactive interference) have been found altered in BPD population (Gagnon, 2017) (Turner et al., 2017) (Koudys et al., 2018), a suggestion is to modulate via NIBS those dysexecutive functioning features clinically related to impulsivity. As several reviews and metanalysis emphasized NIBS applications targeting the prefrontal cortex to enhance cognitive control and peculiar impulsivity features (Brevet-Aeby et al., 2016) (Schroeder et al., 2020) (Teti Mayer et al., 2020 (Friehs et al., 2021), our review is in line with these findings advising to stimulate predominantly the DLPFC also in the case of BPD. ...
Efficacy and tolerability of Brain Stimulation interventions in Borderline Personality Disorder: state of the art and future perspectives – A systematic review
Article
  • Jun 2022
  • PROG NEURO-PSYCHOPH
Treating Borderline Personality Disorder (BPD) is a major challenge for psychiatrists. As Brain Stimulation represents an alternative approach to treat psychiatric disorders, our systematic review is the first to focus on both invasive and Non-Invasive Brain Stimulation (NIBS) interventions in people living with BPD, examining clinical effects over core features and comorbid conditions. Following PRISMA guidelines, out of 422 original records, 24 papers were included regarding Deep Brain Stimulation (n = 1), Electroconvulsive therapy (n = 5), Transcranial Magnetic Stimulation (n = 13) and transcranial Direct Current Stimulation (n = 5). According to impulsivity and emotional dysregulated domain improvements, NIBS in BPD appears to restore frontolimbic network deficiencies. NIBS seems also to modulate depressive features. Safety and tolerability profiles for each technique are discussed. Despite encouraging results, definitive recommendations on Brain Stimulation in BPD are mitigated by protocols heterogeneity, lack of randomized controlled trials and poor quality of included studies, including high risk of methodological biases. To serve as guide for future systematic investigations, protocols optimization proposals are provided, focusing on alternative stimulation sites and suggesting a NIBS symptom-based approach.
View
... Firstly, as several impulsivity facets (e.g., response inhibition, cognitive flexibility, decision-making, planning, problem-solving, delay discounting and proactive interference) have been found altered in BPD population (Gagnon, 2017) (Turner et al., 2017) (Koudys et al., 2018), a suggestion is to modulate via NIBS those dysexecutive functioning features clinically related to impulsivity. As several reviews and metanalysis emphasized NIBS applications targeting the prefrontal cortex to enhance cognitive control and peculiar impulsivity features (Brevet-Aeby et al., 2016) (Schroeder et al., 2020) (Teti Mayer et al., 2020 (Friehs et al., 2021), our review is in line with these findings advising to stimulate predominantly the DLPFC also in the case of BPD. ...
Efficacy and tolerability of Brain Stimulation interventions in Borderline Personality Disorder: state of the art and future perspectives – A systematic review
Article
  • Jun 2022
  • PROG NEURO-PSYCHOPH
Treating Borderline Personality Disorder (BPD) is a major challenge for psychiatrists. As Brain Stimulation represents an alternative approach to treat psychiatric disorders, our systematic review is the first to focus on both invasive and Non-Invasive Brain Stimulation (NIBS) interventions in people living with BPD, examining clinical effects over core features and comorbid conditions. Following PRISMA guidelines, out of 422 original records, 24 papers were included regarding Deep Brain Stimulation (n = 1), Electroconvulsive therapy (n = 5), Transcranial Magnetic Stimulation (n = 13) and transcranial Direct Current Stimulation (n = 5). According to impulsivity and emotional dysregulated domain improvements, NIBS in BPD appears to restore frontolimbic network deficiencies. NIBS seems also to modulate depressive features. Safety and tolerability profiles for each technique are discussed. Despite encouraging results, definitive recommendations on Brain Stimulation in BPD are mitigated by protocols heterogeneity, lack of randomized controlled trials and poor quality of included studies, including high risk of methodological biases. To serve as guide for future systematic investigations, protocols optimization proposals are provided, focusing on alternative stimulation sites and suggesting a NIBS symptom-based approach.
View
... This finding is supported by the findings of Akbari Dehaghi et al. (42). Also, consistent with this finding, meta-analytic studies on neuropsychological function have reported that individuals with BPD show deficits in a wide range of executive functions (EFs), including response inhibition, working mem-ory, cognitive flexibility, decision making, planning, and problem-solving (43). Some studies have identified factors such as depersonalization/derealization as factors influencing suicidal behaviors in BPD that were not seen in the participants of the present study (44). ...
Individual Factors Underlying Suicidal Behaviors in Patients with Borderline Personality Disorder: A Qualitative Study
Article
Full-text available
  • Jan 2022
Background: Borderline personality disorder (BPD) is associated with a high risk of suicide. Limited information is available on the individual factors underlying suicidal behaviors, especially suicide attempts (SAs), in Iranian patients with BPD. Objectives: This study aimed to analyze the individual factors underlying suicidal behaviors in patients with BPD. Methods: This was a qualitative descriptive study that was conducted from May 2020 to February 2021 in Tehran and Karaj, Iran, on 23 participants, including 14 patients with BPD and seven mental health professionals, as well as two members of their families. The research environment included psychiatric inpatient wards, psychiatric emergencies, and psychiatric clinics. Participants were selected through purposive sampling. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: Data analysis revealed five main themes and 15 sub-themes related to the individual factors underlying the identification and prediction of the risk for suicidal behaviors and SAs. The extracted themes included “psychological pain and loneliness”, “defects in the distinction and integration of emotions”, “unconventional behavior and emotion”, “pervasive incompatibility”, and “breakdown of the self-integrity”. Conclusions: The BPD is a complex and challenging disorder in which patients with BPD usually tend to engage in suicidal behaviors, and with the emergence of individual factors underlying the occurrence of such behaviors, appropriate preventive measures and interventions can be taken to reduce suicide-related behaviors such as suicidal thoughts and planning, as well as SAs.
View
... There is, however, evidence indicating that impulse control difficulties in BPD can be corroborated across ostensibly similar neurobiological constructs (Ruocco and Carcone 2016). Neuropsychology is one such method for this purpose, and indeed, BPD is marked by prominent deficits in executive functions (EFs; Koudys et al. 2018). EFs are defined as 'high-level cognitive processes that, through their influence on lower-level processes, enable individuals to regulate their thoughts and actions during goal-directed behaviour' (Friedman and Miyake 2017, p. 186). ...
Executive functioning in adults with borderline personality disorder and first-degree biological relatives
Article
  • Dec 2021
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.
View
Neuropsychological deficits correlate with symptoms severity and cortical thickness in Borderline Personality Disorder
Article
  • Sep 2020
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.
View
View
The Challenge of Transforming the Diagnostic System of Personality Disorders
Article
Full-text available
  • Sep 2017
While the DSM-5 alternative model of personality disorder (PD) diagnosis allows the field to systematically compare categorical and dimensional classifications, the ICD-11 proposal suggests a radical change by restricting the classification of PDs to one category, deleting all specific types, basing clinical service provision exclusively upon a severity dimension, and restricting trait domains to secondary qualifiers without defining cutoff points. This article reflects broad international agreement about the state of PD diagnosis. It is argued that diagnosis according to the ICD-11 proposal is based on broad, potentially stigmatizing descriptions of impaired functioning and ignores much of the impressive body of research and treatment guidelines that have advanced the care of adults and adolescents with borderline and other PDs. Before radically changing classification, which highly impacts the provision of health care, head-to-head field trials coupled with the views of patients as well as thorough debate among scientists are urgently needed.
View
Disadvantageous Decision-Making in Borderline Personality Disorder: partial support from a meta-analytic review
Article
Full-text available
  • Nov 2016
To achieve long-term goals, organisms evaluate outcomes and expected consequences of their behaviors. Unfavorable decisions maintain many symptoms of borderline personality disorder (BPD); therefore, a better understanding of the mechanisms underlying decision-making in BPD is needed. In this review, the current literature comparing decision-making in patients with BPD versus healthy controls is analyzed. Twenty-eight empirical studies were identified through a structured literature search. The effect sizes from studies applying comparable experimental tasks were analyzed. It was found that 1) BPD patients discounted delayed rewards more strongly; 2) reversal learning was not significantly altered in BPD; and 3) BPD patients achieved lower net gains in the Iowa Gambling Task (IGT). Current psychotropic medication, sex and differences in age between the patient and control group moderated the IGT outcome. Altered decision-making in a variety of other tasks was supported by a qualitative review. In summary, current evidence supports the altered valuation of outcomes in BPD. A multifaceted influence on decision-making and adaptive learning is reflected in this literature.
View
Data-driven analysis of simultaneous EEG/fMRI reveals neurophysiological phenotypes of impulse control: EEG/fMRI Reveal Phenotypes of Impulse Control
Article
Full-text available
  • Apr 2016
Response inhibition is the ability to suppress inadequate but prepotent or ongoing response tendencies. A fronto-striatal network is involved in these processes. Between-subject differences in the intra-individual variability have been suggested to constitute a key to pathological processes underlying impulse control disorders. Single-trial EEG/fMRI analysis allows to increase sensitivity for inter-individual differences by incorporating intra-individual variability. Thirty-eight healthy subjects performed a visual Go/Nogo task during simultaneous EEG/fMRI. Of 38 healthy subjects, 21 subjects reliably showed Nogo-related ICs (Nogo-IC-positive) while 17 subjects (Nogo-IC-negative) did not. Comparing both groups revealed differences on various levels: On trait level, Nogo-IC-negative subjects scored higher on questionnaires regarding attention deficit/hyperactivity disorder; on a behavioral level, they displayed slower response times (RT) and higher intra-individual RT variability while both groups did not differ in their inhibitory performance. On the neurophysiological level, Nogo-IC-negative subjects showed a hyperactivation of left inferior frontal cortex/insula and left putamen as well as significantly reduced P3 amplitudes. Thus, a data-driven approach for IC classification and the resulting presence or absence of early Nogo-specific ICs as criterion for group selection revealed group differences at behavioral and neurophysiological levels. This may indicate electrophysiological phenotypes characterized by inter-individual variations of neural and behavioral correlates of impulse control. We demonstrated that the inter-individual difference in an electrophysiological correlate of response inhibition is correlated with distinct, potentially compensatory neural activity. This may suggest the existence of electrophysiologically dissociable phenotypes of behavioral and neural motor response inhibition with the Nogo-IC-positive phenotype possibly providing protection against impulsivity-related dysfunction.
View
Intact implicit statistical learning in borderline personality disorder
Article
  • Jun 2017
Wide-spread neuropsychological deficits have been identified in borderline personality disorder (BPD). Previous research found impairments in decision making, declarative memory, working memory and executive functions; however, no studies have focused on implicit learning in BPD yet. The aim of our study was to investigate implicit statistical learning by comparing learning performance of 19 BPD patients and 19 healthy, age-, education- and gender-matched controls on a probabilistic sequence learning task. Moreover, we also tested whether participants retain the acquired knowledge after a delay period. To this end, participants were retested on a shorter version of the same task 24 hours after the learning phase. We found intact implicit statistical learning as well as retention of the acquired knowledge in this personality disorder. BPD patients seem to be able to extract and represent regularities implicitly, which is in line with the notion that implicit learning is less susceptible to illness compared to the more explicit processes.
View
View
View
Neurocognitive Deficits in Borderline Personality Disorder: Associations With Childhood Trauma and Dimensions of Personality Psychopathology
Article
  • Sep 2016
  • J PERS DISORD
The present study evaluates the severity of neurocognitive deficits and assesses their relations with self-reported childhood trauma and dimensions of personality psychopathology in 45 outpatients with borderline personality disorder (BPD) matched to 56 non-psychiatric controls. Participants completed a comprehensive battery of neurocognitive tests, a retrospective questionnaire on early life trauma and a dimensional measure of personality psychopathology. Patients with BPD primarily showed deficits in verbal comprehension, sustained visual attention, working memory and processing speed. Comorbid posttraumatic stress disorder (PTSD) and an elevated childhood history of physical trauma were each accompanied by more severe neurocognitive deficits. There were no statistically significant associations between neurocognitive function and dimensions of personality psychopathology. These results suggest that patients with BPD display deficits mainly in higher-order thinking abilities that may be exacerbated by PTSD and substantial early life trauma. Potential relationships between neurocognitive deficits and dimensions of personality psychopathology in BPD need further examination.
View
A Neurobiological Model of Borderline Personality Disorder: Systematic and Integrative Review
Article
  • Sep 2016
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.
View
Continuity Between DSM-5 Categorical Criteria and Traits Criteria for Borderline Personality Disorder
Article
  • Jan 2016
Objective: Borderline Personality Disorder (BPD) includes a heterogeneous constellation of symptoms operationalized with nine categorical criteria. As the field of personality disorder research moves to emphasize dimensional traits in its operationalization, it is important to delineate continuity between the nine DSM-IV/DSM-5 categorical criteria for BPD and the traits dimensions in DSM-5 Section III. To date no study has attempted such validation. Method: We examined the associations between the nine categorical DSM-IV/5 criteria for BPD and the trait dimensions of the alternative DSM-5 model for PDs in consecutively recruited psychiatric outpatients (N = 142; 68% females; age M = 29.02, SD = 8.38). This was investigated by means of bivariate correlations followed by multiple logistic regression analysis. Results: The categorical BPD criteria were associated with conceptually related DSM-5 Section III traits (p > .001), except for the criterion of chronic feelings of emptiness. Consistent with the proposed traits-criteria for BPD in DSM-5 Section III we found Emotional Lability, Anxiousness, Separation Insecurity, Depressivity, Impulsivity, Risk Taking, and Hostility to capture conceptually coherent BPD categorical criteria, while Suspiciousness was also strongly associated with BPD criteria. At the domain level, this applied to Negative Affectivity, Disinhibition, and Psychoticism. Notably, Emotional Lability, Impulsivity, and Suspiciousness emerged as unique predictors of BPD (p > .05). Conclusions: In addition to the proposed BPD traits criteria, Suspiciousness and features of Psychoticism also augment BPD features. Provided that these findings are replicated in forthcoming research, a modified traits operationalization of BPD is warranted.
View