The Neuropsychology of Borderline Personality Disorder

Review of Study Published in The Journal of Personality Disorders

          Borderline Personality Disorder is typically associated with deficits related to affect regulation, impulse control, interpersonal relationships, and self-identity.  Previous research also indicates that patients with Borderline Personality Disorder typically show several neuropsychological impairments that are related to right-hemisphere dysfunction.  This impairment is most often observed in the case of impulse control, attention, and decision-making.  According to past etiological models, these neuropsychological impairments can act as a moderator in the development of Borderline Personality Disorder.  Previous studies speculate that the dysfunctional cognitive processes may play an important role in the development of mental distortions that are commonly associated with the disorder.   However, previous research has yet to determine the exact pattern of these neuropsychological deficits, and examine their severity in comparison with other personality disorders.  The purpose of this study was to compare the severity of neuropsychological dysfunction in patients with Borderline Personality Disorder to patients diagnosed with other personality disorders, and a healthy control group. 

          The authors of this study tested two main hypotheses based on the empirical findings of previous research on personality disorders.  The first hypothesis was that patients with Borderline Personality Disorder will show more prominent neuropsychological deficiency than patients with other personality disorders.  The second hypothesis predicted that the observed neuropsychological deficits would be most related to impulsivity.

          Neuropsychological performance was measured using the Repeatable Brief Assessment of Neuropsychological Status (RBANS) test battery.  The RBANS was originally created to provide comprehensive evaluations in studies designed to evaluate the efficacy of therapeutic practices.  It consists of ten subtests that form five distinct index scores of immediate memory, delayed memory, language, visuo-spatial cognition, and attention.  The data collected from neuropsychological assessment were correlated with specific symptoms of Borderline Personality Disorder using the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). The ZAN-BPD defines four clinical dimensions of Borderline Personality Disorder and yields four separate scores for affective, cognitive, impulsivity, and interpersonal sectors.

          The results of this study showed a clear neuropsychological impairment in the Borderline Personality Disorder group compared with the healthy control group.  Post hoc tests indicated that these patients differed from the control group in domains of attention, immediate memory, and delayed memory.  The neuropsychological deficit was less noticeable in subjects with other personality disorders relative to the control group.  Several correlations were also found between RBANS scores and ZAN-BPD impulsivity scores.  

          This research suggests that attention, immediate memory, and delayed memory are the most severely impaired neuropsychological realms associated with personality disorders.  The results further suggest that the neuropsychological impairments observed in Borderline Personality Disorder may be related specifically to frontal and temporal lobe dysfunctions.  The frontal and temporal lobe profiles of the observed impairments also indicate that they are associated with impulsivity.

          One limitation of this study was the fact that the patient groups were treated with psychotropic medications prior to testing.  These medications could potentially affect cognitive performance as compared to the non-medicated control group.  Another limitation of this study is that its correlational design indicates an inability to draw causal conclusions.  The relationship between symptomology, etiology, and neuropsychology must be further studied in order to better understand the direct contribution of each variable on Borderline Personality Disorder features. 

          This study has several implications for future research.  While current models such as Dialectic Behavior Therapy have moderate records of success in the treatment of Borderline Personality Disorder, there is still much that remains a mystery about the etiology and symptomology of personality disorders in general.  This is a great example of the kind of research that will be necessary in order to better understand the origins and complex clinical presentations of these disorders.    

Link to Study 

Extra resources for the formal study of personality disorders:
Psychology Degree Resources
Psychcentral

Do Deficits in Mindfulness Underlie Borderline Personality Features and Core Difficulties?

 

Review of Study Published in the Journal of Personality Disorders

          Previous research includes several different models to identify the core mechanisms responsible for the diverse features associated with Borderline Personality Disorder.  This disorder presents with a variety of features that include ineffective interpersonal skills and emotion-regulation dysfunction.  Individuals diagnosed with Borderline Personality Disorder typically have issues related to awareness, attention, and self-acceptance.   Most previous research regularly associates mindfulness with the presentation of many of these issues; but there is limited research exploring the correlation between mindfulness and Borderline Personality Disorder symptoms.   The purpose of this study was to observe whether, in fact, mindfulness deficits underlie the broad areas of dysfunction commonly associated with the clinical features of this disorder.  To do this, the authors examined the relationship between mindfulness deficits and a diverse non-clinical sample that was representative of a wide range of Borderline Personality features.

            The authors tested three main hypothesis based on the empirical evidence of previous research.  The first hypothesis was that there would be a negative association between mindfulness, and the core areas of dysfunction of Borderline Personality Disorder.  The second hypothesis predicted that the association between mindfulness and these clinical features would be statistically significant when controlling for neuroticism.  The final hypothesis was that mindfulness would be able to predict Borderline Personality Disorder features beyond its associations with the regular functioning of the features associated with this disorder.

          The sample used for this study consisted of 342 undergraduate students who were currently enrolled in an introductory psychology course at the University of North Texas.  Mindfulness was measured using a fifteen item, Likert-type scale known as the Mindfulness Attention Awareness Scale.  This scale assesses several different traits that are characteristic of mindfulness including aspects of both attention and awareness.  Borderline Personality Disorder features were assessed using both self-report scales and written response items.  Neuroticism was also assessed due to its high correlation with Borderline Personality Disorder.  This was accomplished using a six item, likert-type scale that assessed the tendency towards negative emotions.  

            The results of this study indicate that mindfulness is positively correlated with interpersonal and emotional functioning, and negatively related to the dysfunctional emotional and interpersonal features associated with Borderline Personality Disorder.  Although weaker; the negative correlation with Borderline Personality Disorder remained statistically significant when controlling for neuroticism.  Analysis of data suggests that mindfulness significantly predicts Borderline Personality Disorder beyond the effects of features common to the disorder. This research suggests that the dysfunctional features of Borderline Personality Disorder may be explained by problems related to mindfulness combined with features of neuroticism.  Mindfulness was indicated as a main construct for explaining the primary areas of dysfunction common to Borderline Personality Disorder.

             One limitation of this study was the use of undergraduate psychology students to comprise the sample.  This may indicate a limited ability to generalize results to clinical populations.  Another limitation is the inability to draw causal conclusions due to the correlational design of the study.  The relationship between mindfulness and neuroticism must be studied further in order to understand the direct effects of each variable on Borderline Personality Disorder features.

          This study was meticulously designed and analyzed using strict data analysis procedures.  The major problem with this study is the inability to isolate all independent variables.  This is not a reflection of faulty methodology, but an indication of the complex clinical presentation of features related to this disorder.  This problem is most likely characteristic of all clinical studies that attempt to broadly examine Borderline Personality Disorder. 

          This study has broad implications for future research and clinical work.  I am interested in understanding how mindfulness meditation can be positively utilized in clinical application.  The relationship between mindfulness and Borderline Personality Disorder suggests that future research involving mindfulness meditation may be warranted.  It would be interesting to see if the introduction of mindfulness meditation would increase the efficacy of current therapeutic models.

 Link to Study 

A Perfect Example of Dangerously Innacurate Reporting

1 in 2 seniors on antidepressants face drug interactions 
Resulting side effects caused many to stop their prescription, new study finds 

WASHINGTON — More than half of older Americans taking an antidepressant for the first time were already taking another drug that could interact with it and cause side-effects, researchers reported on Friday.

"The research team used a Thomson Reuters database of claims for Medicare, the federal health insurance plan for people over 65."

"They found more than 39,000 patients who started antidepressants between 2001 and 2006. "Twelve commonly reported antidepressant side effects were identified in the month after drug initiation," Mark's team wrote."

"The side-effects meant patients often dropped the drug they were taking. Only 45 percent of those with documented side-effects refilled the prescription for the same antidepressant and a quarter quit taking antidepressants altogether."

"Many adults are at risk of this problem, the researchers noted — other studies show that 25 percent of older adults with chronic illnesses such as arthritis or heart disease also have depression, and they have also been shown to be helped by antidepressants."

Link to Full Article: Do not read if not capable of critical thinking


Wow, I don't even know where to start.  This is a perfect example of the kind of terrible reporting that leads people to annoyingly quote inaccurate statistics/facts.  I think it's important to point out that this article was published with no author by Reuters, and found on msnbc.com.  While I could rant about the inaccuracy of this article all day; I will restrain myself  to discussing a few of it's major problems.

First, I think it is interesting to notice that the research that this article refers to was performed by Thomson Reuters, parent company of Reuters.  Why do I find this interesting?  Maybe it's because the research was conducted by the same company that wrote and published this article.  I wonder if they stand to gain anything by writing about their own research?   Also, I find it suspicious when an article doesn't provide any information about where to find the original research that it references.

Second, the article isn't clear about the implications of the research that its reporting on.  The author haphazardly uses random quotes/statistics throughout the article to make oversimplified and overgeneralized statements about the use of antidepressants to treat depression in the "senior" population.

My biggest problem with this article is that it has the potential to unnecessarily alarm older readers who may be benefiting from the correct use of antidepressant medication.  It presents vague statements regarding antidepressant side effects, and potential drug interactions without providing any information about specific drugs/interactions that seniors should be aware of.  

My favorite quote from this article, "The side-effects meant patients often dropped the drug they were taking.  Only 45 percent of those with documented side-effects refilled the prescription for the same antidepressant and a quarter quit taking antidepressants altogether."  What a revelation!  Most people will either stop taking a medication that causes undesirable side effects or switches to a different medication with the help of their doctor.  The fact that 25 percent of seniors stop taking the antidepressants altogether isn't very alarming when compared to the almost identical proportion of the general public that reportedly does the same thing.  

This article is a great example of how important skepticism and critical thinking are when you get your "news" from the internet/mainstream media. 
  

Talk therapy may help tough-to-treat depression

People with long-lasting depression may benefit from talk therapy when other treatment methods such as antidepressant drugs alone aren't working, suggests a new study. But the topic needs more research, the authors say - and they also point out that talk therapy isn't accessible or affordable for everyone.

"About 15 million adults in America suffer from major depressive disorder - serious cases of depression that last more than two weeks - in any given year, according to the National Institute of Mental Health. Most people who are diagnosed with major depressive disorder get prescribed an antidepressant rather than going straight into talk therapy, explained Dr. Ranak Trivedi, the lead author on the current study from the University of Washington School of Public Health.  But up to half of those people might not feel any better after they start taking the medication, she said."

"Talk therapy costs more than medication, at least in the short term. And insurance companies often put limits on reimbursements (although new rules issued by the Obama administration are intended to improve coverage of mental health care for people whose insurance comes through their employers)."

"But Trivedi said that in the long run, talk therapy may well be worth it. "People who take antidepressants often end up taking them for life," she said. With talk therapy, patients often go for a few months, or sometimes a few years, and then stop when their symptoms have gone away."

Link To Full Article

An interesting article written by Genevra Pittman for Reuters Health on January 13, 2011 that examines the the use of medication and talk therapy in the treatment of depression.  I find it a little frightening that most patients diagnosed with major depressive disorder in this country are prescribed anti-depressants(sometimes several different medications when patients don't respond to their first anti-depressant drug) before they are referred to some form of talk therapy.

The article explains that Dr. Trivedi's research "suggests that talk therapy may be promising for people who don't get better on medication - but they also reflect the fact that many more studies are needed."  While psychotropic medications can be important tools for treating several forms of mental illness, they aren't the only answer.  These widely prescribed drugs are strong medications that produce lasting changes in brain chemistry and cause serious side effects(many of which end up being treated with even more medication).  It's baffling to me how readily these psychotropic medications are dispensed to patients before considering a more benign treatment option such as talk therapy.  Unforunately, it is unlikely that any research showing the effectiveness of non-pharmacological interventions will be widely reported while the pharmaceutical companies continue to provide millions of dollars of "support" to mainstream media, government agencies, and major organizations like the American Psychiatry Association.