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

Meditation Appears to Cause Changes in Brain's Gray Matter

MRI scans show increased volume in parts of brain linked to empathy, awareness

"A mindfulness meditation training program can trigger measurable changes in brain areas associated with awareness, empathy and sense of self within eight weeks, a new study has found."

"The meditation group participants spent an average of 27 minutes a day doing mindfulness meditation exercises. The MRI scans taken after the eight-week program revealed increased gray matter density in the hippocampus (important for learning and memory) and in structures associated with compassion and self-awareness."

"The investigators also found that participant-reported reductions in stress were associated with decreased gray matter density in the amygdala, which plays a role in anxiety and stress."

Link to Full Article

The positive effects of meditation have been known in the East for thousands of years, but the practice only started gaining popularity in Western society in the mid-20th century.  It wasn't until the 1960's that researchers began studying the effects of mediation and learning of its many benefits.  In the last 50 years scientific research has consistently indicated that the daily practice of meditation provides both mental and physical health benefits.  Until recently, researchers have had a very limited understanding of how meditation causes these positive changes.

This article, posted on January 25, 2011 in the health section of U.S. News and World Report, discusses the most recent research findings regarding this age-old practice.  The results of this study(as well as several others) indicate that the regular practice of meditation causes structural changes in the brain.  Increased density in the gray matter of the hippocampus and amygdala were observed after only two months of daily practice.  Neuroscience continues to provide proof of the brain's amazing plasticity.  Practicing meditation capitalizes on the brain's capacity for change, and translates to signifcant imporvements in daily life.  It is never too late to start!

Link To The National Center for Complementary and Alternative Medicine

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.

Cognitive and Behavioral Nutrition: Reading the Labels

Just because a person who plays a doctor on TV says something is good for you, should you listen?

"...before most of us put anything into our bodies, we look at what is in it -- calories, salt, fat grams, etc -- and decide whether we will incorporate it (literally, put it into our bodies). I then ask this question: Do you use that same level of care and consideration of evidence when deciding whether to incorporate ideas and information into your mind or behaviors into your way of living?"

"Well, here's some good news. You can find "cognitive nutrition" and "behavioral nutrition" labels out there. You just need to know what they look like. They're not presented in clean small squares like the nutrition facts on the Krispy Kreme Doughnuts' box, but they do exist in the form of good scientific evidence. And how do we find this information and how do we know what is good scientific evidence? This is where we all need to ratchet up our levels of skepticism and thoughtfulness and decide what we are going to allow into our minds. While not a perfect rule of thumb (witness the autism-measles vaccine fraud), publication of a research finding in a peer-reviewed journal (articles are read and judged by experts in the field before being accepted for publication) is a good indicator of good cognitive and behavioral nutrition. We also need to attend carefully to people who we have good reason to believe are well-trained in making judgments about the goodness or badness of scientific data and their implications."

Link To Full Aricle

Interesting piece published on January 12, 2011 by research psychologist Marshall P. Duke.  With such an extraordinary amount of good and bad information available to us everyday through the internet, mainstream media and social interaction, it is important that we become informed consumers of knowledge.  "If we are going to do something that will affect the physical and/or emotional health and well being of ourselves and our families, we should base what we do on sound, reliable, scientific data -- on good evidence derived from good science."  Dr Duke provides several suggestions to help discern fact from fiction in order to make informed decisions.

Can you control your dreams?

"A lucid dreamer is a person who is aware that he or she is dreaming and is able to manipulate the plot and outcome of the dream, like a video game. It is not uncommon, and in children it can happen frequently, even as an expression of creativity, said Gary Schwartz, professor of psychology and neurology at the University of Arizona."

"Research suggests that various techniques can increase the frequency of lucid dreams. For instance, you can remind yourself before you go to sleep that you want to be aware that you're dreaming when dreams happen, said Deirdre Barrett, psychologist at Harvard University and the Cambridge Health Alliance and editor of Dreaming: The Journal of the International Association for the Study of Dreams."

Link To Full Article

This article, published on January 12, 2011 by CNN gives a brief overview of lucid dreaming and offers several methods that can be used to facilitate the process.  The subject was unfortunately reported on because of a connection to the Arizona shooter Jared Loughner, who apparently took an interest in the phenomenon.  The article then discusses how the inability to distinguish dreams from reality is considered a "red flag" for mental illness.  It is important to note that the author is not suggesting a link between the practice of lucid dreaming and mental illness.

There are several organizations dedicated to the study of dreams and the practice of lucid dreaming, as well as countless books/online sources related to the subject.

The Lucidity Institute Inc. (an online collection of materials on lucid dreaming)

International Association for the Study of Dreams (multidisciplinary organization dedicated to the pure and applied investigation of dreams and dreaming)

Mindfulness Therapy is No Fad, Experts Say

 Jaunuary 8, 2011 | By Chris Woolston, Special to the Los Angeles Times

There is solid evidence that mindfulness therapy, which combines elements of Buddhism and yoga, can relieve anxiety and improve mood

"Mindfulness therapy encourages patients to focus on their breathing and their body, to notice but not judge their thoughts and to generally live in the moment. It may sound a bit squishy and New Agey to some, but Hofmann and other experts say mindfulness has something that discredited theories of the past never had: solid evidence that it can help."

"The treatment seemed to help ease the mental stress of people recovering from cancer and other serious illnesses, but it had the strongest benefits for people diagnosed with mood disorders, including generalized anxiety disorder and recurring depression."

Link to Full Article 

One of many articles exemplifying the numerous applications and proven benefits of mindfulness meditation.  While it's probably more informative to read about this research in scientific journals, it's nice to see this information becoming available through mainstream media.

Rudeness Is a Neurotoxin

"Studies have shown that children exposed to serious psychological trauma during childhood are at risk of suffering increased psychiatric disorders, including depression, anger, hostility, drug abuse, suicidal ideation, loneliness and even psychosis as adults. Using modern brain imaging, the physical damage to these children's brain development can be seen as clearly as a bone fracture on an X-ray. Early-childhood sexual abuse, physical abuse and witnessing domestic violence undermine the normal wiring of brain circuits, especially those circuits connecting the left and right sides of the brain through a massive bundle of connections called the corpus callosum. Impairment in integrating information between right and left hemispheres is associated with increased risk of craving, drug abuse and dependence, and a weakened ability to make moral judgments." 

This article is written by Douglas Fields Ph.D., Chief of the Nervous System Development and Plasticity Section, National Institute of Child Health and Human Development and adjunct professor in the Neuroscience and Cognitive Science Program at the University of Maryland.  Published in the Huffington Post on January 5, 2011, the article explores "rudeness" as it relates to Dr. Fields' scientific research on the biological basis human development.

Link to Full Article 

I first became familiar with Dr Fields' work after reading his most current book, The Other Brain.  This book is an excellent source of information for anyone interested in psychology, neurobiology, and brain science.  It explores the subject of glia and recent scientific research that has established important links between glial cells and brain function.  This research has played a large role in the new understanding of psychiatric illnesses such as schizophrenia and depression, and in neurodegenerative diseases such as Alzheimer's and Parkinson's.  The author also explains how glia are implicated in the newest biological models of addiction.  Dr. Fields offers the reader an extraordinarily informative overview of glia research from it's origins to the newest discoveries in the field.  I highly recommend this book for anyone interested in behavioral neuroscience.    

6 Steps to Achieving Creativity in Business, Personal Life

 It turns out that the creative process involves both art and science

What does it take to produce something truly original? The notion that creativity is the province of right-brain, left-handed artsy types is outdated, says Daniel Goleman, a psychologist and author of Emotional Intelligence. "The creative brain state accesses a whole range of connections throughout the brain," he says. In fact, the latest research suggests that less than a second before the proverbial light bulb switches on, a spike in gamma brain waves appears to bind cells in several regions of the brain into a new neural network.

This article, published yesterday in U.S. News, explores the origin of creativity in the brain.  It offers a step by step guide to harnessing our creative powers using techniques that include mindfulness, mental imagery, and critical analysis.

Link to Full Article

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