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

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. 
  

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.