Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-29T19:07:33.909Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective deficit in executive functioning among patients with borderline personality disorder

Published online by Cambridge University Press:  26 February 2009

V. Ø. Haaland ,
L. Esperaas  and
N. I. Landrø
V. Ø. Haaland*
Affiliation:
Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Oslo, Norway
L. Esperaas
Affiliation:
Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Oslo, Norway Louisenlund Community Mental Health Center, Sørlandet Hospital HF, Kristiansand, Norway
N. I. Landrø
Affiliation:
Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Oslo, Norway
*
*Address for correspondence: V. Ø. Haaland, Dipl. Psych., Sørlandet sykehus HF, Psykiatrisk avdeling, Serviceboks 416, N-4604 Kristiansand, Norway. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aim of this study was to investigate the functioning of patients with borderline personality disorder (BPD) compared to healthy controls on five neuropsychological domains, with regard to the possible effect of differences in IQ.

Method

Out-patients and in-patients with BPD (n=35) and healthy comparison subjects (n=35) were tested with an extensive neuropsychological battery, where most cognitive domains were covered by several tests.

Results

When controlling for the effect of IQ, patients were found to have reduced executive functioning as compared to healthy controls. With regard to the other neuropsychological domains (working memory, attention, long-term verbal memory, and long-term non-verbal memory), no differences were found between the two groups. Within-subject analyses also identified executive functioning as a selective deficit among patients whereas long-term verbal memory was identified as a relative strength. An association was identified between the covariate general intellectual functioning and every neuropsychological domain. No statistically significant differences were found between the subgroups of patients with and without co-morbid post-traumatic stress disorder (PTSD) or between those with and without co-morbid major depression, or between the medicated and unmedicated subgroups on any of the neuropsychological domains.

Conclusions

Patients with BPD demonstrate a selective deficit in executive functioning. This corroborates studies that have identified frontal regions as potential neurobiological substrates of the BPD syndrome. The relative strength of the verbal long-term memory function raises pertinent questions regarding the presumed importance of hippocampal structures.

Keywords

Clinical psychologycognition disorderscognitive scienceneuropsychologypersonality disorders
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 10 , October 2009 , pp. 1733 - 1743
Copyright
Copyright © 2009 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Axelrod, BN, Ryan, JJ, Ward, LC (2001). Evaluation of seven-subtest short forms of the Wechsler Adult Intelligence Scale-III in a referred sample. Archives of Clinical Neuropsychology 16, 1–8.CrossRefGoogle Scholar
Bazanis, E, Rogers, RD, Dowson, JH, Taylor, P, Meux, C, Staley, C, Nevinson-Andrews, D, Taylor, C, Robbins, TW, Sahakian, BJ (2002). Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychological Medicine 32, 1395–1405.CrossRefGoogle ScholarPubMed
Beblo, T, Saavedra, AS, Mensebach, C, Lange, W, Markowitsch, H-J, Rau, H, Woermann, FG, Driessen, M (2006). Deficits in visual functions and neuropsychological inconsistency in borderline personality disorder. Psychiatry Research 145, 127–135.CrossRefGoogle ScholarPubMed
Bechara, A, Damasio, H, Damasio, AR, Lee, GP (1999). Different contributions of the human amygdala and ventromedial prefrontal cortex to decision-making. Journal of Neuroscience 19, 5473–5481.CrossRefGoogle ScholarPubMed
Becker, DF, Grilo, CM, Edell, WS, McGlashan, TH (2000). Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults. American Journal of Psychiatry 157, 2011–2016.CrossRefGoogle ScholarPubMed
Benedict, RHB, Schretlen, D, Groninger, L, Brandt, J (1998). Hopkins Verbal Learning Test – Revised: normative data and analysis of inter-form and test–retest reliability. Clinical Neuropsychologist 12, 43–55.CrossRefGoogle Scholar
Bohus, M, Schmahl, C, Lieb, K (2004). New developments in the neurobiology of borderline personality disorder. Current Psychiatry Reports 6, 43–50.CrossRefGoogle ScholarPubMed
Bryan, J, Luszcz, MA (2000). Measurement of executive function: considerations for detecting adult age differences. Journal of Clinical and Experimental Neuropsychology 22, 40–55.CrossRefGoogle ScholarPubMed
Burgess, JW (1992). Neurocognitive impairment in dramatic personalities: histrionic, narcissistic, borderline, and antisocial disorders. Psychiatry Research 42, 283–290.CrossRefGoogle ScholarPubMed
Callicott, JH, Ramsey, NF, Tallent, K, Bertolino, A, Knable, MB, Coppola, R, Goldberg, T, van Gelderen, P, Mattay, VS, Frank, JA, Moonen, CT, Weinberger, DR (1998). Functional magnetic resonance imaging brain mapping in psychiatry: methodological issues illustrated in a study of working memory in schizophrenia. Neuropsychopharmacology 18, 186–196.CrossRefGoogle Scholar
Carter, CS, Macdonald, AM, Botvinick, M, Ross, LL, Stenger, VA, Noll, D, Cohen, JD (2000). Parsing executive processes: strategic vs. evaluative functions of the anterior cingulate cortex. Proceedings of the National Academy of Sciences USA 97, 1944–1948.CrossRefGoogle ScholarPubMed
Conners, CK (2002). Conners' Continuous Performance test (CPT II). Technical Guide and Software Manual. Multi-Health Systems Inc.: North Tonawanda, NY.Google Scholar
de Visser, SJ, van der Post, J, Pieters, MSM, Cohen, AF, van Gerven, JMA (2001). Biomarkers for the effects of antipsychotic drugs in healthy volunteers. British Journal of Clinical Pharmacology 51, 119–132.CrossRefGoogle ScholarPubMed
Diaz-Asper, CM, Schretlen, DJ, Pearlson, GD (2004). How well does IQ predict neuropsychological test performance in normal adults? Journal of the International Neuropsychological Society 10, 82–90.CrossRefGoogle ScholarPubMed
Dinn, WM, Harris, CL, Aycicegi, A, Greene, PB, Kirkley, SM, Reilly, C (2004). Neurocognitive function in borderline personality disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry 28, 329–341.CrossRefGoogle ScholarPubMed
Domes, G, Winter, B, Schnell, K, Vohs, K, Fast, K, Herpertz, SC (2006). The influence of emotions on inhibitory functioning in borderline personality disorder. Psychological Medicine 36, 1163–1172.CrossRefGoogle ScholarPubMed
Dowson, JH, McLean, A, Bazanis, E, Toone, B, Young, S, Robbins, TW, Sahakian, BJ (2004). Impaired spatial working memory in adults with attention-deficit/hyperactivity disorder: comparisons with performance in adults with borderline personality disorder and in control subjects. Acta Psychiatrica Scandinavica 110, 45–54.CrossRefGoogle ScholarPubMed
Driessen, M, Herrmann, J, Stahl, K, Zwaan, M, Meier, S, Hill, A, Osterheider, M, Petersen, D (2000). Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Archives of General Psychiatry 57, 1115–1122.CrossRefGoogle ScholarPubMed
Dumont, GJH, de Visser, SJ, Cohen, AF, van Gerven, JMA (2005). Biomarkers for the effects of selective serotonin reuptake inhibitors (SSRIs) in healthy subjects. British Journal of Clinical Pharmacology 59, 495–510.CrossRefGoogle ScholarPubMed
Fertuck, EA, Marsano-Jozefowicz, S, Stanley, B, Tryon, WW, Oquendo, M, Mann, JJ, Keilp, JG (2006). The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression. Journal of Personality Disorders 20, 55–70.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997 a). Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). American Psychiatric Press: Washington, DC.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997 b). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Gold, JM, Carpenter, C, Randolph, C, Goldberg, TE, Weinberger, DR (1997). Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Archives of General Psychiatry 54, 159–165.CrossRefGoogle ScholarPubMed
Gronwall, DM (1977). Paced auditory serial-addition task: a measure of recovery from concussion. Perceptual and Motor Skills 44, 367–373.CrossRefGoogle ScholarPubMed
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Heaton, RK (1981). Wisconsin Card Sorting Test Manual. Psychological Assessment Resources, Inc.: Odessa, FL.Google Scholar
Holthausen, EAE, Wiersma, D, Knegtering, RH, Van den Bosch, RJ (1999). Psychopathology and cognition in schizophrenia spectrum disorders: the role of depressive symptoms. Schizophrenia Research 39, 65–71.CrossRefGoogle ScholarPubMed
Haaland, VØ, Landrø, NI (2007). Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder. Journal of the International Neuropsychological Society 13, 699–703.CrossRefGoogle ScholarPubMed
Judd, PH, Ruff, RM (1993). Neuropsychological dysfunction in borderline personality disorder. Journal of Personality Disorders 7, 275–284.CrossRefGoogle Scholar
Kimura, D (1963). Right temporal-lobe damage. Perception of unfamiliar stimuli after damage. Archives of Neurology 8, 264–271.CrossRefGoogle ScholarPubMed
Kunert, HJ, Druecke, HW, Sass, H, Herpertz, SC (2003). Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings. Journal of Personality Disorders 17, 497–509.CrossRefGoogle ScholarPubMed
Landrø, NI, Stiles, TC, Sletvold, H (2001). Neuropsychological function in nonpsychotic unipolar major depression. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 14, 233–240.Google ScholarPubMed
LeGris, J, van Reekum, R (2006). The neuropsychological correlates of borderline personality disorder and suicidal behaviour. Canadian Journal of Psychiatry 51, 131–142.CrossRefGoogle ScholarPubMed
Lenzenweger, MF, Clarkin, JF, Fertuck, EA, Kernberg, OF (2004). Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. Journal of Personality Disorders 18, 421–438.CrossRefGoogle ScholarPubMed
Lund-Johansen, M, Hugdahl, K, Wester, K (1996). Cognitive function in patients with Parkinson's disease undergoing stereotaxic thalamotomy. Journal of Neurology, Neurosurgery and Psychiatry 60, 564–571.CrossRefGoogle ScholarPubMed
Miller, GM, Chapman, JP (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology 110, 40–48.CrossRefGoogle ScholarPubMed
Miyake, A, Friedman, NP, Emerson, MJ, Witzki, AH, Howerter, A, Wager, TD (2000). The unity and diversity of executive functions and their contributions to complex ‘frontal lobe’ tasks: a latent variable analysis. Cognitive Psychology 41, 49–100.CrossRefGoogle ScholarPubMed
Moritz, S, Birkner, C, Kloss, M, Jacobsen, D, Fricke, S, Bothern, A, Hand, I (2001). Impact of comorbid depressive symptoms on neuropsychological performance in obsessive-compulsive disorder. Journal of Abnormal Psychology 110, 653–657.CrossRefGoogle ScholarPubMed
O'Leary, KM, Brouwers, P, Gardner, DL, Cowdry, RW (1991). Neuropsychological testing of patients with borderline personality disorder. American Journal of Psychiatry 148, 106–111.Google ScholarPubMed
Pennington, BF, Ozonoff, S (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry 37, 51–87.CrossRefGoogle ScholarPubMed
Robbins, TW, Weinberger, D, Taylor, JG, Morris, RG (1996). Dissociating executive functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London, Series B: Biological Sciences 351, 1463–1471.Google ScholarPubMed
Saykin, AJ, Gur, RC, Gur, RE, Mozley, PD, Mozley, LH, Resnick, SM, Kester, DB, Stafiniak, P (1991). Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Archives of General Psychiatry 48, 618–624.CrossRefGoogle ScholarPubMed
Shum, D, Short, L, Tunstall, J, O'Gorman, JG, Wallace, G, Shephard, K, Murray, R (2000). Performance of children with traumatic brain injury on a 4-disk version of the Tower of London and the Porteus Maze. Brain and Cognition 44, 59–62.CrossRefGoogle Scholar
Skodol, AE, Gunderson, JG, Pfohl, B, Widiger, TA, Livesley, WJ, Siever, LJ (2002). The borderline diagnosis I: psychopathology, comorbidity, and personality structure. Biological Psychiatry 51, 936–950.CrossRefGoogle ScholarPubMed
Spitznagel, MB, Suhr, JA (2004). Neuropsychological impairment associated with symptoms of schizotypy: role of depressive and paranoid symptoms. Journal of Nervous and Mental Disease 192, 382–384.CrossRefGoogle ScholarPubMed
Spreen, O, Strauss, E (1998). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press: New York.Google Scholar
Sprock, J, Rader, TJ, Kendall, JP, Yoder, CY (2000). Neuropsychological functioning in patients with borderline personality disorder. Journal of Clinical Psychology 56, 1587–1600.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Stevens, A, Burkhardt, M, Hautzinger, M, Schwarz, J, Unckel, C (2004). Borderline personality disorder: impaired visual perception and working memory. Psychiatry Research 125, 257–267.CrossRefGoogle ScholarPubMed
Stuss, D, Bisschop, S, Alexander, M, Levine, B, Katz, D, Izukawa, D (2001). The Trail Making Test: a study in focal lesion patients. Psychological Assessment 13, 230–239.CrossRefGoogle ScholarPubMed
Swirsky-Sacchetti, T, Gorton, G, Samuel, S, Sobel, R, Genetta-Wadley, A, Burleigh, B (1993). Neuropsychological function in borderline personality disorder. Journal of Clinical Psychology 49, 385–396.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
van Reekum, R, Conway, CA, Gansler, D, White, R, Bachman, DL (1993). Neurobehavioral study of borderline personality disorder. Journal of Psychiatry and Neuroscience 18, 121–129.Google ScholarPubMed
Wechsler, D, Nyman, H, Nordvik, H (2003). WAIS-III: Wechsler Adult Intelligence Scale: Manual (Norwegian Edition). Psykologiförlaget: Stockholm.Google Scholar
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A, Reynolds, V (1998). Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry 155, 1733–1739.CrossRefGoogle ScholarPubMed