Frontal Dysfunctions of Impulse Control – A Systematic Review in Borderline Personality Disorder and Attention-Deficit/Hyperactivity Disorder

Abstract

Disorders such as borderline personality disorder (BPD) or attention-deficit/hyperactivity disorder (ADHD) are characterized by impulsive behaviors. Impulsivity as used in clinical terms is very broadly defined and entails different categories including personality traits as well as different cognitive functions such as emotion regulation or interference resolution and impulse control. Impulse control as an executive function, however, is neither cognitively nor neurobehaviorally a unitary function. Recent findings from behavioral and cognitive neuroscience studies suggest related but dissociable components of impulse control along functional domains like selective attention, response selection, motivational control, and behavioral inhibition. In addition, behavioral and neural dissociations are seen for proactive vs. reactive inhibitory motor control. The prefrontal cortex with its sub-regions is the central structure in executing these impulse control functions. Based on these concepts of impulse control, neurobehavioral findings of studies in BPD and ADHD were reviewed and systematically compared. Overall, patients with BPD exhibited prefrontal dysfunctions across impulse control components rather in orbitofrontal, dorsomedial, and dorsolateral prefrontal regions, whereas patients with ADHD displayed disturbed activity mainly in ventrolateral and medial prefrontal regions. Prefrontal dysfunctions, however, varied depending on the impulse control component and from disorder to disorder. This suggests a dissociation of impulse control related frontal dysfunctions in BPD and ADHD, although only few studies are hitherto available to assess frontal dysfunctions along different impulse control components in direct comparison of these disorders. Yet, these findings might serve as a hypothesis for the future systematic assessment of impulse control components to understand differences and commonalities of prefrontal cortex dysfunction in impulsive disorders.

Cyclothymia reloaded: A reappraisal of the most misconceived affective disorder

“…Impulsivity is a dimension that is shared by bipolarity and ADHD (Perugi et al, 2013c;Sebastian et al, 2014), but in clinical practice the differential diagnosis between the mood instability that is typical of ADHD and that of a comorbid mood disorder, especially if "soft", as in the case of cyclothymia, or if complicated by substance abuse, is a really hard one to formulate (Asherson, 2005;Perugi et al, 2013c). In any case, specific studies are almost entirely lacking.…”

Impulsivity and Aggression in Female BPD and ADHD Patients: Association with ACC Glutamate and GABA Concentrations

“…Impulsivity consists of different components including personality traits (eg, tendency to act on the spur of the moment), deficits in executive functions (eg, attention, interference inhibition, information sampling, decision making, delay of gratification), and behavioral inhibition (Sebastian et al, 2013(Sebastian et al, , 2014. Aggressive behavior frequently displayed by patients with BPD (Latalova and Prasko, 2010) and ADHD (Connor et al, 2010) is usually of two different kinds: reactive (or impulsive) aggression and instrumental aggression.…”

“…On a neural level, these symptoms have been associated with abnormalities in fronto-limbic networks, including the anterior cingulate cortex (ACC) (Mancke et al, in press;Sacchetti and Lefler, 2014;Sebastian et al, 2014). In previous research, altered ACC structure and function have been demonstrated in BPD (Rusch et al, 2010b).…”

Neural signature of behavioural inhibition in women with bulimia nervosa

“…Participants reporting a lifetime diagnosis of a borderline personality disorder were also excluded, as this disorder is known to be associated with impairments in inhibitory control and decision making. 30 We obtained oral and written informed consent from all participants before including them in the study. The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee of the Medical School of the University of Heidelberg.…”