Investigating the role of executive attentional control to self-harm in a non-clinical cohort with borderline personality features

Abstract

Self-injurious behavior (or self-harm) is a frequently reported maladaptive behavior in the general population and a key feature of borderline personality disorder (BPD). Poor affect regulation is strongly linked to a propensity to self-harm, is a core component of BPD, and is linked with reduced attentional control abilities. The idea that attentional control difficulties may provide a link between BPD, negative affect and self-harm has yet to be established, however. The present study explored the putative relationship between levels of BPD features, three aspects of attentional/executive control, affect, and self-harm history in a sample of 340 non-clinical participants recruited online from self-harm forums and social networking sites. Analyses showed that self-reported levels of BPD features and attentional focusing predicted self-harm incidence, and high attentional focusing increased the likelihood of a prior self-harm history in those with high BPD features. Ability to shift attention was associated with a reduced likelihood of self-harm, suggesting that good attentional switching ability may provide a protective buffer against self-harm behavior for some individuals. These attentional control differences mediated the association between negative affect and self-harm, but the relationship between BPD and self-harm appears independent.

Executive functioning in psychiatric patients with deliberate self-harm, as compared with a psychiatric and a healthy comparison group

“…Previous studies on EF and DSH have highlighted inhibition and working memory as topics of interests, although cognitive flexibility also has been explored (Drabble et al, 2014;Garreto et al, 2017;Miranda et al, 2012). The results from the present study differ from Fikke et al (2011) results, since they indicate that the domain of cognitive flexibility is primarily affected, and not working memory.…”

“…The need for this was illustrated by the results in the current study, where psychiatric patients with DSH performed worse than the healthy comparison group on multiple measures, but worse than the psychiatric comparison group, specifically on cognitive flexibility. Despite the methodological differences, the results are in line with the studies by Dixon-Gordon et al (2014), Drabble et al (2014), andMiranda et al (2012). Taken together, these results suggest that DSH may be associated with low cognitive flexibility in both nonclinical and clinical samples.…”

“…Dixon-Gordon et al (2014) used a community sample both with and without a history of psychiatric disorders, where a within-group comparison was done categorizing participants according to whether the self-harm was recent, in the past, or if they had no history of self-harm. Drabble et al (2014) used an online non-clinical cohort. In contrast, the current study used a comprehensive test battery with a psychiatric comparison group in order to minimize the number of confounding factors associated with DSH.…”

Self-Harming and Sense of Agency in Patients With Borderline Personality Disorder

“…The clinical functions of self-harm are manifold: affectregulation, anti-dissociation, self-punishment, interpersonal influence, anti-suicide, interpersonal boundaries, and sensation-seeking (6). Furthermore, more recent research has identified in attentional focusing a possible mediator between BPD and self-harm (53). One of the possible hypothesis is that by inducing physical pain, patients with dissociative symptoms may regulate feelings of distress related to dissociation, such as a sense of loss of control, an estrangement from reality, and experiences of numbness (5,54,55).…”

“…The absence of cognitive measures represents another main limit. In recent years, increasing literature focused on the role of neurocognitive deficits in the development of BPD with growing evidence pointing to cognitive deficits in Executive Functions (53,59,60). Although some evidence suggests that NSSI patients may exhibit more severe Executive Functions deficits, several studies support the idea that cognitive neuropsychological deficits may represent one of the core aspects of BPD.…”