The association between neurocognitive functioning and clinical features of borderline personality disorder

Abstract

Objective: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). Methods: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. Results: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale-Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decisionmaking and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. Conclusion: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.

Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment

“…If dissociation has detrimental effects on processing and memory for both for positive and negative emotions, this may partly explain why acute dissociative symptoms can contribute to poor therapy outcome in patients with BPD [ 70 ]. Future neuroimaging studies may investigate dissociation in the context of core symptoms other than emotion dysregulation, such as impulsive and risky decision-making [ 43 ] and interpersonal functioning. Shifting the focus to the investigation of interpersonal processes (e.g., trust and face processing) may help to gain more insight into how dissociation may affect interpersonal functioning in BPD.…”

“…Emotion dysregulation includes a predisposition towards intense, emotional reactions, and maladaptive emotion regulation strategies, e.g., suicidal behavior, non-suicidal self-injury (NSSI), substance abuse, spending sprees, and risky sexual encounters [ 40 , 41 ]. The strength, frequency, and intensity of dissociation correlate with emotional distress [ 42 ] and impulsive decision-making [ 43 ]. Dissociation may also exaggerate difficulties identifying emotions and being aware of them [ 44 ].…”

Investigation of the effects of childhood sexual abuse on disease severity and cognitive functions in borderline personality disorder

“…In an animal study conducted by Dias-Ferreira et al (47), mice exposed to chronic stress were insensitive to the changing reward paradigm and resistant to changing their choices. Likewise, it has been reported that patients with BPD were resistant to the learning with negative feedback (21). Chronic stress was shown to increase corticosteroid levels, causing medial prefrontal cortex atrophy, associative striatum atrophy, and sensorimotor striatum hypertrophy, which can be occur as a decision-making disorder (47).…”

“…One of the important cognitive areas emphasized in BPD patients is the ability to recognize facial emotion. Although most of the studies have shown inconsistent findings, patients with BPD were seen to misclass neutral or ambiguous facial expressions in a negative way consistently (19)(20)(21). Inaccurate negative interpretation of facial emotional expressions of others will likely lead to behavioral and emotional consequences, including rejection or perceiving others as malicious.…”

Attentional problems occur across multiple psychiatric disorders and are not specific for ADHD

“…Attentional problems are common and are associated with multiple psychiatric disorders. [1][2][3][4][5][6] Attention deficit hyperactivity disorder (ADHD) may reflect the most extreme version of attentional problems, but the complaint of inattention may suggest a disorder other than ADHD. Major depressive disorder, substance use disorders, and a host of anxiety disorders have attentional difficulties as one of their common features.…”