The neuropsychology of borderline personality disorder: a meta-analysis and review

Psychiatry Research, 137(3): pp. 191-202.The neuropsychological profile of borderline personality disorder (BPD) is unclear. Past investigations have produced seemingly inconsistent results of precisely what neuropsychological deficits characterize the patient with BPD. A meta-analysis of 10 studies was conducted comparing BPD and healthy comparison groups on select neuropsychological measures comprising six domains of functioning: attention, cognitive flexibility, learning and memory, planning, speeded processing, and visuospatial abilities. BPD participants performed more poorly than controls across all neuropsychological domains, with mean effect sizes (Cohen’s d) ranging from -.29 for cognitive flexibility to -1.43 for planning. The results suggest that persons with BPD perform more poorly than healthy comparison groups in multiple neurocognitive domains and that these deficits may be more strongly lateralized to the right hemisphere. Although neuropsychological testing appears to be sensitive to the neurocognitive deficits of BPD, the clinical utility of these results is limited. Implications of these findings for future neurocognitive investigations of BPD are discussed

A problem-solving task specialized for functional neuroimaging: Validation of the Scarborough adaptation of the Tower of London (S-TOL) using near-infrared spectroscopy

Problem-solving is an executive function subserved by a network of neural structures of which the dorsolateral prefrontal cortex (DLPFC) is central. Whereas several studies have evaluated the role of the DLPFC in problem-solving, few standardized tasks have been developed specifically for use with functional neuroimaging. The current study adapted a measure with established validity for the assessment of problem-solving abilities to design a test more suitable for functional neuroimaging protocols. The Scarborough adaptation of the Tower of London (S-TOL) was administered to 38 healthy adults while hemodynamic oxygenation of the PFC was measured using 16-channel continuous-wave functional near-infrared spectroscopy (fNIRS). Compared to a baseline condition, problems that required two or three steps to achieve a goal configuration were associated with higher activation in the left DLPFC and deactivation in the medial PFC. Individuals scoring higher in trait deliberation showed consistently higher activation in the left DLPFC regardless of task difficulty, whereas individuals lower in this trait displayed less activation when solving simple problems. Based on these results, the S-TOL may serve as a standardized task to evaluate problem-solving abilities in functional neuroimaging studies

Reduced Levels of Vasopressin and Reduced Behavioral Modulation of Oxytocin in Psychotic Disorders

Oxytocin (OT) and arginine vasopressin (AVP) exert robust influence on social affiliation and specific cognitive processes in healthy individuals. Abnormalities in these neuroendocrine systems have been observed in psychotic disorders, but their relation to impairments in behavioral domains that these endocrines modulate is not well understood. We compared abnormalities of OT and AVP serum concentrations in probands with schizophrenia (n = 57), schizoaffective disorder (n = 34), and psychotic bipolar disorder (n = 75); their first-degree relatives without a history of psychosis (n = 61, 43, 91, respectively); and healthy controls (n = 66) and examined their association with emotion processing and cognition. AVP levels were lower in schizophrenia (P = .002) and bipolar probands (P = .03) and in relatives of schizophrenia probands (P = .002) compared with controls. OT levels did not differ between groups. Familiality estimates were robust for OT (h 2 = 0.79, P = 3.97e−15) and AVP (h 2 = 0.78, P = 3.93e−11). Higher levels of OT were associated with better emotion recognition (β = 0.40, P < .001) and general neuropsychological function (β = 0.26, P = .04) in healthy controls as expected but not in any proband or relative group. In schizophrenia, higher OT levels were related to greater positive symptom severity. The dissociation of OT levels and behavioral function in all proband and relative groups suggests that risk and illness factors associated with psychotic disorders are not related to reduced OT levels but to a disruption in the ability of physiological levels of OT to modulate social cognition and neuropsychological function. Decreased AVP levels may be a marker of biological vulnerability in schizophrenia because alterations were seen in probands and relatives, and familiality was high

Which Emotion Regulation Strategies are Most Associated with Trait Emotion Dysregulation? A Transdiagnostic Examination

Although definitions of emotion dysregulation infer difficulties in selecting and implementing emotion regulation (ER) strategies, surprisingly few studies have examined the relationship between trait emotion dysregulation and a wide range of specific ER strategies. The present study used a data-driven approach to assess trait- and state-related ER strategy use in 99 women (aged 18-55) recruited from the community with varying levels of trait emotion dysregulation. Participants completed self-report questionnaires assessing habitual ER strategy implementation and self-ratings of ER strategy use in vivo during negative mood inductions. Principal components analysis revealed four self-report questionnaire-based and three mood-induction-based groupings comprising both optimal and suboptimal strategies. After adjusting for demographic and clinical variables, results from self-report questionnaires indicated that trait emotion dysregulation was significantly associated with higher endorsements of suboptimal strategies in two groupings (e.g., self-criticism, rumination, and social withdrawal; catastrophizing and blaming others) and lower endorsements of optimal ER strategies in one grouping (e.g., cognitive reappraisal and problem solving). In the context of mood induction, trait emotion dysregulation was significantly associated with higher endorsements of suboptimal ER strategies from one cluster only (e.g., expressive suppression, thought avoidance, and self-criticism). Such transdiagnostic, data-driven approaches can uncover how the application of specific ER strategies both habitually and during negative mood states is associated with trait emotion dysregulation

Stressed, sick, and sad: Neuroendoimmune pathways between subjective lifetime stress and depression

Disruptions in stress-sensitive biological systems, notably the immune system and hypothalamic-pituitary-adrenal axis, are strongly implicated in depression, and disturbances in these neuroendoimmune systems could reflect potential pathways through which experiences of stress are translated into depression. To characterize the links between stress and depression, the present study investigated whether neuroendoimmune activity mediates the relationship between perceived stress and depressive symptoms in 59 medically healthy adult females with varying levels of depression. Consistent with hypotheses, both greater perceived stress and higher concentrations of the proinflammatory immune marker, interleukin-6 (IL-6), were associated with greater depressive symptoms. Although neuroendoimmune activity did not significantly mediate the relationship between lifetime perceived stress and depressive symptoms, when considered together, elevated concentrations of IL-6 and lower free cortisol mediated the relationship between severity of childhood stress and current depressive symptoms. These findings shed light on how early life stress may be translated into adulthood depression

Improving treatment outcomes for borderline personality disorder: What can we learn from biomarker studies of psychotherapy?

Purpose of reviewBorderline personality disorder (BPD) is a severe and common psychiatric disorder and though evidence-based psychotherapies are effective, rates of treatment nonresponse are as high as 50%. Treatment studies may benefit from interdisciplinary approaches from neuroscience and genetics research that could generate novel insights into treatment mechanisms and tailoring interventions to the individual.Recent findingsWe provide a timely update to the small but growing body of literature investigating neurobiological and epigenetic changes and using biomarkers to predict outcomes from evidence-based psychotherapies for BPD. Using a rapid review methodology, we identified eight new studies, updating our earlier 2018 systematic review. Across all studies, neuroimaging (n = 18) and genetics studies (n = 4) provide data from 735 participants diagnosed with BPD (mean sample size across studies = 33.4, range 2-115).SummaryWe report further evidence for psychotherapy-related alterations of neural activation and connectivity in regions and networks relating to executive control, emotion regulation, and self/interpersonal functioning in BPD. Emerging evidence also shows epigenetic changes following treatment. Future large-scale multisite studies may help to delineate multilevel treatment targets to inform intervention design, selection, and monitoring for the individual patient via integration of knowledge generated through clinical, neuroscience, and genetics research