Subjective memory complaints and memory performance in patients with borderline personality disorder

Beblo T, Mensebach C, Wingenfeld K, Rullkoetter N, Schlosser N, Driessen M. Subjective memory complaints and memory performance in patients with borderline personality disorder. BMC Psychiatry. 2014;14(1): 255.Background It is still a matter of debate as to whether patients with Borderline Personality Disorder (BPD) suffer from memory deficits. Existing studies indicate no or small impairments in memory test performance. However, it was shown in patients with related disorders, such as depression, that self-reported impairment exceeds test malfunction. In the present study we assessed memory performance of BPD patients through the use of memory tests and a questionnaire for subjective memory complaints (SMC) in everyday life. Methods Thirty-two patients with BPD and 32 healthy control subjects were included in the study. The groups of subjects were comparable with respect to age, education, and gender. Subjects completed verbal and nonverbal memory tests, as well as the everyday memory questionnaire (EMQ). Results BPD patients reported severe SMC but did not show memory test impairment. The results remained stable even when all BPD patients with acute or lifetime depression comorbidity were excluded from analyses. In both groups, SMC and test performances were not related but in BPD patients SMC were related to BPD symptoms. Conclusions Our data indicate memory impairment of BPD patients in everyday life. However, it cannot be ruled out that increased memory complaints result from patients’ negative self-perception. Future research needs to clarify the reasons for memory complaints of BPD patients

Verbal memory functioning in borderline personality disorder : neuropsychological and neuroimaging perspectives

Mensebach C. Verbal memory functioning in borderline personality disorder : neuropsychological and neuroimaging perspectives. Bielefeld (Germany): Bielefeld University; 2006.Clinical features of Borderline Personality Disorder (BPD) as an unstable and dysregulated control over behavior, emotion, and cognition as well as clinical descriptions of temporary disturbances of perception and cognition led to the question of neuropsychological deficits. Although neuropsychological investigations of BPD did not provide a consistent constellation of findings, some evidence is available for a non-domain-specific impairment in multiple domains of memory, attention, visuo-spatial abilities and executive functioning (Fertuck et al., 2006). The clinical features of BPD and neuropsychological findings have been repeatedly discussed as reflecting prefrontal and temporo-limbic dysfunctions. Neuroimaging research provides support for alterations within these brain areas with respect to structure and function (Schmahl & Bremner, 2006). Although often reported neuropsychological outcomes have been repeatedly interpreted as reflecting prefrontal and temporo-limbic brain dysfunctions, these interpretations have to be preliminary since little is known about neurophysiological correlates of basic neuropsychological functions in BPD. With regard to the current state of research, it was considered that further neuropsychological research could benefit by considering three major principles: (i) The investigation of basic neuropsychological functions by the use of brain imaging methods, (ii) the inclusion of neuropsychological tasks with regard to emotional relevant stimuli and affect-laden processing, and (iii) the use of neuropsychological test that consider everyday demands. With regard to these considerations, the studies presented in this thesis aimed at the comprehensive investigation of verbal memory functioning in BPD. The first study examined the neural correlates of verbal memory retrieval in BPD compared with non-psychiatric control subjects. Some prior neuropsychological findings argued for verbal memory malfunctioning in BPD. Furthermore, brain-imaging findings support alterations in prefrontal and limbic brain areas of BPD patients. Since these brain areas have been suggested to be crucial in both, episodic (memory for events and the surrounding context) and semantic memory (memory for facts / knowledge) retrieval (Cabeza & Nyberg, 2000; Markowitsch, 2005), these brain alterations may indicate general deteriorations in memory-related brain circuits. In an fMRI experiment, regional blood oxygenation level dependent (BOLD) signals were assessed during two experimental conditions of interest (episodic retrieval: 24-hour delayed recall of a wordlist; semantic retrieval: completing a lexical fluency task) and a low level baseline (listening to MRI noise) in 18 female right-handed BPD patients and 18 non-psychiatric control subjects matched with respect to sex, age, and education. It was hypothesized that BPD patients would show increased regional BOLD responses in prefrontal and limbic brain areas during both memory retrieval conditions. Although BPD patients and control subjects showed comparable performances in verbal episodic and semantic retrieval, important group differences in regional brain activation became evident. During the retrieval of episodic information, BPD patients showed patterns of increased task-specific regional BOLD responses as compared to controls in the posterior cingulate cortex (BA 23, 31) bilaterally, in the left middle (BA 21) and superior temporal (BA 22) gyri, in the right inferior frontal gyrus (BA 45) and in the right angular gyrus (BA 39). Further, control subjects compared with BPD patients did not show areas with increased BOLD responses. During the retrieval of semantic information, BPD patients as compared with control subjects showed areas of task-specific BOLD responses with respect to the right posterior cingulate cortex (BA 31), right fusiform gyrus (BA 37), left postcentral gyrus (BA 1,2,3) and the left anterior cingulate cortex (BA 24). Again, no areas of increased task-specific BOLD responses of control subjects compared with BPD patients could be found. Despite similar neuropsychological performances of BPD patients and control subjects in episodic and semantic memory tasks the day prior to scanning, the BPD patients showed, as hypothesized, patterns of increased brain activation. However, against the hypotheses, increased regional brain activation was not only evident in prefrontal and limbic brain areas but included further parietal areas. The increased regional brain suggests that BPD patients need to recruit additional cortical resources in order to successfully retrieve information. Thus, increased activation of BPD patients during retrieval might serve as compensation ("cognitive reserve capacity") to perform on a high level comparable to controls. Therefore, increased activation might indicate additional networks for adequate retrieval needed by BPD patients, i.e. increased effort, attention, working memory, or emotional control. However, it has to be noted that the results of the brain imaging study are limited to female patients with BPD since no male were included. Study II examined the neuropsychology of verbal memory functioning in BPD. Most neuropsychological tests used neutral stimulus material to analyze verbal memory functioning whereas everyday requirements often include a variety of emotional relevant stimuli. Further, only few studies used verbal working memory tasks, which demand the control, and inhibition of interference as required in everyday demands. Limited evidence is available suggesting that BPD patients might show a reduced inhibition of emotionally relevant interference during memory tasks (Korfine & Hooley, 2000). For a closer investigation of the impact of interference on memory performance of BPD patients, a verbal learning/interference task was developed (Beblo, Mensebach et al., 2006). This task includes besides a learning condition without interference, conditions which utilize the presentation of additional stimuli of neutral and negative valence for interference purposes. With respect to the verbal/learning interference task, an interaction effect of learning condition (without interference, neutral valenced interference, negative valenced interference) and group (BPD patients, control subjects) on memory performance was expected. BPD patients were expected to show a decreased memory performance compared with control subjects if learning includes the control and inhibition of emotional negative interference, whereas their memory performance was expected to be comparable with control subjects regarding the learning conditions with neutral valenced interference and without interference. Besides the experimental verbal learning/interference task additional standard verbal memory tests covering verbal working memory, delayed memory and semantic memory were applied to control for possible impairment of the BPD patients with regard to standard conditions. 32 (21 females, 11 male) patients with BPD and 35 (23 females, 12 males) non-psychiatric control subjects matched with respect to sex, age, and intelligence took part. The results showed the hypothesized constellation of findings. Whereas memory performance of BPD patients were comparable with the control subjects regarding the learning conditions without interference and with neutral interference, BPD patients showed a significant decrease of memory performance as compared to control subjects in the condition with interference of negative valence. No group differences were found in the further neuropsychological tests, which were applied covering verbal working, delayed and semantic memory performance. These results suggest no general impairment of verbal memory functions in BPD. However, BPD may be characterized by a selective impairment of interference control and inhibition in BPD regarding emotional negative stimuli during learning. The investigation of memory functioning with brain imaging method as well the inclusion of conditions, which require interference control and inhibition, can be characterized as helpful in the understanding of neuropsychological functions in BPD. The present findings may lead to the conclusion that verbal memory functioning is less severe than once thought. Furthermore, the efforts of the present studies made an important contribution to a more concrete determination of possible mechanisms that are impaired during the processing of memory tasks in BPD. In sum, the present studies yielded three major findings: Verbal memory dysfunctions of BPD patients may be less severe impaired than once thought. The use of standard neuropsychological tests suggested no general impaired verbal memory functioning in BPD. However, BPD patients may use additional brain resources during the retrieval of verbal memory contents to perform on a level comparable to control subjects. Further, BPD patients show a reduced control for interference and inhibition during learning. More specifically, the reduced interference control and inhibition during verbal learning was restricted to emotionally relevant stimuli

Autobiographical Memory and Language Use: Linguistic Analyses of Critical Life Event Narratives in a Non-Clinical Population

Rullkoetter N, Bullig R, Driessen M, Beblo T, Mensebach C, Wingenfeld K. Autobiographical Memory and Language Use: Linguistic Analyses of Critical Life Event Narratives in a Non-Clinical Population. APPLIED COGNITIVE PSYCHOLOGY. 2009;23(2):278-287.Previous research indicates a strong association between post-traumatic stress disorder (PTSD), psychopathology. and linguistic indices, but most studies have only compared one traumatic and one neutral life event. Referring, to the Dual Representation Theory for PTSD we investigated the narrative representation of two negative life events, with and without current emotional impact in a non-clinical population. Twenty-five subjects wrote detailed narratives of the two types of life events. Lexical categories were coded and compared between the different scripts. Life events with Current emotional impact were characterised by a greater use of emotional words, especially secondary emotionally words. Proprioceptive words were more often used and there were more errors when present tense was employed. Additionally, a greater number of sentences were found in these scripts. Our data suggest that in healthy subjects a relationship exists between narrative peculiarities and the current emotional impact of autobiographical memory shaped by negative life events. Copyright (C) 2008 John Wiley & Sons, Ltd

Relationship between coping with negative life-events and psychopathology: Major depression and borderline personality disorder

Wingenfeld K, Mensebach C, Rullkoetter N, et al. Relationship between coping with negative life-events and psychopathology: Major depression and borderline personality disorder. PSYCHOLOGY AND PSYCHOTHERAPY-THEORY RESEARCH AND PRACTICE. 2009;82(4):421-425.Ninety psychiatric in-patients and 73 controls have been asked about their coping styles to negative life-events. Patients reported more emotion-oriented coping than controls. Emotion-oriented coping style was positively correlated with psychopathology, while task-oriented coping was negatively correlated with psychopathology in events which the participants had difficulties dealing with

Patients With Borderline Personality Disorder and Major Depressive Disorder Are Not Distinguishable by Their Neuropsychological Performance: A Case-Control Study

Beblo T, Mensebach C, Wingenfeld K, Rullkoetter N, Schlosser N, Driessen M. Patients With Borderline Personality Disorder and Major Depressive Disorder Are Not Distinguishable by Their Neuropsychological Performance. A Case-Control Study. The Primary Care Companion For CNS Disorders. 2011.Objective: Patients with borderline personality disorder (BPD) and patients with major depressive disorder (MDD) exhibit a broad range of neuropsychological deficits. Studies in both groups of patients point to differences but also similarities. However, studies that compare both patient groups are missing from the literature. The present study aimed to compare neuropsychological functioning in BPD and MDD patients. Method: Eighteen patients with BPD, 27 patients with MDD, 17 patients with BPD and MDD, and 76 healthy control subjects were included in the case-control study. Patients were treated for their disorders as inpatients of the Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld (Bielefeld, Germany). All patients met DSM-IV diagnoses as assessed by trained psychotherapists within the first week of their admission. In addition to a comprehensive neuropsychological test battery, the inhibitory control of emotional stimuli was assessed. Data were collected between June 2004 and June 2007. Results: Patients showed only a few impairments and no increased distractibility toward emotionally negative stimuli. Patients with BPD and patients with MDD were not distinguishable by the neuropsychological test results. Conclusions: These data did not support the notion of specific neuropsychological profiles in BPD and MDD. Future research needs to clarify the overlap of symptoms between both disorders

Attention Bias towards Personally Relevant Stimuli: The Individual Emotional Stroop Task

Wingenfeld K, Mensebach C, Driessen M, Bullig R, Hartje W, Beblo T. Attention Bias towards Personally Relevant Stimuli: The Individual Emotional Stroop Task. Psychological Reports. 2006;99(3):781-793.The emotional Stroop task is a widely used method for investigating attentional bias towards stimuli due to mood or affect. In general, standardized stimuli are used, which might not be appropriate when investigating individual contextual frameworks. It was investigated whether words chosen to be related to individuals' personal life events would produce more pronounced Stroop interference (as an indicator of attentional bias) than stimuli without any personal relevance. Twenty-six non-clinical subjects, 20 female and 6 male, participated in the study. Mean age was 36.1 yr. ( SD=18.1). All were recruited by means of local advertising. Stimulus material consisted of four word types: personal words related to negative life events with and without current personal relevance, and negative and neutral words without any personal relevance. Words were presented in three blocks. Analysis of variance showed main effects for word type and blocks, with slower reactions in the personally relevant conditions than in the negative, or neutral conditions, and in response to the first blocks as opposed to the last. These findings indicate that regardless of the word valence, personally relevant stimuli evoke more pronounced Stroop interference than do stimuli without personal relevance

The impact of neutral and emotionally negative distraction on memory performance and its relation to memory complaints in major depression

Beblo T, Mensebach C, Wingenfeld K, et al. The impact of neutral and emotionally negative distraction on memory performance and its relation to memory complaints in major depression. Psychiatry Research. 2010;178(1):106-111.Patients with major depression (MDD) often report relevant cognitive problems in everyday life while performance in standardised neuropsychological tests is not severely disturbed. This discrepancy may partly be due to the differences between the demands of everyday life with the presence of emotionally relevant distractors and standardised neuropsychological settings without those distractors. In the present study, we hypothesise that patients with major depression (MDD) show an increased distractibility towards emotionally negative stimuli and that this distractibility is related to complaints of cognitive functioning in everyday life. Thirty MDD patients and 48 healthy participants performed our recently developed learning paradigm with neutrally and negatively valenced distraction as well as without distraction. Both groups also performed a neuropsychological test battery as well as self- and observer ratings of impairments in memory and attention in every day life. In the MDD sample, cognitive impairments were reported by the patients and their relatives but were not found in the neuropsychological tests. We found a trend towards a poorer memory performance with negatively valenced distraction in the MDD sample when compared to the performance of healthy subjects. However, this impairment was not related to the self- and observer ratings. This result may be due to the fact that the distractors were not personally relevant to the subjects whereas everyday life implies such distractors. Further research is needed to explore everyday cognitive functioning of patients with MDD

Selective Attention in Depression Influence of Emotionality and Personal Relevance

Schlosser N, Mensebach C, Rullkoetter N, et al. Selective Attention in Depression Influence of Emotionality and Personal Relevance. Journal of Nervous & Mental Disease. 2011;199(9):696-702.Selective attention to negative stimuli has been discussed as being an essential characteristic of depressive disorder. Theories and empirical data, however, are contradictory. The present study addressed the question of whether depressive patients selectively attend to negatively valenced and personally relevant or irrelevant stimuli and whether they habituate to these stimuli. Thirty-one inpatients with major depressive disorder and 37 healthy controls participated in the study. They underwent a modification of the emotional Stroop paradigm. The results indicated that personally relevant stimuli evoked more pronounced Stroop interference than did stimuli without personal relevance in all subjects. Furthermore, habituation to personally relevant negative stimuli was seen in both depressive patients and control subjects. The present findings question a generally negative attentional bias as being a specific characteristic of depressive disorder. Furthermore, as depressed patients habituated to personally relevant negative stimuli, exposure therapy might be suitable for the treatment of depressive disorder

Associations of childhood trauma, trauma in adulthood and previous-year stress with psychopathology in patients with major depression and borderline personality disorder

Wingenfeld K, Schaffrath C, Rullkoetter N, et al. Associations of childhood trauma, trauma in adulthood and previous-year stress with psychopathology in patients with major depression and borderline personality disorder. Child Abuse & Neglect. 2011;35(8):647-654

Dexamethasone suppression test in borderline personality disorder—effects of posttraumatic stress disorder

Lange W, Wulff H, Berea C, et al. Dexamethasone suppression test in borderline personality disorder—effects of posttraumatic stress disorder. Psychoneuroendocrinology. 2005;30(9):919-923.Background Divergent findings of hypothalamic-pituitary-adrenal (HPA) axis functioning in borderline personality disorder (BPD) may be caused by a different degree of comorbid posttraumatic stress disorder (PTSD), in which alterations of the HPA axis are well known. Here we investigate alterations of the HPA axis in BPD patients with and without comorbid PTSD compared to healthy controls. Considering previous findings current major depression (MDD) was taken into account as a confounding variable. Methods Apart from clinical assessment the 0.5 mg dexamethasone suppression test (DST) was performed in 21 female borderline patients and 23 healthy controls. Results Twelve BPD patients suffered from comorbid PTSD. Relative suppression (%) did not differ between healthy controls and the total BPD group, but BPD patients with comorbid PTSD showed increased suppression compared to those without. Comorbid MDD was not associated with suppression. Conclusions Our results do not indicate a dysfunction of the HPA axis in BPD. However, comorbid PTSD seems to be associated with a relative hypersuppression in the 0.5 mg DST