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Borderline Personality Disorder (BPD) is a serious psychiatric disorder characterised by turbulent interpersonal relationships, impaired self image, impulsivity, and a recurrent pattern of unstable affect which is usually evident by early adulthood. It has a community prevalence rate of two per cent, and approximately nine per cent of people diagnosed with BPD commit suicide. This suggests that BPD has one of the highest lethality rates of all psychiatric disorders. The course of the disorder shows a steady improvement over the course of early adulthood with the majority of cases remitting by middle age. This positive but incomplete long-term recovery is thought to be a naturalistic outcome that is independent of treatment effect. The reported study sought to test selected components of a multidimensional developmental neuropsychological model of executive functioning in BPD. The model proposed that BPD is characterised by impairments to four neuropsychological executive functions. These include working memory, response inhibition, affective-attentional bias, and problem-solving. The model further proposed that impaired executive functioning in BPD occurs as a result of the failure of ‘experience-dependent’ maturation of orbitofrontal structures. These structures are closely associated with the development of the ‘cognitive executive’. The study incorporated a cross-sectional design to analyse data from a BPD group, a Depressed Control Group, and a Medical Control Group. The overall findings of the study returned limited support for the original hypotheses. There was no evidence of deficits in working memory, response-inhibition, or problem-solving. In contrast, the BPD group returned some evidence of deficits in affective-attentional bias. Therefore, the results suggest that executive functioning remains largely intact in BPD. This also suggests that people with BPD have the working memory resources necessary to facilitate abstract cognition, have the capacity to effectively plan and execute future-oriented acts, and are able to perform appropriate problem-solving functions. These problem-solving returns are also particularly significant because a number of the tasks utilised in the study are known to be associated with so-called ‘frontal-executive’ function. These unremarkable findings challenge the view that people with BPD might experience some form of subtle neurological impairment associated with frontal-lobe compromise. The Stroop measure of affective-attentional bias provided the only supportive evidence for the proposed model, and these findings can be accounted for by at least two different explanations. The first suggests that BPD might be characterised by a hypervigilant attentional set. The specific cause of hypervigilance in BPD is unknown, but some candidate factors appear to be the often-reported abuse histories of borderlines, insecure attachment histories, and deficits in parental bonding. The second interpretation suggests that the Stroop findings reflect a form of ‘response conflict’ in which BPD participants experience difficulties overriding tasks that rely on the enunciation of automatic neural routines. As a result of these findings, further research on the role of arousal, priming, hypervigilance, and response-conflict in BPD is required. It is likely that the Stroop findings reflect a basic, ‘hard-wired’ attentional mechanism that consolidates by early adolescence at the latest. As a result, the Stroop findings have implications for both the prevention and treatment of BPD. A number of prevention strategies could be developed to address the attentional issues identified in the present study. These include assisting children to more effectively regulate arousal and affect, and assisting parents to communicate affectively with children in order to enhance self-regulation. The treatment implications suggest that interventions directed at affective-attentional processes are required, and further suggest the need for new pharmacotherapies and psychological treatments to modify dysfunctional attentional process. Affective neuroscience will have an increasingly important role to play in the understanding of BPD, and the next quarter century is likely to witness exciting advances in understanding this most problematic of disorders.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 5 uppsatser.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2010. / Title from title screen (site viewed July 6, 2010). PDF text: ca. 125 p. ; Mb. UMI publication number: AAT 3397968. Includes bibliographical references. Also available in microfilm and microfiche formats.

Thesis (Ph. D.)--University of Nevada, Reno, 2008. / "May, 2008." Includes bibliographical references (leaves 78-94). Online version available on the World Wide Web.

Thesis (PhD)--Macquarie University, Division of Linguistics & Psychology, Department of Linguistics, 2006. / Bibliography: p. 319-326.

Objective Borderline Personality Disorder (BPD) is a common and serious mental illness, associated with severe emotional dysregulation, a high risk of suicide and self-harm. Those with a diagnosis of BPD often display difficulties with social interaction, making daily life problematic, and sufferers can struggle to form and maintain interpersonal relationships. Childhood trauma is believed to contribute to the development of BPD, however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we investigate the ability of participants with a diagnosis of BPD to make social judgements and recognise emotions from facial stimuli. We also explore the relationship between childhood trauma, brain structure, and brain activation in response to emotional stimuli. Methods Individuals with a diagnosis of borderline personality disorder, as well as matched healthy controls, were recruited to take part in a neuropsychology study of emotion recognition and social judgement from faces. Participants also underwent a magnetic resonance imaging (MRI) scan, during which data was collected for analysis of brain structure, and brain function in response to emotional faces. In addition, all participants completed a structured clinical interview and the Childhood Trauma Questionnaire (CTQ). Results Individuals with a diagnosis of BPD were less well able to correctly identify facial emotions than healthy control participants (p < 0.001), with a particular deficit in the recognition of disgust (p = 0.001). Those with BPD also had difficulty making appropriate social judgements about others from their faces, and between group differences were greatest for judgements of approachability (p = 0.004) and trustworthiness (p = 0.014). Significant correlations were identified between CTQ scores and performance on both tasks in the BPD group. Although no structural brain differences were noted between the BPD group and healthy controls, we found that brain activation correlated to childhood trauma in midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. There was a significant association between incidence of abuse in childhood and psychotic symptoms in adulthood. In addition, there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group, suggesting a potential relationship between childhood trauma, midbrain activity and the development of psychotic symptoms in those with a diagnosis of BPD. Conclusion Abuse in childhood is associated with impaired social and emotional function, as well as increased activation of a network of brain regions in response to emotional stimuli in BPD. Brain abnormalities in BPD appear to be confined to functional activation changes, rather than structural changes, in regions associated with emotional and social information processing. In addition, childhood trauma is correlated with increased psychotic symptoms in adulthood. These results provide striking evidence for the involvement of childhood adversity in the development of symptoms of BPD, and suggest a possible mechanism by which psychotic symptoms may occur.

M.A. / The relatively rapid development of biological approaches to various psychological conditions, has prompted clinicians and researchers to investigate Borderline Personality Disorder more thoroughly. Research has evidenced the uniqueness of Borderline Personality Disorder in terms of description, aetiology and treatment. Of the various aetiologies proposed, the neuropsychological deficit approach is one which is still in its infancy and which may have promise for new treatment strategies. Latest developments delineate neuropsychological deficits in the areas of memory, perception and visuospatial ability. These factors are important for psychotherapeutic purposes. The purpose of this study was to further existing knowledge as regards the aetiology of Borderline Personality Disorder in order to initiate new treatment modalities and management strategies. The study examined whether a battery of neuropsychological tests could detect organic dysfunction in the areas of construction, orientation and attention, memory, perception and concept formation and reasoning in twenty inpatients diagnosed according to DSM-IV criteria, with Borderline Personality Disorder. Two control groups were used, one comprising twenty inpatients diagnosed according to DSM-IV criteria with Personality Disorders from Axis II, Clusters A or C; and the other comprising twenty normal volunteers. Neuropsychological functioning assessed, included measures of attention, construction, visual and auditory-verbal memory, perception, and concept-formation and reasoning. Measurement instruments used in this study included the Digit Symbol subtest of the WAIS-R; Rey Complex Figure; Logical Memory subtest of the WMS-R, Gottschaldt Embedded Figures Test; and the Wisconsin Card Sorting Test. (v) Analysis of variance, multivariate analysis of variance and post hoc tests revealed significant deficits in neuropsychological performance among the borderline personality disorder group and the control group of other personality disorders but not the normal volunteer group. Dysfunction was particularly significant in the areas of attention, visuospatial ability, perceptual organization, and ability to maintain cognitive set. These deficits do not appear to have been attributable to attention deficit disorder, attention deficit hyperactivity disorder, temporal lobe epilepsy, head injury, a concurrent Axis I diagnosis such as major depressive disorder, or current drug and/or alcohol abuse. The observed deficits suggest new ways of understanding the development and maintenance of Borderline Personality Disorder, and provide indications for treatment. In conclusion, it is recommended that full use be made of the measurement instruments used in this study as diagnostic aids to enhance the effectiveness of treatment modalities. It is further recommended that research in this topic be repeated and extended using a larger sample and matched controls.

Aims. Understandings of recovery in borderline personality disorder are limited. Research has suggested that people with borderline personality disorder may not identify with some general mental health recovery principals. It is also not clear if there are differences in perceptions of recovery between people with borderline personality disorder and staff members. The study set out to explore and understand perceptions of recovery in borderline personality disorder and identify which factors are most important. Design and Method. A Q methodology design was used, incorporating 58 statements on recovery that participants were required to sort, in order of how important they felt they were to recovery. An opportunity sample (N= 22) was recruited, consisting of 6 people with a diagnosis of borderline personality disorder and 16 staff members, from various services within the North West of England. Results. Principal component factor analysis with a varimax rotation revealed three factors, representing distinct viewpoints from 19 participants. The dominant viewpoint placed importance on reducing features and symptoms specific to borderline personality disorder. The second viewpoint was concerned with universal, humanistic recovery principals and the third viewpoint saw relationships, both with the self and with others as most important to recovery. Conclusions. Views on recovery in personality disorder are similar to general mental health recovery principals but there also may be recovery views which are more specific to the borderline personality disorder diagnosis. Areas for further research include the extent to which recovery is a transdiagnostic concept and the extent to which recovery values are influenced by therapy models and service requirements.

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