Borderline personality disorder: impaired visual perception and working memory
Introduction
Borderline personality disorder (BPD) is characterized by an enduring pattern of abnormal behavior, cognition, and affect, with onset in early adolescence. The etiology of BPD is unknown. Andrulonis et al., 1980, Andrulonis et al., 1982, Van Reekum et al., 1996 reported that more BPD subjects than controls had suffered traumatic brain injury, and that the neuropsychologic profile of BPD subjects resembled that of persons with brain trauma. EEGs of BPD were reported to contain abnormal slow wave activity (Ogiso et al., 1993, De La Fuente et al., 1998). Neurological soft signs (subtle abnormalities on neurological examination) were significantly more frequent in BPD patients than in controls (Quitkin et al., 1976, Gardner et al., 1987, Stein et al., 1993). Only a few studies pertain to the neuropsychological performance of BPD patients. Burgess, 1991a, Burgess, 1991b), in persons with dramatic personality disorder, found impairments of memory, of sequence planning and performance. Van Reekum et al., 1993, Van Reekum et al., 1996 suggested a dysfunction of prefrontal circuits because of deficits on impulse control and on the Wisconsin Card Sorting Test (WCST Heaton et al., 1993). O'Leary et al. (1991) reported impairments of visual perception, of memory for complex material, of visual discrimination, and of flexibility in the digit symbol test. In a broader sense, inappropriate behavior in BPD might be based on improper decisions about what to do. Decision-making has been found to correlate with working memory performance (Hinson et al., 2002, Hinson et al., 2003), but decision-making certainly involves other processes as well.
Baddeley (2001) recently proposed a four-component model of working memory, adding as a new component the episodic buffer to the ‘classic’ elements, which comprise the phonological loop, the visuospatial sketchpad and the central executive. The episodic buffer is thought to act as a limited storage system capable of integrating information from a variety of sources.
Nuechterlein et al. (1994) and, more recently, Lencz et al. (2003) pointed out that many cognitive tasks, and visual working memory in particular, require a representation of the stimulus to be formed as a first step of information processing. They also demonstrate that backward masking paradigms can differentiate perceptual impairments from deficits in maintaining and manipulating the stimuli. For these reasons, a visual backward masking paradigm was included in the present experiment. Schubert et al. (1985) investigated backward masking in depressed patients with BPD, but they found no differences compared with controls.
The present study attempts to evaluate perception speed (by means of a backward masking paradigm) and working memory (through a series of delayed matching-to-sample tasks in BPD subjects. To explore the impact of the stimulus modality, auditory and visual delayed matching-to-sample (DMS) tasks are employed. In order to differentiate the effects of load from interference, the tasks were performed with and without interfering stimuli, an additional (within-modality) task-mental rotation was added, and finally a cross-modal version (auditory and visual stimuli) was administered.
The following hypotheses were formulated: Compared with controls, (1) BPD patients are impaired in stimulus perception (measured as speed deficit, while accuracy is controlled); (2) BPD patients show impaired working memory (measured as accuracy or speed deficit); (3) more specifically, BPD patients perform worse when the load on the working memory is increased by growing task complexity. Hypothesis (4) assumes that within BPD subjects, dissociation scores correlate with working memory performance.
Section snippets
Subjects
The BPD subjects (n=22) were recruited from in- and out-patients of the Department of Psychiatry, University of Tübingen. Controls (n=25) were recruited by a newspaper advertisement and were matched by age and years of education. Inclusion criteria were female gender, absence of current medication (except antidepressants in the BPD group), age 18–40 years, and right-handedness (Oldfield, 1971). Exclusion criteria were any other current psychiatric or neurologic diagnosis and present suicidal
Backward masking
In the control group 21/25 subjects reached criterion, as compared with 19/22 subjects in the BDP group. The RT and SOA data approximately following a normal distribution, so a repeated measures MANOVA was calculated, with SOA from the block at which criterion was reached and RT as dependent variables, group as between-subject factor, and measurement type (SOA, RT) as within-subject factor. A MANOVA was used because SOA and RT are supposed to correlate. There was a significant main effect for
Discussion
This study takes a neuropsychological approach to borderline psychopathology, assuming that some of the behavioral and cognitive abnormalities result from perceptual and working memory impairment.
BPD subjects were slower than controls in stimulus perception, as SOA required for secure stimulus identification was prolonged in BWM (hypothesis 1). Moreover, in the BWM paradigm, the motor response of BPD subjects was retarded beyond the delay caused by the longer SOA. Also, hypothesis (2), implying
Acknowledgements
The study was supported by ForTüne grant 491-0-0 (AS).
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