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Borderline Personality Disorder Associated With Deficit in Cognitive Control
By Karla Gale NEW YORK (Reuters Health) Nov 27 - Individuals with borderline personality disorder (BPD) appear to have deficits in their ability to resolve conflicting visual stimuli in an attentional test, according to a new study. Dr. Michael I. Posner and associates, of Weill Medical College of Cornell University, describe their research in the Proceedings of the National Academy of Sciences Early Edition for November 25, for which they recruited 39 individuals diagnosed with BPD. Two control groups were used for comparison. One control group included 22 individuals without BPD but who were temperamentally matched with the BPD subjects in having very low self-reported "effortful control" of their behavior, thought or emotion, and very high negative emotionality. In spite of their resemblance to the BPD patients, this group was "coping with life quite well, as opposed to those in the patient population," Dr. Posner told Reuters Health. The other control group comprised 70 individuals who scored average in these two temperamental dimensions. The test in which subjects participated required them to press a key on the left if the central of five arrows pointed leftward or a key on the right if that arrow pointed to the right. The arrows on either side of the central arrow pointed in the same direction as the central arrow (congruent) or the opposite direction (incongruent). Results showed a significant difference between groups (p = 0.03). The mean scores were 140 for BPD patients, 125 for temperamentally matched controls and 105 for average controls. The BPD group differed significantly from average controls (p < 0.01), but the temperamentally matched controls did not differ significantly from either of the other two groups. Dr. Posner believes that, according to this finding, "there is probably something else involved [in BPD] besides the temperamental qualities most commonly associated with it," he said. The authors note that 71% of the BPD patients reported a history of emotional abuse, 38% of physical abuse and 28% of sexual abuse. "These and other aspects of socialization might act together with a lack of effortful control to produce the other symptoms," Dr. Posner's group suggests. "Another possibility is that the difficulties in socialization themselves may produce an inappropriate development of attentional mechanisms for the control of cognition and emotion," they add. According to neuroimaging studies, the authors point out, the dorsal anterior cingulate gyrus is involved in the conflict network. Furthermore, they write, lesions in this area are associated with poor interpersonal relations and with antisocial behavior. The BPD patients are enrolled in an experimental treatment program that includes psychoanalytic therapy and cognitive behavioral therapy, Dr. Posner told Reuters Health. "At the end of 1 year, we will administer the same tests to the patients and the control groups. We will also include imaging studies at baseline and at treatment completion to see what the treatment accomplishes," he added. Proc Natl Acad Sci 2002. 222.pnas.org/cgi/doi/10.1073/pnas.252644699
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