Verbal Memory Dysfunction in Depressed Outpatients With and Without Borderline Personality Disorder

This study contrasts memory functions with emotional words between two groups of patients presenting with symptoms of major depressive disorder (MDD)—20 patients with a comorbid diagnosis of borderline personality disorder (BPD) and 20 patients without BPD—and a group of 20 community adult controls. BPD patients showed poorer recall and recognition memory performances than controls, while MDD patients and controls did not differ significantly on these tasks. BPD patients showed a lower accuracy of recognition memory than MDD patients, despite negligible differences between the two patient groups in the severity of depressive symptoms and in the general level of psychopathology. Controls and BPD patients showed positive word selectivity in recall, while MDD patients showed nonsignificant selectivity differences. These findings provide additional data regarding memory disturbances specific to MDD versus BPD. The selectivity differences are consistent with theories of mood-congruent memory in depression and may serve as a cognitive marker for differentiating BPD from prototypical MDD.     

Overgeneral memory extends to pictorial retrieval cues and correlates with cognitive features in posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) show overgeneral memory (OGM) when retrieving autobiographical memories to word cues. We investigated whether OGM extends to picture cues and whether it is related to PTSD symptoms and cognitions. Trauma survivors with (n = 29) and without (n = 26) PTSD completed the standard Autobiographical Memory Test (AMT) and a novel picture version. Compared to the no-PTSD group, the PTSD group showed OGM in both test versions. Pictures facilitated specific memory retrieval, but this effect was no longer significant when verbal intelligence or depressive symptoms were controlled. OGM correlated with PTSD symptoms and perceived self-change; with intrusive memories, their perceived "nowness," responses to intrusions (thought suppression, rumination, dissociation), and negative interpretations of symptoms.     

Heightened subjective experience of depression in borderline personality disorder

Despite the frequent comorbidity of major depression and borderline personality disorder (BPD), limited research has examined what effect this comorbidity has on the severity, course, and presentation of depression. The purpose of this study was to examine whether the severity of major depressive disorder (MDD) in the context of comorbid borderline personality disorder (BPD) differs from MDD when comorbid BPD is not present and to determine whether different measures of depression yield convergent findings. Sixty patients diagnosed with DSM-IV MDD participated in this study. Twenty-nine were diagnosed with DSM-IV BPD, while the remaining 31 had no Axis II diagnosis. Depression was evaluated with both clinician (Hamilton Rating Scale for Depression) and self-report (Beck Depression Inventory) ratings. While the two groups were rated as similarly depressed by clinicians on the overall rating and the factor scores, the MDD/BPD group reported more severe depressive symptoms on the self-report measure. This difference was significant even after controlling for clinician-rated severity. Gender interacted with diagnosis, males in the BPD group showed the largest discrepancies between clinician ratings and self-reports. Posthoc analyses of HDRS factors with the BDI showed that the clinicianrated cognitive disturbance and retardation factors were correlated with self-rated severity overall. Within subgroups, only the retardation factor was correlated with the BDI. Our results suggest that while depressed individuals with and without BPD may be rated as similarly depressed when assessed with objective rating methods, the subjective experience of the depression may be rated as more intense or severe by patients with comorbid BPD. The mechanism underlying this effect remains unknown, and requires further research.     

The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression

Previous studies of neuropsychological performance in borderline personality disorder (BPD) have exhibited mixed results. The high rate of co-occurring major depressive disorder (MDD) in BPD makes it difficult to specify whether neuropsychological deficits in BPD predominantly reflect co-occurring MDD or unique aspects of their psychopathology. To address this issue, 22 participants with borderline personality disorder and concurrent major depressive disorder (BPD-MDD) and 33 participants with MDD and no concurrent personality disorder were compared on a neuropsychological battery that assessed seven domains of performance: general intellectual functioning, motor skill, psychomotor speed, attention, memory, working memory, and executive function. Neuropsychological performance did not differ between BPD-MDD and MDD. However, BPD-MDD participants reported higher levels of anger, anxiety, and of overall emotional distress compared to MDD. When levels of anxiety were controlled, BPD-MDD participants exhibited superior general intellectual performance, psychomotor speed, and attention. Deficits found in previous BPD samples may reflect their susceptibility to co-occurring MDD. The impact of anxiety on neuropsychological performance in BPD, though, indicates a need for future experimental studies of the effects of mood on cognitive function to determine whether mood dysregulation, rather than core depressive symptoms, underlie cognition impairments in BPD.     

Overgeneral autobiographical memory and chronic interpersonal stress as predictors of the course of depression in adolescents

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of depression in adolescents. As part of a larger longitudinal study of risk for emotional disorders, 55 adolescents with a past history of major depressive disorder or minor depressive disorder completed the Autobiographical Memory Test. Fewer specific memories predicted the subsequent onset of a major depressive episode (MDE) over a 16-month follow-up period, even when covarying baseline depressive symptoms. This main effect was qualified by an interaction between specific memories and chronic interpersonal stress: Fewer specific memories predicted greater risk of MDE onset over follow-up at high (but not low) levels of chronic interpersonal stress. Thus, our findings suggest that OGM, in interaction with chronic interpersonal stress, predicts the course of depression among adolescents, and highlight the importance of measuring interpersonal stress in OGM research.     

Overgeneral autobiographical memory and chronic interpersonal stress as predictors of the course of depression in adolescents

This study investigated whether overgeneral autobiographical memory (OGM) predicts the course of depression in adolescents. As part of a larger longitudinal study of risk for emotional disorders, 55 adolescents with a past history of major depressive disorder or minor depressive disorder completed the Autobiographical Memory Test. Fewer specific memories predicted the subsequent onset of a major depressive episode (MDE) over a 16-month follow-up period, even when covarying baseline depressive symptoms. This main effect was qualified by an interaction between specific memories and chronic interpersonal stress: Fewer specific memories predicted greater risk of MDE onset over follow-up at high (but not low) levels of chronic interpersonal stress. Thus, our findings suggest that OGM, in interaction with chronic interpersonal stress, predicts the course of depression among adolescents, and highlight the importance of measuring interpersonal stress in OGM research.     

The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents

Children of parents with major depressive disorder (MDD) are four to six times more likely than other children to develop MDD. Little research has examined whether comorbid parental diagnoses further increase children's risk. This study examines whether children of parents with comorbid MDD and Borderline Personality Disorder (BPD) (1) are at greater risk for experiencing depressive symptoms and/or episodes and (2) whether such increased risk may be due, in part, to their exhibiting higher levels of cognitive/interpersonal vulnerability factors. Children (n = 140; ages 6-14) of parents with MDD completed measures assessing cognitive/interpersonal vulnerability factors. Parents completed semi-structured clinical interviews assessing severity of current depressive symptoms and BPD. Both children and parents completed a semi-structured clinical interview assessing the child's current and past history of MDD. Children of parents with comorbid MDD and BPD exhibited higher levels of current depressive symptoms and higher levels of cognitive/interpersonal vulnerability factors than children of parents with MDD but no BPD, even after controlling for parents' current levels of depressive symptoms. The relationship between parental BPD and chil-dren's current levels of depressive symptoms was partially mediated by children's cognitive/interpersonal vulnerability factors. Last, children of parents with comorbid BPD and MDD were 6.84 times more likely to exhibit a current or past diagnosis of MDD.     

Borderline Personality Disorder and Posttraumatic Stress Disorder: Time for Integration?

The increasing prevalence of borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) diagnoses among women illustrates problems and limitations of the medical model system (Diagnostic and Statistical Manual of Mental Disorders, fourth edition; American Psychiatric Association, 1994). In particular, diagnoses of BPD continue the trend of overpathologizing women's issues and reinforcing a patriarchal system of diagnosis and treatment. A PTSD diagnosis, with similar criteria, is preferred for traumatized women because it portrays them in a more positive context. This article explores the overlapping relationship between BPD and PTSD and critiques how both are viewed within the mental health community. Previous research on BPD and PTSD is explored, as well as concerns and limitations regarding both diagnostic categories.     

Cognitive vulnerability to depression in individuals with borderline personality disorder

The goal of the current study was to examine whether individuals with comorbid Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD) exhibit greater severity of depressive symptoms than (1) individuals with MDD without BPD and (2) individuals with neither MDD nor BPD. One hundred and forty-one individuals participated in a semi-structured clinical interview assessing MDD and BPD. They also completed measures assessing depressive symptoms, depressogenic attributional style, hopelessness, self-esteem, rumination, and dysfunctional attitudes. In line with hypotheses, individuals with BPD and MDD exhibited higher levels of depressive symptoms and cognitive vulnerability than individuals in the other two groups. In addition, after controlling for the effects of cognitive vulnerability, the effect of group membership on depressive symptoms was reduced, suggesting that the increased severity of depressive symptoms experienced by those with BPD is partially due to their possessing higher levels of cognitive vulnerability to depression.     

The impact of depression and PTSD symptom severity on trauma memory

Posttraumatic stress disorder (PTSD) and depression frequently co-occur following a traumatic event. Differences in the processing of autobiographical memory have been observed in both disorders in the form of overgeneralised memories and negative intrusive memories. The current study examined how symptoms of PTSD and depression influence the phenomenological characteristics of trauma memories. Undergraduate students who had experienced a traumatic event (n?=?696) completed questionnaires online including measures of PTSD and depressive symptom severity. They rated their trauma memory on several phenomenological characteristics using the Memory Experiences Questionnaire [Sutin, A. R., &; Robins, R. W. (2007). Phenomenology of autobiographical memories: The memory experiences questionnaire. Memory.]. Moderated multiple regression was used to examine how PTSD and depressive symptom severity related to each phenomenological characteristic. Symptoms of PTSD and depression were related separately and uniquely to the phenomenological characteristics of the trauma memory. PTSD severity predicted trauma memories that were more negative, contained higher sensory detail, and were more vivid. In contrast, depressive symptom severity predicted trauma memories that were less accessible and less coherent. These findings suggest that depressive and PTSD symptomatology affect traumatic memory differently and support a distinction between these two disorders.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Self-punishment as a regulation strategy in borderline personality disorder

Studies using the Thought Control Questionnaire (TCQ; Wells & Davies, 1994) suggest that the tendency to use self-punishment (e.g., shouting at oneself) in order to control unpleasant internal experiences (e.g., cognitive and emotional) is associated with psychopathology. To evaluate the role of self-punishment in borderline personality disorder (BPD), we first examined whether TCQ scales, including Self-Punishment, were different among adults with BPD (n = 31) when compared to those with other personality disorders (OPD; n = 24), elevated symptoms of major depressive disorder (MDD; n = 24), and healthy controls (n = 105). Findings indicated that Self-Punishment was elevated in the BPD group relative to other groups. Next, Self-Punishment was examined as a potential mediator in the relationship between negative affectivity and BPD symptom severity in all participants. Results indicated that Self-Punishment did not mediate this relationship, but did account for significant variance in BPD symptoms over and above negative affectivity. Implications and future research directions are discussed.     

Amygdalar Volume in Borderline Personality Disorder With and Without Comorbid Post-traumatic Stress Disorder: A Meta-analysis

IntroductionFour studies have found a smaller amygdalar volume in patients with borderline personality disorder (BPD) relative to controls, whereas four other studies have found similar amygdalar volume in BPD patients relative to controls. This study aims to compare amygdalar volumes of BPD patients with controls, and also to compare BPD patients with and without post-traumatic stress disorder (PTSD) with controls in order to determine whether PTSD can explain the heterogeneity of findings.MethodSystematic review and meta-analysis of magnetic resonance imaging studies that measured amygdalar volumes in BPD patients and healthy controls.FindingsA significant reduction of amygdalar volumes in BPD patients was confirmed (p < .001). However, data from the studies that discriminated BPD patients with and without PTSD indicated that amygdalar volumes were significantly smaller in BPD patients without PTSD relative to controls (left: p = .02; right: p = .05), but not in BPD patients with PTSD relative to controls (left: p = .08; right: p = .20).ConclusionThis meta-analysis suggests that amygdalar volumes are reduced in patients with BPD. This pattern is confirmed in BPD patients without PTSD, but not in BPD patients with PTSD, raising the possibility that reduced amygdalar volume in BPD patients cannot be explained by comorbid PTSD.     

Examining the long-term stability of overgeneral autobiographical memory

Overgeneral autobiographical memory (OGM) is a proposed trait-marker for vulnerability to depression, but relatively little work has examined its long-term stability. This study investigated the stability of OGM over several years in 271 late adolescents and young adults participating in a larger longitudinal study of risk for emotional disorders. The Autobiographical Memory Test (AMT) was administered twice, with test–retest intervals ranging from approximately 3 to 6 years. There was evidence of significant but modest stability in OGM over several years. Specifically, Spearman rank correlations (ρs) between the proportions of specific and categoric memories generated on the two AMTs were .31 and .32, respectively. We did not find evidence that the stability of OGM was moderated by the length of the test–retest interval. Furthermore, the stability coefficients for OGM for individuals with and without a lifetime history of major depressive disorder (MDD) were relatively similar in magnitude and not significantly different from one another (ρs=.34 and .42 for the proportions of specific and categoric memories for those with a history of MDD; ρs=.31 for both the proportions of specific and categoric memories for those without a history of MDD). Implications for the conceptualisation of OGM are discussed.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

The impact of depression on abstinence self-efficacy and substance use outcomes among emerging adults in residential treatment

A large proportion of emerging adults treated for substance use disorder (SUD) present with symptoms of negative affect and major depressive disorder (MDD). However, little is known regarding how these comorbidities influence important mechanisms of treatment response, such as increases in abstinence self-efficacy (ASE). This study tested the degree to which MDD and/or depressive symptoms interacted with during-treatment changes in ASE and examined these variables' relation to outcome at 3 months' posttreatment. Participants (N = 302; 74% male) completed measures at intake, midtreatment, end-of-treatment, and at 3-month follow-up. ASE was measured with the Alcohol and Drug Use Self-Efficacy (ADUSE) scale; depressive symptoms were assessed with the Brief Symptom Inventory 18 (BSI 18) Depression scale; and current MDD diagnoses were deduced from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Random coefficient regression analyses focused on during-treatment changes in ASE, with BSI 18 scores and MDD diagnosis included as moderators. At intake, individuals with MDD or high levels of depressive symptoms had significantly lower ASE, particularly in negative affect situations. No evidence for moderation was found: ASE significantly increased during treatment regardless of MDD status. There was a main effect of BSI 18 Depression scores: those with lower BSI 18 scores had lower ASE scores at each time point. MDD and BSI 18 Depression did not predict 3-month outcome, but similar to previous findings ASE did predict abstinence status at 3 months. Treatment-seeking emerging adults with MDD merit particular clinical attention because of their lower reported self-efficacy throughout treatment.     

Post-traumatic stress disorder symptoms of children following the occurrence of Tehran City Park disaster

The authors investigated the post-traumatic stress disorder (PTSD) symptoms of young adolescents who had been directly involved in a disaster in Tehran. The participants were 19 chlidren who had survived a boat sinking in Tehran's city park in 2002. By using the Post-Traumatic Stress Disorder Symptom Scale (PSS; E. B. Foa, D. S. Riggs, C. V. Dancu, & B. O. Rothbaum, 1993) as well as a clinical interview based on the definition cited in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994, p. 424), 16 participants (84.2%) were diagnosed with PTSD using the PSS and 17 (89.5%) were diagnosed with PTSD using the psychiatric interview.     

A Longitudinal Examination of Overgeneral Memory and Psychopathology in Children Following Recent Trauma Exposure

This study represents the first longitudinal examination of the trajectory of overgeneral memory (OGM) in children and how this relates to psychopathology immediately after trauma exposure. We recruited fifty 7‐ to 17‐year‐olds who had experienced an accidental injury that resulted in hospital admission. Assessment of psychological symptoms, OGM and cognitive processes proposed to drive OGM was completed at three points over a 6‐month period post‐trauma. We found that OGM was not related to depressive symptoms and that time since trauma exposure moderated the relationship between post‐traumatic stress disorder symptoms and OGM. Although no relationship was found in the first 3 months following trauma, OGM was protective against post‐traumatic stress disorder symptoms at 6 months post‐trauma. Despite models of OGM (e.g. Williams et al., 2007 ) emphasising the role of rumination and executive control in explaining OGM, we found no evidence that they were related to OGM. Copyright © 2014 John Wiley & Sons, Ltd.     

Suicide Attempts in Major Depressed Patients with Personality Disorder

Suicide attempters who met criteria for borderline personality disorder (BPD) comorbid with major depressive disorder (MDD) were compared to both suicide attempters suffering from MDD alone and to attempters with comorbid MDD and other personality disorders (PD). Participants were 239 (158 patients with comorbid PD and 81 patients with MDD without comorbidity) inpatients consecutively admitted after a suicide attempt made in the last 24 hours. Suicide attempters with comorbid MDD and BPD had more frequent previous suicide attempts and were more likely to have a history of aggressive behaviors and alcohol and drug use disorders compared with patients suffering from MDD without Axis II comorbidity.     

The Relationship of Offense-Specific Forgiveness to Posttraumatic Stress Disorder Symptoms in College Students

The relationship between offense-specific forgiveness and post-traumatic stress disorder (PTSD) symptoms was examined in a cross-sectional survey of 178 college students reporting interpersonal trauma exposure, that is, a trauma exposure in which they identified a specific perpetrator. Higher levels of offense-specific forgiveness were significantly related to lower levels of PTSD symptoms. In path analyses, however, when gender and offense severity were allowed to directly predict both forgiveness and PTSD symptoms, the relationship was reduced to marginal significance. Exploratory analyses revealed that within the five most-commonly endorsed trauma subtypes, the relationship between forgiveness and PTSD symptoms may differ in strength and direction as a function of trauma type. Implications for research and treatment are discussed.