Differential effects of psychopathy and antisocial personality disorder symptoms on cognitive and fear processing in female offenders

Psychopathy and antisocial personality disorder (APD) have long been considered important risk factors for criminal behavior and incarceration. However, little is known about the psychobiological underpinnings that give rise to the disinhibited behavior of female offenders. Using an instructed fear-conditioning paradigm and a sample of incarcerated female offenders, we manipulated attentional focus and cognitive load to characterize and differentiate between the dysfunctional cognitive and affective processes associated with these syndromes. We used fear-potentiated startle (FPS) and event-related potentials as measures of affective and cognitive processing, respectively. After controlling for APD symptoms, psychopathic women displayed greater FPS while attending directly to threat-relevant stimuli and displayed less FPS while performing a demanding task that directed attention to threat-irrelevant information. Conversely, controlling for psychopathy, women with high APD symptoms displayed less overall FPS, especially when instructed to focus on threat-relevant stimuli. However, as the demands on cognitive resources increased, they displayed greater FPS. For both psychopathy and APD, analysis of the event-related potentials qualified these findings and further specified the abnormal cognitive processes associated with these two syndromes. Overall, simultaneous analysis of psychopathy and APD revealed distinct patterns of cognitive processing and fear reactivity.     

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 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.     

Impulsivity mediates the association between borderline personality pathology and body mass index

Borderline personality disorder (BPD) is associated with obesity, a major risk factor for a number of chronic illnesses (e.g., cardiovascular disease). We examined whether impulsivity and affective instability mediate the association between BPD pathology and body mass index (BMI). Participants were a community sample of adults ages 55–64 and their informants. The Structured Interview for DSM-IV Personality measured BPD symptoms and the Revised NEO Personality Inventory measured self- and informant-report impulsivity and affective instability. Mediation analyses demonstrated that only higher self-report impulsivity significantly mediated the association between greater BPD pathology and higher BMI. A subsequent model revealed that higher scores on the impulsiveness (lack of inhibitory control) and deliberation (planning) facets of impulsivity mediated the BPD–BMI association, with impulsiveness exerting a stronger mediation effect than deliberation. Obesity interventions that improve inhibitory control may be most effective for individuals with BPD pathology.     

The interplay of attention and emotion: top-down attention modulates amygdala activation in psychopathy

Psychopathic behavior has long been attributed to a fundamental deficit in fear that arises from impaired amygdala function. Growing evidence has demonstrated that fear-potentiated startle (FPS) and other psychopathy-related deficits are moderated by focus of attention, but to date, no work on adult psychopathy has examined attentional modulation of the amygdala or concomitant recruitment of relevant attention-related circuitry. Consistent with previous FPS findings, here we report that psychopathy-related differences in amygdala activation appear and disappear as a function of goal-directed attention. Specifically, decreased amygdala activity was observed in psychopathic offenders only when attention was engaged in an alternative goal-relevant task prior to presenting threat-relevant information. Under this condition, psychopaths also exhibited greater activation in selective-attention regions of the lateral prefrontal cortex (LPFC) than did nonpsychopaths, and this increased LPFC activation mediated psychopathy’s association with decreased amygdala activation. In contrast, when explicitly attending to threat, amygdala activation did not differ in psychopaths and nonpsychopaths. This pattern of amygdala activation highlights the potential role of LPFC in mediating the failure of psychopathic individuals to process fear and other important information when it is peripheral to the primary focus of goal-directed attention.     

Attachment, borderline personality, and romantic relationship dysfunction

Previous studies have implicated attachment and disturbances in romantic relationships as important indicators for Borderline Personality Disorder (BPD). The current research extends our current knowledge by examining the specific associations among attachment, romantic relationship dysfunction, and BPD, above and beyond the contribution of emotional distress and nonromantic interpersonal functioning in two distinct samples. Study 1 comprised a community sample of women (N = 58) aged 25-36. Study 2 consisted of a psychiatric sample (N = 138) aged 21-60. Results from both Study 1 and Study 2 demonstrated that (1) attachment was specifically related to BPD symptoms and romantic dysfunction, (2) BPD symptoms were specifically associated with romantic dysfunction, and (3) the association between attachment and romantic dysfunction was statistically mediated by BPD symptoms. The findings support specific associations among attachment, BPD symptoms, and romantic dysfunction.     

Overgeneral autobiographical memory predicts higher prospective levels of depressive symptoms and intrusions in borderline patients

Overgeneral memory (OGM), the tendency to retrieve categories of events from autobiographical memory instead of single events, is found to be a reliable predictor for future mood disturbances and post-traumatic symptom severity. Patients with borderline personality disorder (BPD) often report co-morbid episodes of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Therefore, we investigated whether OGM would predict depression severity and (post-traumatic) stress symptoms in BPD patients. At admission (N?=?54) and at six-month follow-up (N?≥?31), BPD patients completed the Structured Clinical Interview for DSM-IV Disorders, the Assessment of DSM-IV Personality Disorders, the Autobiographical Memory Test, the Beck Depression Inventory—2nd edition (BDI-II), and the Impact of Event Scale. OGM at baseline predicted (a) higher levels of depressive symptoms at follow-up and (b) more intrusions related to a stressful event over and above baseline levels of borderline symptoms, depressive symptoms, and intrusions, respectively. No association was found between memory specificity and event-related avoidance at follow-up. Despite previous findings suggesting that OGM in BPD is less robust than in MDD and PTSD, our results suggest that memory specificity in BPD patients may have some relevance for the course of depressive and stress symptomatology in BPD.     

A preliminary, randomized trial of psychoeducation for women with borderline personality disorder

The main objective of this study was to determine whether being taught the latest information concerning borderline personality disorder (BPD) leads to a decline in core BPD symptoms and an improvement in psychosocial functioning. Fifty-five late adolescent women participated in a rigorous diagnostic assessment and 50 met DIB-R and DSM-IV criteria for BPD. All 50 were informed that they met criteria for BPD. Then 30 were randomized to a psychoeducation workshop that took place within a week of diagnostic disclosure. The other 20 were assigned to a waitlist and participated in the workshop at the end of this 12-week study. The two primary outcome measures were readministered each week of the trial: the Zanarini Rating Scale for DSM-IV Borderline Personality Disorder (ZAN-BPD) and the Sheehan Disability Scale (SDS). Immediate psychoeducation concerning the BPD diagnosis was associated with a significantly greater decline in general impulsivity and the storminess of close relationships. However, it did not result in significantly improved psychosocial functioning. Taken together, the results of this study suggest that informing patients about BPD soon after diagnostic disclosure may help to alleviate the severity of two of the core elements of borderline psychopathology-general impulsivity and unstable relationships. They also suggest that such instruction may prove to be a useful and cost-efficient form of pre-treatment.     

Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients

To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.     

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal conflict of Oppositional Defiant Disorder (ODD) and the impulsivity of Attention Deficit Hyperactivity Disorder (ADHD) in particular may be indicative of an early developmental path towards BPD. The present study uses longitudinal data from a clinical sample of 177 boys, initially between the ages of 7 and 12, who were followed up annually to age 18, and who were reassessed at age 24 (n = 142). The study examines the prediction from repeated childhood measures of psychopathology measured annually through adolescence to BPD symptoms assessed at age 24, accounting for the effects of covariates including substance use, other personality disorders at age 24 and harsh physical punishment. The prevalence of BPD in this sample was consistent with other population estimates. Attention Deficit Hyperactivity Disorder (ADHD) and ODD were the only child psychiatric disorders to predict BPD symptoms, and the oppositional behavioral dimension of ODD was particularly predictive of BPD. These results indicate possible developmental links between early psychiatric disorders and BPD.     

An investigation of organic factors in the neuropsychological functioning of patients with borderline personality disorder

The hypothesis to be tested in this study was that the cognitive deficits that have been documented in patients with Borderline Personality Disorder (BPD) are largely the consequence of organic insult, either developmental or acquired. Using a cross-sectional design, 80 subjects (males and females) who met the criteria for BPD participated in the study. They completed a battery of neuropsychological tests and a comprehensive interview assessing organic status as well as measures of the potentially confounding factors of current levels of depression and anxiety. It was expected that BPD-patients with a probable history of organic insult would perform significantly worse than would BPD patients without such a history. Analyses of the results provided partial support for the hypothesis. Subjects with both BPD and a history of organic insult were significantly more impaired on several measures including measures of attention than were BPD only subjects. The results suggested that the impaired cognitive performance of persons diagnosed with BPD may, in part, be attributed to organic factors.     

Use of structured self-report assessment to diagnose borderline personality disorder during major depressive episodes

Diagnosis of borderline personality disorder (BPD) during episodes of major depression (MDE), although clinically important, is complicated in several respects when using self-report methods. Structured interview data were used to select a group of patients with comorbid BPD (n=21) from a sample of outpatients presenting with MDE. This group was compared with a group of MDE patients without BPD (n=24) and with a group of community controls (n=20) using self-report data from the Personality Assessment Inventory (PAI), the revised Personality Diagnostic Questionnaire (PDQ), and the Beck Depression Inventory (BDI). Analyses revealed that the BPD group obtained significantly higher scores on PAI and PDQ scales measuring features of BPD and on the PAI Negative Impression Management scale. The severity and type of MDE symptoms reported on the PAI and BDI did not differentiate the clinical groups. These data show that useful information for the diagnosis of BPD during depressive episodes can be gathered from self-report assessment instruments like the PAI.     

Differential effects of the menstrual cycle on reactive and proactive aggression in borderline personality disorder

Borderline personality disorder (BPD) is characterized by rapidly shifting symptoms, including intense anger and aggressive behavior. Understanding how fluctuations in ovarian hormones across the menstrual cycle may contribute to symptom instability is key for accurate assessment of BPD symptoms and effective interventions. Reactive and proactive aggression, as well as anger-in and anger-out, were assessed daily in 15 physically healthy, unmedicated naturally cycling female individuals meeting criteria for BPD across 35 days. Urine luteinizing hormone surge and salivary progesterone were used to confirm ovulation and verify the cycle phase. Multilevel models evaluated cyclical differences of symptoms between cycle phases. Both forms of aggressive behavior demonstrated marked cycle effects, with reactive aggression highest during the midluteal cycle phase, co-occurring with initial increases in anger and irritability and followed by perimenstrual peaks in anger and anger-in. In contrast, highest levels of proactive aggression were observed during the follicular and ovulatory phases, when emotional symptoms and anger were otherwise at lowest levels. These findings highlight the importance of identifying the function of aggression when considering potential psychological and biological influences. Naturally cycling individuals with BPD may be at elevated risk for luteal worsening of a range of interpersonally reactive symptoms, including reactive aggression, whereas proactive aggression may occur more in phases characterized by less emotional and cognitive vulnerability and greater reward sensitivity. Research on aggression in this population should consider cycle effects. Cycling individuals with BPD attempting to reduce aggressive behavior may benefit from cycle-tracking to increase awareness of these effects and to develop appropriate strategies.     

Family members' knowledge about borderline personality disorder: correspondence with their levels of depression, burden, distress, and expressed emotion

Borderline personality disorder (BPD) is a severe and generally chronic disorder that presents patients and their family members with multiple challenges. Little is currently known about how much family members of patients with BPD know about this disorder. Thirty-two family members of BPD patients were assessed for their level of knowledge about BPD. Knowledge level was then correlated with family members' burden, depression, distress, and expressed emotion. Contrary to expectation, greater knowledge about BPD was associated with higher levels of family members' burden, distress, depression, and greater hostility toward patients. These findings raise concerns about (a) the value of information family members receive about BPD and (b) the importance of the source and accuracy of the information they receive. Further research is warranted and may provide additional information to this understudied area.     

High-lethality status in patients with borderline personality disorder

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.     

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.     

The impact of task-irrelevant emotional stimuli on attention in three domains

Whether task-irrelevant emotional stimuli facilitate or disrupt attention performance may depend on a range of factors, such as emotion type, task difficulty, and stimulus duration. Few studies, however, have systematically examined the influence of these factors on attention performance. Sixty-three adults, scoring within a normative range for mood and anxiety symptoms, completed either an easy or difficult version of an attention task measuring three aspects of attention performance: alerting, orienting, and executive attention. Results showed that in the easy task only, threatening versus nonthreatening task-irrelevant emotional faces facilitated orienting regardless of stimulus duration. These effects were no longer significant during the difficult condition. When the easy and difficult conditions were examined together, duration effects emerged such that stimuli of longer durations lead to greater interference, although effects were nonlinear. Findings illustrate that threat-relevant emotional stimuli facilitate attention during tasks with low cognitive load, but underscore the importance of considering a range of task parameters. Results are discussed in the context of adaptive and maladaptive emotion-attention interactions.     

Emotional responses to a negative emotion induction procedure in Borderline Personality Disorder

The aim of this study was to determine if patients with Borderline Personality Disorder (BPD) present higher emotional response than healthy controls in a laboratory setting. Fifty participants (35 patients with BPD and 15 healthy controls) underwent a negative emotion induction procedure (presentation of standardized unpleasant images). Subjective emotional responses were assessed by means of self-reported questionnaires while biological reactivity during the procedure was measured through levels of salivary cortisol (sCORT) and alphaamylase (sAA). Patients with BPD exhibited significant lower cortisol levels and higher sAA levels compared to controls. Self-reported emotional reactivity did not give rise to differences between groups but participants with BPD did present higher levels of negative emotional intensity at baseline and during the entire procedure. The findings do not give support to the emotional hyperreactivity hypothesis in BPD. However, BPD patients presented heightened negative mood intensity at baseline, which should be considered a hallmark of the disorder. Further studies using more BPD-specific emotion inductions are needed to confirm the trends observed in this study.     

Stress regulation and incision in borderline personality disorder-a pilot study modeling cutting behavior

Emotion dysregulation in Borderline Personality Disorder (BPD) is characterized by high baseline negative intensity, high reactivity, and slow return to baseline. Patients with BPD often engage in self-injurious behavior because it leads to immediate relief of stress levels. We aimed to assess stress regulation as well as the influence of tissue damage on subjective (aversive tension) and objective (heart rate) stress correlates in BPD. In 14 unmedicated patients with BPD and 18 healthy controls, a stress induction was followed by an incision into the forearm conducted by an investigator. For aversive tension, we found elevated baseline levels as well as slower return to baseline in BPD. In controls, incision resulted in a short-term increase of aversive tension, whereas tension and heart rate decreased in the BPD group. Our preliminary results support the hypothesis that tissue damage may play a role in disturbed stress regulation in BPD.     

Clinical,neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review

Attention Deficit/Hyperactivity Disorder (ADHD) symptoms overlap with Borderline Personality Disorder (BPD). Since ADHD presents earlier than BPD, ADHD might be either a risk factor or a prodromal stage in the development of BPD or in the reinforcement of its symptoms. However, despite the similar phenomenological origin of the two disorders, ADHD and BPD patients often present discrete profiles. The present study reviews literature data of the clinical, neuropsychological and structural convergences and divergences of ADHD and BPD. A total of 185 studies were identified that address the association of ADHD and BPD and relate to clinical, neuropsychological and structural parameters. The total number of articles included was 45. ADHD exhibits a more outwardly expressed symptomatology, with difficulties in inhibition control and dysfunction in ventrolateral prefrontal regions. BPD presents a more mixed picture of externalizing and interrelating clinical features with emotionally conditioned cognitive disturbances and dysfunction in the orbitofrontal and dorsolateral prefrontal regions. When considering the three abovementioned parameters there is no unique clear-cut point that can differentiate the two disorders in a definitive way. Both disorders share impulsivity, emotional dysregulation, deficits in attention and decision making, brain volume reductions and connectivity impairments in prefrontal and limbic areas.