Executive neurocognition, memory systems, and borderline personality disorder

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Abstract

Borderline Personality Disorder (BPD) is a common, disabling, and burdensome psychiatric condition. It is characterized by turbulent fluctuations of negative emotions and moods, unstable and conflictual interpersonal relationships, an incoherent and often contradictory sense of self, and impulsive, potentially lethal self-injurious behaviors. The neurobehavioral facets of BPD have not been extensively studied. However, clinical theoreticians and researchers have proposed that the symptoms and behaviors of BPD are, in part, associated with disruptions in basic neurocognitive processes. This review summarizes and evaluates research that has investigated the relationship between executive neurocognition, memory systems, and BPD. Three historical phases of research are delineated and reviewed, and the methodological and conceptual challenges this body of investigation highlights are discussed. Laboratory-based assessment of executive neurocognition and memory systems is integral to an interdisciplinary approach to research in BPD. Such an approach holds promise in elucidating the neurobehavioral facets, development, diagnostic boundaries, prevention, and optimal interventions for this debilitating and enigmatic disorder.

Section snippets

Memory systems

Memory can be organized into five distinct systems (see Schacter, Wagner, & Buckner, 2000 for review): working memory, semantic memory, episodic memory, the perceptual representational system, and procedural memory. Studies of BPD to date have almost exclusively focused on working memory, semantic memory, and, to a lesser extent, episodic memory in BPD.

Working memory involves the conscious storage and manipulation of mental representations. It involves a tripartite set of functions, a central

Historical phases of cognitive inhibition and memory research on BPD

In the next section, we review and summarize the findings from three historical phases of research of cognitive inhibition and memory in the borderline personality.

General discussion

Several questions emerge from the existing studies. (1) How does the literature on executive neurocognition and memory contribute to the understanding of BPD from developmental and neurobiological perspectives? (2) What are the implications of these findings for modeling BPD and refining the taxonomy of BPD in relation to neighboring disorders? (3) What is the clinical relevance of these findings? (4) Can clinical perspectives of BPD help guide future research in this area?

Limitations and caveats

The studies of executive neurocognitive and memory processes and BPD share many measurement and methodological limitations, and investigating BPD individuals raises many unique challenges in clinical research, which we mention briefly. (1) The polythetic nature of DSM-IV (American Psychiatric Association, 1994) BPD diagnostic system creates the frequent occurrence that even individuals who meet criteria for BPD have quite different clinical presentations. (2) The absence of empirically and

Conclusion

In distillation, the main findings of this review are: (1) Well-characterized groups of BPD subjects appear to exhibit non-specific deficits in multiple domains of executive neurocognitive and memory performance in comparison to psychiatric and non-clinical groups. On a cautionary note, complicating factors such as co-occurring conditions, state-dependent effects, omnibus measurement, small sample sizes, and a limited number of studies implore us to be tentative about this pattern of findings.

Acknowledgements

Preparation of this article was supported, in part, by the Leslie Glass Foundation, the Borderline Personality Disorder Research Foundation, and an NIH National Research Service Award (MH015144).

We would like to thank John G. Keilp, Otto F. Kernberg, Michael I. Posner, Steven Roose, the Research Group of the Columbia University Center for Psychoanalytic Training and Research, and three anonymous reviewers for their thoughtful comments on earlier versions of this article. Melissa Stanley

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