Brief report
Executive functioning among patients with borderline personality disorder (BPD) and their relatives

https://doi.org/10.1016/j.jad.2012.05.007Get rights and content

Abstract

Background

Studies focusing on executive functioning in patients with borderline personality disorder (BPD) have shown divergent results. Moreover, little attention has been paid to the potential role of deficits in executive functions as markers of familial vulnerability to BPD. Thus, the aim of the present study was to investigate executive functions in both patients BPD and their unaffected first-degree relatives (parents).

Method

We examined executive functions in four groups: patients with BPD (n=27), age-matched healthy controls (n=29), healthy unaffected parents of patients in the BPD group (n=20) and their respective age-matched controls (n=22). We administered tests that tapped three domains of executive functions: cognitive planning, sustained attention, and spatial working memory. All tests form part of the Cambridge Neuropsychological Test Automated Battery (CANTAB) battery.

Results

BPD patients displayed deficient executive functioning as compared to healthy controls in the domains of cognitive planning, sustained attention and working memory. Both BPD patients and their parents showed reduced latency to initiate the first move on the planning task [CANTAB's Tower of London]. All other measurements of executive functions did not differ significantly between parents of BPD patients and their respective healthy controls.

Limitation

Results should be replicated with a larger sample size.

Conclusions

BPD patients demonstrate a generalized profile of executive dysfunction. In the group comprising their parents, however, we found a lack of evidence for executive dysfunctions. Hence, executive dysfunctions do not appear to be markers of familial vulnerability for BPD.

Introduction

Borderline personality disorder (BPD) patients were found to have deficits in executive functioning (EF) in most (LeGris and van Reekum, 2006), though not all, studies (Kunert et al., 2003, Sprock et al., 2000). Their most significant deficit may be in cognitive planning, as a meta-analysis conducted by Ruocco (2005) points toward. Since EF is considered to be an important determinant of self-regulation (Schmeichel, 2007), deficits in these functions are assumed to underlie the phenotypic features of BPD, such as increased impulsivity, suicidal and self-destructive behaviors (Bazanis et al., 2002, Burgess, 1991).

Although executive dysfunctions have been suggested as markers of familial vulnerability in various disorders (Conklin et al., 2000, Delorme et al., 2007), studies focusing on the EF of relatives with BPD patients are currently lacking. Moreover, only few studies have examined EF in BPD as compared to other disorders (e.g., Dowson et al., 2004). Since studies have shown the substantial heritability of BPD, examining whether BPD patients and their relatives share executive dysfunctions may shed light on the potential role of these deficits as markers of familial vulnerability to BPD. Thus, the present study sought to investigate EF in BPD patients and their unaffected parents. Three domains of EF were assessed: cognitive planning, sustained attention, and working memory. We predicted that BPD patients would show deficits in EF and that their parents would share similar impairments in these functions.

Section snippets

Participants

The present study assessed four groups: BPD patients (BPD), their healthy controls (HC), parents of BPD patients (BPD-P), and their healthy controls (HC-P). Inclusion criteria for the BPD group were: diagnosis of BPD, which was confirmed by a senior psychiatrist using the structured clinical interview for the DSM-IV axis-II personality disorders (SCID-II; First et al., 1995). The lack of an active axis I disorder (Spitzer et al., 1992) was the exclusion criteria (For clinical data, see Table S1

BPD as compared to HC

The ANCOVA revealed a significant group by difficulty level effect on this measure [F(3,159)=3.23, p=.024]. We explored this effect further by comparing the groups at each level of difficulty. The analyses revealed that the groups differed in all difficulty levels (2–5 move stages; p=.001, p=.003, p=.002, p=.000, respectively), indicating that BPD patients had a significantly shorter initial thinking time than the HC group in each level of the ToL task. In addition, the groups differed on the

Discussion

Our findings revealed a profile of generalized executive dysfunctions among BPD patients, which is consistent with previous reports (LeGris and van Reekum, 2006). Importantly, our results of impaired planning in BPD patients is consistent with the meta analysis conducted by Ruocco (2005), who found that the largest deficit in EF of BPD patients was in the planning domain. Given that the frontal lobes have been implicated in tests of EF (Owen et al., 1990), these findings lend support to the

Role of funding source

The authors of this study received no special funds for this research Uncited reference.

Conflict of interest

The authors do not have any conflict of interest in the conduct and reporting of this research.

Acknowledgments

The Center would like to thank Anna Wexler for providing editorial assistance during the preparation and revision of the manuscript.

References (19)

There are more references available in the full text version of this article.

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