Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-17T11:45:24.671Z Has data issue: false hasContentIssue false
  • English
  • Français

Impulsivity in patients with borderline personality disorder: a comprehensive profile compared with healthy people and patients with ADHD

Published online by Cambridge University Press:  23 August 2019

Pavla Linhartová Open the ORCID record for Pavla Linhartová [Opens in a new window] ,
Adéla Látalová ,
Richard Barteček ,
Jan Širůček ,
Pavel Theiner ,
Anastasia Ejova ,
Pavlína Hlavatá ,
Barbora Kóša ,
Barbora Jeřábková  and
Martin Bareš
...Show all authors
Pavla Linhartová*
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Adéla Látalová
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Richard Barteček
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Jan Širůček
Affiliation:
Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic
Pavel Theiner
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Anastasia Ejova
Affiliation:
Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
Pavlína Hlavatá
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic Behavioral and Social Neuroscience Research Group, CEITEC – Central European Institute of Technology, Masaryk University, Brno, Czech Republic
Barbora Kóša
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Barbora Jeřábková
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
Martin Bareš
Affiliation:
First Department of Neurology, St. Anne's Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic Department of Neurology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
Tomáš Kašpárek
Affiliation:
Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
*
Author for correspondence: Pavla Linhartová, E-mail: pavla.linhartova@med.muni.cz
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Impulsivity is a core symptom of borderline personality disorder (BPD). Impulsivity is a heterogeneous concept, and a comprehensive evaluation of impulsivity dimensions is lacking in the literature. Moreover, it is unclear whether BPD patients manifest impaired cognitive functioning that might be associated with impulsivity in another patient group, such as ADHD, a frequent comorbidity of BPD.

Methods

We tested 39 patients with BPD without major psychiatric comorbidities and ADHD, 25 patients with ADHD, and 55 healthy controls (HC) using a test battery consisting of a self-report measure of impulsivity (UPPS-P questionnaire), behavioral measures of impulsivity – impulsive action (Go/NoGo task, stop signal task) and impulsive choice (delay discounting task, Iowa gambling task), and standardized measures of attention (d2 test), working memory (digit span), and executive functioning (Tower of London).

Results

Patients with BPD and ADHD, as compared with HC, manifested increased self-reported impulsivity except sensation seeking and increased impulsive choice; patients with ADHD but not BPD showed increased impulsive action and deficits in cognitive functioning. Negative urgency was increased in BPD as compared to both HC and ADHD groups and correlated with BPD severity.

Conclusions

Patients with BPD without ADHD comorbidity had increased self-reported impulsivity and impulsive choice, but intact impulsive action and cognitive functioning. Controlling for ADHD comorbidity in BPD samples is necessary. Negative urgency is the most diagnostically specific impulsivity dimension in BPD.

Keywords

ADHDattentionborderline personality disordercognitive functionsdecision makingexecutive functionsimpulsivityurgencyworking memory.
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 11 , August 2020 , pp. 1829 - 1838
Check for updates
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alderson, RM, Kasper, LJ, Hudec, KL and Patros, CHG (2013) Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: a meta-analytic review. Neuropsychology 27, 287–302.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM 5. Washington DC, London: American Psychiatric Association.Google Scholar
Andreasen, NC, Flaum, M and Arndt, S (1992) Comprehensive assessment of symptoms and history (CASH): an instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615–623.CrossRefGoogle ScholarPubMed
Barker, V, Romaniuk, L, Cardinal, RN, Pope, M, Nicol, K and Hall, J (2015) Impulsivity in borderline personality disorder. Psychological Medicine 45, 1955–1964.CrossRefGoogle ScholarPubMed
Barteček, R, Hořínková, J, Linhartová, P and Kašpárek, T (2019) Emotional impulsivity is connected to suicidal attempts and health care utilization in patients with borderline personality disorder. General Hospital Psychiatry 56, 54–55.CrossRefGoogle Scholar
Bazanis, E, Rogers, RD, Dowson, JH, Taylor, P, Meux, C, Staley, C, Nevinson-Andrews, D, Taylor, C, Robbins, TW and Sahakian, BJ (2002) Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychological Medicine 32, 1395–1405.CrossRefGoogle ScholarPubMed
Berenson, KR, Gregory, WE, Glaser, E, Romirowsky, A, Rafaeli, E, Yang, X and Downey, G (2016) Impulsivity, rejection sensitivity, and reactions to stressors in borderline personality disorder. Cognitive Therapy and Research 40, 510–521.CrossRefGoogle ScholarPubMed
Bøen, E, Hummelen, B, Elvsåshagen, T, Boye, B, Andersson, S, Karterud, S and Malt, UF (2015) Different impulsivity profiles in borderline personality disorder and bipolar II disorder. Journal of Affective Disorders 170, 104–111.CrossRefGoogle ScholarPubMed
Brickenkamp, R, Schmidt-Atzert, L, Liepmann, D, Hoskovcová, S and Černochová, D (2014) d2 Attention Test Revised (Czech Version). Prague: Hogrefe – Testcentrum.Google Scholar
Cackowski, S, Reitz, AC, Ende, G, Kleindienst, N, Bohus, M, Schmahl, C and Krause-Utz, A (2014) Impact of stress on different components of impulsivity in borderline personality disorder. Psychological Medicine 44, 3329–3340.CrossRefGoogle ScholarPubMed
Chan, RCK, Shum, D, Toulopoulou, T and Chen, EYH (2008) Assessment of executive functions: review of instruments and identification of critical issues. Archives of Clinical Neuropsychology 23, 201–216.CrossRefGoogle ScholarPubMed
Culbertson, W and Zillmer, E (2005) Tower of London – Drexel University, 2nd Edn. Toronto: Multi-Health Systems.Google Scholar
Cyders, MA and Smith, GT (2007) Mood-based rash action and its components: positive and negative urgency. Personality and Individual Differences 43, 839–850.CrossRefGoogle Scholar
DeShong, HL and Kurtz, JE (2013) Four factors of impulsivity differentiate antisocial and borderline personality disorders. Journal of Personality Disorders 27, 144–156.CrossRefGoogle ScholarPubMed
Dinc, L and Cooper, AJ (2015) Positive affective states and alcohol consumption: the moderating role of trait positive urgency. Addictive Behaviors 47, 17–21.CrossRefGoogle ScholarPubMed
Estle, SJ, Green, L, Myerson, J and Holt, DD (2006) Differential effects of amount on temporal and probability discounting of gains and losses. Memory & Cognition 34, 914–928.CrossRefGoogle ScholarPubMed
Feliu-Soler, A, Soler, J, Elices, M, Pascual, JC, Pérez, J, Martín-Blanco, A, Santos, A, Crespo, I, Pérez, V and Portella, MJ (2013) Differences in attention and impulsivity between borderline personality disorder and bipolar disorder. Psychiatry Research 210, 1307–1309.CrossRefGoogle ScholarPubMed
Fernie, G and Tunney, RJ (2006) Some decks are better than others: the effect of reinforcer type and task instructions on learning in the Iowa Gambling Task. Brain and Cognition 60, 94–102.CrossRefGoogle ScholarPubMed
Hagenhoff, M, Franzen, N, Koppe, G, Baer, N, Scheibel, N, Sammer, G, Gallhofer, B and Lis, S (2013) Executive functions in borderline personality disorder. Psychiatry Research 210, 224–231.CrossRefGoogle ScholarPubMed
Jacob, GA, Gutz, L, Bader, K, Lieb, K, Tüscher, O and Stahl, C (2010) Impulsivity in borderline personality disorder: impairment in self-report measures, but not behavioral inhibition. Psychopathology 43, 180–188.CrossRefGoogle Scholar
Kooij, JJS (2012) Adult ADHD: Diagnostic assessment and treatment (3rd ed.). London: Springer-Verlag.Google Scholar
Krause-Utz, A, Cackowski, S, Daffner, S, Sobanski, E, Plichta, MM, Bohus, M, Ende, G and Schmahl, C (2016) Delay discounting and response disinhibition under acute experimental stress in women with borderline personality disorder and adult attention deficit hyperactivity disorder. Psychological Medicine 46, 3137–3149.CrossRefGoogle ScholarPubMed
Lampe, K, Konrad, K, Kroener, S, Fast, K, Kunert, HJ and Herpertz, SC (2007) Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychological Medicine 37, 1717–1729.CrossRefGoogle ScholarPubMed
Law, M, Fleeson, W, Arnold, E and Furr, R (2016) Using negative emotions to trace the experience of borderline personality pathology: interconnected relationships revealed in an experience sampling study. Journal of Personality Disorders 30, 52–70.CrossRefGoogle Scholar
LeGris, J, Toplak, M and Links, PS (2014) Affective decision making in women with borderline personality disorder. Journal of Personality Disorders 28, 698–719.CrossRefGoogle ScholarPubMed
Lieb, K, Völlm, B, Rücker, G, Timmer, A and Stoffers, JM (2010) Pharmacotherapy for borderline personality disorder: cochrane systematic review of randomised trials. British Journal of Psychiatry 196, 4–12.CrossRefGoogle ScholarPubMed
Linhartová, P, Širůček, J, Barteček, R, Theiner, P, Jeřábková, B, Rudišinová, D and Kašpárek, T (2017) Czech versions of impulsivity self-report scales and their psychometric properties. Czech and Slovak Psychiatry 113, 149–157.Google Scholar
Linhartová, P, Širůček, J, Ejova, A, Barteček, R, Theiner, P and Kašpárek, T (2019) Dimensions of impulsivity in healthy people, patients with borderline personality disorder, and patients with attention-deficit/hyperactivity disorder. Journal of Attention Disorders.CrossRefGoogle ScholarPubMed
Lopez, R, Dauvilliers, Y, Jaussent, I, Billieux, J and Bayard, S (2015) A multidimensional approach of impulsivity in adult attention deficit hyperactivity disorder. Psychiatry Research 227, 290–295.CrossRefGoogle ScholarPubMed
MacKillop, J, Weafer, J, Gray, J, Oshri, A, Palmer, A and de Wit, H (2016) The latent structure of impulsivity: impulsive choice, impulsive action, and impulsive personality traits. Psychopharmacology 233, 3361–3370.CrossRefGoogle ScholarPubMed
McClure, G, Hawes, DJ and Dadds, MR (2016) Borderline personality disorder and neuropsychological measures of executive function: a systematic review. Personality and Mental Health 10, 43–57.CrossRefGoogle ScholarPubMed
Mowinckel, AM, Pedersen, ML, Eilertsen, E and Biele, G (2015) A meta-analysis of decision-making and attention in adults with ADHD. Journal of Attention Disorders 19, 355–367.CrossRefGoogle ScholarPubMed
Myerson, J, Green, L and Warusawitharana, M (2001) Area under the curve as a measure of discounting. Journal of the Experimental Analysis of Behavior 76, 235–243.CrossRefGoogle ScholarPubMed
Nica, E and Links, P (2009) Affective instability in borderline personality disorder: experience sampling findings. Current Psychiatry Reports 11, 74–81.CrossRefGoogle ScholarPubMed
Nigg, JT (2017) Annual research review: on the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines 58, 361–383.CrossRefGoogle ScholarPubMed
Odum, AL (2011) Delay discounting: I'm a k, you're a k. Journal of the Experimental Analysis of Behavior 96, 427–439.CrossRefGoogle Scholar
Pani, P, Menghini, D, Napolitano, C, Calcagni, M, Armando, M, Sergeant, JA and Vicari, S (2013) Proactive and reactive control of movement are differently affected in attention deficit hyperactivity disorder children. Research in Developmental Disabilities 34, 3104–3111.CrossRefGoogle ScholarPubMed
Paret, C, Hoesterey, S, Kleindienst, N and Schmahl, C (2016) Associations of emotional arousal, dissociation and symptom severity with operant conditioning in borderline personality disorder. Psychiatry Research 244, 194–201.CrossRefGoogle ScholarPubMed
Paret, C, Jennen-Steinmetz, C and Schmahl, C (2017) Neuroscience and biobehavioral reviews disadvantageous decision-making in borderline personality disorder: partial support from a meta-analytic review. Neuroscience and Biobehavioral Reviews 72, 301–309.CrossRefGoogle ScholarPubMed
Patros, CHG, Alderson, RM, Kasper, LJ, Tarle, SJ, Lea, SE and Hudec, KL (2016) Choice-impulsivity in children and adolescents with attention-deficit/hyperactivity disorder (ADHD): a meta-analytic review. Clinical Psychology Review 43, 162–174.CrossRefGoogle ScholarPubMed
Pedersen, SL, Walther, CAP, Harty, SC, Gnagy, EM, Pelham, WE and Molin, BSG (2016) The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity. Addiction 111, 1582–1589.CrossRefGoogle ScholarPubMed
Peters, JR, Upton, BT and Baer, RA (2013) Brief report: relationships between facets of impulsivity and borderline personality features. Journal of Personality Disorders 27, 547–552.CrossRefGoogle ScholarPubMed
Peters, J, Derefinko, K and Lynam, D (2017) Negative urgency accounts for the association between borderline personality features and intimate partner violence in young men. Journal of Personality Disorders 31, 16–25.CrossRefGoogle ScholarPubMed
Pievsky, MA and Mcgrath, RE (2018) The neurocognitive profile of attention-deficit / hyperactivity disorder: a review of meta-analyses. Archives of Clinical Neuropsychology 33, 143–157.CrossRefGoogle ScholarPubMed
Robinson, ESJ, Eagle, DM, Economidou, D, Theobald, DEH, Mar, AC, Murphy, ER, Robbins, TW and Dalley, JW (2009) Behavioural characterisation of high impulsivity on the 5-choice serial reaction time task: specific deficits in “waiting” versus “stopping”. Behavioural Brain Research 196, 310–316.CrossRefGoogle ScholarPubMed
Rose, P and Segrist, DJ (2014) Negative and positive urgency may both be risk factors for compulsive buying. Journal of Behavioral Addictions 3, 128–132.CrossRefGoogle ScholarPubMed
Sebastian, A, Jacob, G, Lieb, K and Tüscher, O (2013) Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation. Current Psychiatry Reports 15, 339.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal Of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
Stanger, C, Ryan, SR, Fu, H, Landes, RD, Jones, BA, Bickel, WK and Budney, AJ (2012) Delay discounting predicts adolescent substance abuse treatment outcome. Experimental and Clinical Psychopharmacology 20, 205–212.CrossRefGoogle ScholarPubMed
Steenkamp, MM, Suvak, MK, Dickstein, BD, Shea, MT and Litz, BT (2015) Emotional functioning in obsessive-compulsive personality disorder: comparison to borderline personality disorder and healthy controls. Journal of Personality Disorders 29, 794–808.CrossRefGoogle ScholarPubMed
Stevens, A, Burkhardt, M, Hautzinger, M, Schwarz, J and Unckel, C (2004) Borderline personality disorder: impaired visual perception and working memory. Psychiatry Research 125, 257–267.CrossRefGoogle ScholarPubMed
Stoffers-Winterling, J, Völlm, B, Rücker, G, Timmer, A, Huband, N and Lieb, K (2012) Psychological therapies for people with borderline personality disorder. The Cochrane Database of Systematic Reviews 8, 1–259.Google Scholar
Svěrák, T, Linhartová, P, Fiala, A and Kašpárek, T (2018) Repetitive transcranial magnetic stimulation treating impulsivity in borderline personality disorder and attention deficit/hyperactivity disorder. In Ustohal, L (ed.), Transcranial Magnetic Stimulation in Neuropsychiatry. London: IntechOpen, pp. 41–63.Google Scholar
Taherifard, M, Abolghasemi, A and Hajloo, N (2015) Positive and negative urgency and sleep quality among patients with borderline and antisocial personality disorder. Archives of Psychiatry and Psychotherapy 17, 105–112.CrossRefGoogle Scholar
Toplak, ME, Jain, U and Tannock, R (2005) Executive and motivational processes in adolescents with attention-deficit-hyperactivity disorder (ADHD). Behavioral and Brain Functions 12, 1–12.Google Scholar
Tragesser, SL and Robinson, RJ (2009) The role of affective instability and UPPS impulsivity in borderline personality disorder features. Journal of Personality Disorders 23, 370–383.CrossRefGoogle ScholarPubMed
van Eijk, J, Sebastian, A, Krause-Utz, A, Cackowski, S, Demirakca, T, Biedermann, SV, Lieb, K, Bohus, M, Schmahl, C, Ende, G and Tüscher, O (2015) Women with borderline personality disorder do not show altered BOLD responses during response inhibition. Psychiatry Research – Neuroimaging 234, 378–389.CrossRefGoogle Scholar
Wechsler, D (1997) Wechsler Adult Intelligence Scale – Third Edition Manual. San Antonio: The Psychological Corporation.Google Scholar
Weiss, NH, Tull, MT, Sullivan, TP, Dixon-Gordon, KL and Gratz, KL (2015) Posttraumatic stress disorder symptoms and risky behaviors among trauma-exposed inpatients with substance dependence: the influence of negative and positive urgency. Drug and Alcohol Dependence 155, 147–153.CrossRefGoogle ScholarPubMed
Whiteside, SP and Lynam, DR (2001) The five factor model and impulsivity: using a structural model of personality to understand impulsivity. Personality and Individual Differences 30, 669–689.CrossRefGoogle Scholar
Winstanley, CA, Eagle, DM and Robbins, TW (2006) Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clinical Psychology Review 26, 379–395.CrossRefGoogle ScholarPubMed
Zanarini, MC, Gunderson, JG, Frankenburg, FR and Chauncey, DL (1989) The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. Journal of Personality Disorders 3, 10–18.CrossRefGoogle Scholar
Zapolski, TCB, Cyders, MA and Smith, GT (2009) Positive urgency predicts illegal drug use and risky sexual behavior. Psychology of Addictive Behaviors 23, 348–354.CrossRefGoogle ScholarPubMed
Supplementary material: File

Linhartová et al. supplementary material

Linhartová et al. supplementary material 1

Download Linhartová et al. supplementary material(File)
File 26 KB
Supplementary material: File

Linhartová et al. supplementary material

Linhartová et al. supplementary material 2

Download Linhartová et al. supplementary material(File)
File 43.7 KB