Autobiographical Memory Impairment in Borderline Personality Disorder: A Quantitative Meta-Analysis Interpreted In Terms Of The CaR-FA-X Model
Eszter Beran, PhD, Mara J. Richman, MA, and Zsolt Unoka,
Journal of Personality Disorders, Volume 33(6), 818-831, 2019

ABSTACT: Borderline personality disorder (BPD) is characterized by impaired functioning of autobiographical memory (AM). We use a quantitative meta-analysis to assess AM performance in adults diagnosed with BPD as compared to healthy controls (HC). Moderator variables included type of autobiographical memory as well as clinical and demographic variables. Large significant deficits were seen in the BPD group in comparison to the HC group. In the BPD group, effect sizes were large for overgenerality, omission, and specific memories, while not significant for recall. Age influenced the performance of the BPD group; in addition, there was a significant interaction between age and specificity of memory. Gender and IQ did not influence memory performance. Our results confirm that BPD patients show impairment in AM. We explain these impairments in terms of the CaR-FA-X model, based on mechanisms of capture and rumination, functional avoidance, and impaired executive control.

Autobiographical memory (AM)—the memory system that contains personal memories and knowledge of self-related past events—provides an important tool for maintaining stable self-representations. Since recollection processes of AM have basic importance to the composition of the self and a continuing sense of identity (Lorenzzoni, Silva, Poletto, Kristensen, & Gauer, 2014), the normal functioning of AM is considered a prerequisite for adaptive personality functioning (McAdams & Pals, 2006).

AM is composed of memories referring to past personal experience (Conway, 2001). According to Conway and Pleydell-Pearce (2000), “AMs are transitory dynamic mental constructions generated from an underlying knowledge base” (p. 261). During remembering, the knowledge base–contained self-relevant information enters consciousness in the form of personal memories. One important characteristic of AMs is that they contain memories of different specificity: broader conceptual themes in the life story, lifetime periods, general events, and event-specific knowledge (Conway & Pleydell-Pierce, 2000; Conway, Singer & Tagini, 2004). “Broader conceptual themes of the life story’” is based on a person’s understanding of how a normative life story is constructed within a given culture; it is also called the life-story schema. “Lifetime periods” refers to representations of prolonged periods of time with distinct start and end points. “General events” represent repeated or single events in an abstract way; and “event-specific knowledge” represents concrete sensory-perceptual aspects of unique events, including visual imagery. General events represent a form of AM psychologically distinct from specific memories, and in the retrieval process they are accessed earlier. Further, specific and general AMs can be distinguished at a neural level in terms of their greater associations with different regions of a common AM retrieval network (Addis, McIntosh, Moscovitch, Crawley, & McAndrews, 2004).

Autobiographical memory has been examined in several different measures; the Autobiographical Memory Test (AMT) is the most widely used. The AMT was first used by Williams and Broadbent (1986) on suicidal patients. The test requires participants to recall a specific episodic memory, answering to emotionally positive, negative, and neutral cue words within a given time period. Thus, the AMT test measures specific memories and overgeneral memories: extended memories that lasted more than one day; categoric memories, which are thematic summaries of events; and non-memories or semantic associates. In addition, AMT assess the frequency of omissions, in which the participant was unable to furnish a response, as well as latency time, in which participants respond to a given cue word.

Generative retrieval—used by the classic AMT—is a top-down process involving the retrieval of desired specific memories. During this process, the memory cue triggers an effortful search guided by the semantic knowledge of one’s own life, which eventually leads to successful recovery of a target memory. Memory for the target might be elaborated by recovering additional details that give episodic richness to the memory (Addis et al., 2004). The effortful search could fail in case of omission or could be captured at the level of semantic or more general knowledge of one’s life. The reduction in episodic richness could occur early during retrieval, while one is searching for the target memory, or late during retrieval, when one elaborates on recovered information. Elaboration processes might be also sensitive to BPD because they depend on an interaction between the recovery of specific details mediated by the hippocampus and strategic control processes mediated by the prefrontal cortex (PFC). Both processes and their associated brain regions are known to be affected in BPD, especially with early trauma history (Nunes et al., 2009), as well as in PTSD (Gilbertson et al., 2002) and depression (Young et al., 2012).

Williams and colleagues’ (2007) CaR-FA-X model postulates that overgeneral memory (OGM) results when the generative retrieval search process is aborted prematurely as a result of one or more of the three proposed mechanisms (Williams et al., 2007): capture and rumination (CaR), functional avoidance (FA), and impaired executive control (X) (Sumner, 2012). Capture and rumination refers to processes during retrieval by which conceptual self-relevant information activates rumination and hence “captures” cognitive resources and disrupts the retrieval search. Functional avoidance refers to the affect regulatory strategy by which retrieval of specific memories is avoided. Impaired executive control means that deficits in executive resources limit the ability to conduct a successful retrieval search (Sumner, 2012).

Retrieval of event-specific knowledge has been shown so far to be reduced in AM memories of patients with depression, trauma survivors, acute stress disorder, schizophrenia, PTSD, eating disorders, and parasuicide (Williams et al. 2007); however, it may also apply to borderline personality disorder. 

In BPD, research on AM has been contradictory. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013), patients’ diagnoses of BPD are characterized by identity disturbance: “markedly and persistently unstable self-image or sense of self” as well as “chronic feelings of emptiness,” which could be related to AM malfunctioning (Bech, Elkit & Simonsen, 2015). Further, individuals with BPD are characterized with impaired fronto-limbic connections, reduced volume of hippocampus that may underlie impaired executive functions, rumination, and capture. Also, individuals with BPD have high rates of childhood trauma (e.g., Goodman & Yehuda, 2002; Yen et al., 2002), PTSD (McGlashan et al., 2000; Yen et al., 2002; Zanarini et al., 1998), and depression (McGlashan et al., 2000; Zanarini et al., 1998), suggesting that if traumatic events, PTSD, and depression are crucial to overgenerality, then it would most likely be evident in BPD (Moore and Zoellner, 2007).

According to several earlier studies, people with BPD have a tendency for overgeneral memory (Jones et al., 1999; Korfine, 1998; Maurex et al., 2010)—thought to be a dissociative mechanism serving to avoid painful negative memories—but further studies failed to confirm this claim (Renneberg, Theobald, Nobs, & Weisbrod, 2005; Reid & Startup, 2010). Another finding contradictory to motives mentioned behind overgeneralization is that BPD patients recall more negative memories than healthy controls (Nigg, Lohr, Westen, Gold, & Silk, 1992) and view such as more relevant for today’s life (Rosenbach & Renneberg, 2015).

To our knowledge, there has been no meta-analysis on BPD in AM. In this study, we use a quantitative meta-analysis on AM performance of adults clinically diagnosed with BPD. We assess AM functioning in BPD patients as compared to healthy control participants (HC). We use Williams and colleagues’ (2007) CaR-FA-X model to interpret our findings. In addition, we discuss the limitation of our results based on the potential confounding factors that were not reported in most of the studies, like traumatic life events, comorbid depression, and PTSD that may be responsible for the overgeneral memory impairment.

. . . we sought to look at all the autobiographical memory types in the AMT; however, only the overgeneralizing, omission, specific, and recall types were reported in the final studies included in the meta-analysis.

Overgeneralizing referred to the participants’ response in the AMT when they could not recall personal memories of specific events; omission referred to the absence of responses to the AMT cue word, specific referred to the retrieving of a personal memory of specific events; and recall referred to the latency of retrieving specific memories to cue words.

DISCUSSION The present meta-analysis extends the current literature in autobiographical memory functioning in patients with BPD by quantifying the magnitude of autobiographical memory impairment relative to HC participants. We also specified potential moderator variables that may influence autobiographical memory performance in BPD. We found two systematic reviews on BPD (Bech et al., 2015; Van den Broeck, Claes, Pieters, Hermans, & Raes, 2015), but according to our present knowledge, there is no meta-analysis on autobiographical memory functioning in this patient population. Our metaanalysis extends these narrative reviews by quantifying the contradictory results of the previous studies, and by adding further studies into our analysis comprising of 2,024 participants (BPD: n = 1,017, HC: n = 1,007).

We found a large overall effect size for autobiographical memory impairments in the BPD group. Because this meta-analysis was well powered and not undermined by a significant publication bias, we concluded that autobiographical memory impairment as measured by the AMT distinguishes BPD patients from healthy comparison participants; however, the high heterogeneity across studies pointed to the importance of taking into account the moderating effects of the patients’ age, gender, and intelligence.

In the BPD group, the effect size was very large for overgenerality, omission, and specificity, while it was not significant for recall latency. These results regarding the specificity of memories of BPD patients suggest that they responded more with repeated events and with memories that lasted longer than one day to AMT cue words, as well as came up with more overgeneral memories and fewer specific memories in response to cue words in AMT than the HC. Also, the BPD group omitted more answers in AMT than the HC. However, they did not differ from the HC in recall latency when responding to cue words.

Our results indicate that the diagnosis of BPD is associated with significant autobiographical memory impairments. Gender and intelligence did not influence autobiographical memory performance of the BPD patients. However, age as a moderating variable did influence BPD patients’ AM performance. Older BPD patients (oldest age = 30.8 years) report more specific autobiographical memories, as memory specificity increases with age in BPD, but not in the HC group. Although these results are in accordance with some previous research, they do however contradict others. Older participants were also found to have better AM performance in a study by Kennedy, Mather, and Carstensen (2004) in healthy females. This may be related to the symptom reduction with age in BPD patients (Gunderson et al., 2011). In other studies, it was found that females consistently recalled more AMs than males, and they were generally faster in recalling (Fujita, Diener, & Sandvick, 1991). However, other studies found no gender differences in AM performance (Kihlstrom & Harackiewicz, 1982; Strongman & Kemp, 1991), except for negative memories, of which women recalled more than men (Ros & Latorre, 2010).

THE CAR-FA-X MODEL
Our main findings on impaired AM functioning in BPD patients point to a specific retrieval style characterized by high level of overgenerality, low level of specificity, and more categorical answers to AMT cue words, as well as retrieving more extended and semantic memories to AMT cue words. These results can be conceptualized within the context of a basic model of autobiographical memory: the self-memory system model of Conway and colleagues (Conway & Pleydell-Pearce, 2000).

In the self-memory system model, four broad levels of specificity have been identified: more broad, conceptual themes in the life story, lifetime periods, general events, and event-specific knowledge. Over-general, low-specific memories fit the non-event-specific memory category. In the AMT task, however, the goal is to retrieve event-specific AMs. As opposed to non-event-specific memories, event-specific AMs can be retrieved via two processes: generative and direct retrieval. Generative retrieval—used by the classic AMT—is a top-down process involving the retrieval of desired specific memories. In AUTOBIOGRAPHICAL MEMORY IN BPD 827 contrast, direct retrieval results in the retrieval of a specific memory when event-specific knowledge is activated by cues in the environment (rather than retrieved intentionally by the individual) (Sumner, 2012). The Williams and colleagues’ (2007) CaR-FA-X model postulates that overgeneral memory (OGM) results when the generative retrieval search process is aborted prematurely as a result of one or more of the three proposed mechanisms (Williams et al., 2007): capture and rumination (CaR), functional avoidance (FA), and impaired executive control (X) (Sumner, 2012).

Capture.
Our findings on high overgenerality and low specificity among BPD may be explained by the CaR-FA-X model. BPD patients are characterized by a high level of early maladaptive schemas (EMS) (Kellogg, & Young, 2006; Unoka & Richman, 2016) that may capture the memory retrieval at more general levels of memory representation and block the retrieval of specific autobiographical memories.

In Spinhoven, Bockting, Kremers, Schene, and Williams’s study (2007), patients with BPD completed the Young Schema Questionnaire (YSQ) and the AMT. In the AMT, BPD patients retrieved fewer specific AMs in response to cue words that thematically matched highly endorsed schemas. These results suggest that an impaired retrieval of specific memories may be the result of certain cues activating generic, higher-order mental representations. Thus, we suggest that early maladaptive schema captured retrieval processes may lead to non-specific and malevolent interpersonal representations in BPD.

Rumination. It was also found that sadness-related and anger-related ruminations are both characteristic to BPD patients (Selby, Anestis, Bender, & Joiner, 2009). We found only one study (Van den Broeck et al., 2015) that investigated the association between the level of rumination and OGM among BPD patients, and it found that the more severe the BPD patients’ depressive symptoms were and the more they ruminated, the less capable they were of retrieving specific AMs. However, when depression severity scores measured by the Beck Depression Inventory-II (BDI; Beck Steer, & Brown, 1996) were partialed out, sadness-related ruminations and memory specificity were no longer significantly related. In addition, the association between memory specificity and depressive severity were independent of the state or diagnosis of depression (Van den Broeck et al., 2015). It is a further question whether the association between low level of specificity and more general rumination or anger-related rumination—also specific to BPD patients—could be also be affected by the severity of depression. To further understand the associations between rumination and AM specificity in BPD, we need further research.

Functional Avoidance. Core BPD symptoms like self-harming behavior, drug and alcohol abuse, different forms of dissociations, and unstable identity have a function of avoiding emotionally painful experiences. These kinds of avoidant behaviors have a short-term advantage of distress reduction, but in the long run they may cause further problems by preventing patients from processing important information and experiences, as well as refraining from rigid attempts to suppress negative cognitions/emotions, which may have paradoxical effects of enhancing the accessibility of these thoughts and/ or the intensity of these emotions (Berking Neacsiu, Comtois, & Linehan, 2009).

Overgenerality and a low level of specificity answers to AMT cue words may play a similar role in avoiding emotionally painful memories. We can speculate that BPD patients who use the aforementioned avoidant strategies may also use more overgeneral memory as an avoidant strategy, and there should therefore be an association between them. Some findings indicate an association between dissociation and more general memories (Jones et al., 1999), while others do not (Kremers et al., 2004; Renneberg et al., 2005). It has been shown that BPD patients who showed the greatest overgeneral retrieval reported the fewest parasuicidal acts (Startup et al., 2001). According to the authors’ interpretation of this result, overgeneral autobiographical recall may help protect individuals with BPD from parasuicidal acts by helping them avoid distressing memories

Impaired Executive Control. During the recalling of a specific AM by the effortful generative retrieval process, generic descriptions are progressively inhibited to reach to a specific event (Conway & Pleydell-Pearce, 2000). In case of insufficient executive control, the process of episodic memory retrieval is prematurely interrupted, leading to the recollection of a general memory (Haque & Conway, 2001; Heeren, Van Broeck, & Philippot, 2009; Williams et al., 2007). It was found that cognitive flexibility and executive control play an important role in specific AM retrieval (Dalgleish et al., 2007; Heeren et al., 2009; Williams & Dritschel, 1992). In addition, cognitive flexibility may partially mediate the impact of mindfulness training on overgeneral (categoric) memories (Heeren at al., 2009). Also, one metaanalytic study on BPD found a significant impairment of executive functioning (Unoka & Richman, 2016), while other studies found that better visual (Maurex et al., 2010) and verbal (Reid & Startup, 2010) working memory was associated with higher memory specificity (Spinhoven et al., 2007). Our finding of a high level of omission in the BPD group may also be related to impaired executive functioning. Again, further research is needed to clarify the specific role of executive impairments in overgeneral memory among patients suffering from BPD.

To sum up, there are reasons both for and against thinking that high overgenerality and low specificity among BPD patients may be explained by the CaR-FA-X model. To fully answer this question, further investigation is needed. Studies that investigated the association between overgeneral memory and some elements of the CaR-FA-X model are correlational, and it is a further problem that the elements of the model measured by the questionnaires or rating scales included items not specifically related to autobiographical memory. It is not possible to make a conclusive evaluation of the model from research using such designs. It would be important to conduct studies that include all the elements of the CaR-FA-X model and experimentally manipulate them in an autobiographical memory retrieval context.

One important limitation of the AMT cueing task is that it indexes access to valenced memories without directly indexing memories that are personally AUTOBIOGRAPHICAL MEMORY IN BPD 829 important to the individual (Jansari & Parkin, 1996; Rybash & Monaghan, 1999). To address this limitation, Singer and Moffitt (1991, 1992) developed an approach that indexed “self-defining memories.” Self-defining memories are defined as memories that reflect one’s identity and are affectively intense, repetitive, and vivid, and comprise enduring concerns about oneself (Singer & Salovey, 1993).

In addition to the use of the CaR-FA-X model, there are other interpretations of our results that point to limitations with our study. The use of medication, early trauma experiences, general symptom severity, severity of depressive symptoms, and PTSD and depression comorbidity could play a role in the level of memory specificity in our BPD sample. We could not test their potential effects because there were not enough studies providing information for calculation of an effect size.

LIMITATIONS AND CONCLUSIONS
This meta-analysis is limited by several factors. The number of studies included is small, with only some autobiographical domains. Another issue is that although we uncovered an association between autobiographical memory impairments and BPD, the studies included were cross-sectional. To solve the issues around the CaR-Fa-X model and the state or trait nature of BPD and autobiographical memory impairments, a longitudinal followthrough cohort study with repeated measures in both symptoms and cognitive domains and AM is required. Future research should focus on a study design that includes participant groups with a range of severity levels along first and second axis symptom dimensions, detailed reporting of comorbidity, and common measures of autobiographical memory, trauma type, and severity, which would provide a better comparison across groups, as well as a clearer indication of the way in which severity of BPD is related to cognitive impairment.

Research on Borderline Personality Disorder and Memory

Positron-Emission Tomography and Personality Disorders
Peter F. Goyer, et.al.
Neuropsychopharmacology volume 10, pages 21–28 (1994)
Abstract
This study used positron-emission tomography to examine cerebral metabolic rates of glucose (CMRG) in 17 patients with DSM III-R diagnoses of personality disorder. Within the group of 17 personality disorder patients, there was a significant inverse correlation between a life history of aggressive impulse difficulties and regional CMRG in the frontal cortex of the transaxial plane approximately 40 mm above the canthomeatal line (CML) (r = −.56, p = 0.17). Diagnostic groups included antisocial (n = 6), borderline (n = 6), dependent (n = 2), and narcissistic (n = 3). Regional CMRG in the six antisocial patients and in the six borderline patients was compared to a control group of 43 subjects using an analysis of covariance with age and sex as covariates. In the borderline personality disorder group, there was a significant decrease in frontal cortex metabolism in the transaxial plane approximately 81 mm above the CML and a significant increase in the transaxial plane approximately 53 mm above the CML (F[1,45] = 8.65, p = .005; and F[1,45] = 7.68, p = .008, respectively).

Differential information processing in borderline personality and major depressive disorders.
Kurtz, John E.. Vanderbilt U, US
Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 55(11-B), May, 1995. pp. 5076.
Abstract:
Information processing models for understanding the nature of mental disorders have become increasingly prominent in the study of psychopathology, yet little is known about the cognitive aspects of borderline personality disorder (BPD). In contrast, cognitive theories of major depressive disorder (MDD) have been well-articulated and extensively researched. This project compared the cognitive features of BPD and MDD using a series of experimental tasks. Based on the literature, several hypotheses were advanced that predicted more negativistic evaluative style in BPD and greater deficits of recall and recognition memory in MDD. The BPD group consisted of 20 patients who met criteria for both BPD and MDD, and the MDD group consisted of 20 patients who met criteria for MDD but not BPD. Diagnostic determinations were made using standard criteria from two structured interview instruments. The Control group consisted of 20 adult volunteers with no history of significant depressive symptoms nor indications of BPD. All three groups were comparable with respect to gender, age, years of education, and career occupation. Subjects participated in an evaluative judgment task in which they responded ‘like’ or ‘dislike’ to each of 48 target words. The word stimuli were classified into four affective valences: positive, negative, neutral, and ambivalent. BPD patients gave more dislike responses, particularly to neutral words, than MDD patients and Control subjects, who did not differ from each other. Subjects’ recall and recognition memory for these words was tested. BPD patients recalled fewer words and showed poorer recognition accuracy than Control subjects. The recall and recognition performances of the MDD patients were better than the BPD patients and worse than the Control subjects, but these differences were not statistically significant. The familiar positive word selectivity effect was observed with the recall data but not with the recognition data. The results indicate t

Memory functioning in borderline personality disorder.
Korfine, Lauren. Harvard U, US
Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 59(5-B), Nov, 1998. pp. 2421.
Abstract:
Borderline personality disorder (BPD) is characterized by extreme instability of affect, behavior, and cognition. Clinical anecdotes depict individuals who tend to experience abandonment, rejection, and negative evaluation in the behavior of other people, even in the absence of objective cues of that nature. The purpose of this research is to understand the cognitive and information-processing underpinnings of this clinical phenomenon. The present study was an exploration of potential memory deficits and affective memory biases in individuals with BPD. Three groups of study participants took part in the study: (1) outpatient individuals with BPD (n=22), (2) BPD individuals from the community (n=23), and (3) normal controls (n=20). Memory impairment was examined using the Wechsler Memory Scale – Revised, a standard battery of memory tasks. BPD subjects in this sample did display memory deficits relative to controls on three WMS-R subtests (Visual Paired Associates-Immediate and Visual Memory Span, and Visual Reproduction-Delayed). A directed forgetting paradigm was used to determine whether individuals with BPD showed memory biases for salient stimuli. Study participants were exposed to three types of words (borderline, neutral, positive) and were cued to either remember or to forget each word as it was presented. On free recall, participants with BPD recalled significantly more of the borderline words from the ‘forget’ condition than did controls. In other words, BPD participants remembered borderline words that they were instructed to forget. These results may be consistent with enhanced encoding of salient words and perhaps, related themes, in BPD individuals. An autobiographical memory task was used to determine whether individuals with BPD show deficits in their ability to retrieve specific personal memories. Recall of personal memories was found to be impaired in BPD subjects on this task relative to controls. In addition, themes of abandonment, rejection, and negative evaluation emerged in the memories of BPD subjects and not in the memories of control subjects. The findings suggest that individuals with BPD may have subtle deficits in memory for complex visual stimuli, and they may show biased information-processing of negatively valenced stimuli related themes presumed to be salient in this population.

Verbal memory dysfunction in depressed outpatients with and without borderline personality disorder.
Kurtz, John E.
Journal of Psychopathology and Behavioral Assessment, Vol 21(2), Jun, 1999. pp. 141-156.
Abstract:
Contrasts memory functions with emotional words between 2 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 participated. All Ss were 18–50 yrs old. Ss responded to word stimuli assessments and completed self-report assessments. 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.

A positron emission tomography study of memories of childhood abuse in borderline personality disorder.
Schmahl, Christian G., et.al.
Biological Psychiatry, Vol 55(7), Apr, 2004. pp. 759-765.
Abstract:
Borderline personality disorder (BPD) is a common psychiatric disorder, which is linked to early stressors in many cases; however, the impact of traumatic events in the etiology of BPD is still unclear. This study was conducted to measure the neural correlates of recall of traumatic memories in women with and without BPD. Twenty women with a history of childhood physical or sexual abuse underwent measurement of brain blood flow with positron emission tomography imaging while they listened to scripts describing neutral and personal traumatic abuse events. Brain blood flow during exposure to trauma and neutral scripts was compared between women with and without BPD. Memories of trauma were associated with increases in blood flow in right dorsolateral prefrontal cortex and with decreased blood flow in left dorsolateral prefrontal cortex in women without BPD. There was also increased blood flow in right anterior cingulate and left orbitofrontal cortex in women without BPD. Women with BPD failed to activate anterior cingulate gyrus and orbitofrontal cortex. Also, no blood flow changes were seen in dorsolateral prefrontal gyrus in women with BPD. Dysfunction of dorsolateral and medial prefrontal cortex, seems to be correlated with the recall of traumatic memories in women with BPD.

Women with Borderline Personality Disorder.
Clayton, Anita H.
Primary Psychiatry, Vol 11(10), Oct, 2004. pp. 21-22.
Abstract:
A number of brain dysfunctions have been noted in individuals with bipolar personality disorder (BPD). Dysfunction of dorsolateral and medial prefrontal cortex, including the anterior cingulate, has been correlated with the recall of traumatic memories and memories of abandonment in women with BPD.Women with BPD frequently present with comorbid diagnoses that influence the approach to treatment and outcome. Symptoms of major depression or bipolar disorder may be obscured by angry outbursts, impulsivity, and interpersonal conflict, or the mood disorder may be misinterpreted as the affective instability of BPD. Assessment of duration of symptoms and evaluation of the severity of the identified stressor can be important in recognizing comorbidity. General issues in treatment include treating comorbid conditions, avoiding medications that may lower inhibitions on impulsive behaviors, and providing a holding environment with structure and limits. Psychotherapy should address symptoms, triggers, and harmful behaviors.

Functional MRI correlates of the recall of unresolved life events in borderline personality disorder.
Beblo, Thomas, et.al.
Psychological Medicine, Vol 36(6), Jun, 2006. pp. 845-856.
Abstract:
Background: Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls. Method: Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories. Results: When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2 x 2 factorial analysis (ΔBPD – Δcontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition. Conclusions: The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.

Executive neurocognition, memory systems, and borderline personality disorder.
Fertuck, Eric A., et.al.
Clinical Psychology Review, Vol 26(3), May, 2006. pp. 346-375.
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.

Reduced Self-Referential Source Memory Performance Is Associated With Interpersonal Dysfunction in Borderline Personality Disorder.
Minzenberg, Michael J., et.al.
Journal of Personality Disorders, Vol 20(1), Feb, 2006. pp. 42-54.
Abstract:
Source memory is impaired in schizophrenia, and this deficit is related to symptoms of interpersonal antagonism such as suspiciousness and hostility. The present study evaluated source memory in borderline personality disorder (BPD) and its relation to interpersonal antagonism. Forty-one noninpatient adults with BPD according to the DSM-IV and 26 healthy control subjects performed a verbal source memory test requiring completion of sentences with and without emotional content (‘Hot’ vs. ‘Cold’ sentences). Subjects also completed self-report measures of suspiciousness and interpersonal antagonism (Buss-Durkee Hostility Inventory) and depression (Beck Depression Inventory). The BPD group showed no significant difference from the control group in self-referential source memory, recognition memory, response bias, and performance enhancement for items with emotion content. However, in the BPD group, poorer self-referential source memory was significantly related to Hostility measures including suspiciousness, but not with Depression scores. In contrast, generic item recognition memory was unrelated to Hostility. Heterogeneity in source memory function may be specifically related to some of the hallmark interpersonal disturbances of BPD, independent of the effects of general negative affect or general memory impairment.

Funktionelle Bildgebung bei der Borderline-Persönlichkeitsstörung.
Translated Title: Functional neuroimaging in borderline personality disorder.
Schnell, Knut, et.al.,
PTT: Persönlichkeitsstörungen Theorie und Therapie, Vol 10(3), Sep, 2006. pp. 188-198.
Source Title Translation: PTT: Personality Disorders – Theory and Therapy
Abstract:
Borderline personality disorder is characterized by states of intensive, aversive tension and the tendency, to act impulses put without anticipating consequences. Research on neurobiological underpinnings in borderline personality disorder focuses on clarifying the nature of affect regulation, from a theoretical point of view, observations from lesions studies indicating affective instable behaviour after damage of the medial and orbital prefrontal cortex, a dysfunction of these and closely interconnected regions—the amygdala in particular—has been hypothesized. By means of functional neuroimaging, volumetric alterations of amygdala and hippocampus have been found in borderline personality disorder, which, however, are probably not independent of comorbid conditions such as posttraumatic stress disorder or depression. Data from positron emission tomography hove provided evidence for pharmacological abnormalities particularly in the sense of a reduced prefrontal serotonergic activity. Data from functional neuroimaging techniques, PET and fMRI, have furthermore indicated changes of limbic functions and regulatory prefrontal areas, for example when presenting emotionally relevant visual stimuli or in tasks which challenge the recall of autobiographic memories. Although the findings are not always consistent and appear to be modulated by comorbid conditions, knowledge from neuroimaging helps to understand the problem of affect regulation in borderline personality disorder.

Enhanced emotion-induced amnesia in borderline personality disorder.
Hurlemann, René, et.al.
Psychological Medicine, Vol 37(7), Jul, 2007. pp. 971-981.
Abstract:
Background: Current biological concepts of borderline personality disorder (BPD) emphasize the interference of emotional hyperarousal and cognitive functions. A prototypical example is episodic memory. Pre-clinical investigations of emotion-episodic memory interactions have shown specific retrograde and anterograde episodic memory changes in response to emotional stimuli. These changes are amygdala dependent and vary as a function of emotional arousal and valence. Method: To determine whether there is amygdala hyper-responsiveness to emotional stimuli as the underlying pathological substrate of cognitive dysfunction in BPD, 16 unmedicated female patients with BPD were tested on the behavioural indices of emotion-induced amnesia and hypermnesia established in 16 healthy controls. Results: BPD patients displayed enhanced retrograde and anterograde amnesia in response to presentation of negative stimuli, while positive stimuli elicited no episodic memory-modulating effects. Conclusion: These findings suggest that an amygdala hyper-responsiveness to negative stimuli may serve as a crucial aetiological contributor to emotion-induced cognitive dysfunction in BPD.

Altered memory and affective instability in prisoners assessed for dangerous and severe personality disorder.
Kirkpatrick, Tim, et.al.
The British Journal of Psychiatry, Vol 190(Suppl 49), May, 2007. Special Issue: Assessment, risk and outcome in severe personality disorder. pp. s20-s26.
Abstract:
Background: Previous studies of borderline personality disorder report neuropsychological impairments in several domains, including memory. No studies have compared memory functioning in high-risk prisoners with borderline personality disorder with similar prisoners with other personality disorders.
Aims: To explore mnemonic impairments in prisoners undergoing personality assessment as part of the dangerous and severe personality disorder initiative or detained in a medium secure facility.
Method: We investigated memory function in 18 prisoners with borderline personality disorder and 18 prisoners with other personality disorders.
Results: Prisoners with borderline personality disorder exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance.
Conclusions: These data suggest that memory deficits have some specificity in relation to the constituent traits of borderline personality disorder and indicate that neuropsychological assessment may be a source of useful adjunctive information for distinguishing between the cognitive and psychological difficulties of individual prisoners.

Neural correlates of episodic and semantic memory retrieval in borderline personality disorder: An fMRI study.
Mensebach, Christoph, et.al.
Psychiatry Research: Neuroimaging, Vol 171(2), Feb, 2009. pp. 94-105.
Abstract:
Verbal memory impairment in borderline personality disorder (BPD) is still a matter of debate. In this study we combine investigations of both, memory retrieval as well as underlying neural circuits in BPD. Functional magnetic resonance imaging (fMRI) was used to study regional brain activation in 18 right-handed female patients with BPD and 18 matched controls during the retrieval of an episodic memory retrieval (EMR) task (free recall of a word list) and a semantic memory retrieval (SMR) task (verbal fluency). Despite unaffected performance in EMR and SMR, patients with BPD showed task-specific increased activation compared with controls. During EMR, the increased activation encompassed the posterior cingulate cortex bilaterally, the left middle and superior temporal gyrus, the right inferior frontal gyrus, and the right angular gyrus. SMR was associated with increased activation of the posterior cingulate cortex, of the right fusiform gyrus, of the left anterior cingulate cortex, and of the left postcentral gyrus. Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls.

Cognitive memory control in borderline personality disorder patients.
Sala, M., et.al.
Psychological Medicine, Vol 39(5), 2009. pp. 845-853.
Abstract:
Background: It has been demonstrated that the mechanism of cognitive memory control in humans is sustained by the hippocampus and prefrontal cortices, which have been found to be structurally and functionally abnormal in borderline personality disorder (BPD). We investigated whether the memory control mechanism is affected in BPD. Method: Nineteen Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV BPD patients and 19 matched healthy controls (HC) performed a specific think/no-think paradigm exploring the capacity of remembering and suppressing pair of words previously learned. After the think-no think phase, the second member of each word pair has to be remembered either when subjects are presented with the cue word showed at the beginning of the test (Same Probe Test; SPT) or when they are presented with an extra-list categorical word (Independent Probe Test; IPT). We evaluated the effect of suppression and of retrieval activity on later retention of words. Results: Both on the SPT and on the IPT, HC showed the expected improvement of memory retrieval on to-be-remembered words, unlike BPD patients. On the SPT, HC, but not BPD patients, correctly recalled significantly more words among remembered words (RW) than among suppressed words (SW). Similarly to HC, subjects with BPD without a history of childhood abuse showed a significantly higher percentage of correctly recalled words among RW than among SW. Conclusions: The mechanism of active retrieval of memories and of improvement through repetition is impaired in BPD, particularly in those who experienced traumatic experiences. This impairment might play an important role, possibly resulting in the emergence of unwanted memories and dissociative symptoms.

Higher executive control and visual memory performance predict treatment completion in borderline personality disorder.
Fertuck, Eric A., et.al.
Psychotherapy and Psychosomatics, Vol 81(1), Dec, 2011. pp. 38-43.
Abstract:
Background: Non-completion of a prescribed course of treatment occurs in 20–60% of individuals diagnosed with borderline personality disorder (BPD). While symptom severity, personality traits and environmental factors have been implicated as predictors of treatment non-completion (TNC), there have been no studies of neuropsychological predictors in this population. Methods: From a randomized controlled trial, a subsample of 31, unmedicated outpatients diagnosed with BPD with recent self-injurious behavior was assessed on 5 neuropsychological domains. Patients were also assessed for general IQ, demographic and other salient clinical variables. Patients were randomized to one of four treatment conditions, which lasted up to 1 year. Number of weeks in treatment (WIT) up to 1 year was utilized as the index of TNC. Results: Thirty-three percent of the subsample (n = 12) did not complete 1 year of treatment. However, more WIT were predicted by better baseline executive control (Trails B; p < 0.01) and visual memory performance (Benton visual retention; p < 0.001); other neuropsychological domains did not predict WIT. Conclusion: In the treatment of outpatients with BPD, better executive control and visual memory performance predict more WIT. Assessing and addressing these neurocognitive factors in treatment may reduce TNC in this high-risk population.

HPA axis alterations in mental disorders: Impact on memory and its relevance for therapeutic interventions.
Wingenfeld, Katja, et.al.
CNS Neuroscience & Therapeutics, Vol 17(6), Dec, 2011. pp. 714-722.
Abstract:
Dysfunctions in hypothalamic–pituitary–adrenal (HPA) axis have been reported for several mental disorders that are also often characterized by memory disturbances. It is now well established that glucocorticoids influence cognitive processes by enhancing memory consolidation and impairing memory retrieval. There is further evidence for an association between HPA axis related disturbances and memory function in mental disorders. The present selective review provides a brief overview of HPA axis dysfunction and its impact on memory function in major depressive disorder, posttraumatic stress disorder, and borderline personality disorder. Furthermore, the relevance of these findings for therapeutic intervention is discussed.

Relationship between personality disorder dimensions and verbal memory functioning in a community population.
Park, Subin, et.al.
Psychiatry Research, Vol 196(1), Mar 30, 2012. pp. 109-114.
Abstract:
Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions.

Effects of cortisol on memory in women with borderline personality disorder: Role of co-morbid post-traumatic stress disorder and major depression.
Wingenfeld, K., et.al.
Psychological Medicine (2013). March; 43(3):495-505
Abstract:
Background: Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD). Method: In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10 mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied. Results: Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects : in this subgroup (BPD+MDD) the effects of cortisol on memory were absent. Conclusions: The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs).

Emotions and memory in borderline personality disorder.
Winter, Dorina, et.al.
Psychopathology, Vol 47(2), Mar, 2014. pp. 71-85.
Abstract:
Memory processes such as encoding, storage, and retrieval of information are influenced by emotional content. Because patients with borderline personality disorder (BPD) are particularly susceptible to emotional information, it is relevant to understand whether such memory processes are altered in this patient group. This systematic literature review collects current evidence on this issue. Research suggests that emotional information interferes more strongly with information processing and learning in BPD patients than in healthy controls. In general, BPD patients do not seem to differ from healthy control subjects in their ability to memorize emotional information, but they tend to have specific difficulties forgetting negative information. Also, BPD patients seem to recall autobiographical, particularly negative events with stronger arousal than healthy controls, while BPD patients also show specific temporo-prefrontal alterations in neural correlates. No substantial evidence was found that the current affective state influences learning and memory in BPD patients any differently than in healthy control subjects. In general, a depressive mood seems to both deteriorate and negatively bias information processing and memories, while there is evidence that dissociative symptoms impair learning and memory independently of stimulus valence. This review discusses methodological challenges of studies on memory and emotions in BPD and makes suggestions for future research and clinical implications.

Subjective cognitive complaints and functional disability in patients with borderline personality disorder and their nonaffected first-degree relatives.
Ruocco, Anthony C., et.al.
Can Journal of Psychiatry (2014). June; 59(6):335-44
Abstract:
Objective: To examine the contributions of subjective cognitive complaints to functional disability in patients with borderline personality disorder (BPD) and their nonaffected relatives. Method: Patients with BPD (n = 26), their first-degree biological relatives (n = 17), and nonpsychiatric control subjects (n = 31) completed a self-report measure of cognitive difficulties and rated the severity of their functional disability on the World Health Organization Disability Assessment Schedule 2.0. Results: After accounting for group differences in age and severity of depressive symptoms, patients and relatives endorsed more inattention and memory problems than control subjects. Whereas probands reported greater disability than relatives and control subjects across all functional domains, relatives described more difficulties than control subjects in managing multiple life activities, including domestic activities and occupational and academic functioning, and participating in society. For both probands and relatives, inattention and memory problems were linked primarily to difficulties with life activities, independent of depression and other comorbid psychiatric disorders. Conclusions: Problems with inattention and forgetfulness may lead to difficulties carrying out activities of daily living and occupational or academic problems in patients with BPD, as well as their nonaffected first-degree relatives.

Subjective memory complaints and memory performance in patients with borderline personality disorder.
Beblo, Thomas, et.al.
BMC Psychiatry, Vol 14, Sep 6, 2014. ArtID: 255
Abstract:
Background: It is still a matter of debate as to whether patients with Borderline Personality Disorder (BPD) suffer from memory deficits. Existing studies indicate no or small impairments in memory test performance. However, it was shown in patients with related disorders, such as depression, that self-reported impairment exceeds test malfunction. In the present study we assessed memory performance of BPD patients through the use of memory tests and a questionnaire for subjective memory complaints (SMC) in everyday life. Methods: Thirty-two patients with BPD and 32 healthy control subjects were included in the study. The groups of subjects were comparable with respect to age, education, and gender. Subjects completed verbal and nonverbal memory tests, as well as the everyday memory questionnaire (EMQ). Results: BPD patients reported severe SMC but did not show memory test impairment. The results remained stable even when all BPD patients with acute or lifetime depression comorbidity were excluded from analyses. In both groups, SMC and test performances were not related but in BPD patients SMC were related to BPD symptoms. Conclusions: Our data indicate memory impairment of BPD patients in everyday life. However, it cannot be ruled out that increased memory complaints result from patients’ negative self-perception. Future research needs to clarify the reasons for memory complaints of BPD patients.

Autobiographical memory in borderline personality disorder—A systematic review.
Bech, Morten, et.al.
Personality and Mental Health, Vol 9(2), May, 2015. pp. 162-171.
Abstract:
Borderline personality disorder is a severe psychiatric illness. A key feature of the disorder is a disorganized sense of self often referred to as identity diffusion. Autobiographical memory is memory for personal life events.One of the main functions of these memories is to enable us to understand who we are by connecting past, present and future experiences. It seems that autobiographical memory is in some way disrupted in individuals with borderline personality disorder. A systematic review is conducted looking at studies that focus on the potential connections. We find that although a number of studies have been published results remain inconsistent. Furthermore, we find that many of the studies suffer from inadequate designs particularly regarding the reported measures of autobiographical memory. We discuss potential links between personality functioning, identity diffusion, autobiographical memory and borderline personality disorder.

Effects of mineralocorticoid receptor stimulation via fludrocortisone on memory in women with borderline personality disorder.
Wingenfeld, Katja, et.al.
Neurobiology of Learning and Memory, Vol 120, Apr, 2015. pp. 94-100.
Abstract:
In a previous study, we found that in contrast to healthy controls, hydrocortisone administration had enhancing effects on memory in patients with borderline personality disorder (BPD). Because hydrocortisone acts on glucocorticoid receptors (GR) and mineralocorticoid receptors (MR), it is unclear which receptor mediated these effects. The aim of the current study was to test whether more selective MR stimulation with fludrocortisone improves memory in BPD. In a placebo-controlled, randomized, within-subject, cross-over study, 39 medication-free women with BPD and 39 healthy women received placebo or 0.4mg fludrocortisone prior to cognitive testing. We measured verbal memory, visuospatial memory, and working memory. We found a significant group by fludrocortisone interaction on verbal memory and visuospatial memory. In both tests patients with BPD, but not healthy women, had impaired memory performance after fludrocortisone compared to placebo. In contrast, working memory was improved after fludrocortisone compared to placebo in both groups. Contrary to our hypothesis, we found impairing effects of MR stimulation on hippocampus-mediated verbal memory and visuospatial memory in BPD but not in healthy controls. In contrast, working memory, which depends more on the prefrontal cortex, was improved after MR stimulation across groups. Future studies should systematically disentangle beneficial and adverse effects of MR stimulation in health and disease.

Suicide attempters with Borderline Personality Disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories.
Silvers, Jennifer A., et.al.
Journal of Psychiatric Research, Vol 81, Oct, 2016. pp. 71-78.
Abstract:
Suicidal behavior and difficulty regulating emotions are hallmarks of Borderline Personality Disorder (BPD). This study examined neural links between emotion regulation and suicide risk in BPD. 60 individuals with BPD (all female, mean age = 28.9 years), 46 of whom had attempted suicide, completed a fMRI task involving recalling aversive personal memories. Distance trials assessed the ability to regulate emotion by recalling memories from a third-person, objective viewpoint. Immerse trials assessed emotional reactivity and involved recalling memories from a first-person perspective. Behaviorally, both groups reported less negative affect on Distance as compared to Immerse trials. Neurally, two sets of findings were obtained. The first reflected differences between attempters and non-attempters. When immersing and distancing, attempters showed elevated recruitment of lateral orbitofrontal cortex, a brain region implicated in using negative cues to guide behavior. When distancing, attempters showed diminished recruitment of the precuneus, a region implicated in memory recall and perspective taking. The second set of findings related to individual differences in regulation success—the degree to which individuals used distancing to reduce negative affect. Here, we observed that attempters who successfully regulated exhibited precuneus recruitment that was more similar to non-attempters. These data provide insight into mechanisms underlying suicide attempts in BPD. Future work may examine if these findings generalize to other diagnoses and also whether prior findings in BPD differ across attempters and non-attempters. (

Autobiographical memory impairment in borderline personality disorder: A quantitative meta-analysis interpreted in terms of the CaR-FA-X model.
Beran, Eszter, et.al.
Journal of Personality Disorders, Vol 33(6), Dec, 2019. pp. 818-831.
Abstract:
Borderline personality disorder (BPD) is characterized by impaired functioning of autobiographical memory (AM). We use a quantitative meta-analysis to assess AM performance in adults diagnosed with BPD as compared to healthy controls (HC). Moderator variables included type of autobiographical memory as well as clinical and demographic variables. Large significant deficits were seen in the BPD group in comparison to the HC group. In the BPD group, effect sizes were large for overgenerality, omission, and specific memories, while not significant for recall. Age influenced the performance of the BPD group; in addition, there was a significant interaction between age and specificity of memory. Gender and IQ did not influence memory performance. Our results confirm that BPD patients show impairment in AM. We explain these impairments in terms of the CaR-FA-X model, based on mechanisms of capture and rumination, functional avoidance, and impaired executive control.

Psychophysiological stress response and memory in borderline personality disorder.
Duesenberg, Moritz, et.al.
European Journal of Psychotraumatology, Vol 10(1), Jan, 2019. ArtID: 1568134
Abstract (English):
Background: Previously, we found that patients with borderline personality disorder (BPD) but not healthy controls (HC) showed improved memory retrieval after hydrocortisone administration. Objective: In this study, we examined whether increases in endogenous cortisol after psychosocial stress are associated with memory function in patients with BPD and in healthy individuals. Methods: We recruited 49 female patients with BPD and 49 female HC. All participants were exposed to a psychosocial stressor, the Trier Social Stress Test (TSST) and a control condition (Placebo (P-)TSST) in randomized order. Salivary cortisol, alpha amylase (sAA) and blood pressure were measured in response to stress. Subsequently, we examined free recall of a previously learned word list, autobiographical memory, and working memory. Results: We found a stresstimegroup interaction effect for the cortisol response and for sAA to stress, which is mainly triggered by a slightly different increase in cortisol between groups from pre to post TSST. Furthermore, BPD patients showed a less pronounced increase in diastolic blood pressure compared to HC after stress. There was no effect of stress on memory performance in any tests, either in healthy controls or in patients with BPD. Conclusion: Our results suggest a slightly blunted response of the HPA axis and the sympathetic nervous system to stress in BPD compared to healthy women. In contrast to hydrocortisone administration, psychosocial stress did not improve memory retrieval in BPD patients. This might be explained by lower cortisol concentrations and parallel increases in norepinephrine and negative affect after stress

Enhanced memory for negative social information in borderline personality disorder.
Niedtfeld, Inga, et.al.
Journal of Abnormal Psychology, Vol 129(5), Jul, 2020. pp. 480-491.
Abstract (English):
Biased social cognition toward an enhanced processing of negative social information might contribute to instability in interpersonal relationships. Such interpersonal dysfunctions are important for the understanding of several mental disorders, among them borderline personality disorder (BPD). To experimentally test enhanced memory retrieval of negative social information, using a newly developed variant of a looking-at-nothing paradigm, 45 BPD patients and 36 healthy women learned positive and negative personality traits of different target persons. In a translational memory test, participants were asked to use the learned information to evaluate statements about the target person. In addition to behavioral measures of memory performance, we investigated eye gaze patterns to decompose memory retrieval processes. We hypothesized that BPD patients would retrieve negative as compared to positive person information more accurately than healthy controls, and show increased eye gaze toward spatial locations where negative information was provided during the learning phase. Results pointed to a more accurate retrieval of negative person attributes in the patient group as compared with healthy controls, thereby corroborating a negativity bias in social cognition in an exemplary sample of patients with interpersonal problems. Interestingly, the observed negativity bias for person memory was associated with BPD severity, stronger expectancies to be rejected by others, and social detachment. No group differences regarding eye fixation behavior were found. We propose that enhanced retrieval of negative person information might be associated with dysfunctional cognitive schemas as well as reduced behavioral trust, and be of relevance for mental disorders characterized by interpersonal difficulties.

General Scientific Summary—Social cognition is altered in borderline personality disorder (BPD), which is a prominent example of a mental disorder with marked interactional problems, especially with regard to enhanced processing of negative social information. Our study points to heightened memory retrieval of negative person attributes in BPD as compared with healthy controls, which might contribute to reduced interpersonal trust and interpersonal dysfunction.

Disrupted relationship between hippocampal activation and subsequent memory performance in borderline personality disorder.
Carcone, Dean, et.al.
Journal of Affective Disorders, Vol 274, Sep 1, 2020. pp. 1041-1048.
Abstract:
Background: Borderline personality disorder (BPD) is associated with subjective reports of forgetfulness and deficits on tests of memory performance. However, it is not yet known whether individuals with BPD show different patterns of activation in the hippocampus during episodic memory encoding, especially for materials that are not emotionally-valenced. Methods: Participants with BPD (n = 20) and non-psychiatric controls (n = 21) completed a memory encoding task in which they viewed scenes without emotional content during functional magnetic resonance imaging scans. Subsequently, they completed a recognition memory test outside of the scanner and neural activation during the presentation of successfully remembered scenes was contrasted with scenes that were subsequently forgotten. Results: Controls exhibited significant left hippocampal activation during successful memory encoding, displaying greater activity during the presentation of subsequently remembered versus forgotten scenes, and the strength of this activation was related to their recognition memory performance. Although hippocampal activation was observed for the BPD group during successful memory encoding, it did not reach significance when implementing a non-parametric statistical approach. Additionally, individual hippocampal recruitment was not significantly correlated with recognition memory performance in the BPD group. The strength of this correlation, but not the overall magnitude of hippocampal activation, was significantly different between the groups. Limitations: Participants with BPD had comorbid psychiatric diagnoses and varied treatment histories. Whether patients and controls differentially perceived emotional content in the neutral scene memoranda was not tested. Conclusions: Memory problems in BPD may be partially explained by a disrupted relationship between hippocampal activation and successful memory encoding.

When bad gets worse: Negative wording amplifies negative recall in persons with the borderline personality trait.
Maraz, Aniko, et.al.
Applied Cognitive Psychology, Nov 22, 2020.
Abstract:
Summary The emotional valence of memory recall strongly influences the extreme, and often self‐destructive behavioral response. Overall, 4427 people from the community filled out our screening questionnaire, of which 674 (mean age: 32.9 years, 64.7% women) passed the threshold for the likely presence of borderline personality disorder (BPD). Participants watched one of 9 possible video clips differing in valence (positive, negative or neutral). Results indicate support (ß = .151, p < .05) for a negative cognitive tendency in the evaluations proportionate to the severity of BPD but only when the impression is assessed with negatively‐worded items. This effect is detectable regardless of other factors such as negative mood, extremity of the answers or general impression of the character. These effects are unaffected by acute trauma. To conclude, different factors influence the recall of emotional stimuli, depending on the valence of the stimuli and the valence of the rating scale in persons with strong borderline tendencies.