Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli.

This study investigated M. Linehan’s (1993) theory that individuals meeting criteria for borderline personality disorder (BPD) have high biological vulnerability to emotion dysregulation, including high baseline emotional intensity and high reactivity to emotionally evocative stimuli. Twenty individuals with BPD, 20 age-matched individuals with generalized social anxiety disorder (SAD), and 20 age-matched normal controls (NCs) participated in 2 separate emotion induction conditions, a standardized condition, and a personally relevant condition. Respiratory sinus arrhythmia (RSA), skin conductance response (SCR), and self-report measures were collected throughout the experiment. BPD participants displayed heightened biological vulnerability compared with NCs as indicated by reduced basal RSA. BPD participants also exhibited high baseline emotional intensity, characterized by heightened SCR and heightened self-reported negative emotions at baseline. However, the BPD group did not display heightened reactivity, as their physiological and self-reported changes from baseline to the emotion inductions tasks were not greater than the other 2 groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting of emotional words.

Emotional material may induce processing limitations affecting memory performance. In the present study, the authors investigated how the emotional content of words influences the degree to which participants can be directed to forget them. In Experiment 1, the authors found that negative-valence words were recalled better when participants were told to forget them than when they were told to remember them. This effect was only obtained when a study-list of negative words was presented after the cue to remember or forget the first list. The effect was correlated with negative mood as assessed by the PANAS. Similar results were obtained in Experiment 2, in which the induction of negative arousal by a mild stressor abolished the directed forgetting of words when the following study list was comprised of negative words. These results support the idea that directed forgetting relies on cognitive control processes that may be disrupted by negative emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder.

Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an “oddball” task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Heightened sensitivity to facial expressions of emotion in borderline personality disorder.

Individuals with borderline personality disorder (BPD) have been hypothesized to exhibit significant problems associated with emotional sensitivity. The current study examined emotional sensitivity (i.e., low threshold for recognition of emotional stimuli) in BPD by comparing 20 individuals with BPD and 20 normal controls on their accuracy in identifying emotional expressions. Results demonstrated that, as facial expressions morphed from neutral to maximum intensity, participants with BPD correctly identified facial affect at an earlier stage than did healthy controls. Participants with BPD were more sensitive than healthy controls in identifying emotional expressions in general, regardless of valence. These findings could not be explained by participants with BPD responding faster with more errors. Overall, results appear to support the contention that heightened emotional sensitivity may be a core feature of BPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remembering the Good, Forgetting the Bad: Intentional Forgetting of Emotional Material in Depression.

The authors examined intentional forgetting of negative material in depression. Participants were instructed to not think about emotional nouns that they had learned to associate with a neutral cue word. The authors provided participants with multiple occasions to suppress the unwanted words. Overall, depressed participants successfully forgot negative words. Moreover, the authors obtained a clear practice effect. However, forgetting came at a cost: Compared with the nondepressed participants and with the depressed participants who were instructed to forget positive words, depressed participants who were instructed to forget negative words showed significantly worse recall of the baseline words. These results indicate that training depressed individuals in intentional forgetting could prove to be an effective strategy to counteract automatic ruminative tendencies and mood-congruent biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting of trauma cues in adults reporting repressed or recovered memories of childhood sexual abuse.

An item-cuing directed forgetting task was used to investigate whether women reporting repressed (n?=?13) or recovered (n?=?13) memories of childhood sexual abuse (CSA) exhibit an avoidant encoding style (and resultant impaired memory) for trauma cues relative to women reporting no CSA experience (n?=?15). All participants viewed intermixed trauma (e.g., molested), positive (e.g., confident), and categorized neutral (e.g., mailbox) words on a computer screen and were instructed either to remember or to forget each word. The results provided no support for the hypothesis that people reporting either repressed or recovered memories of CSA are especially adept at forgetting words related to trauma. These groups recalled words they were instructed to remember more often than words they were instructed to forget regardless of whether they were trauma related. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting affects both direct and indirect tests of memory.

In two experiments, subjects were instructed either to remember or to forget each word. Following study, two tests were given, one a direct test of memory requiring conscious recollection of the study list and the other an indirect test that could be performed without awareness of the study list. In Experiment 1, subjects recognized more remember than forget words (direct test) and completed more remember than forget fragments (indirect test) on both immediate and 1-week delayed tests. In Experiment 2, subjects showed superior recall (direct test) and greater repetition priming in lexical decision (indirect test) for remember than for forget words. The consistent directed forgetting effect on both types of tests is in accord with the idea that forget items are inhibited at the time of retrieval and that retrieval manipulations, unlike elaboration manipulations at encoding, affect direct and indirect tests in similar ways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting in acute stress disorder.

The rationale underpinning the diagnosis of acute stress disorder is that cognitive mechanisms result in avoidant processing of aversive experiences. This study investigated acutely traumatized participants with either acute stress disorder (ASD; n=15) or no ASD (n=14) and nontraumatized comparison participants (n=16). Participants were administered intermixed presentations on a computer screen of positive, neutral, and trauma-related words that were followed by instructions to either remember or forget each word. On a subsequent recall test, ASD participants displayed poorer recall of to-be-forgotten trauma-related words than did non-ASD participants. Severity of psychopathology was negatively correlated with to-be-remembered positive words. These findings are consistent with the proposal that people who develop ASD display an aptitude for superior forgetting of aversive material. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retrieval monitoring and anosognosia in Alzheimer's disease.

This study explored the relationship between episodic memory and anosognosia (a lack of deficit awareness) among patients with mild Alzheimer's disease (AD). Participants studied words and pictures for subsequent memory tests. Healthy older adults made fewer false recognition errors when trying to remember pictures compared with words, suggesting that the perceptual distinctiveness of picture memories enhanced retrieval monitoring (the distinctiveness heuristic). In contrast, although participants with AD could discriminate between studied and nonstudied items, they had difficulty recollecting the specific presentation formats (words or pictures), and they had limited use of the distinctiveness heuristic. Critically, the demands of the memory test modulated the relationship between memory accuracy and anosognosia. Greater anosognosia was associated with impaired memory accuracy when participants with AD tried to remember words but not when they tried to remember pictures. These data further delineate the retrieval monitoring difficulties among individuals with AD and suggest that anosognosia measures are most likely to correlate with memory tests that require the effortful retrieval of nondistinctive information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The rejection–rage contingency in borderline personality disorder.

Though long-standing clinical observation reflected in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) suggests that the rage characteristic of borderline personality disorder (BPD) often appears in response to perceived rejection, the role of perceived rejection in triggering rage in BPD has never been empirically tested. Extending basic personality research on rejection sensitivity to a clinical sample, a priming–pronunciation experiment and a 21-day experience-sampling diary examined the contingent relationship between perceived rejection and rage in participants diagnosed with BPD compared with healthy controls. Despite the differences in these 2 assessment methods, the indices of rejection-contingent rage that they both produced were elevated in the BPD group and were strongly interrelated. They provide corroborating evidence that reactions to perceived rejection significantly explain the rage seen in BPD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.     

A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder.

A randomized controlled trial was conducted to determine whether a manual-based psychodynamic treatment, labeled dynamic deconstructive psychotherapy (DDP), would be feasible and effective for individuals with co-occurring borderline personality disorder (BPD) and alcohol use disorder. Thirty participants were assessed every 3 months during a year of treatment with either DDP or treatment as usual (TAU) in the community. DDP participants showed statistically significant improvement in parasuicide behavior, alcohol misuse, institutional care, depression, dissociation, and core symptoms of BPD, and treatment retention was 67% to 73%. Although TAU participants received higher average treatment intensity, they showed only limited change during the same period. The results support the feasibility, tolerability, and efficacy of DDP for the co-occurring subgroup and highlight the need for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is there hypermnesia and reminiscence for information intentionally forgotten?

Memory performance was examined across consecutive tests in three directed-forgetting experiments. Following word-method or list-method cueing to forget, significant directed forgetting was observed for all tests: Free recall for remember cue words always exceeded free recall for forget cue words. Moreover, following either cueing method, similar magnitudes of hypermnesia (improved free recall across tests) and reminiscence (recovery of words across tests) were observed for both word types. Regardless of cueing method, after an initial free recall test, the level of recovery for both word types did not differ significantly. That is, directed forgetting was not observed for the reminiscence data. Taken together, the results suggest that cues to forget impair the encoding of information but, after an initial memory test, they do not interrupt the accessing of that information. These findings are consistent with the selective rehearsal account but not the retrieval inhibition account of directed forgetting. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability and variability of affective experience and interpersonal behavior in borderline personality disorder.

This study examined both mean levels and intraindividual variability in the mood and interpersonal behavior of individuals with borderline personality disorder (BPD) and nonclinical control participants over a 20-day event-contingent recording period. Individuals in the BPD group experienced more unpleasantly valenced affect and were less dominant, more submissive, more quarrelsome, and more extreme in overall levels of behavior than control participants. In addition to these mean-level differences, individuals with BPD also reported more intraindividual variability in overall affect valence and in pleasantly valenced affect; displayed greater variability in dominant, quarrelsome, and agreeable behaviors; and exhibited an increased tendency to "spin" among interpersonal behaviors relative to nonclinical control participants. The findings document behavioral and affective manifestations of BPD in the context of naturally occurring interpersonal situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retrieval Inhibition in Directed Forgetting Following Severe Closed-Head Injury.

A variant of the list method directed forgetting procedure was used to examine the role of inhibition in memory performance following severe closed-head injury (CHI). Twenty-four participants with severe CHI and 24 controls studied picture and word stimuli in both forget and remember conditions. Memory testing for the to-be-forgotten and to-be-remembered items consisted of a free-recall test followed by a source-monitoring task. Despite poorer recall performance, the participants with CHI exhibited a directed forgetting effect similar to that in controls. Item recognition scores indicated that the inhibited items were not forgotten but rather were items whose accessibility had been lowered. These findings suggest that residual memory deficits in patients with severe CHI are unlikely to reflect inefficient retrieval inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nontraumatic pathways to borderline personality disorder.

Clinicians who treat borderline personality disorder (BPD) generally assume that this disorder is caused by childhood abuse. This assumption is strongly supported in the BPD literature, which indicates that the majority of individuals with BPD have suffered emotional, physical, and sexual abuse. What is often missed or simply ignored in discussions of BPD is that this same body of research also suggests that a significant minority of borderline individuals have not suffered childhood abuse. This article reviewed the literature on the prevalence of childhood abuse and BPD, offered a number of hypotheses about nontraumatic pathways to BPD, and briefly considered treatment implications for nontraumatized BPD individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Item-specific encoding produces an additional benefit of directed forgetting: Evidence from intrusion errors.

List-method directed forgetting involves encoding 2 lists, between which half of the participants are told to forget List 1. When participants are free to study however they want, directed forgetting impairs List 1 recall and enhances List 2 recall in the forget group compared with a control remember group. In a large-scale experiment, the current work demonstrated that when item-specific encoding instructions were enforced during learning, directed forgetting impaired List 1 recall, but it did not enhance List 2 recall. This pattern was found regardless of whether encoding was incidental or intentional. Whenever directed forgetting did not enhance List 2 recall, it nevertheless reduced cross-list intrusions. These results indicate that directed forgetting can help differentiate memories from one another, thereby reducing intrusions from irrelevant competing memories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The crucial role of postcue encoding in directed forgetting and context-dependent forgetting.

People can intentionally forget previously studied material if, after study, a forget cue is provided and new material is learned. It has recently been suggested that such list-method directed forgetting arises because the forget cue induces a change in internal context and causes context-dependent forgetting of the studied material (L. Sahakyan & C. M. Kelley, 2002). The authors compared directed forgetting and context-dependent forgetting by examining whether, like a forget cue, a change in internal context needs subsequent learning of new material to be effective. Participants studied an item list and, after study, received a remember cue or a forget cue or their internal context was changed through an imagination task. In each condition, half the participants learned a second list, and the other half fulfilled an unrelated distractor task. Both the forget cue and the change in internal context induced forgetting of the first list only when learning of the second list was interpolated. These results suggest that postcue encoding of new material is crucial for both directed forgetting and (some forms of) context-dependent forgetting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural relations between borderline personality disorder features and putative etiological correlates.

This study assessed the structural relations between borderline personality disorder (BPD) features and purported etiological correlates. Approximately 5,000 18-year-old nonclinical young adults were screened for BPD features, and 2 cohorts of participants (total N?=?421; approximately one half of whom endorsed significant borderline features) completed the laboratory phase of the study. Measures included self-report and interview-based assessments of BPD psychopathology, personality, psychopathology in biological parents, and childhood physical and sexual abuse. Significant relations between BPD features and purported etiological correlates of BPD were found. A multivariate model that included parental psychopathology, childhood abuse, and personality factors provided an adequate fit to the data and supported the contention that the personality traits disinhibition and negative affectivity underlie BPD features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does comorbid substance use disorder exacerbate borderline personality features? A comparison of borderline personality disorder individuals with vs. without current substance dependence.

There is compelling evidence that comorbid borderline personality disorder (BPD) negatively impact the clinical courses and outcomes of substance use disorders (SUD). Conversely, there is little evidence that concurrent SUD exacerbates the clinical characteristics of BPD. Thus, this study sought to examine whether the presence of current substance dependence among BPD patients would be associated with stronger BPD-relevant personality traits and behavioral characteristics. Female BPD patients without (BOR; n = 37) or with current substance dependence (BSUD; n = 19), and female non-BPD/SUD controls (CON; n = 48) were compared with respect to impulsivity, affective lability, affective intensity, externalizing behaviors, and self-harming/suicidal tendencies, taking into consideration their comorbid mood disorders, anxiety disorders, and antisocial personality disorder. Results indicated that both BOR and BSUD groups scored higher than CON in most of the measures, but BOR and BSUD failed to reveal significant group differences especially when the influence of comorbid psychopathology was removed. The overall pattern of findings remained identical even when comparing BPD patients with versus without the diagnosis of lifetime substance dependence. Our results do not support the notion that BPD individuals with SUD display more severe BPD features than individuals with BPD alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)