Neurocognitive profiles of people with borderline personality disorder

• Published in: Current opinion in psychiatry Vol. 26; no. 1; pp. 90 - 96
• Main Authors: Mak, Arthur D.P, Lam, Linda C.W
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-01-2013; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Borderline Personality Disorder - pathology; Borderline Personality Disorder - physiopathology; Borderline Personality Disorder - psychology; Brain; Brain - physiopathology; Classification; Cognition; Cognition Disorders - physiopathology; Cognition Disorders - psychology; Cognitive ability; Cognitive style; Cortex (cingulate); Cortex (prefrontal); Cortex (visual); Decision making; Electroencephalography; Electrophysiological recording; Emotions; Empathy; Executive Function - physiology; Feedback; Hemispheric laterality; Hippocampus; Humans; Jumping; Magnetoencephalography; Perceptual Disorders - physiopathology; Perceptual Disorders - psychology; Personality; Personality disorders; Psychiatry; Reviews; Structure-function relationships; Visual evoked potentials
• ISSN: 0951-7367; 1473-6578
• DOI: 10.1097/YCO.0b013e32835b57a9

PURPOSE OF REVIEWThis review summarizes recent neurocognitive research to better delineate the nosology, prognostication and cause underlying borderline personality disorder (BPD).
RECENT FINDINGSBPD had marked clinical heterogeneity with high comorbidity. Executive dysfunction in this disorder was linked to suicidality and treatment adherence, and may serve as an endophenotype. BPD was also characterized by cognitive distortions such as risky decision-making, deficient feedback processing, dichotomous thinking, jumping to conclusion, monocausal attribution and paranoid cognitive style. Social cognition deficits recently described in BPD include altered social inference and emotional empathy, hypermentalization, poorer facial emotional recognition and facial expressions. In electrophysiological studies, BPD was found to have predominantly right hemispheric deficit in high-order cortical inhibition. Reduced left orbitofrontal activity by visual evoked potential and magnetoencephalography correlated with depressive symptoms and functional deterioration. Brain structures implicated in BPD include the hippocampus, dorsolateral prefrontal cortex and anterior cingulate cortex. Abnormal anatomy and functioning of frontolimbic circuitry appear to correlate with cognitive deficits.
SUMMARYFrontolimbic structural and functional abnormalities underlie the broad array of cognitive abnormalities in BPD. Further research should espouse broader considerations of effects of comorbidity and clinical heterogeneity, and include community samples and, possibly, longitudinal designs.