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Impact of stress on different components of impulsivity in borderline personality disorder

Published online by Cambridge University Press:  06 March 2014

S. Cackowski ,
A.-C. Reitz ,
G. Ende ,
N. Kleindienst ,
M. Bohus ,
C. Schmahl  and
A. Krause-Utz
S. Cackowski*
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
A.-C. Reitz
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
G. Ende
Affiliation:
Department of Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
N. Kleindienst
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
M. Bohus
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
C. Schmahl
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
A. Krause-Utz
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
*
*Address for correspondence: S. Cackowski, M.A., Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J5, D-68159 Mannheim, Germany. (Email: sylvia.cackowski@zi-mannheim.de)
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Abstract

Background.

Previous research on impulsivity in borderline personality disorder (BPD) has revealed inconsistent findings. Impulsive behaviour is often observed during states of emotional distress and might be exaggerated by current attention deficit hyperactivity disorder (ADHD) symptoms in individuals with BPD. We aimed to investigate different components of impulsivity dependent on stress induction controlling for self-reported ADHD symptoms in BPD.

Method.

A total of 31 unmedicated women with BPD and 30 healthy women (healthy controls; HCs), matched for age, education and intelligence, completed self-reports and behavioural tasks measuring response inhibition (go/stop task) and feedback-driven decision making (Iowa Gambling Task) under resting conditions and after experimental stress induction. ADHD symptoms were included as a covariate in the analyses of behavioural impulsivity. Additionally, self-reported emotion-regulation capacities were assessed.

Results.

BPD patients reported higher impulsive traits than HCs. During stress conditions – compared with resting conditions – self-reported impulsivity was elevated in both groups. Patients with BPD reported higher state impulsivity under both conditions and a significantly stronger stress-dependent increase in state impulsivity. On the behavioural level, BPD patients showed significantly impaired performance on the go/stop task under stress conditions, even when considering ADHD symptoms as a covariate, but not under resting conditions. No group differences on the Iowa Gambling Task were observed. Correlations between impulsivity measures and emotion-regulation capacities were observed in BPD patients.

Conclusions.

Findings suggest a significant impact of stress on self-perceived state impulsivity and on response disinhibition (even when considering current ADHD symptoms) in females with BPD.

Keywords

Borderline personality disorderimpulsivitystress
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 15 , November 2014 , pp. 3329 - 3340
Copyright
Copyright © Cambridge University Press 2014 

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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Press: Washington, DC.Google Scholar
Arntz, A, Appels, C, Sieswerda, S (2000). Hypervigilance in borderline disorder: a test with emotional Stroop paradigm. Journal of Personality Disorders 14, 366–373.CrossRefGoogle ScholarPubMed
Baer, RA, Peters, JR, Eisenlohr-Moul, TA, Geiger, PJ, Sauer, SE (2012). Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature. Clinical Psychology Review 32, 359–369.CrossRefGoogle ScholarPubMed
Beblo, T, Mensebach, C, Wingenfeld, K, Rullkoetter, N, Schlosser, N, Driessen, M (2011). Patients with borderline personality disorder and major depressive disorder are not distinguishable by their neuropsychological performance: a case–control study. Primary Care Companion to CNS Disorders 13, PMC3121210.Google Scholar
Bechara, A, Damásio, AR, Damásio, H, Anderson, SW (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 7–15.Google Scholar
Beck, AT, Steer, RA, Ball, R, Ranieri, W (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment 67, 588–597.CrossRefGoogle Scholar
Berlin, HA, Rolls, ET, Iversen, SD (2005). Borderline personality disorder, impulsivity, and the orbitofrontal cortex. American Journal of Psychiatry 162, 2360–2373.Google Scholar
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect 27, 169–190.Google Scholar
Bernstein, EM, Putnam, FW (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease 174, 727–735.CrossRefGoogle ScholarPubMed
Bohus, M, Limberger, MF, Frank, U, Chapman, AL, Kuehler, T, Stieglitz, RD (2007). Psychometric Properties of the Borderline Symptom List (BSL). Psychopathology 40, 126–132.Google Scholar
Bornovalova, MA, Lejuez, CW, Daughters, SB, Zachary Rosenthal, M, Lynch, TR (2005). Impulsivity as a common process across borderline personality and substance use disorders. Clinical Psychology Review 25, 790–812.Google Scholar
Chapman, AL, Dixon-Gordon, KL, Layden, BK, Walters, KN (2010). Borderline personality features moderate the effect of a fear induction on impulsivity. Personality Disorders 1, 139–152.Google Scholar
Chapman, AL, Leung, DW, Lynch, TR (2008). Impulsivity and emotion dysregulation in borderline personality disorder. Journal of Personality Disorders 22, 148–164.Google Scholar
Coffey, SF, Schumacher, JA, Baschnagel, JS, Hawk, LW, Holloman, G (2011). Impulsivity and risk-taking in borderline personality disorder with and without substance use disorders. Personality Disorders: Theory, Research and Treatment 2, 128–141.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Dinn, WM, Harris, CL, Aycicegi, A, Greene, PB, Kirkley, SM, Reilly, C (2004). Neurocognitive function in borderline personality disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 28, 329–341.CrossRefGoogle ScholarPubMed
Domes, G, Winter, B, Schnell, K, Vohs, K, Fast, K, Herpertz, SC (2006). The influence of emotions on inhibitory functioning in borderline personality disorder. Psychological Medicine 36, 1163–1172.Google Scholar
Dougherty, DM, Bjork, JM, Huckabee, HC, Moeller, FG, Swann, AC (1999). Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Research 85, 315–326.CrossRefGoogle ScholarPubMed
Dougherty, DM, Mathias, CW, Marsh, DM, Jagar, AA (2005). Laboratory measures of impulsivity. Behavior Research Methods 37, 82–90.CrossRefGoogle ScholarPubMed
Ferrer, M, Andión, O, Matalí, J, Valero, S, Navarro, JA, Ramos-Quiroga, JA, Torrubia, R, Casas, M (2010). Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder. Journal of Personality Disorders 24, 812–822.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-IV Axis I Disorders – Clinical Version (SCID-CV). American Psychiatric Press: Washington, DC.Google Scholar
Fossati, A, Novella, L, Donati, D, Donini, M, Maffei, C (2002). History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: a controlled study. Comprehensive Psychiatry 43, 369–377.Google Scholar
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41–54.Google Scholar
Haaland, VØ, Landrø, NI (2007). Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder. Journal of the International Neuropsychological Society 13, 699–703.Google Scholar
Henry, C, Mitropoulou, V, New, AS, Königsberg, HW, Silverman, J, Siever, LJ (2001). Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. Journal of Psychiatric Research 35, 307–312.Google Scholar
Hochhausen, NM, Lorenz, AR, Newman, JP (2002). Specifying the impulsivity of female inmates with borderline personality disorder. Journal of Abnormal Psychology 111, 495–501.CrossRefGoogle ScholarPubMed
Hurlemann, R, Hawellek, B, Maier, W, Dolan, RJ (2007). Enhanced emotion-induced amnesia in borderline personality disorder. Psychological Medicine 37, 971–981.Google Scholar
Jacob, G, Gutz, L, Bader, K, Lieb, K, Tüscher, O, Stahl, C (2010). Impulsivity in borderline personality disorder: impairment in self-report measures, but not behavioral inhibition. Psychopathology 43, 180–188.Google Scholar
Jacob, G, Ower, N, Buchholz, A (2013). The role of experiential avoidance, psychopathology, and borderline personality features in experiencing positive emotions: a path analysis. Journal of Behavior Therapy and Experimental Psychiatry 44, 61–68.Google Scholar
Kirkpatrick, T, Joyce, E, Milton, J, Duggan, C, Tyrer, P, Rogers, RD (2007). Altered emotional decision-making in prisoners with borderline personality disorder. Journal of Personality Disorders 21, 243–261.CrossRefGoogle ScholarPubMed
Kolotylova, T, Koschke, M, Bär, KJ, Ebner-Priemer, U, Kleindienst, N, Bohus, M, Schmahl, C (2010). Development of the “Mannheim Multicomponent Stress Test” (MMST). Psychotherapie, Psychosomotik, Medizinische Psychologie 60, 64–72.Google Scholar
Krause-Utz, A, Oei, NY, Niedtfeld, I, Bohus, M, Spinhoven, P, Schmahl, C, Elzinga, BM (2012). Influence of emotional distraction on working memory performance in borderline personality disorder. Psychological Medicine 26, 605–615.Google Scholar
Krause-Utz, A, Sobanski, E, Alm, B, Valerius, G, Kleindienst, N, Bohus, M, Schmahl, C (2013). Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity disorder: an exploratory study. Journal of Nervous and Mental Disease 201, 116–123.Google Scholar
Kunert, HJ, Druecke, HW, Sass, H, Herpertz, SC (2003). Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings. Journal of Personality Disorders 17, 497–509.Google Scholar
Lampe, K, Konrad, K, Kroener, S, Fast, K, Kunert, HJ, Herpertz, SC (2007). Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychological Medicine 37, 1717–1729.Google Scholar
Lawrence, KA, Allen, JS, Chanen, AM (2010). Impulsivity in borderline personality disorder: reward-based decision-making and its relationship to emotional distress. Journal of Personality Disorders 24, 786–799.CrossRefGoogle ScholarPubMed
LeGris, J, Links, PS, van Reekum, R, Tannock, R, Toplak, M (2012). Executive function and suicidal risk in women with borderline personality disorder. Psychiatry Research 196, 101–108.Google Scholar
Lenzenweger, MF, Clarkin, JF, Fertuck, EA, Kernberg, OF (2004). Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. Journal of Personality Disorders 18, 421–438.Google Scholar
Leyton, M, Okazawa, H, Diksic, M, Paris, J, Rosa, P, Mzengeza, S, Young, SN, Blier, P, Benkelfat, C (2001). Brain regional α-[11C]methyl-l-tryptophan trapping in impulsive subjects with borderline personality disorder. American Journal of Psychiatry 158, 775–782.Google Scholar
Lejuez, CW, Kahler, C, Brown, R (2003). A modified computer version of the Paced Auditory Serial Addition Task (PASAT) as a laboratory-based stressor. Behavior Therapist 26, 290–293.Google Scholar
Linehan, MM (1993). Cognitive-Behavioural Treatment of Borderline Personality Disorder. Guilford Press: New York.Google Scholar
Loranger, AW (1999). International Personality Disorder Examination (IPDE): DSMIV and ICD-10 Modules. Psychological Assessment Resources: Odessa, FL.Google Scholar
Lynam, DR, Miller, JD, Miller, DJ, Bornovalova, MA, Lejuez, CW (2011). Testing the relations between impulsivity-related traits, suicidality, and nonsuicidal self-injury: a test of the incremental validity of the UPPS model. Personality Disorders: Theory, Research, and Treatment 2, 151–160.CrossRefGoogle ScholarPubMed
Magen, E, Gross, JJ (2010). The cybernetic process model of self-control: situation- and person-specific considerations. In Handbook of Personality and Self-Regulation (ed. Hoyle, R. H.), pp. 353–374. Blackwell Publications: New York.Google Scholar
Mak, AD, Lam, LC (2013). Neurocognitive profiles of people with borderline personality disorder. Current Opinions in Psychiatry 26, 90–96.CrossRefGoogle ScholarPubMed
Maurex, L, Zaboli, G, Wiens, S, Asberg, M, Leopardi, R, Ohman, A (2009). Emotionally controlled decision-making and a gene variant related to serotonin synthesis in women with borderline personality disorder. Scandinavian Journal of Psychology 50, 5–10.Google Scholar
McCloskey, MS, New, AS, Siever, LJ, Goodman, M, Koenigsberg, HW, Flory, JD, Coccaro, EF (2009). Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder. Journal of Psychiatric Research 43, 1036–1048.CrossRefGoogle ScholarPubMed
Mensebach, C, Wingenfeld, K, Driessen, M, Rullkoetter, N, Schlosser, N, Steil, C, Schaffrath, C, Bulla-Hellwig, M, Markowitsch, H-J, Woermann, FG, Beblo, T (2009). Emotion-induced memory dysfunction in borderline personality disorder. Cognitive Neuropsychiatry 14, 524–541.Google Scholar
Moeller, FG, Barratt, ES, Dougherty, DM, Schmitz, JM, Swann, AC (2001). Psychiatric aspects of impulsivity. American Journal of Psychiatry 158, 1783–1793.Google Scholar
New, AS, Hazlett, EA, Newmark, RE, Zhang, J, Triebwasser, J, Meyerson, D, Lazarus, S, Trisdorfer, R, Goldstein, KE, Goodman, M, Koenigsberg, HW, Flory, JD, Siever, LJ, Buchsbaum, MS (2009). Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder. Biological Psychiatry 66, 1107–1114.Google Scholar
Patton, JH, Stanford, MS, Barratt, ES (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51, 768–774.Google Scholar
Philipsen, A (2006). Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. European Archives of Psychiatry and Clinical Neuroscience 256, 42–46.Google Scholar
Philipsen, A, Feige, B, Hesslinger, B, Scheel, C, Ebert, D, Matthies, S, Limberger, MF, Kleindienst, N, Bohus, M, Lieb, K (2009). Borderline typical symptoms in adult patients with attention deficit/hyperactivity disorder. Attention Deficit and Hyperactivity Disorders 1, 11–18.Google Scholar
Philipsen, A, Limberger, MF, Lieb, K, Feige, B, Kleindienst, N, Ebner-Priemer, U, Barth, J, Schmahl, C, Bohus, M (2008). Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. British Journal of Psychiatry 192, 118–123.Google Scholar
Prehn, K, Schulze, L, Rossmann, S, Berger, C, Vohs, K, Fleischer, M, Hauenstein, K, Keiper, P, Domes, G, Herpertz, SC (2013). Effects of emotional stimuli on working memory processes in male criminal offenders with borderline and antisocial personality disorder. World Journal of Biological Psychiatry 14, 71–78.Google Scholar
Raven, J, Raven, JC, Court, JH (2003). Raven's Progressive Matrices und Vocabulary Scales. Pearson Assessment: Frankfurt.Google Scholar
Reinhardt, T, Kleindienst, N, Treede, RD, Bohus, M, Schmahl, C (2013). Individual modulation of pain sensitivity under stress. Pain Medicine 14, 676–685.Google Scholar
Reinhardt, T, Schmahl, C, Wüst, S, Bohus, M (2012). Salivary cortisol, heart rate, electrodermal activity and subjective stress responses to the Mannheim Multicomponent Stress Test (MMST). Psychiatry Research 198, 106–111.Google Scholar
Rentrop, M, Backenstrass, M, Jaentsch, B, Kaiser, S, Roth, A, Unger, J, Weisbrod, M, Renneberg, B (2008). Response inhibition in borderline personality disorder: performance in a Go/Nogo task. Psychopathology 41, 50–57.Google Scholar
Retz-Junginger, P, Retz, W, Blocher, D, Stieglitz, RD, Georg, T, Supprian, T, Wender, PH, Rösler, M (2003). Reliability and validity of the German short version of the Wender Utah Rating Scale for the retrospective assessment of attention deficit/hyperactivity disorder [article in German]. Nervenarzt 74, 987–993.Google Scholar
Ruchsow, M, Groen, G, Kiefer, M, Buchheim, A, Walter, H, Martius, P, Reiter, M, Hermle, L, Spitzer, M, Ebert, D, Falkenstein, M (2008). Response inhibition in borderline personality disorder: event-related potentials in a Go/Nogo task. Journal of Neural Transmission 115, 127–33.Google Scholar
Schuermann, B, Kathmann, N, Stiglmayr, C, Renneberg, B, Endrass, T (2011). Impaired decision making and feedback evaluation in borderline personality disorder. Psychological Medicine 41, 1917–1927.CrossRefGoogle ScholarPubMed
Sebastian, A, Jacob, G, Lieb, K, Tüscher, O (2013 a). Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Current Psychiatry Reports 15, 339.Google Scholar
Sebastian, A, Pohl, MF, Klöppel, S, Feige, B, Lange, T, Stahl, C, Voss, A, Klauer, KC, Lieb, K, Tüscher, O (2013 b). Disentangling common and specific neural subprocesses of response inhibition. NeuroImage 64, 601–615.Google Scholar
Sieswerda, S, Arntz, A, Mertens, I, Vertommen, S (2007). Hypervigilance in patients with borderline personality disorder: specificity, automaticity, and predictors. Behaviour Research and Therapy 45, 1011–1024.Google Scholar
Silbersweig, D, Clarkin, JF, Goldstein, M, Kernberg, OF, Tuescher, O, Levy, KN, Brendel, G, Pan, H, Beutel, M, Pavony, MT, Epstein, J, Lenzenweger, MF, Thomas, KM, Posner, MI, Stern, E (2007). Failure of frontolimbic inhibitory function in the context of negative emotion in borderline personality disorder. American Journal of Psychiatry 164, 1832–1841.Google Scholar
Spielberger, CD (1996). Manual for the State-Trait Anger Expression Inventory: Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Stiglmayr, C, Schmahl, C, Bremner, J, Bohus, M, Ebner-Priemer, U (2009). Development and psychometric characteristics of the DSS-4 as a short instrument to assess state dissociative experience during neuropsychological experiments. Psychopathology 42, 370–374.Google Scholar
Svaldi, J, Philipsen, A, Matthies, S (2012). Risky decision-making in borderline personality disorder. Psychiatry Research 197, 112–118.Google Scholar
Van Dijk, F, Lappenschaar, M, Kan, C, Verkes, RJ, Buitelaar, J (2011). Lifespan attention deficit/hyperactivity disorder and borderline personality disorder symptoms in female patients: a latent class approach. Psychiatry Research 190, 327–334.Google Scholar
Völker, KA, Spitzer, C, Limberg, A, Grabe, H-J, Freyberger, HJ, Barnow, S (2009). Executive dysfunctions in female patients with borderline personality disorder with regard to impulsiveness and depression. Psychotherapie Psychosomatik Medizinische Psychologie 59, 264–272.Google Scholar
Whiteside, SP, Lynam, DR (2001). The Five Factor Model and impulsivity: using a structural model of personality to understand impulsivity. Personality and Individual Differences 30, 669–689.Google Scholar
Wingenfeld, K, Mensebach, C, Rullkoetter, N, Schlosser, N, Schaffrath, C, Woermann, FG, Driessen, M, Beblo, T (2009). Attentional bias to personally relevant words in borderline personality disorder is strongly related to comorbid posttraumatic stress disorder. Journal of Personality Disorders 23, 141–155.Google Scholar
Wingrove, J, Bond, AJ (1997). Impulsivity: a state as well as trait variable. Does mood awareness explain low correlations between trait and behavioural measures of impulsivity? Personality and Individual Differences 22, 333–339.Google Scholar
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