Hostname: page-component-5db58dd55d-m58mf Total loading time: 0 Render date: 2026-05-26T12:34:08.538Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of emotional distraction on working memory performance in borderline personality disorder

Published online by Cambridge University Press:  08 March 2012

A. Krause-Utz ,
N. Y. L. Oei ,
I. Niedtfeld ,
M. Bohus ,
P. Spinhoven ,
C. Schmahl  and
B. M. Elzinga
A. Krause-Utz*
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
N. Y. L. Oei
Affiliation:
Institute of Psychology, Clinical Health and Neuropsychology Unit, Leiden University, Leiden, The Netherlands Leiden Institute for Brain and Cognition, Leiden, The Netherlands
I. Niedtfeld
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
M. Bohus
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
P. Spinhoven
Affiliation:
Institute of Psychology, Clinical Health and Neuropsychology Unit, Leiden University, Leiden, The Netherlands Leiden Institute for Brain and Cognition, Leiden, The Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
C. Schmahl
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
B. M. Elzinga
Affiliation:
Institute of Psychology, Clinical Health and Neuropsychology Unit, Leiden University, Leiden, The Netherlands Leiden Institute for Brain and Cognition, Leiden, The Netherlands
*
*Address for correspondence: A. Krause-Utz, M.A., Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J 5, D-68159 Mannheim, Germany. (Email: Annegret.Krause-Utz@zi-mannheim.de)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Emotion dysregulation, characterized by heightened emotional arousal and increased emotional sensitivity, is a core feature of borderline personality disorder (BPD). Although current theories emphasize the disruptive potential of negative emotions on cognitive functioning in BPD, behavioral and neurobiological data on this relationship are still lacking.

Method

Using functional magnetic resonance imaging (fMRI), neural activity was investigated in 22 unmedicated BPD patients and 22 healthy participants (matched for age, education and intelligence) performing an adapted Sternberg working memory task, while being distracted by emotional (negatively arousing) and neutral pictures from the International Affective Picture System (IAPS).

Results

Emotional distraction was associated with significantly higher activation in the amygdala and decreased activation in the dorsolateral prefrontal cortex (DLPFC), extending findings of previous studies in healthy individuals. Patients with BPD showed significantly longer reaction times (RTs) along with significantly higher activation in the amygdala and insula during emotional distraction compared to healthy participants, suggesting that they were more distracted by emotional pictures during the working memory task. Moreover, in the group of BPD patients, a significant negative correlation was found between activation in limbic brain regions and self-reports of current dissociative states.

Conclusions

Our findings suggest hyper-responsiveness to emotionally distracting pictures in BPD patients that negatively affects working memory performance. This stresses the importance of emotion dysregulation in the context of cognitive functioning. Moreover, our findings suggest that dissociative states have a dampening effect on neural reactivity during emotional challenge in BPD.

Keywords

Borderline personality disorderdissociationworking memory

Information

Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 10 , October 2012 , pp. 2181 - 2192
Copyright
Copyright © Cambridge University Press 2012

Access options

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

Article purchase

Temporarily unavailable

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Bohus, M, Limberger, MF, Frank, U, Sender, I, Gratwohl, T, Stieglitz, RD (2001). Development of the Borderline Symptom List [in German]. Psychotherapie, Psychosomatik, medizinische Psychologie 51, 201–211.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Davis, M, Whalen, PJ (2001). The amygdala: vigilance and emotion. Molecular Psychiatry 6, 13–34.CrossRefGoogle ScholarPubMed
Dolcos, F, McCarthy, G (2006). Brain systems mediating cognitive interference by emotional distraction. Journal of Neuroscience 26, 2072–2079.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.CrossRefGoogle ScholarPubMed
Donegan, NH, Sanislow, CA, Blumenberg, HP, Fulbright, RK, Lacadie, C, Skudlarski, P, Gore, JC, Olson, IR, McGlashan, TH, Wexler, BE (2003). Amygdala hyperreactivity in borderline personality disorder: implications for emotional dysregulation. Biological Psychiatry 54, 1284–1293.CrossRefGoogle ScholarPubMed
Drevets, WC, Raichle, ME (1998). Reciprocal suppression of regional cerebral blood flow during emotional versus higher cognitive processes: implications for interactions between emotion and cognition. Cognition and Emotion 12, 353–385.CrossRefGoogle Scholar
Ebner-Priemer, UW, Badeck, S, Beckmann, C, Wagner, A, Feige, B, Weiss, I, Lieb, K, Bohus, M (2005). Affective dysregulation and dissociative experience in female patients with borderline personality disorder: a startle response study. Journal of Psychiatric Research 39, 85–92.CrossRefGoogle ScholarPubMed
Ebner-Priemer, UW, Mauchnik, J, Kleindienst, N, Schmahl, C, Peper, M, Rosenthal, MZ, Flor, H, Bohus, M (2009). Emotional learning during dissociative states in borderline personality disorder. Journal of Psychiatry and Neuroscience 34, 214–222.Google ScholarPubMed
Elzinga, BM, Ardon, A, Heijnis, M, De Ruiter, M, van Dyck, R, Veltman, D (2007). Neural correlates of enhanced working-memory performance in dissociative disorder: a functional MRI study. Psychological Medicine 37, 235–245.CrossRefGoogle ScholarPubMed
Fertuck, EA, Jekal, A, Song, I, Wyman, B, Morris, MC, Wilson, ST, Brodsky, BS, Stanley, B (2009). Enhanced ‘Reading the Mind in the Eyes’ in borderline personality disorder compared to healthy controls. Psychological Medicine 39, 1979–1988.CrossRefGoogle ScholarPubMed
Fertuck, EA, Lenzenweger, MF, Clarkin, JF, Hoermann, S, Stanley, B (2006). Executive neurocognition, memory systems, and borderline personality disorder. Clinical Psychology Review 26, 346–375.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1997). Structured Clinical Interview for DSM-V Axis I Disorders – Clinical Version (SCID-CV). American Psychiatric Press: Washington, DC.Google Scholar
Foa, E (1995). Posttraumatic Stress Diagnostic Scale Manual. National Computer Systems Inc.: Minneapolis, MN.Google Scholar
Gläscher, J (2009). Visualization of group inference data in functional neuroimaging. Neuroinformatics 7, 73–82.CrossRefGoogle ScholarPubMed
Grant, B, Chou, S, Goldstein, R, Huang, B, Stinson, F, Saha, T, Smith, S, Dawson, D, Pulay, A, Pickering, R, Ruan, W (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 69, 533–545.CrossRefGoogle ScholarPubMed
Gratz, KL, Roemer, L (2004). Multidimensional assessment of emotion regulation: development, factor structure, and initial validation of the Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41–45.CrossRefGoogle Scholar
Haaland, V, Landrø, N (2009). Pathological dissociation and neuropsychological functioning in borderline personality disorder. Acta Psychiatrica Scandinavica 119, 383–392.CrossRefGoogle ScholarPubMed
Hurlemann, R, Hawellek, B, Maier, W, Dolan, RJ (2007). Enhanced emotion-induced amnesia in borderline personality disorder. Psychological Medicine 37, 971–981.CrossRefGoogle ScholarPubMed
Kleindienst, N, Limberger, MF, Ebner-Priemer, UW, Mauchnik, J, Dyer, A, Berger, M, Schmahl, C, Bohus, M (2011). Dissociation predicts poor response to Dialectical Behavioral Therapy in female patients with Borderline Personality Disorder. Journal of Personality Disorders 25, 432–447.CrossRefGoogle ScholarPubMed
Kuo, JR, Linehan, MM (2009). Disentangling emotion processes in borderline personality disorder: physiological and self-reported assessment of biological vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology 118, 531–544.CrossRefGoogle ScholarPubMed
Lang, PJ, Bradley, MM, Cuthbert, BN (2005). International Affective Picture System (IAPS): Digitized Photographs, Instruction Manual and Affective Ratings. Technical Report A-6. University of Florida: Gainesville, FL.Google Scholar
Lanius, RA, Vermetten, E, Loewenstein, R, Brand, B, Schmahl, C, Bremner, JD, Spiegel, D (2010). Emotion modulation in PTSD: clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry 167, 640–647.CrossRefGoogle ScholarPubMed
Lis, E, Greenfield, B, Henry, M, Guilé, JM, Dougherty, G (2007). Neuroimaging and genetics of borderline personality disorder: a review. Journal of Psychiatry and Neuroscience 32, 162–173.Google ScholarPubMed
Loranger, AW (1999). International Personality Disorder Examination (IPDE): DSM-IV and ICD-10 Modules. Psychological Assessment Resources: Odessa, FL.Google Scholar
Mensebach, C, Wingenfeld, K, Driessen, M, Rullkoetter, N, Schlosser, N, Steil, C, Schaffrath, C, Bulla-Hellwig, M, Markowitsch, HJ, Woermann, FG, Beblo, T (2009). Emotion-induced memory dysfunction in borderline personality disorder. Cognitive Neuropsychiatry 14, 524–541.CrossRefGoogle ScholarPubMed
Morey, R, Dolcos, F, Petty, C, Cooper, D, Hayes, J, LaBar, KS, McCarthy, G (2009). The role of trauma-related distractors on neural systems for working memory and emotion processing in posttraumatic stress disorder. Journal of Psychiatric Research 43, 809–817.CrossRefGoogle ScholarPubMed
Oei, NYL, Tollenaar, M, Elzinga, BM, Spinhoven, P (2010). Propranolol reduces emotional distraction in working memory: a partial mediating role of propranolol-induced cortisol increases? Neurobiology of Learning and Memory 93, 388–395.CrossRefGoogle ScholarPubMed
Oei, NYL, Tollenaar, M, Spinhoven, P, Elzinga, BM (2009). Hydrocortisone reduces emotional distracter interference in working memory. Psychoneuroendocrinology 34, 1284–1293.CrossRefGoogle ScholarPubMed
Oei, NYL, Veer, IM, Wolf, OT, Spinhoven, P, Rombouts, SARB, Elzinga, BM (2011). Stress shifts brain activation towards ventral ‘affective’ areas during emotional distraction. Social Cognitive and Affective Neuroscience. Published online: 14 April 2011. doi:10.1093/scan/nsr024.Google ScholarPubMed
Ogawa, S, Lee, T, Kay, A, Tank, D (1990). Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proceedings of the National Academy of Sciences USA 87, 9868–9872.CrossRefGoogle ScholarPubMed
Patton, J, Stanford, M, Barratt, E (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51, 768–774.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Rosenthal, MZ, Gratz, KL, Kosson, DS, Cheavens, JS, Lejuez, CW, Lynch, TR (2008). Borderline personality disorder and emotional responding: a review of the research literature. Clinical Psychology Review 28, 75–91.CrossRefGoogle ScholarPubMed
Rösler, M, Retz, W, Thome, J, Schneider, M, Stieglitz, RD, Falkai, P (2006). Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience 256 (Suppl. 1), i3–i11.CrossRefGoogle ScholarPubMed
Sierra, M, Berrios, GE (1998). Depersonalization: neurobiological perspectives. Biological Psychiatry 44, 898–908.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Skodol, AE, Gunderson, JG, Pfohl, B, Widiger, TA, Livesley, WJ, Siever, LJ (2002). The borderline diagnosis I: psychopathology comorbidity, and personality structure. Biological Psychiatry 51, 936–950.CrossRefGoogle ScholarPubMed
Spielberger, CD, Gorsuch, RL, Lushene, RE (1970). Manual for the State-Trait Anxiety Inventory. Consulting Psychologist Press: Palo Alto, CA.Google Scholar
Spitzer, C, Barnow, S, Freyberger, HJ, Grabe, HJ (2007). Dissociation predicts symptom-related treatment outcome in short-term inpatient psychotherapy. Australian and New Zealand Journal of Psychiatry 41, 682–687.CrossRefGoogle ScholarPubMed
Sternberg, S (1966). High-speed scanning in human memory. Science 153, 652–654.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
Stiglmayr, CE, Ebner-Priemer, UW, Bretz, J, Behm, R, Mohse, M, Lammers, CH, Anghelescu, IG, Schmahl, C, Schlotz, W, Kleindienst, N, Bohus, M (2008). Dissociative symptoms are positively related to stress in borderline personality disorder. Acta Psychiatrica Scandinavica 117, 139–147.CrossRefGoogle ScholarPubMed
Stiglmayr, CE, Shapiro, DA, Stieglitz, RD, Limberger, MF, Bohus, M (2001). Experience of aversive tension and dissociation in female patients with borderline personality disorder – a controlled study. Journal of Psychiatric Research 35, 111–118.CrossRefGoogle ScholarPubMed
Tzourio-Mazoyer, N, Landeau, B, Papathanassiou, D, Crivello, F, Etard, O, Delcroix, N, Mazoyer, B, Joliot, M (2002). Automated anatomical labeling of activations in SPM using a macroscopic anatomical parcellation of the MNI MRI single-subject brain. NeuroImage 15, 273–289.CrossRefGoogle ScholarPubMed
Wechsler, D (1987). WMS-R: Wechsler Memory Scale – Revised (Manual). The Psychological Corporation: San Antonio, TX.Google Scholar
Wechsler, D (1997). Wechsler Adult Intelligence Scale. Third Edition. The Psychological Corporation: San Antonio, TX.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.CrossRefGoogle ScholarPubMed
Woolrich, M, Behrens, T, Beckmann, C, Smith, S (2004). Multilevel linear modelling for FMRI group analysis using Bayesian inference. NeuroImage 21, 1732–1747.CrossRefGoogle ScholarPubMed