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Neuropsychological function in bulimia with comorbid borderline personality disorder and depression

Published online by Cambridge University Press:  24 June 2014

Cecilia M. Bourke ,
Richard J. Porter ,
Patrick Sullivan ,
Cynthia M. Bulik ,
Frances A. Carter ,
Virginia V. McIntosh  and
Peter R. Joyce
Cecilia M. Bourke
Affiliation:
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
Richard J. Porter*
Affiliation:
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
Patrick Sullivan
Affiliation:
UNC Departments of Genetics, Psychiatry, and Epidemiology, Carolina Center for Genome Sciences, Chapel Hill, North Carolina, USA
Cynthia M. Bulik
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
Frances A. Carter
Affiliation:
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
Virginia V. McIntosh
Affiliation:
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
Peter R. Joyce
Affiliation:
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
*
Richard J. Porter, MB BS, MD, MA, DipObst, MRCPsych, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch 8140, New Zealand. Tel: +64-3-372-0400; Fax: +64-3-372-0407; E-mail: richard.porter@chmeds.ac.nz
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Abstract

Background:

In bulimia nervosa (BN), borderline personality disorder (BPD) and major depression (MDD) are frequently comorbid conditions. Executive function has been found to be impaired in BPD and MDD, but the impact of comorbidity on neuropsychological function has rarely been investigated.

Objective:

To investigate neuropsychological function in BN with a focus on comorbid BPD and MDD.

Methods:

One hundred forty-four medication-free female patients entering a study of psychological treatments for BN performed a brief battery of neuropsychological tests. Comorbid MDD and BPD were systematically identified using standard interviews. Neuropsychological test results were compared.

Results:

Forty-one subjects had comorbid BPD and 35 had comorbid MDD, while 15 had both. There was no effect of comorbid MDD, but there was a significant effect of BPD and a significant interaction between the diagnosis of MDD and BPD on executive tasks (trail making and Stroop). Thus, compared with subjects without BPD, subjects with BPD performed significantly worse on tests of executive function, while the group with both comorbidities performed even worse.

Conclusions:

There appears to be an additive effect of BPD and MDD resulting in impaired executive neuropsychological function. Future studies on either disorder and on BN should examine and account for the effect of comorbidity.

Keywords

borderline personality disorderbulimia nervosamajor depressive disorderneuropsychological function
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 18 , Issue 3-4 , June 2006 , pp. 162 - 167
Copyright
Copyright © 2006 Blackwell Munksgaard

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References

Fairburn, CG, Beglin, SJ. Studies of the epidemiology of bulimia nervosa Am J Psychiatry 1990;147:401–408. Google ScholarPubMed
Gunderson, JG. Borderline personality disorder: A clinical guide. Washington, DC: American Psychiatric Publishing, 2001. Google Scholar
O’Brien, KM, Vincent, NK. Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev 2003;23:57–74. CrossRefGoogle ScholarPubMed
Travers, C, King, R. An investigation of organic factors in the neuropsychological functioning of patients with borderline personality disorder. J Personal Disord 2005;19:1–18. CrossRefGoogle ScholarPubMed
Abela, JRZ, Payne, AVL, Moussaly, N. Cognitive vulnerability to depression in individuals with borderline personality disorder. J Personal Disord 2003;17:319–329. CrossRefGoogle ScholarPubMed
Jones, BP, Duncan, CC, Brouwers, P, Mirsky, AF. Cognition in eating disorders. J Clin Exp Neuropsychol 1991;13:711–728. CrossRefGoogle ScholarPubMed
Lauer, CJ, Gorzewski, B, Gerlinghoff, M, Backmund, H, Zihl, J. Neuropsychological assessments before and after treatment in patients with anorexia nervosa and bulimia nervosa. J Psychiatr Res 1999;33:129–138. CrossRefGoogle ScholarPubMed
McKay, SE, Humphries, LL, Allen, ME, Clawson, DR. Neuropsychological test performance of bulimic patients. Int J Neurosci 1986;30:73–80. CrossRefGoogle ScholarPubMed
Laessle, RG, Bossert, S, Hank, G, Hahlweg, K, Pirke, KM. Cognitive performance in patients with bulimia nervosa: relationship to intermittent starvation. Biol Psychiatry 1990;27:549–551. CrossRefGoogle ScholarPubMed
Kaye, W, Bastiani, AM, Moss, H. Cognitive style of patients with anorexia nervosa and bulimia rervosa. Int J Eat Disord 1995;18:287–290. 3.0.CO;2-Y>CrossRefGoogle Scholar
Ferraro, FR, Wonderlich, S, Jocic, Z. Performance variability as a new theoretical mechanism regarding eating disorders and cognitive processing. J Clin Psychol 1997;53:117–121. 3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
O’Leary, KM, Brouwers, P, Gardner, DL, Cowdry, RW. Neuropsychological testing of patients with borderline personality disorder. Am J Psychiatry 1991;148:106–111. Google ScholarPubMed
Judd, PH, Ruff, RM. Neuropsychological dysfunction in borderline personality disorder. J Personal Disord 1993;7:275–284. CrossRefGoogle Scholar
Swirsky-Sacchetti, T, Gorton, G, Samuel, S, Sobel, R, Genetta-Wadley, A, Burleigh, B. Neuropsychological function in borderline personality disorder. J Clin Psychol 1993;49:385–396. 3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Bazanis, E, Rogers, RD, Dowson, JHet al. Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychol Med 2002;32:1395–1405. CrossRefGoogle ScholarPubMed
Dinn, WM, Harris, CL, Aycicegi, A, Greene, PB, Kirkley, SM, Reilly, C. Neurocognitive function in borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2004;28:329–341. CrossRefGoogle ScholarPubMed
Stevens, A, Burkhardt, M, Hautzinger, M, Schwarz, J, Unckel, C. Borderline personality disorder: impaired visual perception and working memory. Psychiatry Res 2004;125:257–267. CrossRefGoogle ScholarPubMed
Leyton, M, Okazawa, H, Diksic, Met al. Brain regional alpha-[11C]methyl-L-tryptophan trapping in impulsive subjects with borderline personality disorder. Am J Psychiatry 2001;158:775–782. CrossRefGoogle ScholarPubMed
Posner, MI, Rothbart, MK, Vizueta, Net al. Attentional mechanisms of borderline personality disorder. Proc Natl Acad Sci U S A 2002;99:16366–16370. CrossRefGoogle ScholarPubMed
Fertuck, EA, Lenzenweger, MF, Clarkin, JF. The association between attentional and executive controls in the expression of borderline personality disorder features: a preliminary study. Psychopathology 2005;38:75–81. CrossRefGoogle ScholarPubMed
Lenzenweger, MF, Clarkin, JF, Fertuck, EA, Kernberg, OF. Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. J Personal Disord 2004;18:421–438. CrossRefGoogle ScholarPubMed
Dougherty, DM, Bjork, JM, Huckabee, HCG, Moeller, FG, Swann, AC. Laboratory measures of aggression and impulsivity in women with borderline personality disorder. Psychiatry Res 1999;85:315–326. CrossRefGoogle ScholarPubMed
Sprock, J, Rader, TJ, Kendall, JP, Yoder, CY. Neuropsychological functioning in patients with borderline personality disorder. J Clin Psychol 2000;56:1587–1600. 3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Kunert, HJ, Druecke, HW, Sass, H, Herpertz, SC. Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings. J Personal Disord 2003;17:479–509. CrossRefGoogle ScholarPubMed
Porter, RJ, Gallagher, P, Thompson, JM, Young, AH. Neurocognitive impairment in drug-free patients with major depressive disorder. Br J Psychiatry 2003;182:214–220. CrossRefGoogle ScholarPubMed
Kurtz, JE, Morey, LC. Verbal memory dysfunction in depressed outpatients with and without borderline personality disorder. J Psychopathol Behav Assess 1999;21:141–156. CrossRefGoogle Scholar
Fertuck, EA, Marsano-Jozefowicz, S, Stanley, Bet al. The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression. J Personal Disord 2006;20:55–70. CrossRefGoogle ScholarPubMed
Troop, NA, Serpell, L, Treasure, JL. Specificity in the relationship between depressive and eating disorder symptoms in remitted and nonremitted women. Int J Eat Disord 2001;30:306–311. CrossRefGoogle ScholarPubMed
O’Leary, KM. Borderline personality disorder. Neuropsychological testing results. Psychiatr Clin North Am 2000;23:41–60, vi. CrossRefGoogle ScholarPubMed
Bulik, CM, Sullivan, PF, Carter, FA, McIntosh, VV, Joyce, PR. The role of exposure with response prevention in the cognitive-behavioural therapy for bulimia nervosa. Psychol Med 1998;28:611–623. CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JB, Gibbon, M, First, MB. The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992;49:624–629. CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JB, Gibbon, M. Structured clinical interview for DSM-III-R – personality disorders (SCID-II, 3/1/87). New York: Biometrics Research Department, New York State Psychiatric Institute, 1987. Google Scholar
Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatr 1960;23:56–62. CrossRefGoogle ScholarPubMed
Lezak, MD. Neurophysiological assessment. 3rd edn. New York: Oxford University Press, 1995. Google Scholar
Wechsler, D. Wechsler Adult Intelligence Scale – Revised. New York: The Psychological Corporation, 1981. Google Scholar
Spreen, O, Strauss, E. A compendium of neuropsychological tests: administration, norms, and commentary. 2nd edn. New York: Oxford University Press, 1998. Google Scholar
Stroop, JR. Studies of interference in serial verbal reactions. Exp Psychol 1935;18:643–661. CrossRefGoogle Scholar
Grant, MM, Thase, ME, Sweeney, JA. Cognitive disturbance in outpatient depressed younger adults: evidence of modest impairment. Biol Psychiatry 2001;50:35–43. CrossRefGoogle ScholarPubMed
Cowen, PJ. Back to the future: the neurobiology of major depression. Psychol Med 1998;28:253–255. CrossRefGoogle Scholar
Hansenne, M, Pitchot, W, Ansseau, M. Serotonin, personality and borderline personality disorders. Acta Neuropsychiatr 2002;14:66–70. CrossRefGoogle Scholar
Riedel, WJ. Cognitive changes after acute tryptophan depletion: what can they tell us? Psychol Med 2004;34:3–8. CrossRefGoogle ScholarPubMed
Porter, RJ, Phipps, AJ, Gallagher, P, Scott, A, Stevenson, PS, O’Brien, JT. Effects of acute tryptophan depletion on mood and cognitive function in older recovered depressed subjects. Am J Geriatr Psychiatry 2005;13:607–615. CrossRefGoogle ScholarPubMed