Neuropsychological deficits in borderline personality disorder

168 Pages·2012·1.59 MB·English

by  Human, Christine.

NEUROPSYCHOLOGICAL DEFICITS
IN BORDERLINE PERSONALITY DISORDER
BY
CHRISTINE HUMAN
DISSERTATION
submitted in fulfilment of the requirements for the degree
MASTER OF ARTS
in
RESEARCH PSYCHOLOGY
in the
FACULTY OF ARTS
at the
RAND AFRIKAANS UNIVERSITY
SUPERVISOR: DR DEON DE BRUIN
November 1998
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DECLARATION
I, Christine Anne Human,
hereby declare that this dissertation is my own work
and has not been presented for any degree at another university.
The work reported in this dissertation was performed
in Wards 4 and 5 of the Tara Hospital, Gauteng,
under the guidance and supervision of
Dr. Mara Profis.
ACKNOWLEDGEMENTS
I would. like' to- express- my sincere gratitude to- the following- people/ and
orgartinerations- without whose support I would. have been, unable to- complete
this- dtssertationt
My supervisor, Professor Eddie Wolff:
First and foremost for your brilliance and ex-per-WS&
Secondly, for your conztowit support and ava2abaitY; your
enthusiasm/ with, regard, to- my vyp 1;4 your warmth, an& sense/ of
humour; your belief in, my ability to- succeed.; the positive/ impact
you, have had on my career a4p Craton*
And most of all... for allowin• me space'!
Dr. Deon, de Bruin for "stepping- in; at short notice to- 64w/4e the.
evaluation/of this- dasertatten,
Rand. Afrikaans- University for their financial, assistance in
cmuCtudi,40, me/a/ merit bursary.
Dr. J. L. van, Wyk , and, M 1.4s-El,sabe, S mit of Rand. Afrikaans- University
Stztristtok Department for their much needed, patience/ and.
ence, with, the/ data outalysisi
Mrs. 1ZiaBentruidenhout.of Rand, Afracteww tiniNersity: "organi/ber-
of- note", for her radiant countenance, friendship, and diligence,
and/for typitua•tiii4 , dissertattoni
The Superintendent c‘nd, Management Committee/ of Tara Hospital,
for their permbssion far conduct the research at Tara
Dr. Mara, Proff* for her invaluable, input and enthusia4ipt, try my
re/search, topic/.
Staff of Ward* 4 and, 5 at Tarot,: in, particular, Janet Branch, and
Lee Sack, for their a4,sistance, and for accepting, me. a,s, part of their '
profe4sionab team, for a. fully year tuhtle, the practical/ a4pects, of they
research, were being, conauaeth.
The. pattenty of Ward* 4 and, 5, 5th, and 6th, year medical students,
and final-year nursing, students, who- partiapateth tn, the study.
Maureen, flaye,s, and Godfrey Macktal,a, of the Rudolf geerlintei
Library, Tara, Hospital, for their effCcieney and, wi.12ingness, to- seep
out reference*
My friends:
Vane/1w, for her constant emotional' support and/ for helping, me.
stretch, thelhmitk.
Judith/ for planting, the "seed, of de4Cref to pursue research, in the.
area of BPD.
Jochai., for the. hours, he. spent listening, to- �"hatch," and giNe.
birth, to- this- research.
Roy, for extend tnfr my intent iw neuropsychology.
George,, my mentor, what:, cha2lerujed. my occasional less-than-
logical. inference*
My family:
Mark; Tracy, Michele, Geary, and. asui - for lyeing, "owini.present".
Ki,m, for her loving-support and Siiiste-ntnej, to- e4cerPtk.
Court, for hi* excitement try my achievements; and for hits, loyal,
support and.lovex
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ABSTRACT
The relatively rapid development of biological approaches to various psychological
conditions, has prompted clinicians and researchers to investigate Borderline Personality
Disorder more thoroughly.
Research has evidenced the uniqueness of Borderline Personality Disorder in terms of
description, aetiology and treatment. Of the various aetiologies proposed, the
neuropsychological deficit approach is one which is still in its infancy and which may
have promise for new treatment strategies. Latest developments delineate
neuropsychological deficits in the areas of memory, perception and visuospatial ability.
These factors are important for psychotherapeutic purposes.
The purpose of this study was to further existing knowledge as regards the aetiology of
Borderline Personality Disorder in order to initiate new treatment modalities and
management strategies. The study examined whether a battery of neuropsychological
tests could detect organic dysfunction in the areas of construction, orientation and
attention, memory, perception and concept formation and reasoning in twenty inpatients
diagnosed according to DSM-IV criteria, with Borderline Personality Disorder. Two
control groups were used, one comprising twenty inpatients diagnosed according to
DSM-IV criteria with Personality Disorders from Axis II, Clusters A or C; and the other
comprising twenty normal volunteers. Neuropsychological functioning assessed, included
measures of attention, construction, visual and auditory-verbal memory, perception, and
concept-formation and reasoning.
Measurement instruments used in this study included the Digit Symbol subtest of the
WAIS-R; Rey Complex Figure; Logical Memory subtest of the WMS-R, Gottschaldt
Embedded Figures Test; and the Wisconsin Card Sorting Test.
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Analysis of variance, multivariate analysis of variance and post hoc tests revealed
significant deficits in neuropsychological performance among the borderline personality
disorder group and the control group of other personality disorders but not the normal
volunteer group. Dysfunction was particularly significant in the areas of attention,
visuospatial ability, perceptual organization, and ability to maintain cognitive set. These
deficits do not appear to have been attributable to attention deficit disorder, attention
deficit hyperactivity disorder, temporal lobe epilepsy, head injury, a concurrent Axis I
diagnosis such as major depressive disorder, or current drug and/or alcohol abuse. The
observed deficits suggest new ways of understanding the development and maintenance
of Borderline Personality Disorder, and provide indications for treatment.
In conclusion, it is recommended that full use be made of the measurement instruments
used in this study as diagnostic aids to enhance the effectiveness of treatment modalities.
It is further recommended that research in this topic be repeated and extended using a
larger sample and matched controls.
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LIST OF TABLES
TABLE �
PAGE
2.3.A �DSM-IV General diagnostic criteria for a Personality
Disorder �7
3.2.2A �DSM-IV Multiaxial Classification �24
3.3A �Diagnostic Criteria for 301.83 Borderline Personality
Disorder �25
3.5A �Major Orientations to BPD �35
5.2.1a �Characteristics of the three groups: BPD, OTHER PD and
NORMALS �72
6.3.1.1A Multivariate Analysis of Variance: The group effect of
the experimental and control groups on the grouped data
of the Digit Symbol subtest of the WAIS-R and the
Logical Memory Subtest of the WMS-R 94
6.3.1.2A Multivariate Analysis of Variance: The group effect of
the experimental and control groups on the grouped data
of the Gottschaldt Embedded Figures Test 95
6.3.2.1A Univariate Analysis of Variance: The effect of the
experimental and control groups on Values for the Digit
Symbol subtest of the WAIS-R 96
6.3.2.1B SCHEFFE Post Hoc Test: Significance of differences in
cell means of the experimental on the control groups for
the dependent variable Digit Symbol subtest of the
WAIS-R (DS) 97
6.3.2.2A Analysis of Variance: The effect of the experimental and
control groups on the values for the Logical Memory
subtest of the WMS-R (LOG MEM) 98
6.3.2.3A Analysis of Variance: The effect of the experimental and
control groups on values for the Gottschaldt Embedded
Figures Test (GEF) _ 99
�
TABLE PAGE
6.3.2.3B �SCHEFFE Post Hoc Test: Significance of differences in
cell means of the experimental on the control groups for
the dependent variable Gottschaldt Embedded Figures
Test (GEF) 100
6.3.2.4A Analysis of Variance: The effect of the experimental and
control groups on values for the Wisconsin Card Sorting
Test 101
6.3.2.4B DUNNETT T3: Significance of differences in cell means
of the experimental on the control groups for the
dependent variable Wisconsin Card Sorting Test 102
6.3.3.1A Multivariate Analysis of Variance: The group effect of
the experimental and control groups on the Rey Complex
Figure Test: RCF I, II and III 103
6.3.3.2A Repeated Measures Analysis of Variance: The effect of
the experimental and control groups on values for the Rey
Complex Figure Test (RCF) 104
6.3.3.213(i) DUNNETT T3 Post Hoc Test: Significance of differences
in cell means of the experimental on the control groups
for the dependent variable Rey Complex Figure
Immediate copy (RCF I) 105
6.3.3.2B(ii) DUNNETT T3 Post Hoc Test: Significance of differences
in cell means of the experimental on the control groups
for the dependent variable Rey Complex Figure 3-minute
recall — (RCF II) 105
6.3.3.2B(iii) Significance of differences in cell means of the
experimental on the control groups for the dependent
variable Rey Complex Figure: 45-minute delayed recall —
(RCF III) 106
6.3.3.3A Multivariate Analysis of Variance: The group effect of
the experimental and control groups on the Logical
Memory subtest I and II (LOG MEM I and II) 107
TABLE � PAGE
6.3.3.4A �Repeated Measures Analysis of Variance: The effect of
the experimental and control groups on values for the
Logical Memory subtest I (LOG MEM I) 108
6.3.3.4B Repeated Measures Analysis of Variance: The effect of
the experimental and control groups on values for the
Logical Memory subtest II (LOG MEM II) 108
6.3.3.4A(i) DUNNETT T3 Post Hoc Test: Significance of differences
in cell means of the experimental on the control groups
for the dependent variable Logical Memory I (LOG
MEM I) 109
6.3.3.3B(i) DUNNETT T3 Post Hoc Test: Significance of differences
in cell means of the experimental on the control groups
for the dependent variable Logical Memory subtest II
(LOG MEM II) 110
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LIST OF FIGURES
FIGURE � PAGE
6.4.1A �Digit Symbol:•verage and variability distribution for the
Digit Symbol subtest for the three groups BPD,
NORMAL and OTHER PD �111
6.4.2A Logical Memory: Average and variability distribution for
the Logical Memory subtest for the three groups BPD,
NORMAL and OTHER Pb 112
6.4.2.1A Logical Memory I and II: Average and variability
distribution for the Logical Memory subtest (LOG MEM
I and II) for the three groups BPD, NORMAL and
OTHER PD 113
6.4.3A Rey Complex Figure: Average and variability distribution
for the Rey Complex Figure (RCF 1, II and III) for the
three groups BPD, NORMAL and OTHER PD 114
6.4.4A Gottschaldt Embedded Figures: Average and variability
distribution for the Gottschaldt Embedded Figures Test
for the three groups BPD, NORMAL and OTHER PD 115
6.4.5A Wisconsin Card Sorting: Total correct. Average and
variability distribution for the three groups on the
Wisconsin Card Sorting Test: Total Correct 117
6.4.5B Wisconsin Card Sorting: Total error. Average, and
variability distribution for the three groups on the
Wisconsin Card Sorting Test: Total Error 117
6.4.5C Wisconsin Card Sorting: Total perseverative errors.
Average and variability distribution for the three groups
on the Wisconsin Card Sorting Test: Total Perseverative
Errors 118