Subjective Cognitive Complaints and Functional Disability in Patients with Borderline Personality Disorder and Their Nonaffected First-Degree Relatives

Abstract

French

Objective:

To examine the contributions of subjective cognitive complaints to functional disability in patients with borderline personality disorder (BPD) and their nonaffected relatives.

Method:

Patients with BPD (n = 26), their first-degree biological relatives (n = 17), and nonpsychiatric control subjects (n = 31) completed a self-report measure of cognitive difficulties and rated the severity of their functional disability on the World Health Organization Disability Assessment Schedule 2.0.

Results:

After accounting for group differences in age and severity of depressive symptoms, patients and relatives endorsed more inattention and memory problems than control subjects. Whereas probands reported greater disability than relatives and control subjects across all functional domains, relatives described more difficulties than control subjects in managing multiple life activities, including domestic activities and occupational and academic functioning, and participating in society. For both probands and relatives, inattention and memory problems were linked primarily to difficulties with life activities, independent of depression and other comorbid psychiatric disorders.

Conclusions:

Problems with inattention and forgetfulness may lead to difficulties carrying out activities of daily living and occupational or academic problems in patients with BPD, as well as their nonaffected first-degree relatives.

Keywords

borderline personality disorder family study cognition attention memory functional disability employment activities of daily living

References

Lenzenweger

Lane

Loranger

, DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;62(6):553–564.

Leichsenring

Leibing

Kruse

, Borderline personality disorder. Lancet. 2011;377(9759):74–84.

Ruocco

. The neuropsychology of borderline personality disorder: A meta-analysis and review. Psychiatry Res. 2005;137(3):191–202.

Park

Hong

Lee

, Relationship between personality disorder dimensions and verbal memory functioning in a community population. Psychiatry Res. 2012;196(1):109–114.

Krause-Utz

Sobanski

Alm

, Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity disorder: An exploratory study. J Nerv Ment Dis. 2013;201(2):116–123.

Jungwirth

Fischer

Weissgram

, Subjective memory complaints and objective memory impairment in the Vienna–Transdanube aging community. J Am Geriatr Soc. 2004;52(2):263–268.

Prouteau

Verdoux

Briand

, Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program. Schizophr Res. 2004;69(1):85–91.

Fossati

Novella

Donati

, History of childhood attention deficit/hyperactivity disorder symptoms and borderline personality disorder: A controlled study. Compr Psychiatry. 2002;43(5):369–377.

Ferrer

Andion

Matali

, Comorbid attention-deficit/hyperactivity disorder in borderline patients defines an impulsive subtype of borderline personality disorder. J Pers Disord. 2010;24(6):812–822.

10.

Dowson

McLean

Bazanis

, The specificity of clinical characteristics in adults with attention-deficit/hyperactivity disorder: A comparison with patients with borderline personality disorder. Eur Psychiatry. 2004;19(2):72–78.

11.

Bowie

Depp

McGrath

, Prediction of real-world functional disability in chronic mental disorders: A comparison of schizophrenia and bipolar disorder. Am J Psychiatry. 2010;167(9):1116–1124.

12.

Grant

Chou

Goldstein

, Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69(4):533–545.

13.

Skodol

Gunderson

McGlashan

, Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry. 2002;159(2):276–283.

14.

Zanarini

Jacoby

Frankenburg

, The 10-year course of social security disability income reported by patients with borderline personality disorder and Axis II comparison subjects. J Pers Disord. 2009;23(4):346–356.

15.

Siever

Torgersen

Gunderson

, The borderline diagnosis III: Identifying endophenotypes for genetic studies. Biol Psychiatry. 2002;51(12):964–968.

16.

Ruocco

Laporte

Russell

, Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder. Neuropsychology. 2012;26(4):473–482.

17.

Gvirts

Harari

Braw

, Executive functioning among patients with borderline personality disorder (BPD) and their relatives. J Affect Disord. 2012;143(1–3):261–264.

18.

White

Gunderson

Zanarini

, Family studies of borderline personality disorder: A review. Harv Rev Psychiatry. 2003;11(1):8–19.

19.

Bowie

Leung

Reichenberg

, Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry. 2008;63(5):505–511.

20.

Wechsler

WTAR: Wechsler Test of Adult Reading. Manual. San Antonio (TX): The Psychological Corporation; 2002.

21.

First

Spitzer

Gibbon

, Structured Clinical Interview for DSM-IV Axis I Disorders—patient edition (SCID-I/P, 11/2002 revision). New York (NY): Biometrics Research Department, New York State Psychiatric Institute; 2002.

22.

Pfohl

Blum

Zimmerman

Structured Interview for DSM-IV Personality (SIDP-IV). Iowa City (IA): The University of Iowa; 1995.

23.

Beck

Steer

Brown

. Beck Depression Inventory. 2nd ed. San Antonio (TX): Psychological Corporation; 1996.

24.

Conners

Erhardt

Sparrow

Conners' Adult ADHD Rating Scales (CAARS). Toronto (ON): MHS Toronto; 1999.

25.

Conners

Sitarenios

Parker

, The revised Conners' Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. J Abnorm Child Psychol. 1998;26(4):257–268.

26.

World Health Organization (WHO). Measuring health and disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva (CH): WHO; 2010.

27.

World Health Organization (WHO). International Classification of Functioning, Disability and Health (ICF). Geneva (CH): WHO; 2001.

28.

American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Washington (DC): APA; 2013.

29.

Morris

DeShon

. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods. 2002;7(1):105–125.

30.

Benjamini

Drai

Elmer

, Controlling the false discovery rate in behavior genetics research. Behav Brain Res. 2001;125(1–2):279–284.

31.

Benjamini

Hochberg

Controlling the false discovery rate: A practical and powerful approach to multiple testing. J R Stat Soc Series B Stat Methodol. 1995;57:289–300.

32.

Skodol

Pagano

Bender

, Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychol Med. 2005;35(3):443–451.

33.

Patterson

Goldman

McKibbin

, UCSD performance-based skills assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophr Bull. 2001;27(2):235–245.

34.

Hall

. Global assessment of functioning: A modified scale. Psychosomatics. 1995;36(3):267–275.