University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2007 Neuropsychological Correlates of Borderline Personality Disorder Christopher S. Miller The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Miller, Christopher S., "Neuropsychological Correlates of Borderline Personality Disorder" (2007). Graduate Student Theses, Dissertations, & Professional Papers. 700. https://scholarworks.umt.edu/etd/700 This Dissertation is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. Running head: NEUROPSYCHOLOGICAL CORRELATES OF BORDERLINE Neuropsychological Correlates of Borderline Personality Disorder By Christopher S. Miller, M.A. B.A., The University of Dayton, 1992 M.A., The University of Montana, 2004 Presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy The University of Montana Spring 2007 Approved by: Dr. David A. Strobel, Dean Graduate School Stuart Hall, Ph.D., Chair Department of Psychology Christine Fiore, Ph.D. Department of Psychology Allen Szalda-Petree, Ph.D. Department of Psychology Jennifer Waltz, Ph.D. Department of Psychology Polly Peterson, Ph.D. Miller, Christopher, S., Ph.D., Spring 2007 Clinical Psychology Neuropsychological Correlates of Borderline Personality Disorder Chairperson: Stuart Hall, Ph.D. In the current study, participants with borderline personality disorder (BPD) displayed deficits in neuropsychological functioning when compared with healthy controls. Participants with BPD performed worse on all measures of cognitive functioning: attention, verbal memory, processing speed and a measure of general neuropsychological functioning. The study found that depression was significantly more prevalent in the BPD sample compared with the control sample and that there was a significant inverse correlation between level of depression and scores on a general index of neuropsychological functioning. Results from ANCOVA analyses revealed significant differences existed in neuropsychological performance on all four measures of cognitive functioning between the two groups after controlling for depression. The role of effort in testing with persons with BPD was explored, with results indicating that participants with BPD provided good effort. Lastly, the study’s findings showed that those participants with a BPD diagnosis and a neurological disease performed worse on the measure of general neuropsychological functioning compared with individuals with BPD who had no history of a diagnosed neurological disease. Results from ANCOVA analyses revealed that significant differences in neuropsychological performance on all measures of cognitive functioning existed between the two groups after controlling for presence of a diagnosed neurological disorder. Implications of the study findings have been presented and discussed. Also, possible confounds to the study’s findings were identified and discussed in the hope that future replications of the current study will control for such variables and result in robust research findings. Suggestions for future research in this area have been provided to assist in the construction of a more complete neuropsychological profile of BPD. ii Acknowledgements Several important individuals deserve recognition. I would like to thank my outside committee member, Polly Peterson, for her collaborative work with Marla Lemons and the staff at Montana State Hospital in assisting me with the onerous task of participant recruitment in rural Montana. The participants deserve thanks for their willingness and patience in completing the study protocol. I greatly appreciate the valuable feedback offered by Chris Fiore, Allen Szalda-Petree and Jennifer Waltz as my committee members at The University of Montana. I am grateful for Stuart Hall for serving as chairperson and for his dedication my success. I would like to extend a very special thank you to Mom and Dad for their love and generosity that have been instrumental in helping me achieve my goals. I want to express my deepest gratitude to Beth for her many years of support throughout my professional development, but more importantly for helping me to grow as a person. Last, but certainly not least, I am most thankful for my dearest friend, Alan, who has been a true inspiration and a mountain of encouragement for me. iii Table of Contents Introduction......................................................................................................................... 1 Diagnostic Features of Borderline Personality Disorder ................................................ 3 Prevalence....................................................................................................................... 6 Etiology of BPD.............................................................................................................. 6 Object Relations Theory ............................................................................................. 6 Biosocial Theory....................................................................................................... 11 Diathesis-Stress Model ............................................................................................. 13 Neurobiological Theory............................................................................................ 14 Neuropsychology of BPD............................................................................................. 17 Neuropsychological Literature on BPD........................................................................ 19 Attention ................................................................................................................... 20 Verbal Memory......................................................................................................... 22 Visual Memory ......................................................................................................... 28 Visual Perception...................................................................................................... 30 Processing Speed ...................................................................................................... 32 Meta-analysis and Review of Neuropsychological Functioning in Persons with BPD 32 Validity and Effort in Assessment Data........................................................................ 37 Limitations to the Existing Literature........................................................................... 40 The Current Study......................................................................................................... 42 Hypotheses.................................................................................................................... 45 Exploratory Areas ......................................................................................................... 45 Method.............................................................................................................................. 46 Participant Recruitment ................................................................................................ 46 iv Informed Consent Form................................................................................................ 48 Human Subjects Protections ......................................................................................... 49 Demographic Questionnaire ......................................................................................... 51 Measures ....................................................................................................................... 51 General WMS-III and WAIS-III Normative Data Information................................ 51 Attention Tests.......................................................................................................... 52 Spatial Span. ......................................................................................................... 52 Seashore Rhythm Test. ......................................................................................... 52 The Ruff 2 & 7 Selective Attention Test. ............................................................. 52 Verbal Memory Tests ............................................................................................... 54 Logical Memory.................................................................................................... 54 California Verbal Learning Test-II. ...................................................................... 55 Processing Speed Tests............................................................................................. 56 Digit Symbol......................................................................................................... 56 Symbol Search ...................................................................................................... 57 Paced Auditory Serial Addition Test. ................................................................... 58 Test of Effort............................................................................................................