Cognitive Functioning and Functional Abilities in Borderline ..., Summaries of Psychotherapy

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Cognitive Functioning and

Functional Abilities in

Borderline Personality Disorder

Anthony C. Ruocco, Ph.D.

Department of Psychology, University of Toronto

Topics In This Presentation:

1. What Is Cognition?

2. Examples Of Cognitive Tests Used By

Neuropsychologists

3. Why Evaluate Cognition In BPD?

4. Cognitive Functions In BPD

5. Functional Abilities In People With BPD And Their

Relatives

6. Summary and Future Directions

Cognitive Functions Often Evaluated By Neuropsychologists

Examples of Cognitive

Tests Used By

Neuropsychologists

Working Memory § Working memory is the ability to maintain and manipulate information “online” for brief periods of time. For example: Remember these three words—apple, table, and mouse. Now count backward by five from the number 76. [Time 10 seconds.] Tell me the three words that I asked you to remember.

Verbal and Visual Memory § Verbal and visual memory reflect the ability to learn and recall different types of information. For example, verbal memory can be tested in this way: Remember this list of 10 words. [Read examinee the list of words.] After 20 minutes, I’m going to ask you to repeat the same list of words. For example, visual memory can be tested in this way: I’d like you to remember these 10 designs. [Show examinee a page with 10 designs.] After 20 minutes, I’m going to ask you to draw each of these designs from memory.

How Is Neuropsychological Testing Used in Clinical Practice? § To aid in making a diagnosis (for example, diagnosing ADHD, a learning disorder, or dementia). § To assist in treatment planning (for example, identifying a need for memory aids during psychotherapy or to remember to take medications).

Why Evaluate Cognition

in Borderline Personality

Disorder?

Poor Focus &

Concentration

Memory

Problems and

Distortions

Impulsive

Behaviours

Difficulties

with Logical

Reasoning

Kroll (1988)

People With Childhood ADHD Have A High Risk Of Developing BPD As Adults § Attention-­‐deficit hyperactivity disorder (ADHD) and BPD appear to share several symptoms, including impulsiveness, emotional instability, and difficulty controlling anger. § Children with ADHD are 5 times more likely than children without ADHD to develop BPD later in adulthood (Fischer et al., 2002).

Precautions When Interpreting Results Of Cognitive Functioning In BPD ü Not all people with BPD have cognitive difficulties. ü These results present the averages of how people with BPD perform on standardized tests of cognition. ü Some people with BPD have difficulties with many cognitive abilities, whereas others perform in the average or even superior range. ü There may be many reasons that a person with BPD may experience cognitive difficulties—for example, due to sedating medications, fatigue caused by poor sleep, and other physical and mental disorders. ü Understanding what might be a significant or problematic weakness in cognition for any one individual should be made in consultation with a psychologist with expertise in neuropsychology.

People With BPD And Their Relatives Report Many Cognitive Limitations 0 1 2 3 4 Inattention Hyperactivity Impulsivity Self-­‐Concept Z-­‐SCORE Proband (n=26) Relative (n=17) Control (n=31) Ruocco et al. (2014) Weakness

People With BPD Have Cognitive Deficits Affecting A Range of Abilities -­‐1. -­‐1. -­‐1. -­‐1. -­‐ -­‐0. -­‐0. -­‐0. -­‐0. 0 Cohen’s d Effect Size Ruocco (2005) Weakness 266 patients with BPD 255 healthy controls

People With BPD May Also Have Greater Variability In Their Cognitive Abilities § Some research suggests that patients with BPD (as well as those with schizophrenia and depression) may show high degrees of variability in how quickly they respond to visual information (e.g., press a button to a specific letter of the alphabet) (Kaiser et al., 2008). § Ruocco and Bahl (2014) extended this research to memory functioning in patients with BPD. They showed that patients showed larger than average discrepancies in their verbal and visual memory abilities, but neither one was consistently better or worse than the other.