NEUROPSYCHOLOGICAL TESTING RESULTS - 06/09/11
Resumen |
Neuropsychology has had relatively limited impact on the practice of psychiatry and on the evaluation and treatment of personality disorders. Clinicians might be tempted to ask, What use is neuropsychology? What is its value added? This article reviews the existing literature on neuropsychological testing of patients with borderline personality disorder (BPD), comments on how neuropsychological testing research has contributed to the understanding of BPD, and closes with brief observations on how this research might contribute to the assessment and treatment of this group of patients in general.
In research studies focusing on the cause of specific disorders, neuropsychological tools are helpful for the following reasons.
• | Neuropsychological testing identifies functional areas in which cognitive or motor abilities are abnormal in a disorder. |
• | Patterns of neuropsychological deficits can be examined to see whether they are consistent with various etiologic hypotheses about specific disorders. |
• | Patterns of neuropsychological deficits can be conceptually linked to dysfunction in specific brain regions, usually based on generalizations from studies of localized brain injuries. |
• | In conjunction with functional brain imaging techniques, neuropsychological techniques can be used as challenges (analogous to pharmacologic challenges) to activate (or fail to activate) specific brain regions. |
Several systematic neuropsychological samples have been gathered in the population of people with BPD. One challenge in drawing overall conclusions from the results is that a wide variety of testing approaches exist, each of which is comprised of a handful of studies. The contributions of several of these testing approaches are evaluated to determine whether they confirm clinical impressions and whether they offer new insights into the disorder.
Cognition is medically defined as “mental activities associated with thinking, learning, and memory.”68 What kinds of cognitive impairment have been identified in the clinical literature that would lead one to undertake psychological testing to better document and define this impairment? The early emphasis in defining BPD was on the conditions under which these patients displayed disturbed thinking. People with this diagnosis were thought to be so “on the border” of psychosis that, with sufficient stress, they would cross over into psychotic thinking. Following this working hypothesis, several often-quoted early studies used the “structured” Wechsler Adult Intelligence Scale (WAIS) and contrastingly “unstructured” Rorschach inkblot projective test to purportedly show normal scores on the WAIS but psychotic thought processes on the Rorschach.13, 19, 41, 52, 54, 58, 59, 65, 66, 81 Reviewers of the early “normal WAIS/disturbed Rorschach” studies,46, 75, 84, 86 however, have concluded that this construct remains unproven because of several methodologic issues but primarily because of a diagnostic misinterpretation. These studies were done decades before the DSM1 formulation of the disorder. The patients on whom this belief is based most likely had schizotypal personality disorder rather than BPD. In addition to more refined diagnostic systems and instruments, a more refined description of the characteristics of quasipsychotic symptoms in this population is now available.87 Newer studies of these symptoms have used projective testing in better-defined populations; these results are examined.
Research assessing in detail the domains of learning and memory functioning in BPD has only been undertaken much more recently. These areas show the clearest empiric evidence of cognitive impairment in BPD and have carefully diagnosed the subjects, re-examined the “normal WAIS” portion of the earlier paradigm, and administered additional batteries with specific tests of problem solving, motor skills, and auditory and visual memory. These results are described in detail.
Standard dictionaries, as opposed to medical dictionaries, also include the concepts of perception and judgment in their definitions of cognition, describing it as “the process of knowing in the broadest sense, including perception, memory, and judgment.”77 Visual perceptual issues were examined as part of the tests of visual memory mentioned earlier and raise interesting questions about visual perception in BPD. Broader issues of distorted perception in this population are raised by clinical observations detailing how individuals with BPD misperceive the world, their relationships, and their own role in cause and effect. Given the clinical examples of lapses in judgment arising in part from these misperceptions, one wonders whether a broad impairment of judgment in general or of social judgment in particular could be documented in testing. An effort to quantify and elucidate this area within the context of object relations has been made. A related effort examines the way individuals with BPD process emotion-laden material specifically. One is also led to question and discuss the possible role of depression, affective lability, state-dependent learning, and dissociation in these findings.
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| Address reprint requests to Kathleen M. O'Leary, MSW, National Institute of Mental Health, Building 10/Room 3N218, 10 Center Drive MSC 1274, Bethesda, MD 20892–1274 |
Vol 23 - N° 1
P. 41-60 - mars 2000 Regresar al número
Artículo precedente
- NEUROTRANSMITTER DYSFUNCTION IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER
- Irene G. Gurvits, Harold W. Koenigsberg, Larry J. Siever
- OVERVIEW OF BIOLOGIC FACTORS
- Kenneth R. Silk
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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