Executive functioning in adults with borderline personality disorder and first-degree biological relatives

Abstract

Objectives

Behavioural dysregulation is a heritable core symptom domain in borderline personality disorder (BPD) that is likely influenced by the integrity of executive functions (EFs). However, the extent to which familial risk for BPD confers decrement to EFs has yet to be comprehensively studied.

Methods

In this family study, probands with BPD (n = 73), first-degree biological relatives (n = 65), and healthy controls without psychiatric diagnoses (n = 77) were assessed in abstraction, attentional vigilance, working memory, cognitive flexibility, interference resolution, planning, problem solving, and response inhibition.

Results

In univariate analyses, probands demonstrated lower response inhibition than relatives. Comparatively, discriminant function analyses revealed that lower interference resolution and response inhibition jointly discriminated probands from relatives and controls, whereas a combination of less efficient problem solving and difficulty manipulating mental information discriminated probands and relatives from controls. Moreover, the subset of psychiatrically non-affected relatives demonstrated a pattern of resilience to psychiatric morbidity substantiated by stronger response inhibition and abstraction abilities despite less efficient problem solving.

Conclusions

Familial risk for BPD is represented predominantly by a pattern of problem-solving and working memory deficits. Resilience to a psychiatric disorder in non-affected relatives reflects both EF weaknesses and strengths, highlighting potential protective factors that should be considered in future neurocognitive research on BPD families.

Keywords:

• Borderline personality disorder
• family study
• impulsivity
• executive functioning
• discriminant analysis

Acknowledgements

The authors would like to thank Amanda Uliaszek and Konstantine Zakzanis for their advice during the development of this project for Jacob Koudys’s M.A. thesis, Jie Chang, Alexander Daros, Jaeger Lam, Justine Ledochowski, Jacob Lang, and Liam Wright for their assistance in data collection and preparation, and all participants for devoting their time to participate in this study. We would also like to thank the families that participated in the study and those who provided feedback on the preliminary findings.

Statement of interest

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research under Grant 123413; Canadian Institutes of Health Research under Grant MSH130177; Ministry of Research, Innovation and Science under Grant ER14-10-185; University of Toronto Scarborough Research Excellence Faculty Scholar Award; and Vanier Canada Graduate Scholarship.