Abstract
Introduction: An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD). In an elaborative case description of such a patient with intermittent rhythmic delta and theta activity (IRDA/IRTA), the BPD symptoms where linked to the frequency of the IRDAs/IRTAs and vanished with the IRDAs/IRTAs following anticonvulsive therapy. This observation raised a question regarding the prevalence of such EEG abnormalities in BPD patients. The aim of this retrospective study was to identify the frequency of EEG abnormalities in a carefully analyzed psychiatric collective. Following earlier reports, we hypothesized an increased prevalence of EEG abnormalities in BPD patients.Participants and Methods: We recruited 96 consecutive patients with BPD from the archive of a university clinic for psychiatry and psychotherapy, and compared the prevalence of EEG abnormalities to those of 76 healthy controls subjects. The EEGs were rated by three different blinded clinicians, including a consultant specializing in epilepsy from the local epilepsy center.Results: We found a significant increase in the prevalence of IRDAs and IRTAs in BPD patients (14.6%) compared to the control subjects (3.9%; p = 0.020).Discussion: In this blinded retrospective case-control study, we were able to confirm an increased prevalence of pathological EEG findings (IRDAs/IRTAs only) in BPD patients. The major limitation of this study is that the control group was not matched on age and gender. Therefore, the results should be regarded as preliminary findings of an open uncontrolled, retrospective study. Future research performing prospective, controlled studies is needed to verify our findings and answer the question of whether such EEG findings might predict a positive response to anticonvulsive pharmacological treatment.
Highlights
An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD)
We found a significant increase in the prevalence of IRDAs and IRTAs in BPD patients (14.6%) compared to the control subjects (3.9%; p = 0.020)
Episodic dissociative phenomena that are often related to very aversive states of inner tension belong to the features of BPD and because this is reminiscent of complex partial epileptic seizures, a pathophysiological link to epilepsy has been discussed in the past (Harris et al, 2002; Williams et al, 2006; Tebartz van Elst et al, 2011)
Summary
An increased prevalence of pathological electroencephalography (EEG) signals has been reported in patients with borderline personality disorder (BPD). In an elaborative case description of such a patient with intermittent rhythmic delta and theta activity (IRDA/IRTA), the BPD symptoms where linked to the frequency of the IRDAs/IRTAs and vanished with the IRDAs/IRTAs following anticonvulsive therapy. This observation raised a question regarding the prevalence of such EEG abnormalities in BPD patients. The concept of BPD was developed in the 1970s and was introduced as a specific diagnostic category in DSM-III in 1980 (Goldstein, 1983) It is characterized by the core features of emotional instability, impulsivity, and instability of self-image and interpersonal relationships (Lieb et al, 2004). There has been discussion as to whether patients with specific epilepsy syndromes such as juvenile myoclonic epilepsy might develop BPD features more often than people with other forms of epilepsy or healthy controls (de Araujo Filho and Yacubian, 2013)
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