Similar or Different Neuropsychological Profiles? Only Set Shifting Differentiates Women With Bipolar vs. Borderline Personality Disorder.

Ioannis Michopoulos,Nikolaos Smyrnis,Rossetos Gournellis,Kalliopi Tournikioti,Anna Karavia,Panagiotis Ferentinos,Antonios Paraschakis

doi:10.3389/fpsyt.2021.690808

Abstract

There is ongoing debate about the similarities and differences between bipolar disorder (BD) and borderline personality disorder (BPD). Very few studies have concurrently assessed their neuropsychological profile and only on a narrow array of neuropsychological tests. We aimed to investigate the differences of these two patient groups on visual memory, executive function, and response inhibition. Twenty-nine BD patients, 27 BPD patients and 22 controls (all female) were directly compared on paired associates learning (PAL), set shifting (ID/ED), problem solving (SOC), and response inhibition (SSRT) using Cambridge Neuropsychological Test Automated Battery (CANTAB). Rank-normalized outcomes were contrasted in one-way ANOVA tests. Discriminant analysis was finally performed to predict BD or BPD patient status. BD patients performed significantly worse than controls on all tasks. BPD patients performed significantly worse than HC on all tests except SST. Significant differences between the two patient groups were recorded only on ID/ED, where BPD patients performed worse (p = 0.044). A forward stepwise discriminant analysis model based on ID/ED and SOC predicted correctly patients' group at 67.9% of cases. In conclusion, BD and BPD female patients appear to be more similar than different as regards their neuropsychological functions. This study is the first to show that BPD patients display more deficits than BD patients when directly compared on the set shifting executive function test, a marker of cognitive flexibility. Discerning BD from BPD patients through neuropsychological performance is promising but would improve by using additional subtler tests and psychometric evaluation.

Highlights

There is a debate if Borderline personality disorder (BPD) is a specific syndrome or should be a part of bipolar disorder spectrum disorders [1]
We focused on several neuropsychological domains: paired associates learning, as a marker of visuo-spatial memory, problem solving as a marker of planning, set shifting as a marker of cognitive flexibility and response inhibition as a marker of impulsivity
The two patient groups displayed no significant differences on HAMD-17 and Young Mania Rating Scale (YMRS) scores

Summary

Introduction

There is a debate if BPD is a specific syndrome or should be a part of bipolar disorder spectrum disorders [1]. Bipolar disorder (BD) and Borderline personality disorder (BPD) share predisposing factors, clinical features, and similar response to medication with mood stabilizers [2,3,4]. Childhood trauma and family history of bipolarity are two common factors found in both BD and BPD [3]. Regarding clinical features, they both present with mood dysregulation, impulsivity, suicidality and psychotic, or dissociative symptoms [4]. A plethora of studies have compared either BD or BPD patients with healthy controls (HC) but only few have directly compared the neuropsychological profile of the two patient groups [2, 6], even though this could lead to valuable insights on their pathophysiology and management

Objectives

Methods

Results

Conclusion