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Selective attention to negative stimuli has been discussed as being an essential characteristic of depressive disorder. Theories and empirical data, however, are contradictory. The present study addressed the question of whether depressive patients selectively attend to negatively valenced and personally relevant or irrelevant stimuli and whether they habituate to these stimuli. Thirty-one inpatients with major depressive disorder and 37 healthy controls participated in the study. They underwent a modification of the emotional Stroop paradigm. The results indicated that personally relevant stimuli evoked more pronounced Stroop interference than did stimuli without personal relevance in all subjects. Furthermore, habituation to personally relevant negative stimuli was seen in both depressive patients and control subjects. The present findings question a generally negative attentional bias as being a specific characteristic of depressive disorder. Furthermore, as depressed patients habituated to personally relevant negative stimuli, exposure therapy might be suitable for the treatment of depressive disorder.

Introduction. Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference. Methods. 47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency. Results. Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder. Discussion. The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.

Objective: Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present study aimed to investigate neural correlates of response inhibition in BPD by using an emotional Stroop paradigm extending the task to word stimuli which were related to stressful life events. Methods: Twenty BPD patients and 20 healthy controls underwent functional magnetic resonance imaging (fMRI) while performing the individual emotional Stroop task. A block design was used with the following word type conditions: neutral words, general negative words, and individual negative words. The individual negative words were recruited from a prior interview conducted with each participant. Results: While BPD patients had overall slower reaction times in the Stroop task compared to healthy controls, there was no increased slowing with emotional interference. Controls exhibited significant fMRI blood oxygenation level-dependent signal increases in the anterior cingulate cortex as welt as in frontal cortex contrasting generally negative vs. neutral and individual negative vs. neutral conditions, respectively. BPD patients did not show equivalent signal changes. Conclusions: These results provide further evidence for a dysfunctional network of brain areas in BPD, including the ACC and frontal brain regions. These areas are crucial for the regulation of stress and emotions, the core problems of BPD patients. (C) 2008 Elsevier Ltd. All rights reserved.

Previous research indicates a strong association between post-traumatic stress disorder (PTSD), psychopathology. and linguistic indices, but most studies have only compared one traumatic and one neutral life event. Referring, to the Dual Representation Theory for PTSD we investigated the narrative representation of two negative life events, with and without current emotional impact in a non-clinical population. Twenty-five subjects wrote detailed narratives of the two types of life events. Lexical categories were coded and compared between the different scripts. Life events with Current emotional impact were characterised by a greater use of emotional words, especially secondary emotionally words. Proprioceptive words were more often used and there were more errors when present tense was employed. Additionally, a greater number of sentences were found in these scripts. Our data suggest that in healthy subjects a relationship exists between narrative peculiarities and the current emotional impact of autobiographical memory shaped by negative life events. Copyright (C) 2008 John Wiley & Sons, Ltd.

Zusammenfassung: Der emotionale Stroop Test ist ein in der Forschung häufig eingesetztes Verfahren, um Interferenzeffekte durch emotionale oder krankheitsrelevante Stimuli zu untersuchen. So konnte gezeigt werden, dass Patienten mit Alkoholabhängigkeit verlangsamte Reaktionszeiten auf alkoholspezifische Reize aufweisen. Inwieweit dieser Effekt bei Wiederholungsmessungen stabil ist, wurde bisher weniger intensiv untersucht. Dies ist insofern erstaunlich, als dass sowohl Theorien existieren, die eine Normalisierung der Reaktionszeiten nahe legen (Habituation), als auch Konzepte, die gleich bleibende oder zunehmend verlangsamte Reaktionszeiten erwarten lassen (Sensitivierung), möglicherweise assoziiert mit verstärktem oder neu entstehendem Craving. In dieser Studie wurden 20 Patienten mit Alkoholabhängigkeit nach abgeschlossenem Alkoholentzug mit einem Stroop Test untersucht, in dem u. a. individuell bedeutsame alkoholbezogene Wörter präsentiert wurden. Zunächst konnten frühere Befunde einer verstärkten Interferenz durch alkoholassoziierte Wörter repliziert werden. Weiterhin konnte gezeigt werden, dass Patienten mit einer Alkoholerkrankung an diese Stimuli habituieren. In weiteren Studien sollte untersucht werden, inwieweit dieser Habituationseffekt auch auf physiologischer Ebene nachweisbar ist.

Alterations in hypothalamic-pituitary-adrenal axis feedback regulation have been repeatedly reported in patients with borderline personality disorder (BPD). Due to the cross-sectional design of these studies, little is known about the longitudinal course of HPA axis functioning. In a sample of 13 patients with BPD, the dexamethasone suppression test (DST) has been used in a one-year follow-up study. There were no changes of cortisol concentrations before or after dexamethasone intake between baseline and follow-up examination. Patients with comorbid posttraumatic stress disorder (PTSD) showed more pronounced cortisol suppression compared to those without PTSD. The DST seems to be a stable marker of alterations in HPA axis feedback regulation in BPD, which is also reflected by substantial correlations between percentage of cortisol suppression at baseline and follow-up examination.

The emotional Stroop task is a widely used method for investigating attentional bias towards stimuli due to mood or affect. In general, standardized stimuli are used, which might not be appropriate when investigating individual contextual frameworks. It was investigated whether words chosen to be related to individuals' personal life events would produce more pronounced Stroop interference (as an indicator of attentional bias) than stimuli without any personal relevance. Twenty-six non-clinical subjects, 20 female and 6 male, participated in the study. Mean age was 36.1 yr. ( SD=18.1). All were recruited by means of local advertising. Stimulus material consisted of four word types: personal words related to negative life events with and without current personal relevance, and negative and neutral words without any personal relevance. Words were presented in three blocks. Analysis of variance showed main effects for word type and blocks, with slower reactions in the personally relevant conditions than in the negative, or neutral conditions, and in response to the first blocks as opposed to the last. These findings indicate that regardless of the word valence, personally relevant stimuli evoke more pronounced Stroop interference than do stimuli without personal relevance.

Background. Patients with borderline personality disorder (BPD) frequently report unresolved life events but it is still poorly understood, how these experiences are represented in the brain. Using functional magnetic resonance imaging (fMRI), the present study aimed at investigating the neural correlates of the recall of unresolved life events in patients with BPD and healthy controls.Method. Twenty female BPD patients and 21 healthy control subjects underwent fMRI. During measurement subjects recalled unresolved and resolved negative life events. Individual cue words were used to stimulate autobiographical memory. After scanning, subjects rated their emotional states during the recall of both types of memories.Results. When contrasting unresolved and resolved life events, patients showed significant bilateral activation of frontotemporal areas including the insula, amygdala, and the anterior cingulate cortex, the left posterior cingulate cortex, right occipital cortex, the bilateral cerebellum and the midbrain. In healthy subjects, no differential brain activation was related to these conditions. The 2×2 factorial analysis (ΔBPD−Δcontrols) revealed similar results with bilateral activation of the frontal cortex including parts of the insula and of the orbitofrontal cortex, temporal activation including the amygdala, activation of the right occipital cortex, and parts of the cerebellum. Patients but not controls reported higher levels of anxiety and helplessness during the unresolved versus resolved memory condition.Conclusions. The activation of both, the amygdala and prefrontal areas, might reflect an increased effortful but insufficient attempt to control intensive emotions during the recall of unresolved life events in patients with BPD.

Abstract. Whereas learning in every day life requires the inhibition of irrelevant information, standardized memory tests usually do not contain interfering stimuli. The present study aims at an initial evaluation of a new verbal learning paradigm that considers learning with emotionally neutral or negative interference, and learning without interference. In three learning trials, 82 healthy subjects learned three 15-item word lists derived from the Auditory Verbal Learning Test. Word recall in both conditions with interference was decreased, especially in the first learning trial and regardless of emotional valence. Working memory, therefore, might be more affected by interference than learning. These first promising results indicate the usability of the new verbal paradigm for clinical purposes.

Borderline personality disorder (BPD) may be associated with smaller hippocampi in comparison to hippocampal size in controls. However, specific pathology in hippocampal substructures (i.e., head, body and tail) has not been sufficiently investigated. To address hippocampal structure in greater detail, we studied 39 psychiatric inpatients and outpatients with a DSM-IV diagnosis of BPD and 39 healthy controls. The hippocampus and its substructures were segmented manually on magnetic resonance imaging scans. The volumes of hippocampal substructures (and total hippocampal volume) did not differ between BPD patients and controls. Exploratory analysis suggests that patients with a lifetime history of posttraumatic stress disorder (PTSD) may have a significantly smaller hippocampus - affecting both the hippocampal head and body - in comparison to BPD patients without comorbid PTSD (difference in total hippocampal volume: -10.5%, 95%CI -2.6 to -18.5, significant). Also, patients fulfilling seven or more DSM-IV BPD criteria showed a hippocampal volume reduction, limited to the hippocampal head (difference in volume of the hippocampal head: -16.5%, 95%CI -6.1 to -26.8, significant). Disease heterogeneity in respect to, for example, symptom severity and psychiatric comorbidities may limit direct comparability between studies; the results presented here may reflect hippocampal volumes in patients who are "less" affected or they may simply be a chance finding. However, there is also the possibility that global effects of BPD on the hippocampus may have previously been overestimated.

Zusammenfassung. Für den deutschsprachigen Raum stehen derzeit kaum evaluierte Instrumente zur Erfassung traumatischer Ereignisse in der Kindheit und Jugend zur Verfügung. Während das strukturierte klinische Interview für DSM-IV das Vorliegen einer Traumatisierung in der Kindheit und Jugend mittels eines binären Items erfasst, wird mit dem „Early Trauma Inventory” (ETI; Bremner, Vermetten & Mazure, 2000 ) ein breites Spektrum traumatischer Ereignisse erhoben. Beim ETI handelt es sich um ein halbstandardisiertes klinisches Interview mit den Skalen „Emotionale Erfahrungen”, „Erzieherische/Körperliche Bestrafung”, „Sexuelle Erlebnisse” und „Generelle Traumata”. An einer Stichprobe von 230 Probanden wurden die Reliabilität und Validität der deutschen Übersetzung überprüft. Es konnten gute Reliabilitätskoeffizienten gefunden werden sowie hohe bis moderate Korrelationen zwischen dem ETI und einem Fragebogen zur Erfassung traumatischer Erfahrungen in der Kindheit (CTQ). Niedrigere Korrelationskoeffizienten fanden sich zwischen dem ETI und entfernt assoziierten Konstrukten, wie z.B. Depressivität. Insgesamt sprechen die Ergebnisse für eine zufriedenstellende psychometrische Qualität des ETI.

Objective: Patients with borderline personality disorder (BPD) and patients with major depressive disorder (MDD) exhibit a broad range of neuropsychological deficits. Studies in both groups of patients point to differences but also similarities. However, studies that compare both patient groups are missing from the literature. The present study aimed to compare neuropsychological functioning in BPD and MDD patients. Method: Eighteen patients with BPD, 27 patients with MDD, 17 patients with BPD and MDD, and 76 healthy control subjects were included in the case-control study. Patients were treated for their disorders as inpatients of the Clinic of Psychiatry and Psychotherapy Bethel, Ev. Hospital Bielefeld (Bielefeld, Germany). All patients met DSM-IV diagnoses as assessed by trained psychotherapists within the first week of their admission. In addition to a comprehensive neuropsychological test battery, the inhibitory control of emotional stimuli was assessed. Data were collected between June 2004 and June 2007. Results: Patients showed only a few impairments and no increased distractibility toward emotionally negative stimuli. Patients with BPD and patients with MDD were not distinguishable by the neuropsychological test results. Conclusions: These data did not support the notion of specific neuropsychological profiles in BPD and MDD. Future research needs to clarify the overlap of symptoms between both disorders.

Given the relevance of child maltreatment for the development and treatment of many mental disorders, the objective of our study was the psychometric evaluation of the German version of the Childhood Trauma Questionnaire (CTQ). In a sample of psychiatric patients (N=1 524) the established factor structure (i.e. sexual, physical and emotional abuse as well as physical and emotional neglect) was replicated by means of confirmatory factor analysis. The internal consistency of all scales (apart from physical neglect) was high (Cronbachs α ≥ 0.89). Correlations between the CTQ and self-report measures for posttraumatic stress, dissociation and general psychopathology were low to moderate. The psychometric properties of the German version of the CTQ were similar to the American original; it proved to be a reliable and valid screen for the retrospective assessment of child maltreatment.

Patientin DK wurde zum ersten Mal mit 9 Jahren von ihrem Vater vergewaltigt. Der sexuelle Missbrauch setzte sich uber viele Jahre fort. Mit 11 Jahren wurde sie zusatzlich von ihrem Cousin sexuell missbraucht. Nach diesen Erfahrungen hatte sie nach eigenen Angaben das Vertrauen in fast alle Menschen verloren. Im Jugendalter fand sie zwar einige Bekannte, allerdings keine echten Freunde. Nach Abschluss des Abiturs studierte sie Geschichte und Philosophie. Im Alter von 20 Jahren begab sie sich zum ersten Mal aufgrund von Depression, Angstzustanden, Aggressivitat und sozialen Problemen in psychotherapeutische Behandlung. Seitdem ist sie mehrfach in psychiatrischen und psychosomatischen Kliniken behandelt worden. Trotz dieser Belastungen schloss sie ihr Studium erfolgreich ab und arbeitet seitdem als Redakteurin. In der neuropsychologischen Untersuchung der inzwischen 31-jahrigen Patientin fielen insbesondere extreme Leistungsunterschiede zwischen den einzelnen Testergebnissen auf mit z. T. unterdurchschnittlichen, aber auch uberdurchschnittlichen Ergebnissen.

Patients with major depression (MDD) often report relevant cognitive problems in everyday life while performance in standardised neuropsychological tests is not severely disturbed. This discrepancy may partly be due to the differences between the demands of everyday life with the presence of emotionally relevant distractors and standardised neuropsychological settings without those distractors. In the present study, we hypothesise that patients with major depression (MDD) show an increased distractibility towards emotionally negative stimuli and that this distractibility is related to complaints of cognitive functioning in everyday life. Thirty MDD patients and 48 healthy participants performed our recently developed learning paradigm with neutrally and negatively valenced distraction as well as without distraction. Both groups also performed a neuropsychological test battery as well as self- and observer ratings of impairments in memory and attention in every day life. In the MDD sample, cognitive impairments were reported by the patients and their relatives but were not found in the neuropsychological tests. We found a trend towards a poorer memory performance with negatively valenced distraction in the MDD sample when compared to the performance of healthy subjects. However, this impairment was not related to the self- and observer ratings. This result may be due to the fact that the distractors were not personally relevant to the subjects whereas everyday life implies such distractors. Further research is needed to explore everyday cognitive functioning of patients with MDD.

Given the relevance of child maltreatment for the development and treatment of many mental disorders, the objective of our study was the psychometric evaluation of the German version of the Childhood Trauma Questionnaire (CTQ). In a sample of psychiatric patients (N=1 524) the established factor structure (i. e. sexual, physical and emotional abuse as well as physical and emotional neglect) was replicated by means of confirmatory factor analysis. The internal consistency of all scales (apart from physical neglect) was high (Cronbachs alpha >/= 0.89). Correlations between the CTQ and self-report measures for posttraumatic stress, dissociation and general psychopathology were low to moderate. The psychometric properties of the German version of the CTQ were similar to the American original; it proved to be a reliable and valid screen for the retrospective assessment of child maltreatment. Language: en

BackgroundRecall of adverse life events under brain imaging conditions has been shown to coincide with activation of limbic and prefrontal brain areas in borderline personality disorder (BPD). We investigate changes of functional magnetic resonance imaging (fMRI) activation patterns during the recall of unresolved adverse life events (ULE) over 1 year.MethodThirteen female BPD patients participated in the study. During fMRI measurement subjects recalled ULE and negative but resolved life events (RLE) after individual cue words to stimulate autobiographical memory retrieval. Subjective intensity of emotional and sensoric experiences during recall was assessed as well as standardized measures of psychopathology.ResultsA 2×2 factorial analysis of fMRI data (Δt1/t2×ΔULE/RLE) revealed major right more than left differences of activation (i.e. t1>t2) of the posterior more than anterior cingulate, superior temporal lobes, insula, and right middle and superior frontal lobes (second-level analysis,t=3.0,puncorrected=0.003). The opposite contrast (Δt2/t1×ΔULE/RLE) did not reveal any differences. We did not find changes of emotional or sensoric qualities during recall (ULEversusRLE) or of psychopathology measures over the 1-year period.ConclusionsAlthough subjective and clinical data did not change within 1 year, we observed a substantial decrease of temporo-frontal activation during the recall of ULE from t1 to t2. If future research confirms these findings, the question arises whether the decrease of neural activation precedes clinical improvement in BPD.

Current research indicates altered inhibitory functioning in borderline personality disorder (BPD). The emotional stroop task is a widely used method for investigating inhibition of interference. In the present study we used an individualized version of the emotional stroop task to investigate inhibitory functioning in BPD with respect not only to valence but also to personal relevance of the stimuli. Thirty-one BPD patients and 49 healthy controls performed the individual emotional stroop task that consisted of (1) words related to personal negative life events that were currently relevant (2) words related to personal negative life events that were not currently relevant, (3) negative words that were not personally relevant, and (4) neutral words. BPD patients showed greater interference only for words related to personal negative life events with current relevance. A comparison between BPD patients with and without posttraumatic stress disorder (PTSD) revealed reduced inhibitory functioning only in BPD patients with PTSD. Inhibition of interference in BPD patients seems not to be altered in general but is exclusively disturbed in those with comorbid PTSD when highly relevant personal factors are the focus of attention.

Verbal memory impairment in borderline personality disorder (BPD) is still a matter of debate. In this study we combine investigations of both, memory retrieval as well as underlying neural circuits in BPD. Functional magnetic resonance imaging (fMRI) was used to study regional brain activation in 18 right-handed female patients with BPD and 18 matched controls during the retrieval of an episodic memory retrieval (EMR) task (free recall of a word list) and a semantic memory retrieval (SMR) task (verbal fluency). Despite unaffected performance in EMR and SMR, patients with BPD showed task-specific increased activation compared with controls. During EMR, the increased activation encompassed the posterior cingulate cortex bilaterally, the left middle and superior temporal gyrus, the right inferior frontal gyros, and the right angular gyrus. SMR was associated with increased activation of the posterior cingulate cortex, of the right fusiform gyros, of the left anterior cingulate cortex, and of the left postcentral gyros. Our findings suggest that BPD patients may need to engage larger brain areas to reach a level of performance in episodic and semantic retrieval tasks that is comparable to that of healthy controls. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

For Borderline Personality Disorder (BPD) cognitive and perceptual impairments were reported in some but not all studies. The aim of the present study was to analyze the neuropsychological performance of BPD patients in different domains. Predominant impairments of visual functions and an increased intra-individual variation of test performances within neuropsychological domains were expected. We investigated 22 patients with BPD and a matched sample of 22 healthy control subjects. A comprehensive clinical and neuropsychological test battery was administered. Effect sizes indicate primarily deficits of visual functions such as visual memory (Wechsler Memory Scale-Revised, WMS-R: Visual pair associates and visual reproduction, Complex Figure Test: Recall) and visuo-spatial abilities (Leistungspruefsystem, LPS 9 and 10: Spatial imagination and embedded figures), but also of executive functions (Tower of Hanoi, Trail Making Test-B, semantic and figural fluency, LPS 4: Reasoning). In addition, the intra-individual ranges of neuropsychological test results in BPD patients were increased compared to those of healthy subjects. This finding might be due to a high degree of temporary stress that interferes with effective cognitive processing. Further research is needed to confirm the present results and to control for stress during the test procedure. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

Summary Background Divergent findings of hypothalamic-pituitary-adrenal (HPA) axis functioning in borderline personality disorder (BPD) may be caused by a different degree of comorbid posttraumatic stress disorder (PTSD), in which alterations of the HPA axis are well known. Here we investigate alterations of the HPA axis in BPD patients with and without comorbid PTSD compared to healthy controls. Considering previous findings current major depression (MDD) was taken into account as a confounding variable. Methods Apart from clinical assessment the 0.5 mg dexamethasone suppression test (DST) was performed in 21 female borderline patients and 23 healthy controls. Results Twelve BPD patients suffered from comorbid PTSD. Relative suppression (%) did not differ between healthy controls and the total BPD group, but BPD patients with comorbid PTSD showed increased suppression compared to those without. Comorbid MDD was not associated with suppression. Conclusions Our results do not indicate a dysfunction of the HPA axis in BPD. However, comorbid PTSD seems to be associated with a relative hypersuppression in the 0.5 mg DST.