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Delay discounting and response disinhibition under acute experimental stress in women with borderline personality disorder and adult attention deficit hyperactivity disorder

Published online by Cambridge University Press:  30 August 2016

A. Krause-Utz ,
S. Cackowski ,
S. Daffner ,
Esther Sobanski ,
Michael M. Plichta ,
M. Bohus ,
G. Ende  and
C. Schmahl
A. Krause-Utz*
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
S. Cackowski
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
S. Daffner
Affiliation:
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
Esther Sobanski
Affiliation:
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany AHG Clinics for Psychosomatics, Bad Duerkheim, Germany
Michael M. Plichta
Affiliation:
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
M. Bohus
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Faculty of Health, Antwerp University, Antwerp, Belgium
G. Ende
Affiliation:
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department Neuroimaging, Central Institute of Mental Health, Mannheim, Germany
C. Schmahl
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
*
*Address for correspondence: Dr Annegret Krause-Utz, Ph.D., Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J5, D-68159 Mannheim, Germany. (Email: [email protected])
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Abstract

Background

Impulsivity is a core feature of borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD). In BPD, impulsive behavior primarily occurs under acute stress; impulse control deficits under non-stress conditions may be partly related to co-morbid ADHD. We aimed to investigate whether acute experimental stress has an impact on self-reported impulsivity, response inhibition (action withholding, action cancelation) and delay discounting in BPD compared to ADHD.

Method

Thirty female BPD patients, 28 female ADHD patients (excluding patients with co-morbid BPD and ADHD), and 30 female healthy controls (HC) completed self-reports and behavioral measures of impulsivity (IMT, assessing action withholding; GoStop, measuring action cancelation, Delay Discounting Task) under baseline conditions and after an experimental stress induction (Mannheim Multicomponent Stress Test).

Results

Both patient groups reported higher impulsivity than HC, ADHD reported higher trait impulsivity than BPD. On the IMT, ADHD showed significant action-withholding deficits under both conditions, while BPD performed significantly worse than HC under stress. In BPD but not ADHD and HC, action-withholding deficits (IMT) were significantly increased under stress compared to baseline, while no group/stress effects were found for action cancelation (GoStop). Delay discounting was significantly more pronounced in BPD than in HC (no stress effect was found).

Conclusions

In BPD, behavioral deficits in action withholding (but not in action cancelation) appear to be influenced by acute experimental stress. Delay discounting seems to be a general feature of BPD, independent of co-morbid ADHD and acute stress, possibly underlying typical expressions of behavioral impulsivity in the disorder.

Keywords

Adult attention deficit hyperactivity disorderborderline personality disorderdelay discountingimpulsivityresponse inhibitionstress
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 15 , November 2016 , pp. 3137 - 3149
Copyright
Copyright © Cambridge University Press 2016 

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