Executive Function, Iowa Gambling Task Decision Making and Suicide Risk in Women with Borderline Personality Disorder

Neuropsychological deficits may perpetuate the risk and chronicity of psychiatric disorder. Borderline Personality Disorder, characterized by significant suicide risk, intense affect and behavioural dysregulation, is frequently associated with the executive function (EF) deficits of decision making and inhibitory control. However, the role of inhibitory control on decision making remains poorly understood. This study examined the relationships among working memory, cognitive and motor inhibitory control, and IGT decision-making performance in 41 women with BPD and 41 healthy controls. Associations among EF and suicide risk were also explored. Experimental tasks included the Iowa Gambling Task, Digit Span, Stroop and Stop Tasks, and Raven’s Matrices. Only IGT decision-making deficits distinguished BPD subjects from healthy controls. Weaker yet normal range IQ and EFs in BPD women did not explain their disadvantageous IGT performance. Contrary to expectations, IGT deficits in BPD women did not predict any suicidal risk; however, intact interference control was as sensitive to suicidal risk as was depression. Normal interference control was associated with a reduction in suicide risk. While IGT decision making may be a marker for BPD, Stroop interference control is more sensitive to suicide risk and may represent a vulnerability for suicide that exists beyond psychiatric diagnosis.Ph