20140911 eabct den haag
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Overgeneral memory (OGM) refers to the tendency to recall categories of events from memory, rather than specific memories, even when it is explicitly instructed to recall specific events. Unlike depressed and traumatized patients, patients diagnosed with borderline personality disorder (BPD) inconsistently show OGM. Non-suicidal self-injury (NSSI) on the other hand, is very common in patients with BPD. Like OGM, NSSI is considered to be an affect-regulation mechanism. This study investigated how these strategies relate to each other. Based on earlier findings (Startup et al., 2001), we hypothesized that NSSI and OGM would be inversely associated. Fifty three BPD patients completed the Structured Clinical Interview for DSM-IV Disorders (Axis II as well as Axis I-mood modules), the Autobiographical Memory Test to assess OGM, and the Self-Injury Questionnaire - Treatment Related (SIQ-TR) to assess NNSI. We found that patients who engage in NSSI do not differ from patients who do not with respect to OGM. However, we found that participants who use more different NSSI methods showed less OGM, but this association disappeared when we controlled for age. We propose a balance-model of affect-regulation as one possible explanation for the relationship between these two affect-regulation behaviours, and discuss the clinical relevance of our findings.
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20140911 eabct den haag
- 1. Grant 1900114N Autobiographical Memory Specificity and Non-Suicidal Self-Injury in Borderline Personality Disorder Kris Van den Broeck1,2, Laurence Claes2, Guido Pieters1,2, Ann Berens3, & Filip Raes2 1UPC KU Leuven; 2University of Leuven; 3PZ Duffel
- 2. Overgeneral memory (OGM) • Autobiographical Memory Task (Williams & Broadbent, 1986) o Happy – ‘that one time, when I broke my racquet in that thrilling tiebreak against my brother’ • Patients with MDD/PTSD: o Happy – ‘each time I play tennis’ • Affect-regulation strategy? • Memory Specificity Training (MeST; Raes et al., 2009) • Mixed findings in BPD
- 3. Non-suicidal self-injury (NSSI) • “Any socially unaccepted behaviour including deliberate and direct injury to one’s own body surface without suicidal intent” (APA, 1994). • NSSI frequency vs NSSI diversity • Core affect-regulation strategy of BPD patients? (89% engaged in NSSI; 70% multiple methods; Zanarini et al., 2008)
- 4. Startup et al. (2001) • Hypothesis: OGM and parasuicidal gestures (PS ! >< NSSI) are positively related. • OGM and PS frequency were negatively related, r = - .47, p < .05. • Not replicated by Renneberg et al. (2005); Maurex et al. (2010)
- 5. Our study • Aim: examining the association between assumed affect-regulation strategies • Hypothesis: o Based on Startup et al. (2001): BPD patients not engaged in NSSI will show more OGM o Alternatively, given that OGM and NSSI are both associated with (avoidant) affect-regulation, OGM and NSSI may also be positively related. • Exploratory: how does NSSI diversity relate toOGM?
- 6. Methods Participants • N = 53 (8 males) • 18-51 years of age (M = 29.47; SD = 8.45) • From UPC KU Leuven (77.36%) and PZ Duffel (22.64%) Instruments • SCID-II • Autobiographical Memory Test (AMT) • Self-Injury Questionnaire –Treatment Related (SIQ-TR)
- 7. Results The mean numbers of specific and categoric memories retrieved by participants who reported lifetime NSSI compared to those who did not. Lifetime NSSI (n = 44) No lifetime NSSI (n = 9) F p N specific memories 14.73 14.44 .103 .749 N categoric memories .84 1.33 1.402 .242 Note. NSSI = non-suicidal self-injury; N = number of [specific/categoric] memories.
- 8. Results Correlations between age, the number of specific and general categoric memories, and the number of different lifetime NSSI methods. Correlations below the diagonal are controlled for age. 2 3 4 1. Age -.37** .35* -.42** 2. S - -.73** .26$ 3. GC -.55** - -.34* 4. N# NSSIs-LT .10 -.28 - Note. NSSI = non-suicidal self-injury; S = number of specific memories retrieved during Autobiographical Memory Test administration; GC = number of general categoric memories retrieved; N# NSSIs-LT = number of different NSSI methods used during lifetime. $ p = .06, * p < .05, ** p < .01.
- 9. Discussion • Frequency of NSSI is not associated withOGM (no replication of Startup et al., 2002). • Yet, NSSI diversity is negatively correlated withOGM balance-model: behavioural vs cognitive coping? therapeutical implications: treating one affects the other!
- 10. Discussion • Older patients show less (lifetime!) NSSI diversity and are less specific. o With respect to OGM: replication o With respect to NSSI diversity: • IncreasingOGM affects memory for NSSI diversity? • Selection bias? • Mortality effect? • Cohort effect? • The association between NSSI diversity and OGM disappears when age is partialled out. o Spurious correlation o BPD patients develop cognitive coping skills when growing older (by therapy?)
- 11. Results M SD Range Descriptive statistics of the Autobiographical Memory Test (AMT). N / % specific memories 14.68 / .87 2.38 / .13 7 – 18 N / % general categorical memories .92 / .05 1.14 / .07 0 – 6 N / % general extended memories .42 / .02 .77 / .04 0 – 4 N / % no memory retrievals .49 / .03 .93 / .06 0 – 3 N / % same event retrievals .40 / .02 .63 / .04 0 – 2 N omissions 1.09 1.30 0 – 6 Note. N = number of [type of answers on the Autobiographical Memory Test]; % = proportion of [type of answers on the Autobiographical Memory Test]. In computing %, we do not take into account omissions, e.g., % specific memories is = N specific memories / (18 – N omissions), with 18 being the total number of cues of the Autobiographical Memory Test.
- 12. Results Frequencies and percentages of recent and lifetime NSSI in our sample, arranged by different NSSI methods, and by the number of different NSSI methods that were used during the period of interest, as measured by the Self-Injury Questionnaire – Treatment Related (SIQ-TR). Recent (during the last month) Lifetime Prevalence N / % Scratching 13 / 24.5 30 / 56.6 N / % Bruising 9 / 17.0 23 / 43.4 N / % Cutting 17 / 32.1 39 / 73.6 N / % Burning 3 / 5.7 15 / 28.3 N / % Biting 4 / 7.5 13 / 24.5 N / % Total NSSI 28 / 52.8 44 / 83.0 0 25 / 47.2 9 / 17.0 1 16 / 30.2 11 / 20.8 2 8 / 15.1 11 / 20.8 3 2 / 3.8 8 / 15.1 4 2 / 3.8 7 / 13.2 5 - 7 / 13.2
Editor's Notes
- Overgeneral memory refers to the tendency to retrieve categories of events instead of single events. It is generally measured with the Autobiographical Memory Test. In this taks, respondents are presented with cues, such as happy or lazy. They are instructed to retrieve specific memories – memories referring to events that happened only once and did not last longer than one day – in response to each cue. E.g., ‘that one time…’ Over the past 30 years, depressed and traumatised individuals have robustly shown to be biased on this task. Compared to controls, they retrieve higher proportions of categoric memories, referring to a series of events, e.g., ‘each time…’ It has been suggested that OGM serves affect-regulation. Indeed, in order not to get overwhelmed by the intense feelings associated with a single adverse event, it may be useful not to retrieve all the details of that event. Yet, it seems that this affect-regulation strategy has generalized in depressed and traumatised individuals to memories in general, and this may be problematic. Being less specific regarding personal memories may complicate future problem solving abilities. Indeed, it has been shown that OGM predicts future mood disturbances as well as post-trauma symptoms. Recently, some researchers have tried to train patients to become more specific while retrieving memories. Results showed that this led to reduced levels of complaints at follow-up, suggesting that this could be a promising strategy for fighting the burden of recurrent depression and prolonged PTSD. BPD patients often show co-morbid MDD and PTSD, and deficient problem solving abilities. However, contrary to what could be expected, findings on OGM in these patients have yielded mixed results.
- A more behaviourally strategy that has been suggested to regulate affect, is non-suicidal self-injury. NSSI is defined as .... Respondents report a decrease in negative affect and an increase in positive feelings following NSSI. Recently, attention grew for NSSI diversity – the numbers of different methods used to hurt oneself – besides to NSSI frequency. NSSI diversity, rather than NSSI frequency, has been shown to be associated with different measures of suicidality, severity of BPD or depression. Therefore, NSSI diversity is considered a marker of severity of psychopathology. Although NSSI is common in a wide range of psychiatric diagnoses, it is traditionally considered a symptom of BPD.
- Three studies have examined the relationship between these assumed affect-regulation strategies in BPD patients. Startup et al. (2002) expected to find a positive association between these concepts, given that early studies on OGM detected OGM in parasuicidal patients. Yet, they found that patients who often engaged in self-injury retrieved less categoric memories (and more specific ones). They suggested that OGM, at least for some BPD patients, would come in handy to reduce NSSI. (Yet, we now know that other problems will arise then…). Their findings were not replicated in two other samples of BPD patients.
- We aimed to study the relationship between OGM and NSSI, both assumed affect-regulation strategies. Based on the findings of Startup et al. (2001), we hypothesised that BPD patients who have not engaged in NSSI will show more OGM. Alternatively, given that OGM and NSSI are both associated with avoidance, both concepts may also be positively related. Furthermore, given the recent increase in attention for NSSI diversity, we explored how NSSI diversity related to OGM.
- 53 BPD patients (diagnosed with SCID) were recruited in two belgian hospitals. We administered the AMT and the Self-Injury Questionnaire, in which respondents are asked to indicate how long ago they performed five types of NSSI (severe scratching, bruising, cutting, burning and biting oneself). Additional questions address the taxonomy (frequency, location on the body etc.) and functionality of NSSI. This questionnaire allows us to distinguish between participants who only recently (during the past month), ever (liftime), or never have hurt themselves, as well as between patients who use one or more NSSI methods.
- No differences between patients of different settings with respect to the variables of interest (AMT, SIQ-TR). This table shows the levels of memory specificity in patients who have reported recent NSSI, compared to those who have reported not to have engaged in recent NSSI (during the past month). No differences were found between these participants. Likewise, participants who have never been engaged in NSSI were not found to be more overgeneral than those who have ever used NSSI, thereby refuting both our hypotheses.
- Exploring the associations between NSSI diversity and OGM, we discovered that the more different methods were applied during lifetime, the more specific and the less categoric memories were retrieved. It should be noted, however, that both memory specificity and NSSI diversity were found to decrease with age. When we controlled for age, the associations between OGM and NSSI diversity disappeared.
- To conclude then, we were not able to replicate the findings of Startup et al. (2001). Perhaps this is due to their focus on parasuicidal acts, also including gestures with suicidal intent, or to their operationalisation of OGM. Yet, we found that NSSI diversity was negatively correlated with OGM, suggesting a balance-model on affect-regulation. This matches theories on BPD development (Linehan, Cascade model), suggesting that due to their hypervigilance, BPD patients are less successful in regulating their affect cognitively. This has important therapeutical implications. It means that when we try to treat one of these aspects, BPD patients may develop another detrimental affect-regulation strategy. Put otherwise, these findings suggest that, in order to be effective, treatment should simultaneously address both OGM and NSSI diversity.
- We further found that older patients showed less NSSI diversity and were less specific. With respect to OGM, this finding is in line with was is found in depressed and traumatised patients. With respect to NSSI diversity, this is a peculiar finding. Finally, the association between NSSI diversity and OGM disappears when age is partialled out. This may suggest that we only observed a spurious correlation, that results from the association of both concepts with age. Alternatively, though, it may also suggest that BPD patients when time passes by do develop more cognitive coping skills, hopefully by the influence of therapy.