Presentation at the DGPPN Congress in Berlin, Germany on November 27th, 2009.

1. Overgeneral memory in
borderline personality
disorder
kris.van.den.broeck@uc-kortenberg.be
Psychologist – Behavioural therapist
In collaboration with prof. dr. Guido Pieters MD (UPC-KULeuven),
prof. dr. Laurence Claes (KULeuven) and prof. dr. Filip Raes (KULeuven)

2. Where it all started…
• Studies on cognitive functioning in depressed patients
(20th Century):
– Depressed patients are more likely to retrieve negative than
positive information
– Depressed patients need more time to retrieve positive
information out of their memory compared to negative
information

3. Where it all started…
• Williams & Broadbent (1986):
– Attempt to replicate these findings in 25 patients who recently
tried to commit suicide by auto-intoxication
– 2 control groups:
• 25 inpatients, same hospital
• 25 ‘healthy’ people
– Hypotheses:
• The suicide-attempters will retrieve more negative life events than positive
ones
• It will take longer to retrieve positive information than negative information
among the suicide-attempters
– Using their Autobiographical Memory Task (AMT)
– Controlling for substance (ab)use

4. Where it all started…
• The Autobiographical Memory Task (AMT)
– Instruction: retrieving memories that refer to personally experienced
events that did not last longer than one day
– 3 practice cues
– 10 (or more) cues of different valence (+ / - / °), e.g.: happy, clumsy, …
– Time to the first response is recorded, max 30s (or 60s)
– Respondent is prompted in case retrieval is not a specific memory
– First responses are rated afterwards as
• Specific memory
• General memory
– Categoric memory
– Extended memory
• Same event
• No memory
• No response

5. Where it all started…
• The Autobiographical Memory Task (AMT): Example:
– Cue: “happy”
– “I am happy every time I play tennis” = General categoric memory
– ‘I was happy during the holidays last year” = General extended memory
– “The last birthday party of my niece. Roger had bought flowers.
My mum had to sneeze – she is really allergic, you know –
thereby knocking over the bottle of wine. The face of Mimi was
worth millions!” = Specific memory

6. Where it all started…
• Williams & Broadbent (1986):
– Results:
• The suicide-attempters retrieve more negative life events than positive
ones
• It take longer to retrieve positive information than negative
information among the suicide-attempters
– These findings could be explained by the quality of the retrieved
memory; 32% of the memories given by the suicide-attempters
following positive cues were overgeneral (categoric) memories!

7. How it evolved…
• The findings of Williams and Broadbent (1986) are often
replicated during the last decades:
– In depressed patients
– In remitted depressed patients
– In traumatized patients
• OGM has been associated with:
– Severity of depression
– Hopelessness
– Rumination
– Problem solving capacities (number and quality)
– Avoidant style towards thoughts and feelings
– Negative prognosis (less / slower remission; higher relapse rates)
– More recently with: the meaning that the AMT-cues have for the
respondent (self-discrepancy)

8. How it evolved...
• Self-discrepancy in depressed patients:

9. How it evolved…
• Theoretical framework: the CaR-FA-X-model:
Capture and
Rumination
Overgeneral
Functional memory
Avoidance Consequences,
e.g. impaired
problem solving
eXecutive
capacity and
control Following Williams et al.(2007)

10. What about BPD patients?
• Overgeneral memory is very likely in patients with
borderline personality disorder (BPD) because:
– They often report mood lability
– They often have trauma in their history
– They ruminate
– They experience difficulties in problem solving
• However… Table 1 Studies on OGM in BPD patients: an overview
Authors (PY) OGM in BPD?
Jones, Heard, Startup, Swales, Williams & Jones (1999) Yes
Startup, Heard, Swales, Jones, Williams & Jones (2001) Negatively associated with self-injury
Arntz, Meeren & Wessel (2002) No
Kremers, Spinhoven & van der Does (2004) No, relation with current depression
Kremers, Spinhoven, van der Does & Van Dyck (2006) No
Renneberg, Theobald, Nobs & Weisbrod (2005) No
Reid (2007) Yes / No
Maurex, Lekander, Nilsonne, Andersson, Asberg & Ohman (2009) Yes

11. What about BPD patients?
Our study - Hypotheses
• Our hypotheses:
– On the relationship between OGM, depression severity and
rumination:
1. As in (previously) depressed patients, there is a negative relation
between memory specificity and depression severity in BPD
patients
2. As in (previously) depressed patients, there is a negative relation
between memory specificity and rumination in BPD patients
– On the relationship between OGM and the meaning of the cue:
3. As in depressed patients: the more the AMT-cue is approaching
themes that are highly relevant for the respondent, the more likely
it is that the respondent experiences difficulties in retrieving
specific information.
4. The more relevant (this is: discrepant) the AMT-cue is for the
respondent, the more likely it is that the respondent experiences
difficulties in retrieving specific information.

12. What about BPD patients?
Our study - Method
• Participants:
– N = 34, 27 female, all diagnosed with BPD (team)
– Mean age = 27.71
– Mostly single (78.10%), unemployed (40.60%), secondary
school (79.40%)
• Instruments and method: groups of 2-8 respondents,
questionnaires were administered at respondents’ own
pace:
– Autobiographical Memory Task (AMT – written version)
– Ruminative Response Scale (RRS)
– Beck Depression Inventory II (BDI-II)
– Self-Description Questionnaire (SDQ)

13. What about BPD patients?
Our study – Results H1 / H2
Table 2 Correlations between proportion specific and general memories, rumination
and depression
% GC RRS-total BDI-total
%S -.66** -.38* -.58**
% GC - .24 .29
RRS-total - .58**
BDI-total -
% S = proportion specific memories, % GC = proportion general categoric memories; * p < .05, ** p < .01
• Participants are depressed (mean BDI=33.31; Sd=12.97)
• The correlational pattern resembles the findings of depressed patients.
• However, r%S, RRS total . BDI total = -.11, p=.58, suggesting that (lack of) specificity
is mainly associated with depression severity.
• This relationship was not explained by diagnostic status (currently depressed
or not).

14. What about BPD patients?
Our study - SDQ
Self-Description Questionnaire (SDQ)
«The following questionnaire is about personal characteristics and self-descriptions.
You will be asked to think about and describe a number of different ‘self-concepts’ …
Your ‘ideal self’ is the kind of person you’d really like to be. It’s defined by the
characteristics you would ideally like to have. It’s not necessary that you actually
have these characteristics now. Please list seven characteristics that describe how
you would ideally like to be.» Δ=Discrepancy!
Ideal
Assertive
Actua
l
• 220 people rated (online) to what degree each self-description was
synonymous to each AMT cues:
Ir = Index of AMT self-relevance
Id = Index of AMT discrepancy

15. What about BPD patients?
Our study – Results H3 / H4
• At first sight no relations were shown between the indices and
%S:
rIr, %S = -.12, p=.50
rId, %S = .12, p=.50
• But when we only selected the current depressed BPD
patients, the analyses were conform our expectations:
rIr, %S = -.63, p=.04 (vs rIr, %S = .02, p=.94 in the non-depressed)
rId, %S = -.88, p=.00 (vs rId, %S = .35, p=.11 in the non-depressed)

16. What about BPD patients?
Our study – Results H3 / H4
• Linear Regression Analyses:
– Dependent Variable: %S
– Predictors:
• Block 1: current depression
• Block 2: BDI-total, Index
• Block 3: BDI-total x Index - interaction

17. What about BPD patients?
Our study – Results H3 / H4
Predictor β t p
Current depression .037 .222 .826
BDI-total -7.336 -2.142 .041
Ir -1.094 -2.089 .046
BDI x Ir interaction 7.009 2.007 .055
Predictor β t p
Current depression .067 .408 .687
BDI-total -1.112 -2.346 .027
Id -.913 -1.079 .290
BDI x Id interaction 1.351 1.334 .194

18. What about BPD patients?
Our study – Conclusion
• To summarize:
– On the relationship between OGM, depression severity and
rumination:
1. As in (previously) depressed patients, there is a negative
relation between memory specificity and depression severity in
BPD patients
2. As in (previously) depressed patients, there is negative
relation between memory specificity and rumination in BPD
patients
– On the relationship between OGM and the meaning of the cue:
3. / 4. As in depressed patients: the more the AMT-cue is
approaching themes that are highly relevant / discrepant for the
respondent, the more likely it is that the respondent experiences
difficulties in retrieving specific information.
• Depression (severity) seems to play an important
role in OGM in BPD patients

19. What about BPD patients?
Our study – Limitations & Implications
• Limitations:
– sample size
– no SCID-diagnoses
– written AMT
• Therapeutic implications:
– Cfr. depressed patients
• Memory Specificity Training (MEST, Raes et al., 2006)
• Realistic goals, small steps