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Cognitive Therapy and Research, Vol. 29, No. 3, June 2005 ( C© 2005), pp. 343–358DOI: 10.1007/s10608-005-4267-4

Autobiographical Memory in Borderline PersonalityDisorder and Depression1

Babette Renneberg,2,4 Erika Theobald,2 Monika Nobs,2

and Matthias Weisbrod3

Responses to an autobiographical memory test (AMT, Williams & Broadbent, 1986)are examined in a sample of 30 female psychiatric inpatients with borderline person-ality disorder (BPD) in comparison to a group of 27 depressed inpatients and a non-clinical control group of 30 women. Concordant with the literature, depressed patientsretrieved fewer specific memories than the control group, generated significantly morecategoric memories than participants of both other groups, and needed more time forretrieval. Contrary to expectation, patients with BPD did not differ from normal con-trol participants in specificity, nor latency of their retrieved memories. In both clinicalgroups, hedonic tone of retrieved memories was more often negative than in the con-trol group. In this sample of inpatients with BPD, specificity of memories was notrelated to self-reported level of depression, dissociative symptoms, or frequency ofself-mutilation.

KEY WORDS: borderline personality disorder; autobiographical memory; depression; dissociation.

Borderline personality disorder (BPD) is characterized by a pervasive pat-tern of instability in interpersonal relationships, affectivity, self-image, and markedimpulsivity. Affective dysregulation is postulated to be a central mechanism ofthe disorder (e.g., Linehan, 1993). In recent years, research on cognitive andinformation-processing factors in BPD has emerged (e.g., Arntz, Appels, &Sieswerda, 2000; Cloitre, Cancienne, Brodsky, Dulit, & Perry, 1996; Jones et al.,1999; Korfine & Hooley, 2000), adding to knowledge about underlying mechanismsof emotion regulation for this group of severely disturbed patients. One such areaof research involves autobiographical memory.

1Parts of the research were presented at the XXX Congress of the European Association of Behaviouraland Cognitive Therapies, EABCT, in Granada, Spain, September 2000.

2Department of Psychology, University of Heidelberg, Germany.3Department of Psychiatry, University of Heidelberg, Germany.4Correspondence should be directed to Babette Renneberg, Department of Psychology, Free Universityof Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany; e-mail: [email protected].

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344 Renneberg, Theobald, Nobs, and Weisbrod

Autobiographical memory refers to memories of one’s personal life andplays a major role for identity and emotion regulation (e.g., Christianson & Safer,1996; Schacter, 1996). Different interpersonal and intrapersonal functions ofautobiographical memory have been reported. Among them are such importantintrapersonal functions as mood regulation, self-concept formation, and problem–solving. Interpersonal functions include social interaction, self-disclosure andempathy (Cohen, 1998; Conway, 1996).

Research on quality of autobiographical memories in clinical populations hasfrequently employed the autobiographical memory test (AMT), first described byRobinson (1976). In a seminal study Williams and Broadbent (1986) applied theAMT to investigation of autobiographical memory in suicide attempters. The au-thors found that patients who attempted suicide with an overdose of drugs, com-pared to a group of patients hospitalised for physical investigations, had difficultiesretrieving specific memories in a cued recall test with the instruction: “What eventdoes this word remind you of?” Subsequently, the AMT has been used numeroustimes to examine the specificity and latency of recall of memories of events of one’spersonal life. The most crucial variable in these studies is the number of specificmemories. A memory is characterized as specific if it refers to an occasion or anevent, located in time and place, for example, “when I met my friend at the trainstation last Saturday.”

The relationship of autobiographical memory to depression has been studiedextensively (e.g., Brewin, Reynolds, & Tata, 1999; Goddard, Dritschel, & Burton,1996; Kuyken & Brewin, 1995; Mackinger, Pachinger, Leibetseder & Fartacek, 2000;Moore, Fraser, & Williams, 1988; Puffet, Jehin-Marchot, Timsit-Berthier, & Timsit,1991; Williams, & Scott, 1988). A well-established finding of these studies is that de-pressed patients retrieve fewer specific memories than control groups, displaying an“overgeneral retrieval” style. Furthermore, depressed patients need more time toretrieve memories than control groups. Closer examination of answers of depressedpatients revealed that overgeneral retrieval is largely accounted for by a high num-ber of categoric descriptions (i.e., a summary of generic events, e.g., “when I go fora walk,” see Healy & Williams, 1999, for a review).

Such an overgeneral retrieval style may have more than academic relevance.In several studies, overgeneral retrieval has proved to be related to poor prob-lem solving (Evans, Williams, O’Loughlin, & Howells, 1992; Goddard et al., 1996;Sidley, Whitaker, Calam, & Wells, 1997), and it may be a predictor for the courseof depression (Brittlebank, Scott, Williams, & Ferrier, 1993; but see Brewin et al.,1999). Mackinger et al. (2000) provide further evidence for the persistent nature ofovergeneral retrieval style. Examining autobiographical memories in formerly de-pressed women in comparison to women who were never depressed, the authorsconcluded that the characteristic pattern of retrieval remains stable after remissionof depression.

Autobiographical memory effects are not limited to samples of depressed pa-tients. Two groups of researchers have replicated Williams and Broadbent’s (1986)findings of overgeneral recall in patients who attempted suicide (Evans et al., 1992;Sidley et al., 1997). Moreover, McNally, Lasko, Macklin, and Pitman (1995) re-ported patients with PTSD have similar difficulties in retrieving specific memories.

Autobiographical Memory in BPD 345

Because depression and PTSD co-occur frequently in patients with BPD (Zanariniet al., 1998; Zimmerman & Mattia, 1999), and one of the diagnostic criteria forBPD is parasuicidal behavior, these findings are particularly pertinent to the presentinvestigation of autobiographical memory in BPD. Also relevant is Kuyken andBrewin’s (1995) finding that depressed patients with a history of childhood sex-ual abuse retrieve less specific memories than patients with no history of child-hood sexual abuse. High rates of reported childhood sexual abuse are very commonamong patients with BPD (e.g., Wagner & Linehan, 1994; Zanarini, Dubo, Lewis,& Williams, 1997).

Jones et al. (1999) compared BPD outpatients’ responses in an AMT to thoseof a normal control group. Patients with BPD recalled more overgeneral memo-ries and had more omissions (responses where participants exceeded the time limitof 30 sec to retrieve a memory) than the control group. While these findings sug-gest that patients with BPD may also have difficulties retrieving specific memories,Arntz, Meeren, & Wessel (2002) as well as Kremers, Spinhoven, & van der Does(2004) did not find evidence for overgeneral recall in BPD patients. Thus, resultsfor overgeneral retrieval in BPD are inconsistent. The first aim of the present studywas to shed further light on the controversial issue of specificity of autobiographicalmemory in BPD.

What are the functions of overgeneral memories? Williams (1996) hypothe-sized that in depression overgeneral retrieval occurs to block emotional memoriesthat have negative valence in order to avoid emotional turmoil associated with suchmemories. In a later publication, Williams, Stiles, & Shapiro (1999) describe an as-similation model for painful and dangerous thoughts. In this model, the authorsassume eight stages of processing adverse experiences, incorporating “warding off”as well as the occurrence of unwanted thoughts. This model has high relevance forautobiographical memories in depression and PTSD. The applicability of the modelto BPD has not been examined yet.

An indicator for accessibility of memories is the speed of recall. Typically andin comparison to other memory tasks, participants need a long time to retrieve au-tobiographical memories in the AMT (control participants 8–15 sec). For depressedpatients and patients after a suicide attempt it has been reported that they need alonger time to retrieve responses in the AMT than comparison groups (e.g., Evanset al., 1992; Goddard et al., 1996). There are no data available on the speed of recallin autobiographical memory for patients with BPD. However, latency may be animportant distinguishing feature for BPD in comparison to other clinical disorders.

In most studies on autobiographical memory and depression, authors examinedthe specificity of memories in response to positive and negative cues but not the cur-rent hedonic quality of the retrieved memories. This omission is significant, in thatbias toward negative memory retrieval in depression is widely documented (for anoverview see Teasdale & Barnard, 1993). For example, Clark and Teasdale (1982)showed that the more depressed a person was while making the ratings, the less pos-itive the hedonic tone of personal memories. Like depressed patients, BPD patientsreport extremely negative assumptions about the self and others (Arntz, Dietzel, &Dreessen, 1999; Renneberg, Schmidt-Rathjens, Hippin, Backenstrass, & Fydrich, inpress). Do patients with BPD show a similar retrieval bias for negatively valenced


memories than depressed patients? To our knowledge there are no published dataon the hedonic tone of autobiographical memories in patients with BPD. A test ofthis question is the second goal of the present study.

Aims of the present study are to examine the specificity, latency of recall, andhedonic tone of retrieved autobiographical memories in female inpatients with BPDcompared to depressed inpatients, and to a control group of healthy women. Suchdata may provide information regarding the differences between these disordersand add information concerning mechanisms of emotion regulation in BPD. Last,to shed more light on possibly related phenomena in BPD like dissociation and self-mutilation, we examined correlations between specificity of autobiographical mem-ories and self-reported depressive and dissociative symptoms, as well as frequencyof self-mutilation.

METHOD

Participants

Clinical participants were 30 women with BPD and 27 with unipolar major de-pression. All were inpatients at the Department of Psychiatry University of Heidel-berg, referred to the study by the treating clinician. Exclusion criteria were acutepsychotic symptoms, a history of bipolar disorder, and organic brain disease. De-pressed patients had no concurrent Axis II diagnosis of the dramatic cluster. Ofthe BPD patients, 63% had an Axis I diagnosis of major depression and 37% ful-filled criteria for PTSD. The control group comprised 30 women recruited through asnowball system. They were matched for age and years of education to the patientswith BPD.

Measures

Structured Clinical Interview for DSM IV (SKID I and II)

The German version of the SCID I and SCID II (SKID; Wittchen, Wunderlich,Gruschwitz, & Zaudig, 1997; SKID II, Fydrich, Renneberg, Schmitz, & Wittchen,1997) was administered by six trained research assistants, who were in ongoingsupervision by the first author for the SCID interviews. A diagnosis of BPD wasverified with the therapists of the patients. A question assessing frequency of self-mutilation was added to the borderline section of the SCID II.

Interrater reliability was assessed using 26 randomly selected audiotaped in-terviews that were rated by a second rater, who was unaware of diagnostic group.Overall interrater reliability for affective disorders was excellent κ = .91. Specifi-cally, interrater reliability for MDD was perfect, κ = 1.0, and reliability for a diag-nosis of BPD was also very good, κ = .89.

Control Group

Research assistants conducted a telephone screening for psychological disor-ders, applying the SCID screening questions (German version, SKID I; Wittchen


et al., 1997) and two additional questions assessing current mood. The SCID II ques-tionnaire (Fydrich et al., 1997) was mailed before the experiment and used to screenfor possible Axis II symptomatology. Participants were excluded if they endorsedtwo or more items of the borderline section of the questionnaire after verification,or received a BDI score of >11. Control subjects completed the same self-reportmeasures as the clinical groups.

Beck Depression Inventory (BDI)

The German version of the 21-item BDI (Beck, Steer, & Garbin, 1988;Hautzinger, Bailer, Worall, & Keller, 1995) was employed to assess severity of de-pression. Reliability and validity of the widely used BDI have been extensively doc-umented (Beck, Steer, & Garbin, 1988; for the German version of the questionnaire,Richter, Werner, & Bastine, 1994).

Dissociative Experiences Scale (DES)

A German version of the DES (Carlson & Putnam, 1993) (Brunner, Resch,Parzer, & Koch, 1999) was used to assess frequency of dissociative experiences.Reliability of the German version is excellent: Cronbach’s α = .95 and test retestreliability r = .89.

Symptom Check List—90-Revised (SCL-90-R)

The GSI (global severity of symptoms) score of the SCL-90 R was used to as-sess current subjective experience of symptoms (German version, Franke, 1995).Reliability for the GSI is very good Cronbach’s α = .98 (Franke, 1995).

Means and standard deviations of the self-report measures are shown inTable II.

Autobiographical Memory Test (AMT)

The AMT was administered following the procedure described by Williams andBroadbent (1986). The test comprised 15 emotional cue words: 5 positive (happy,successful, safe, carefree, interested), 5 negative (sorry, lonely, hurt, clumsy, angry)and 5 neutral adjectives (modern, personal, oval, cultural, historic). Words were pre-sented on cards in a fixed order alternating between positive, negative and neutralwords. Participants were asked: “What event does this word remind you of?” Thelatency to the first word of each response was timed using a stop watch. If partic-ipants offered a nonspecific response, a standardised prompt was given (“Can youthink of a specific time, a particular event?”), and the cumulative time was recorded.Participants were given 60 sec to retrieve a specific memory. Before testing, partici-pants were given training examples until they demonstrated their understanding ofthe task. A memory was characterized as specific if it referred to an occasion thatdid not span more than a day. The crucial variable for specificity is the quality ofthe first response. Participants described their memories out loud. After completionof the test, they were asked to date the event they had recalled and to categorically


Table I. Demographic Characteristics of Inpatients with BPD, DepressedInpatients, and a Normal Control Group

Mean (SD)

BPD Depressed Controls

Age 28.5 (9.1) 39.1 (8.0) 28.4 (8.6)Range 18–48 25–55 18–47Years of education 10.8 (1.77) 10.6 (1.58) 11.1 (1.51)

Note. Depressed patients were significantly older than both other groups(p<.000). BPD: Borderline Personality Disorder.

rate the hedonic tone as either pleasant, unpleasant, or neutral. Always indicatinghow they felt about the memory today.

To permit assessment of interrater reliability, videotaped responses of thefirst 45 participants were coded independently by two out of five raters, one ofwhom was, in all cases, unaware of participants’ group membership. Agreement forwhether memories were categorized as specific or global was high, κ = .86.

Procedure

Subsequent to diagnostic procedures, and on a different day, research assistantsadministered a battery of self-report questionnaires prior to the AMT. To avoid in-troduction of error due to diurnal cycle effects, time of assessment was held con-stant. All participants completed the AMT in the early afternoon. All participantsprovided written informed consent and were paid 50 German Marks (approximately$23) for participation.

Demographic characteristics of the three groups are presented in Table I anddescriptive data on symptom measures in Table II.

RESULTS

Specificity of Retrieved Memories

A 3 (group: BPD, depressed, control) × 3 (cue type: positive, negative, neu-tral) ANOVA with repeated measures on the second factor was used to analyse

Table II. Means (Standard Deviations) of Self-Reported Symptomatalogy

BPD Depressed Controls

SCL-R GSI 1.37 (0.59) 1.44 (0.78) 0.27 (0.22)BDI 28.7 (11.1) 24.4 (8.8) 3.9 (2.7)DES 23.9 (11.8) 18.8 (13.5) 9.5 (6.9)

Note. On all measures participants of the control group differed signifi-cantly from clinical groups. No significant differences were detected be-tween clinical groups. BPD: Borderline Personality Disorder; SCL-90-R:Symptom Checklist Revised; GSI: Global Severity Index; BDI: Beck De-pression Inventory; DES: Dissociative Experiences Scale.


Table III. Number and Latencies of Specific First Responses on the Autobiographical Memory Test

BPD Depressed Control Group

M SD M SD M SD

Number of specific memoriesPositive cues 2.87 1.38 2.37 1.42 3.33 0.99Negative cues 3.23 1.22 3.00 1.41 3.73 1.08Neutral cues 3.00 1.62 2.67 1.47 3.33 1.21

Latencies to specific memories (sec)Positive cues 23.5 12.1 30.2 12.1 18.5 8.5Negative cues 19.1 11.9 22.2 9.6 16.4 8.8Neutral cues 23.9 13.4 26.9 12.8 21.1 11.0

Note. BPD: Borderline Personality Disorder.

differences between groups on number of first specific responses on the AMT.Means and standard deviations of number of specific memories are provided inTable III. The main effect for group factor was significant [F(2, 84) = 4.02, p = .02,η2 = .09]. Post hoc Tukey tests revealed that this was due to the difference betweenthe depressed inpatients and the nonclinical control group (p = .016), whereas thegroup of patients with BPD did not differ significantly from the nonclinical con-trol group or the depressed group (all ps > .25) in number of specific memories.Analyses also showed a main effect for valence of the cue words [F(2, 83) = 6.17,p = .003, η2 = .13]. All groups retrieved the highest number of specific memoriesin response to negative cue words and fewest specific memories in response to pos-itive cue words. The Group × Cue type interaction was not significant (p = .90,η2 = .006).

It is well established that overgeneral retrieval of depressed patients is largelyaccounted for by a high number of categoric memories (“when I go for a walk”)rather than memories that refer to an extended period of time (“when I lived inPhiladelphia”). Analyses of number of first responses that were categoric showed amain effect for group [F(2, 84) = 6.17, p = .003, η2 = .13]. Post hoc Tukey tests re-vealed that depressed patients retrieved significantly more categoric memories thanboth other groups (Tukey tests, both ps < .041). There was no significant differ-ence between BPD patients and the control group in number of categoric memories(p = .59).

Age and Specificity of Memories

Because samples differed significantly in age, depressed patients being olderthan both other groups, it was possible that group differences in specificity of mem-ories were actually due to differences in age. To test the relationship of age to speci-ficity of recall, a multiple regression analysis was conducted with number of specificfirst responses as the criterion. Following Aiken and West’s (1993) procedures, wecentered age and created two dummy-coded diagnosis variables to represent thethree diagnostic groups, testing each clinical group against the control group. Nei-ther age nor the interactions of age with diagnostic group contributed significantlyto the variance in number of specific responses (all ps >.49), and all effects were


small (srs < .072). Thus, the observed group differences on specificity are not dueto age differences.

Hedonic Tone of Retrieved Memories

Three mixed model ANOVAs (3 group × 3 valence of cue words) were con-ducted with number of positive, negative or neutral hedonic tone of retrievedmemories as the dependent variable, respectively. In the analysis for number ofmemories with negative hedonic tone, the main effect for group was significant[F(2, 84) = 13.6, p < .001, η2 = .24]. Both clinical groups (depressed patients M =5.81, SD = 1.73, patients with BPD M = 5.67, SD = 1.93) rated more memories asunpleasant than did the control group (M = 3.7, SD = 1.51). Post hoc Tukey testsrevealed that both clinical groups differed significantly (ps < .001) from the con-trol group, but not from each other (p = .94). There was also a main effect for cuetype [F(2, 83) = 214.5, p < .001, η2 = .84], with all groups judging more memoriesas unpleasant in response to negative cues than to positive or neutral cues. The in-teraction of Cue Type × Group was not significant (p = .37, η2 = .025).

Effects were also significant but less pronounced for positive hedonic tone ofmemories. Again the main effect for group [F(2, 84) = 3.63, p = .031, η2 = .08] wassignificant. Post hoc Tukey tests showed trends for both depressed (p = .055) andborderline patients (p = .061) to retrieve less positive memories than the controlgroup. Main effect for cue type was also significant [F(2, 83) = 262.0, p < .001,η2 = .86]. All groups retrieved highest number of positive memories in response topositive cues, followed by neutral cues and then negative cue words. The interactionCue Type × Group was not significant (p = .58, η2 = .017).

For memories rated as neutral, again a main effect for group [F(2, 84) = 4.19,p = .02, η2 = .09] and a main effect for cue type [F(2, 83) = 15.2, p < .001, η2 = .27]emerged. There was a trend for an interaction of Cue Type × Group [F(4, 166) =2.35, p = .056, η2 = .05]. In response to negative cue words, the control group ratedtheir memories more often as neutral (M = 1.6, SD = 1.2) than did both clinicalgroups (BPD: M = 0.70, SD = 0.87, depressed: M = 0.66, SD = 0.83).

Association of Specificity of Retrieval with Depression, PTSD,and Dissociative Symptoms

Of the BPD patients, 63% fulfilled criteria for current major depression accord-ing to the SCID I. Accordingly, it was possible borderline patients differed fromthe normal control group because of their high rate of depression (cf. Wilhelm,McNally, Baer, & Florin, 1997). Hence, a 2 (depressed, nondepressed) by 3 (cuetype) ANOVA with repeated measures on the second factor was conducted toassess differences in number of specific memories in the group of BPD patients.The main effect for group was small and not significant [F(1, 27) = 0.88, p = .36,η2 = .032]. Thus, in the group of borderline patients, number of specific memorieswas not related to current major depression. Since overgeneral retrieval has alsobeen reported for PTSD, and 37% of the sample of BPD patients fulfilled criteriafor PTSD (SCID data on PTSD diagnoses were missing for 2 of the BPD patients), a


similar analysis was conducted to test for the difference of BPD patients with PTSDand those without. The effect was also small and not significant (p = .61, η2 = .01).

To test the relationship of level of depression (BDI scores) to specificity ofrecall, a multiple regression analysis was conducted with number of specific firstresponses as the criterion. BDI scores were centered, and two dummy-coded diag-nosis variables created to represent the three diagnostic groups, testing each clinicalgroup against the control group. The interaction terms of BDI scores and diagnosticgroup were also entered into the equation. All effects were small and not statisticallysignificant (all ps > .29, all srs <. |12|).

A similar multiple regression analysis was computed to test the predictive valueof frequency of dissociative symptoms (DES scores) on number of specific memo-ries. No significant relation was detected between DES scores or interaction of di-agnostic group with DES scores on number of specific memories (all ps > .31, allsrs < .|11|).

Finally, for the BPD group frequency of self-mutilation was correlated withnumber of specific memories in response to the three different cue types. All cor-relations were small and not significant (all rs < .|13|). This correlation was onlycomputed for the BPD group, because very few depressed patients reported acts ofself-mutilation.

Latency of Retrieval

Mean latencies (in seconds) to retrieve a specific memory are shown inTable III. A 3 (group) × 3 (cue type) ANOVA with repeated measures on the sec-ond factor was used to analyse the time taken to retrieve the first specific memory.This generated a significant main effect for group [F(2, 84) = 5.95, p = .005, η2 =.12] and a main effect for valence of cue words [F(2, 84) = 8.63, p < .001, η2 = .09].The interaction was not significant (p = .36). Depressed patients (M = 26.4 sec,SD = 1.7) needed significantly more time than the control group (M = 18.7 sec,SD = 1.6) to retrieve a specific memory. There was a trend (p = .07) for patientswith BPD (M = 22.1, SD = 1.6) to be faster than the depressed group. Comparedto the control group, borderline patients did not need significantly more time toretrieve a specific memory (p = .13). All participants more quickly retrieved mem-ories in response to negative than to positive and neutral cue words.

DISCUSSION

The aim of the present study was to compare different aspects of autobiograph-ical memory retrieval in a group of depressed women, a group of women with BPD,and a nonclinical control group to shed further light on this important aspect ofmemory for identity and emotion regulation.

Results for depressed patients are concordant with the literature, showing char-acteristic difficulties in retrieving specific memories compared to the control group.Furthermore, the well established finding that overgeneral recall in depressedpatients is largely due to a high number of categoric descriptions (Barnhofer,


de Jong-Meyer, Kleinpaß, & Nikesch, 2002; for a review see Williams, 1996) wasreplicated. Patients with BPD, however, did not differ from normal control partici-pants in the specificity of their retrieved memories. Although in both clinical groups,hedonic tone of retrieved memories was more often negative than in the controlgroup. Moreover, depressed patients showed longer latencies of recall, whereasBPD patients did not differ in reaction times from normal control participants.

The phenomenon of overgeneral recall in depression is well documented in theliterature, data on autobiographical memory in BPD are scarce and controversial;therefore special emphasis is placed on the discussion of results for the group ofborderline patients.

The only variable that distinguished autobiographical memory in patients withBPD from the control group was the current hedonic tone of retrieved memories:Similar to depressed patients, borderline patients retrieved more unpleasant memo-ries than healthy women. A bias for negative memory retrieval has been extensivelydocumented for depression (for an overview see Teasdale & Barnard, 1993), but toour knowledge this finding has not been previously reported in empirical studies onautobiographical memory retrieval for BPD. This result is in line with other researchon basic assumptions of patients with BPD (Arntz et al., 1999; Renneberg, Schmidt-Rathjens, Hippin, Backenstrass, & Fydrich, in press) demonstrating the prevalenceof extremely negative cognitions of self and others in borderline patients.

The comparison of autobiographical memory retrieval between the two clin-ical groups indicates a different pattern of autobiographical memory retrieval inBPD than depressed patients: Patients with BPD do not display the “mnemonic in-terlock” (Williams, 1996) that has been described for depression (Barnhofer et al.,2002; Healy & Williams, 1999). The present data suggest that BPD patients’ au-tobiographical retrieval style is characterised by a relatively fast and easy accessto negatively valenced memories, which may also be specific. Thus, this retrievalis unlikely to protect them against emotional turmoil. Another finding of our re-search group (Reber, Schubert, Renneberg, Wilke, & Schmitt, 2001) supports thisnotion: According to a content analysis of memories retrieved during the AMT,BPD patients’ responses suggested especially high accessibility of painful memo-ries and/or an openness to talk about such memories. In the experimental situa-tion with an unfamiliar female experimenter, a number of borderline patients re-sponded to the cue words (e.g., hurt) with memories of self-mutilation or sexualabuse, whereas none of the depressed (or control participants) reported such mem-ories. In terms of the assimilation model (Williams, Stiles, & Shapiro, 1999), BPDpatients may not be at the stage of “warding off,” instead they may be able to ver-balize their pain but not reach the acceptance level (Williams, Stiles, Shapiro, 1999,p. 296).

Another observation of our study was that BPD patients are more motivatedto cooperate and could more easily follow instructions for any of the tasks com-pared to depressed patients. The autobiographical memory model described byConway & Pleydell-Pearce (2000) provides a framework for interpretation. The cur-rent goal of the “working self” (Conway & Pleydell-Pearce, 2000) for the BPD pa-tients may be more oriented to performance and the current interaction, i.e. theywant “to do their best” in this situation. For depressed patients, in contrast, it is


much more difficult to show any motivation, and they are impaired in their exec-utive functioning for other tasks as well (e.g., Kaiser et al., 2003). A ruminativestyle is characteristic for depression (e.g., Watkins & Teasdale, 2001), whereas thathas not been shown to be the case for BPD. BPD patients may have more cogni-tive flexibility compared to depressed patients and may move more flexible throughthe hierarchies of the autobiographical memory system (Conway & Pleydell-Pearce,2000).

Further corroboration for the accessibility of emotionally disturbing specificmemories is provided by a study of autobiographical memory in a sample of ado-lescent psychiatric inpatients (Swales, Williams, & Wood, 2001). The authors founda positive correlation between hopelessness and specific memories in response tonegative cues in the clinical group, indicating that patients who were more hopelessretrieved more specific memories. Moreover, this phenomenon of repeated specificrecall was found more frequently in participants who had a past history of parasui-cidal behavior (common in BPD patients). The authors relate this “hopelessnessspecificity” to intrusive memories, because patients’ responses often referred totraumatic experiences. The comparatively easy access of such negative memoriesmay explain part of the problems with emotion regulation typical for BPD, withstrong emotional reactions changing rapidly. In psychotherapy, patients with BPDare often overwhelmed by negative feelings evoked by autobiographical memories.In this context, it should be mentioned that BPD belongs to the “dramatic” clusterof PDs, and these patients frequently involve others to solve their problems(Linehan, 1993). It may be one of the strategies of BPD patients to talk to othersabout their disturbing experiences rather openly, searching for understanding andcommunicating the urgency of their pain.

Regarding the specificity of recall in BPD, present findings are discrepant fromthe results of the study by Jones et al. (1999). A possible explanation is that par-ticipants in the current study were psychiatric inpatients, usually admitted to thehospital in a crisis, whereas Jones et al. examined outpatients with BPD. Partici-pants in the present study were severely disturbed BPD patients, usually admittedin an acute crisis.

Results of the present study are supported by data from Arntz et al. (2002) andpartly by Kremers, Spinhoven, van der Does (2004). These authors also did not finda significant difference in specificity of recall between a group of BPD patients anda nonclinical control group. Note, however, that Kremers et al. did find that BPDpatients with comorbid depression showed overgeneral recall while BPD patientswithout depression did not. In contrast, in our sample BPD patients with and with-out concurrent major depression did not differ in overgeneral retrieval. Both sam-ples were diagnosed using the SCID. Differences between the Dutch sample andour sample again were inpatient/outpatient status. Additionally, participants in thepresent sample were paid for participation, when they did not receive compensationin the Kremers’ et al. study. BPD patients are performing quite well in a structuredsituation with specific instructions, being rewarded for their participation. Speakingin terms of the model by Conway and Pleydell-Pearce (2000), the working-self ofBPD patients seems to be oriented to goals related to the performance and to therelationship that is important in the present moment.


A problem for research on borderline disorder is that these patients form a veryheterogeneous group. Some patients display more impulsivity while others are moreintroverted and extremely insecure. We applied several data analytic techniques inorder to find meaningful subgroups in our sample, however, we were not able toidentify meaningful patterns. This remains a task for future studies with even largersample sizes.

In line with almost all other studies on autobiographical memory with clinicalparticipants (for a review see Williams, 1996), in the present study level of depres-sion assessed with the BDI was not related to the total number of specific memories.It is puzzling that severity of depressive symptoms is not related to overgeneral re-call, whereas a diagnosis of depression clearly is. Recently, Dalgleish, Spinks, Yiend,and Kuyken (2001) pointed out that results regarding the predictive power of over-general recall for future depressive symptoms vary according to the measure em-ployed to assess severity of depression. In a sample of participants with seasonalaffective disorder, number of overgeneral memories predicted follow-up scores onthe Hamilton Rating Scale of Depression (HRSD, Hamilton, 1960), even when ini-tial symptom level was controlled, whereas BDI scores did not. Although stronglycorrelated, the two measures of depressive symptoms differ in mode of administra-tion (self-report versus clinician’s ratings) and in content. The BDI assesses moreclearly the cognitive symptoms of depression, whereas the HRSD has a stronger fo-cus on somatic-vegetative symptoms. Dalgleish et al. conclude that overgeneral re-trieval may be more closely and independently related to somatic—vegetative thanto cognitive symptoms of depression. We checked this idea for the present samples,reanalysing self-reported depression according to the factor structure of the BDI,described by Startup, Rees, & Barkham (1992). However, more pronounced vege-tative symptoms were not (r = −.18) related to number of specific first responses inthe BPD group, nor in any other group.

Furthermore, results from the present study and those of Kremers et al. do notsupport a relationship between specificity of recall and level of dissociative symp-toms in BDP patients, both hypothesized to be possible strategies for the avoidanceof distressing emotions (Jones et al., 1999).

What are the underlying mechanisms of hampered accessibility of specificmemories? Accessibility of specific memories has been linked to a deficit in workingmemory, to an impairment of the central executive function. It could also be thatdeficits in encoding are responsible for global retrieval (Healy & Wiliams, 1999).The present data indicate that, relative to normal control participants, depressedpatients more clearly demonstrate this deficit in cognitive resources than do patientswith BPD. These results are in line with other studies (Sprock, Rader, Kendall, &Yoder, 2000) on memory functioning in BPD and depression. In their comparisonof borderline patients, depressed patients, and a normal control group, these au-thors found little difference between the BPD patients and the normal comparisongroup on tasks of executive functioning and memory, whereas the depressed groupwas consistently significantly different from the control group across tasks. In thesame line, Kunert, Druecke, Sass, & Herpertz (2003) also found no differences be-tween BPD patients and a nonclinical control group in different aspects of executivefunctioning and memory.


Although low power might be responsible for the nonsignificant differencesbetween borderline patients and controls in the present study, power was ade-quate for the large effect typical of research on overgeneral recall in depression.The effect size for the comparison of BPD patients and control group (η2 = .045)was much smaller than for the comparison of depressed patients and control group(η2 = .143).

Generalization of the present results is limited by our exclusion of male pa-tients. Although gender differences in autobiographical memory have not been re-ported for clinical samples, Davis (1999) found gender differences in autobiograph-ical memory for childhood emotional experiences in nonclinical samples. Anotherlimitation of the study is the lack of a direct measure of intensity of feelings associ-ated with retrieved memories. It is an assumption of the model by Williams (1996)that retrieval of categoric memories leads to less emotional turmoil than recall ofspecific memories. However, in their dual memory model of emotion, Philippot,Bayens, Douilliez, & Francart (2004) state that overgeneral retrieval may even en-hance emotional arousal. Our research group is currently investigating the associa-tion between emotional intensity and specific versus general memories in an attemptto replicate the findings by Philippot, Schaefer, & Herbette (2003). This aspect ofquality of autobiographical memory could help to further clarify the association ofautobiographical memory and mechanisms of emotion regulation, highly relevantfor borderline disorder.

ACKNOWLEDGMENTS

This research was supported by the German Research Foundation (DFG, RE1419/1-1) and by a Stipend to the first author by the State of Baden-Wurttemberg,“Margarete-von-Wrangell Habilitationsprogramm.” The authors would like tothank Dianne Chambless for her helpful comments on an earlier version of thispaper.

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Documents

seasonal affective disorder

borderline personality disorder

childhood emotional experiences

childhood sexual abuse

structured clinical interview

dissociative experiences scale

normal control group

multiple regression analysis