Original Articles

Effects of cortisol on memory in women with borderline personality disorder: role of co-morbid post-traumatic stress disorder and major depression

K. Wingenfeld^a1a2 c1, M. Driessen^a3, K. Terfehr^a2, N. Schlosser^a3, S. Carvalho Fernando^a3, C. Otte^a1, T. Beblo^a3, C. Spitzer^a4, B. Löwe^a2 and O. T. Wolf^a5

^a1 Department of Psychiatry and Psychotherapy, Charité University Berlin, Campus Benjamin Franklin, Berlin, Germany

^a2 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany

^a3 Department of Psychiatry and Psychotherapy, Ev. Hospital Bielefeld-Bethel, Bielefeld, Germany

^a4 Department of Psychiatry and Psychotherapy, Asklepios Fachklinikum Tiefenbrunn, Göttingen, Germany

^a5 Department of Cognitive Psychology, Ruhr University Bochum, Bochum, Germany

Abstract

Background Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD).

Method In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10 mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied.

Results Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects: in this subgroup (BPD + MDD) the effects of cortisol on memory were absent.

Conclusions The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs).

(Received June 04 2012)

(Revised July 19 2012)

(Accepted July 23 2012)

(Online publication September 19 2012)

Key words

• Autobiographical memory;
• borderline personality disorder;
• cortisol;
• declarative verbal memory;
• HPA axis;
• major depression;
• post-traumatic stress disorder;
• working memory

Correspondence:

^c1 Address for correspondence to: Dr K. Wingenfeld, Department of Psychiatry and Psychotherapy, Charité University Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany. (Email: katja.wingenfeld@charite.de)