17

British Journal of Clinical Psychology (2004), 43, 1729

2004 The British Psychological Society
Autobiographical memory in depressed and non-
depressed patients with borderline personality
disorder
I.P. Kremers,* Ph. Spinhoven and A.J.W. Van der Does
Department of Psychology, Leiden University, The Netherlands
Objectives. The present study investigated the specificity of autobiographical
memories among depressed and non-depressed borderline patients, compared with
depressed patients and controls. The influence of childhood trauma, intrusions of
traumatic events, avoidance of intrusions, dissociation and depression on memory
specificity was also studied.
Method. The Autobiographical Memory Test (AMT), a trauma interview and self-
report measures of intrusions, avoidance, depression and dissociation were
administered to 83 borderline outpatients, 26 depressed outpatients and 30 controls.
Results. Depressed borderline patients and depressed patients reported fewer
specific memories than controls. Depressed patients generated fewer specific
memories than non-depressed borderline patients. Neither trauma nor traumatic
intrusions, avoidance of intrusions or dissociation were related to the specificity of
memories. Level of depressive symptoms (BDI) was also not related, but the presence
of a depression was.
Conclusion. In this large sample of outpatients with borderline personality disorder,
only the subgroup with a co-morbid diagnosis of depression had trouble remembering
specific events from the past. Trauma, intrusions, avoidance of intrusions and
dissociation seem to be unrelated to the specificity of autobiographical memories in
borderline personality disorder.
People remember their past differently, not only because of the different lives people
live, but also because different people remember in different ways. Not everyone is
equally capable of remembering specific events from their past. In 1986, Williams and
Broadbent used the Autobiographical Memory Test (AMT) in which respondents were
www.bps.org.uk
* Correspondence should be addressed to Ismay P. Kremers, Department of Psychology, Leiden University, Wassenaarseweg
52, 2333 AK Leiden, The Netherlands (e-mail: kremers@fsw.leidenuniv.nl).
asked to retrieve a specific memory in reaction to a cue word, e.g. depressed, anxious
or happy. Williams and Broadbent (1986) found that patients who had recently
attempted suicide by overdose had more trouble than normal controls in generating
specific autobiographical memories. Instead of recounting memories of events that
occurred on a particular day, as the task demanded, they often responded with
categorical memories like: every Friday when I go to my aerobics class.
Several studies have suggested that not only suicidal patients (Williams & Dritschel,
1988), but also depressed patients (Goddard, Dritschel, & Burton, 1996; Kuyken &
Dalgleish, 1995; Moore, Watts, & Williams, 1988; Puffet, Jehin-Marchot, Timsit-Berthier,
& Timsit, 1991; Wessel, Meeren, Peeters, Arntz, & Merckelbach, 2001a; Williams &
Scott, 1988) and patients with bipolar disorder (Scott, Stanton, Garland, & Ferrier,
2000) show the same lack of specificity, as compared with normal controls. Moreover,
in patients with obsessive-compulsive disorder (Wilhelm, McNally, Baer, & Florin,
1997) the overgenerality of the reported memories was not a function of obsessive-
compulsive disorder per se, but was related to a co-morbid diagnosis of depression.
Therefore many authors would agree that the phenomenon of overgeneral memory is
related to depression. This conclusion may be premature, however, given the results of
recent studies on the influence of traumatic events on the specificity of autobio-
graphical memories. Depressed adult survivors of childhood abuse, especially those
reporting high levels of avoidance of intrusive memories of the abuse, generated more
overgeneral memories than depressed patients without a history of childhood abuse
(Kuyken & Brewin, 1995). Similar results were obtained among cancer patients: greater
avoidance was associated with more overgeneral memories (Brewin, Watson,
McCarthy, Hyman, & Dayson, 1998). However, Brewin, Reynolds, and Tata (1999)
found overgeneral recall to be more strongly associated with intrusive memories.
Supporting evidence for the relationship between trauma and memory retrieval also
comes from the study by de Decker, Hermans, and Eelen (2000) who found a positive
correlation between reported trauma and overgeneral memories among adolescents.
Furthermore, students who report childhood sexual abuse (Henderson, Hargreaves,
Gregory, & Williams, 2002), patients suffering from post-traumatic stress disorder
(McNally, Lasko, & Pitman, 1995; McNally, Litz, Prassas, Shin, & Weathers, 1994) and
acute stress disorder (Harvey, Bryant, & Dang, 1998), also exhibited difficulties in
generating specific memories on the AMT, even after controlling for the influence of
depression. Patients with persecutory delusions also have difficulties in generating
specific memories. It is suggested that their delusions may, at least in part, be facilitated
by the overgeneralized recall of problematic relationships in early life (Kaney, Bowen-
Jones, & Bentall, 1999). These studies suggest that deficits in retrieving specific
personal memories may be more strongly related to psychological disturbance arising
from trauma than to depression.
The alleged association of traumatic experiences and dissociation (for a review see
Merckelbach & Muris, 2001) has led some researchers to study the role of dissociation
on overgeneral memory. Harvey et al. (1998), in their study among subjects with acute
stress disorder, found specificity of autobiographical memories to be negatively
correlated with dissociation. In addition, Jones, Heard, Startup, Swales, Williams, and
Jones (1999) found a positive correlation between overgenerality and dissociation in
borderline patients. In a non-clinical sample however, Wessel, Merckelbach, Kessels,
and Horselenberg (2001b) did not find support for this relation; they found no
differences between college students who were either high or low on dissociation on
autobiographical memory specificity.
18 I.P. Kremers et al.
Because overgeneral autobiographical memories have been associated with suicide
attempts, depression, trauma and dissociation, borderline patients constitute a very
interesting group in which to study this phenomenon. In view of the high rates of
suicide attempts, the frequent occurrence of depression and the high rates of childhood
trauma and dissociation (e.g. Herman, Perry, & van der Kolk, 1989; Ogata et al., 1990;
Weaver & Clum, 1993; Zanarini, 1997), it would not be surprising if borderline patients
have difficulties in recalling specific autobiographical memories. Jones et al. (1999),
indeed, found that 23 patients with borderline personality disorder produced more
overgeneral memories than a control group did. They suggested that the tendency of
dissociate helped these patients to avoid recalling episodic information that would
evoke negative emotions and therefore accounted for the lack of specificity. This
reasoning has much in common with what Williams (1996) called the affect regulation
hypothesis. He suggested that children who are confronted with extremely negative
events consolidate their memories in a general way, in order to avoid the negative
emotions that are associated with these events, Jones et al. did not study the influence
of depression and trauma.
The present study was designed to investigate the specificity of autobiographical
memories among out-patients diagnosed with a borderline personality disorder. To
investigate the influence of depression, a depressed and a non-depressed subgroup
were studied. AMT scores were compared with those of depressed out-patients and
controls. Secondly, the influence of reported childhood trauma and intrusions,
avoidance of intrusions and dissociation on memory specificity was also studied.
Method
Participants
As part of a multi-centre treatment trial, 83 out-patients with DSM-IV borderline
personality disorder participated in this study. Included were patients with a primary
diagnosis of borderline personality disorder (SCID-II: First, Spitzer, Gibbon, & Williams,
1994; Dutch translation: Weertman, Arntz, & Kerkhofs, 2000). The presence of
depression was assessed with the SCID-I (First, Spitzer, Gibbon, & Williams, 1997;
Dutch translation: van Groenestijn, Akkerhuis, Kupka, Schneider, & Nolen, 1999). A
comparison sample of 30 female controls was recruited through advertisements in a
local newspaper, community centres and on the Internet. Excluded were women
reporting severe childhood sexual or physical abuse and women suffering from a DSM-
IV axis I disorder. Twenty-six out-patients with a primary diagnosis of depression were
also studied. They were recruited as part of an outcome study by Stienen (2001). For
this group, exclusion criteria were: psychotic disorder, bipolar disorder and substance
abuse. In both comparison groups, diagnoses were determined with the Mini
International Neuropsychiatric Interview (MINI: Sheehan et al., 1998; Overbeek,
Schruers, & Griez, 1999). Axis II pathology was not assessed in these groups. After a
complete description of the study, informed written consent was obtained from all
participants. The study was approved by the local Medical Ethical Committee.
19 Autobiographical memory in BPD
Measures
Autobiographical Memory Test (AMT)
McNally et al. (1995) modified the autobiographical memory paradigm, which was used
by Williams and Broadbent (1986). In the modified version, respondents are asked to
mention a specific moment at which they exhibited the trait that is written on a card. A
specific memory is defined as a memory that refers to a particular event in the past that
happened on one particular day, lasting no longer than 1 day.
We used the following positive (+) and negative () words: friendly (+), guilty (),
impolite (), honest (+), helpful (+), jealous (), intelligent (+), selfish (), humorous
(+) and hostile (). Words were read aloud and at the same time were shown on a card.
The cue words were presented after the following practice words: proud, cautious and
persistent. The task was started only after it was clear during the practice phase that the
respondent understood the purpose of the task. Respondents were allowed 60 seconds
to remember an event and if they did not come up with one, the next word was
presented.
Scoring
Answers were recorded on audiotape. The following scoring categories were used: (a)
specific, (b) categoric, (c) extended, (d) does not comply with the task, not audible or
missed out by the interviewer and (e) omission. Specific was scored when the
respondents first memory referred to a particular event on one particular day. The
memory was scored categoric when the memory referred to repeated events. The
category extended was scored when the remembered event lasted longer than 1 day.
Category (d) was scored when subjects did not mention a memory. After every specific
memory, the subject was asked to indicate how long ago the event took place.
The tapes were scored by the first author and a random sample of 20% was scored
independently by a trained rater in order to assess the inter-rater reliability. The level of
agreement between the raters was good (Cohen, 1968): a value of .89 was obtained
for the three most important categories: specific, categoric and missing. Because of the
low frequency of memories in the extended category and categories (d) and (e) in all
groups, these categories were not further analysed. In the present study, only specific
memories were analysed and discussed. In the context of the present study, specific
and categoric memories can be regarded as the inverse of each other because of the low
frequencies in the other categories, though they are conceptually distinct.
Trauma interview
A childhood trauma interview (adapted from Arntz, Dietzel, & Dreessen, 1999) was used
which assesses sexual, physical and emotional abuse before the age of 18 years. The
interview was administered in two phases. First, participants were presented with a list
of events and were asked to indicate which of these events had ever happened to them.
Next, they were interviewed about the details of the event: who the perpetrator was, at
what age the abuse took place, how long it had lasted and whether they were
emotionally burdened by the abuse at the time it took place. Composite scores of sexual,
physical and emotional abuse were created (adapted from Weaver & Clum, 1993).
Impact of Event Scale (IES)
The IES (Brom & Kleber, 1985; Horowitz, Wilner, & Alvarez, 1979) assesses signs and
symptoms of avoidance (eight items) and intrusion (seven items) after traumatic life
20 I.P. Kremers et al.
events during the last 7 days. The IES was administered directly following the trauma
interview and only in cases where the respondent indicated that at least one traumatic
event had happened.
Beck Depression Inventory (BDI)
The BDI (Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961; Bouman, Luteijn,
Albersnagel, & van der Ploeg, 1985) is a 21-item self-report questionnaire which
measures depressive symptoms during the past week.
Dissociative Experiences Scale (DES)
The DES (Carlson & Putman, 1993; Draijer & Boon, 1993) is a 28-item self-report scale
to measure the proneness to experience dissociative phenomena. Participants are
required to rate how often (percentage of time) each experience has happened to them
on a scale from 0 to 100%. The average score across all items is the total score.
Procedure
Initially, patients were tested in one or two sessions in the third month of treatment.
Several months into the study, the assessment procedure was re-scheduled to
immediately before the start of treatment. The tests were presented in a fixed order:
AMT, trauma interview, IES, BDI and DES. The depressed participants filled in the BDI
after the AMT had been administered, but the trauma interview, the IES and the DES
were not administered in this group.
Results
Respondents
Five borderline patients were not included in the analyses because of missing data on
the dependent variables, making the total number of participants 83. Six participants
were male. Mean age was 30.7 years (SD = 8). Seven individuals were excluded from
the control group because of severe childhood trauma. The mean age of the final
sample of 30 controls was 34.7 years (SD = 7.4). All were female. The depression
sample comprised 26 out-patients with a current depressive episode. Eleven patients
were male. Mean age was 46 years (SD = 7.8).
The demographic characteristics of all groups are shown in Table 1. One-way
analyses of variance (ANOVA) revealed significant differences among groups in terms of
age (F[3, 134] = 25.03, p < .001) and level of education (
2
= 14.28, p < .05). A post
hoc Bonferroni test showed that depressed patients were older than both depressed
(p < .001) and non-depressed borderline patients (p < .001) and controls (p < .001).
Depressed and non-depressed borderline patients had a significantly lower level of
education than depressed patients (p < .05 and p < .01, respectively). Controls did not
differ from depressed borderline patients (p = .11), non-depressed borderline patients
(p = .12) or depressed patients (p = .13) with regard to level of education.
Table 2 shows the psychometric data for the borderline and control group. As
expected, groups differed in childhood traumatic experiences (F[2, 107] = 10.58,
p < .001), number of intrusions (F[2, 98] = 19.64, p < .001) and avoidance of these
intrusions (F[2, 98] = 27.76, p < .001), DES (F[2, 105] = 13.55, p < .001) and BDI
21 Autobiographical memory in BPD
scores (F[3, 130] = 68.21, p < .001). Controls reported fewer childhood traumatic
experiences compared with both depressed (p < .001) and non-depressed borderline
patients (p < .001). The same holds true for intrusions (both borderline groups:
p < .001), avoidance of intrusions (both borderline groups: p < .001) and dissociation
(both borderline groups: p < .001). Controls reported lower BDI scores compared with
both borderline groups (p < .001) and depressed patients (M = 23.6, SD = 7.1,
p < .001). Surprisingly, depressed patients had lower BDI scores than the depressed
borderline patients (p = .01). As expected, the non-depressed borderline patients
scored lower on the BDI than the depressed borderline patients did (p < .01).
Table 1. Demographic measures for depressed and non-depressed (Depr, N-depr) borderline
personality disorder (bpd) patients, controls and depressed patients
Depr bpd N-depr bpd Controls Depressed
N = 47 N = 36 N = 30 N = 26
Variable M (SD) M (SD) M (SD) M (SD)
Age 29.8 (8.1) 31.8 (7.8) 34.7 (7.4) 46.0 (7.8)
Education
a
Low 27 22 11 6
High 20 11 19 20
Gender Female 44 33 30 15
Male 3 3 11
Note. Minor discrepancies in column totals are due to missing values.
a
Low education = high school, high education = more than high school.
Table 2. Means and standard deviations for trauma and depression variables in depressed (Depr) and
non-depressed (N-depr) borderline personality disorder (bpd) patients and controls
Depr bpd N-depr bpd Controls
N = 47 N = 36 N = 30
Variable M SD M SD M SD
Trauma-c 13.0 5.0 14.7 3.9 6.7 5.0
Range 021 Range 621 Range 017
Sexual 2.6 2.7 3.2 2.6 0.6 1.3
Range 05 Range 07 Range 07
Physical 4.8 2.3 5.2 2.0 2.8 2.5
Range 07 Range 07 Range 07
Emotional 5.6 2.0 6.2 1.3 3.3 3.1
Range 07 Range 07 Range 07
IES-tot 37.6 22.1 32.2 18.2 3.6 9.9
IES-intrusions 17.1 11.6 15.6 9.9 2.0 5.5
IES-avoidance 20.6 12.2 16.6 10.2 1.5 4.4
BDI 29.5 9.4 23.1 8.6 3.9 7.1
DES 23.4 14.0 21.1 12.1 9.2 9.7
Notes. Trauma-c, total composite score trauma; Trauma-c sexual, composite score sexual trauma;
Trauma-c physical, composite score physical trauma; Trauma-c emotional, composite score emotional
trauma; IES-tot, Impact of Event Scale; IES-intr, Intrusion scale of Impact of Event Scale; IES-avoid,
Avoidance scale of Impact of Event Scale; BDI, Beck Depression Inventory; DES, Dissociative
Experiences Scale.
22 I.P. Kremers et al.
Age and level of education in relationship to memory specificity
As groups differed significantly in age and level of education, the influence of age and
education on the specificity of memories was investigated. Separate multiple regression
analyses (see Aiken & West, 1991) were conducted with specificity of memories as the
dependent variable. In these analyses, both age and level of education were entered
into the equation, with education as a dummy variable. Moreover, two dummy-coded
grouping variables were created to represent the different groups, testing each patient
group (depressed and borderline patients) against the other groups. Results showed
that neither age or the interaction of age with group affected the specificity of
autobiographical memory. However, trends towards significance were observed with
respect to education (p = .07) and the interaction of education with group (p = .08).
Given these trends, it was decided to analyse differences between groups on the basis
of memory scores adjusted for between-group differences in level of education.
Although adjusted mean scores were used in the statistical analysis, the values of non-
adjusted mean scores for memory scores are presented in the text and tables for the
sake of comparison with results of previous studies on this topic.
AMT scores in borderline patients, normal controls and depressed patients
A 4 (group: depressed and non-depressed borderline, control, depressed) 6 2 (cue
type: negative, positive) ANOVA with repeated measurements on the second factor was
conducted to see whether groups differed on specificity scores and if there was a
different response pattern to positive and negative cue words (see Table 3). Level of
education was entered as a covariate. A main effect of group was found: F(3,
131) = 7.27, p < .001. A post hoc Bonferroni test with percentage of specific memories
as the dependent variable showed that depressed borderline patients and depressed
patients reported fewer specific memories than controls (p < .05 and p = .001,
respectively). Depressed patients generated fewer specific memories than non-
depressed borderline patients (p < .01). No cue type main effect (F[3, 131] = 0.003,
p = .96) or group 6 cue type interactions were found (F[3, 131] = 1.15, p = .33).
Analyses showed no significant differences (at p = .05) on any AMT measure
between the 45 patients assessed before the start of treatment and the 38 patients
assessed after 3 months. Because of the differences in gender composition, we repeated
the 4 62 ANOVAs, but now with only female respondents. The results were the same.
Table 3. Means and standard deviations for percentages of specific memories for depressed (Depr)
and non-depressed (N-depr) borderline personality disorder (bpd) patients, controls and depressed
patients
Depr bpd N-depr bpd Controls Depressed
N = 47 N = 36 N = 30 N = 26
Memories M SD M SD M SD M SD
% specific 59.0 19.6 69.8 18.8 75.3 18.5 54.4 25.8
Note. % specific, percentage of specific memories.
23 Autobiographical memory in BPD
Correlates of autobiographical memory in borderline patients
In the borderline group, AMT scores did not correlate significantly with scores on the
trauma questionnaire, IES, DES and BDI (Table 4). The presence of post-traumatic stress
disorder (present in 29% of the borderline patients) was also not correlated with scores
on the AMT.
Temporal aspects of memories
While listening to the AMT tapes, the first rater (I.P.K.) noticed that borderline patients
often came up with a very recent event. We therefore decided to look into the temporal
aspects of the remembered events more carefully. The following categories were used:
(a) the event had occurred during the previous month; (b) the event had occurred more
than 10 years ago (see McNally et al., 1995). Depressed borderline patients
remembered relatively more events from the previous month (M = 72.6%) than
controls (M = 52.7%), but they did not differ from non-depressed borderline patients
(M = 70.1%) or depressed patients (M = 65.9%) (F[3, 135] = 3.04, p < .05). In addition,
depressed borderline patients reported relatively fewer events from more than 10 years
ago (M = 2.2) than controls (M = 10.8) (F[3, 135] = 2.87, p < .05). Again, non-
depressed borderline patients (M = 4.4%) and depressed patients (M = 7.4%) did not
differ from both the other groups.
Discussion
The aims of the present study were twofold. Firstly, to examine the level of specificity
of autobiographical memories of borderline out-patients, and secondly, to investigate
the role of depression, reported childhood trauma, intrusions, avoidance of intrusions
and dissociation. The present study shows that non-depressed borderline patients did
not differ from controls with regard to the percentage of specific memories, whereas
depressed borderline patients reported fewer specific memories than controls (cf.
Renneberg, Theobald, Nobs, & Weisbrod, 2000).
Previous studies have suggested that overgeneral memories are related to both
childhood and adult trauma (de Decker, 2001; de Decker et al., 2000; Harvey et al.,
1998; Henderson et al., 2002; Kuyken & Brewin, 1995; McNally et al., 1994, 1995;
Wessel, Merckelbach, & Dekkers, 2002) and depression (Goddard et al., 1996; Kuyken
& Dalgleish, 1995; Moore et al., 1988; Puffet et al., 1991; Wessel et al., 2001a; Williams
& Dritschel, 1988; Williams & Scott, 1988). In the present study, childhood trauma, i.e.
sexual, physical and emotional abuse, was unrelated to the level of specificity of
Table 4. Correlation matrix of AMT scores with psychopathology measures in borderline personality
disordered patients
Variable Trauma IES Intru Avoid PTSD DES BDI
% spec .04 .07 .03 .11 .02 .19 .20
Notes. % spec, percentage of specific memories; Trauma, total composite score trauma; IES, Impact of
Event Scale; Intru, Intrusion scale of Impact of Event Scale; Avoid, Avoidance scale of Impact of Event
Scale; PTSD, presence of posttraumatic stress disorder; DES, Dissociative Experiences Scale; BDI, Beck
Depression Inventory.
24 I.P. Kremers et al.
autobiographical memories. The same holds true for intrusions, avoidance of intrusions,
dissociation and the presence of a post-traumatic stress disorder. Given the fact that
mean trauma composite scores were high, and the variance substantial, the lack of
relationship between trauma and autobiographical memory cannot be explained by
restricted range or other statistical artifacts. One important limitation is that the validity
of the trauma interview is yet unknown, so the results need to be interpreted carefully.
Of course, replication of these findings with a validated trauma measure in a larger
sample would be valuable.
BDI scores were also unrelated to the specificity of autobiographical memories, a
finding that is supported by several other studies (Brittlebank, Scott, Williams, & Ferrier,
1993; Jones et al., 1999; Kuyken & Brewin, 1995; Mackinger, Pachinger, Leibetseder, &
Fartacek, 2000; Merckelbach, Muris, & Horselenberg, 1996; Phillips & Williams, 1997;
Williams & Dritschel, 1988). Dalgleish, Spinks, Yiend, and Kuyken (2001) suggest that
the association between memory specificity and depressive symptomatology depends
on the measure that is used. They found a non-significant relationship between scores
on the AMT and the BDI and a significant relationship between scores on the AMT and
the Hamilton Rating Scale for Depression (Hamilton, 1960). This pattern would be
obtained if autobiographical memory specificity is not related to the cognitive
symptoms of depression, but rather to its somatic-vegetative symptoms (Dalgleish et
al., 2001). In contrast with BDI scores, depression was related to AMT scores.
In the study of Jones et al. (1999), borderline patients retrieved significantly more
general memories and the number of general memories was significantly correlated
with scores on the Dissociative Experiences Scale (r = .39, p < .05). In the present
study the correlation between the percentage of specific memories and scores on the
DES was r = .19 and non-significant. However, the mean DES score in Jones study
was 39.9 (SD 17.0), whereas borderline patients in our sample scored much lower, with
a mean of 22.4 (SD 13.1). This suggests that one possible explanation for the
contradictory results is the difference in level of psychopathology.
Jones borderline patients had higher BDI scores, although part of this difference may
be due to the use of different versions of the BDI (see Beck, Steer, & Brown, 1996).
Relatively high BDI scores suggest that Jones group contained more borderline patients
with a depressive episode. Another possible explanation for the different results is
related to the scoring categories. Jones et al. only used three categories. We used five
categories, so relatively fewer memories were coded as categoric. Furthermore, Jones
used a time limit of 30 seconds per trial, whereas in our study a time limit of 60 seconds
was used, which means that, in our study, patients had more time to recall a specific
event.
The present study only included borderline patients who sought treatment. Maybe
borderline patients who do not have overgeneral memories are the ones who function
less well in daily life and therefore seek treatment. Startup et al. (2001) found that
overgeneral recall in borderline patients may help them to avoid distressing memories,
suggesting that overgenerality may have some adaptive function.
Borderline patients as well as both other groups did not react differently to positive
and negative cue words. The relevance of cue word valence is still subject to discussion.
Some studies support the idea that positive words elicit fewer specific memories in
clinical groups (Harvey et al., 1998; Puffet et al., 1991; Williams & Broadbent, 1986;
Williams & Scott, 1988), other studies found the opposite (Jones et al., 1999; Mackinger
et al., 2000) and other studies found no effect of valence (Brittlebank et al., 1993;
Goddard et al., 1996; McNally et al., 1995).
25 Autobiographical memory in BPD
In the present study, the AMT version by McNally et al. (1995) was administered, in
which traits are presented and subjects are asked to remember a specific occasion on
which they exhibited the trait in question. It was expected that it would be more difficult
to react with specific self-representations on these self-referenced words compared with
nouns (Klein & Loftus, 1993; Williams, 1994). Theories on self-representation in
traumatized individuals imply that negative traits (relative to positive traits) dominate the
self-schema (e.g. McNally, 1993). Therefore it was expected that the borderline group
would have more trouble recalling specific events in reaction to positive words. This was
not the case: non-depressed borderline patients produced more specific memories in
reaction to positive as well as negative words than depressed patients.
More detailed analyses revealed that depressed borderline patients retrieved more
memories of recent events (cf. McNally et al., 1995; Williams, Teasdale, Segal, &
Soulsby, 2000). This raises the possibility that borderline patients are only able to
remember specific events that happened recently. Of course, it is also possible that age
differences between the groups may account for the temporal differences. It is
interesting to see what will happen when the AMT instruction is adapted and
borderline patients are required to recall events from the more distant past (cf.
Mackinger et al., 2000).
In conclusion, borderline patients with a co-morbid diagnosis of depression had
trouble remembering specific events from the past. Trauma, intrusions, avoidance of
intrusions and dissociation seem to be unrelated to the specificity of autobiographical
memories in borderline personality disorder.
Acknowledgements
The present study was supported by grant no. OG 97-002 from the fund for evaluative research in
medicine of the Dutch Healthcare Insurance Board, awarded to A. Arntz (principal investigator,
Maastricht University), R. Van Dyck (Vrije Universiteit Amsterdam), and Ph. Spinhoven (Leiden
University). We wish to thank the research assistants for their invaluable help.
References
Aiken, L. S., & West , S. G. (1991). Multiple regression: Testing and interpreting interactions.
Newbury Park, CA: Sage.
Arntz, A., Dietzel, R., & Dreessen, L. (1999). Assumptions in borderline personality disorder:
Specificity, stability and relationship with etiological factors. Behaviour Research and
Therapy, 37, 545557.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual of the Beck Depression Inventory. San
Antonio, TX: Psychological Corporation.
Beck, A. T., Ward, C. H., Mendelsohn, M., Mock, J, & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4, 561571.
Bouman, T. K., Luteijn, F., Albersnagel, F. A., & Ploeg, F. A. E. van der (1985). Enige ervaringen
met de Beck Depression Inventory (BDI) [Some experiences with the Beck Depression
Inventory]. Gedrag-Tildschrift voor Psychologie, 13, 1324.
Brewin, C. R., Reynolds, M., & Tata, P. (1999). Autobiographical memory processes and the
course of depression. Journal of Abnormal Psychology, 108, 511517.
Brewin, C. R., Watson, M., McCarthy, S., Hyman, P., & Dayson, D. (1998). Intrusive memories and
depression in cancer patients. Behaviour Research and Therapy, 36, 11311142.
26 I.P. Kremers et al.
Brittlebank, A. D., Scott, J., Williams, J. M. G., & Ferrier, I. N. (1993). Autobiographical memory in
depression: State or trait marker? British Journal of Psychiatry, 162, 118121.
Brom, D., & Kleber, R. J. (1985). De schok verwerkings lijst [The Impact of Event Scale].
Nederlands Tijdschrift voor de Psychologie, 40, 164168.
Carlson, E., & Putman, F. W. (1993). An update on the Dissociative Experiences Scale.
Dissociation, VI, 1627.
Cohen, J. (1968). Weighted kappa: Nominal scale agreement with provision for scaled
disagreement or partial credit. Psychological Bulletin, 70, 213220.
Dalgleish, T., Spinks, H., Yiend, J., & Kuyken, W. (2001). Autobiographical memory style in
seasonal affective disorder and its relationship to future symptom remission. Journal of
Abnormal Psychology, 110, 335340.
Decker, A. de (2001). Autobiographical memory in traumatized adolescents. Unpublished
doctoral dissertation, University of Leuven, Belgium.
Decker, A. de, Hermans, D., & Eelen, P. (2000). Veralgemeende herinneringen bij mensen met
emotionele problemen [Overgeneral memories in people with emotional disorders].
Gedragstherapie, 33, 101124.
Draijer, N., & Boon, S. (1993). The validation of the Dissociative Experiences Scale against the
criterion of the SCID-I, using receiver operating characteristics (ROC) analysis. Dissociation, 6,
2837.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1994). Structured clinical interview
for DSM-IV personality disorders (SCID-II). New York: New York State Psychiatric Institute,
Biometrics Research Department.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview
for DSM-IV axis I disorders (SCID-I/P). New York: New York State Psychiatric Institute,
Biometrics Research Department.
Goddard, L., Dritschel, B., & Burton, A. (1996). Role of autobiographical memory in social
problem solving and depression. Journal of Abnormal Psychology, 105, 609616.
Groenestijn, M. A. C. van, Akkerhuis, G. W., Kupka, R. W., Schneider, N., & Nolen, W. A. (1999).
Gestructureerd klinisch interview voor de vaststelling van DSM-IV As I stoornissen [Dutch
adaptation of the SCID for DSM-IV axis I disorders]. Lisse: Swets and Zeitlinger.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and
Psychiatry, 23, 5662.
Harvey, A. G., Bryant, R. A., & Dang, S. T. (1998). Autobiographical memory in acute stress
disorder. Journal of Consulting and Clinical Psychology, 66, 500506.
Henderson, D., Hargreaves, I., Gregory, S., & Williams, J. M. G. (2002). Autobiographical memory
and emotion in a non-clinical sample of women with and without a reported history of
childhood sexual abuse. British Journal of Clinical Psychology, 41, 129141.
Herman, J. L., Perry, C., & Kolk, B. A. van der (1989). Childhood trauma in borderline personality
disorder. American Journal of Psychiatry, 146, 490495.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective
stress. Psychosomatic Medicine, 41, 209218.
Jones, B., Heard, H., Startup, M., Swales, M., Williams, J. M. G., & Jones, R. S. P. (1999).
Autobiographical memory and dissociation in borderline personality disorder. Psychological
Medicine, 29, 13971404.
Kaney, S., Bowen-Jones, K., & Bentall, R. P. (1999). Persecutory delusions and autobiographical
memory. British Journal of Clinical Psychology, 38, 97102.
Klein, S. B., & Loftus, J. (1993). The mental representation of trait and autobiographical
knowledge about the self. In T. K. Skrull & R. S. Wyer (Eds.), The mental representation of
trait and autobiographical knowledge about the self (pp. 149). Hillsdale, NJ: Erlbaum.
Kuyken, W., & Brewin, C. R. (1995). Autobiographical memory functioning in depression and
reports of early abuse. Journal of Abnormal Psychology, 104, 585591.
Kuyken, W., & Dalgleish, T. (1995). Autobiographical memory and depression. British Journal of
Clinical Psychology, 34, 8992.
27 Autobiographical memory in BPD
Mackinger, H. F., Pachinger, M. M., Leibetseder, M. M., & Fartacek, R. R. (2000). Autobiographical
memories in women remitted from major depression. Journal of Abnormal Psychology, 109,
331334.
McNally, R. J. (1993). Self-representation in post-traumatic stress disorder: A cognitive
perspective. In Z. V. Segal & S. J. Blatt (Eds.), The self in emotional distress: Cognitive and
psychodynamic perspectives (pp. 7191). New York: Guilford.
McNally, R. J., Lasko, N. B. M. M. L., & Pitman, R. K. (1995). Autobiographical memory
disturbance in combat-related posttraumatic stress disorder. Behaviour Research and
Therapy, 33, 619630.
McNally, R. J., Litz, B. T., Prassas, A., Shin, L. M., & Weathers, F. W. (1994). Emotional priming of
autobiographical memory in post-traumatic stress disorder. Cognition and Emotion, 8, 351
367.
Merckelbach, H., & Muris, P. (2001). The causal link between self-reported trauma and
dissociation: A critical review. Behaviour Research and Therapy, 39, 245254.
Merckelbach, H., Muris, P., & Horselenberg, R. (1996). Correlates of overgeneral memories in
normal subjects. Behavioural and Cognitive Psychotherapy, 24, 109115.
Moore, R. G., Watts, F. N., & Williams, J. M. G. (1988). The specificity of personal memories in
depression. British Journal of Clinical Psychology, 27, 275276.
Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M. (1990). Childhood
sexual and physical abuse in adult patients with borderline personality disorder. American
Journal of Psychiatry, 147, 10081013.
Overbeek, T., Schruers, K., & Griez, E. (1999) M.I.N.I. [Dutch translation of the MINI-International
Neuropsychiatric Interview, version 5.0.0]. Maastricht: University of Maastricht, The Nether-
lands.
Phillips, S., & Williams, J. M. G. (1997). Cognitive impairment, depression and the specificity of
autobiographical memory in the elderly. British Journal of Clinical Psychology, 36, 341347.
Puffet, A., Jehin-Marchot, D., Timsit-Berthier, M., & Timsit, M. (1991). Autobiographical memory
and major depressive states. European Psychiatry, 6, 141145.
Renneberg, B., Theobald, E., Nobs, M., & Weisbrod (2000). Autobiographical memory in
borderline personality disorder and depression. Paper presented at the XXX Congress of the
European Association of Behavioural and Cognitive Therapies, EABCT, Granada, Spain.
Scott, J., Stanton, B., Garland, A., & Ferrier, I. N. (2000). Cognitive vulnerability in patients with
bipolar disorder. Psychological Medicine, 30, 467472.
Sheehan, D. V., Lecrubier, Y., Harnett-Sheehan, K., Amorim, P., Janavs, J., Weiller, E., Hergueta, T.,
Baker, R., & Dunbar, G. C. (1998). The MINI-International Neuropsychiatric Interview
(M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for
DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 2233.
Startup, M., Heard, H., Swales, M., Jones, B., Williams, J. M. G., & Jones, R. S. P. (2001).
Autobiographical memory and parasuicide in borderline personality disorder. British Journal
of Clinical Psychology, 40, 113120.
Stienen, K. (2001). Mindfulness based cognitive therapy in the treatment of current depression.
Unpublished masters thesis, University of Leiden, Leiden, The Netherlands.
Weaver, T. L., & Clum, G. A. (1993). Early family environments and traumatic experiences
associated with borderline personality disorder. Journal of Consulting and Clinical
Psychology, 61, 10681075.
Weertman, A., Arntz, A., & Kerkhofs, M. L. M. (2000). Gestructureerd Klinisch Interview voor
DSM-IV Persoonlijkheidsstoornissen [Dutch adaptation of the SCID for DSM-IV personality
disorders]. Lisse: Swets and Zeitlinger.
Wessel, I., Meeren, M., Peeters, F., Arntz A., & Merckelbach, H. (2001a). Correlates of
autobiographical memory specificity. Behaviour Research and Therapy, 39, 409421.
Wessel, I., Merckelbach, H., & Dekkers, Th. (2002). Autobiographical memory in war survivors.
Journal of Traumatic Stress, 15, 227234.
Wessel, I., Merckelbach, H., Kessels, C., & Horselenberg, R. (2001b). Dissociation and
28 I.P. Kremers et al.
autobiographical memory specificity. Clinical Psychology and Psychotherapy, 8, 411415.
Wilhelm, S., McNally, R. J., Baer, L., & Florin, I. (1997). Autobiographical memory in obsessive-
compulsive disorder. British Journal of Clinical Psychology, 36, 2131.
Williams, J. M. G. (1994). Interacting cognitive subsystems and unvoiced murmurs. Cognition
and Emotion, 8, 571579.
Williams, J. M. G. (1996). Depression and the specificity of autobiographical memory. In D. C.
Rubin (Ed.), Remembering our past: Studies in autobiographical memory (pp. 244267).
Cambridge: University Press.
Williams, J. M. G., & Broadbent, K. (1986). Autobiographical memory in suicide attempters.
Journal of Abnormal Psychology, 95, 144149.
Williams, J. M. G., & Dritschel, B. H. (1988). Emotional disturbance and the specificity of
autobiographical memory. Cognition and Emotion, 2, 221234.
Williams, J. M. G., & Scott, J. (1988). Autobiographical memory in depression. Psychological
Medicine, 18, 689695.
Williams, J. M. G., Teasdale, J. D., Segal, Z. V., & Soulsby, J. (2000). Mindfulness-based cognitive
therapy reduces overgeneral autobiographical memory in formerly depressed patients.
Journal of Abnormal Psychology, 109, 150155.
Zanarini, M. C. (Ed.). (1997). Role of sexual abuse in the etiology of borderline personality
disorder. Washington, DC: American Psychiatric Press.
Received 11 February 2002; revised version received 24 January 2003
29 Autobiographical memory in BPD