Attention and self-control for BPD

Rabu, 13 Januari 2010

The term self-control has been defined as ‘engaging in behaviours that result in delayed (but more) reward’ (Logue 1995, p. 3). The concept relates closely to those of delay of or deferral of gratification, self-regulation, self-discipline, and conscience. All such concepts imply being able to engage in something that provides less immediate pleasure in the expectation of greater long-term benefit or the satisfaction of an ethical imperative. As borderline pathology entails impulsivity, and yielding to immediate demands, the possibility of a deficit in self-control is obviously of relevance. Conditions co-morbid with BPD centrally involve issues of self-control, for example, addiction problems, eating disorders, ASPD, and associated childhood disorders such as ADHD and conduct disorder. Insufficiency of self-control has been observed to emerge early in life and to show impressive consistency over contexts and time across studies (see, e.g. Block 1996). Kochanska and colleagues (1997) designed a number of ingenious tests of self-control for young children.

Cortical localization of self-control invariably points to the pre-frontal cortex (Barkley 1997; Metcalfe and Mischel 1999). PET scan studies have shown that making choices between small likely rewards and large unlikely rewards entails activity in the right inferior and orbital pre-frontal cortex (Rogers et al. 1999). These pre-frontal regions are known to have rich interconnections with limbic structures likely to be involved in drives, rewards, and motivation. As these structures are also wellconnected to dorso-pre-frontal cortical areas that serve a broad range of cognitive processes independent of social or emotional salience, the orbital and
inferior pre-frontal cortex may be ideally suited to co-ordinate the probabilities
of outcomes with their emotional reward value. Further, and once again in line
with dysfunctions we have noted above, low serotonin activity is associated
with impulsiveness (Linnoila and Virkkunen 1992) while enhanced serotonergic
activity appears to enhance delayed gratification (Bizot et al. 1999).

There is considerable accumulating evidence that self-control and the capacity to direct attention are linked (Posner and Rothbart 1998, 2000). For example, in one study a laboratory measure of the ability to suppress attention to irrelevant stimuli was correlated with self-report of success in college students (Diefendorff et al. 1998). Attention may be just one component of self-control but it is likely to be an extremely important one (Cousens and Nunn 1997). Strong arguments have been advanced to suggest that self-control is a feature of temperament and therefore genetically determined. There is also good evidence that the quality of mother–child relationship is a further important predictor of the growth of self-control skills (Olson et al. 1990; Silverman and Ragusa 1990;Jacobsen et al. 1997; Mauro and Harris 2000; Strayhorn 2002). Stable relationships with individuals with whom a powerful affective bond is retained, outside of relationships with the primary caregiver, turn out to be important (Lewis 2000) because relationships serve as the context for the development of several aspects of emotion regulation (Bell and Calkins 2000).