Compliance on neuropsychological performance validity testing in patients with borderline personality disorder

Complaints of cognitive dysfunction are common in patients with borderline personality disorder (BPD), and they are often accompanied by deficits on neuropsychological testing. Prior studies of BPD, however, did not evaluate compliance on neuropsychological performance validity testing, which could partially account for cognitive deficits observed in patients. The aims of the current study were to evaluate the frequency at which patients with BPD show less than adequate compliance on performance validity testing, and whether patients showing less compliance perform lower on standardized neuropsychological measures. Fifty outpatients with BPD completed the Victoria Symptom Validity Test, a 2-alternative, forced-choice recognition test as part of a larger neuropsychological test battery for research on cognitive functioning in BPD. As a group, patients with BPD made more errors and had longer response latencies on seemingly difficult items as compared to healthy individuals. Based on established guidelines for interpretation of performances on the Victoria Symptom Validity Test, 2% of the sample was classified as probably not compliant, 10% questionably compliant, and 88% compliant. Patients with questionably or probably not compliant performances had lower estimated premorbid intellectual functioning and displayed poorer response control on neuropsychological testing than compliant patients. These findings highlight the value of incorporating performance validity testing in neuropsychological studies of patients with BPD and suggest that prior research on the disorder should be interpreted with caution because the results may not be based on valid performances.