Childhood trauma in borderline personality disorder

Subjects with borderline personality disorder (N = 21) or borderline traits (N = 11) and nonborderline subjects with closely related diagnoses (N = 23) were interviewed in depth regarding experiences of major childhood trauma. Significantly more borderline subjects (81%) gave histories of such trauma, including physical abuse (71%), sexual abuse (68%), and witnessing serious domestic violence (62%); abuse histories were less common in those with borderline traits and least common in the subjects with no borderline diagnosis. These results demonstrate a strong association between a diagnosis of borderline personality disorder and a history of abuse in childhood.     

童年期创伤与边缘型人格障碍

既往研究认为边缘型人格障碍可能与童年期创伤经历有关,童年期经历的虐待与欺凌事件严重影响疾病的发展和预后.文章就童年期创伤对边缘型人格障碍发生机制、临床特征以及治疗和预后的影响进行阐述,旨在为进一步探索边缘型人格障碍的发生、发展以及早期干预提供依据.     

World assumptions and the role of trauma in borderline personality disorder

The present study tested whether borderline personality disorder (BPD) is characterized by specific worldviews as hypothesized by cognitive models, using Janoff-Bulman's [(1989) Social Cognition, 7, 113-136] world assumptive model of negative effects of trauma. A second aim of this study was to investigate the role of trauma in the content of worldviews of BPD patients. Fifteen BPD patients, 14 patients with Cluster C personality disorders (PD), 19 patients with axis-I psychopathology and 21 non-patients filled out the World Assumptions Scale, the Personality Disorder Belief Questionnaire, a childhood trauma checklist (assessing physical, emotional and sexual abuse) and the BPD Checklist (severity of BPD psychopathology). BPD patients appear to view the world as malevolent and perceive less luck independent of trauma but dependent of BPD psychopathology. Furthermore, BPD patients have low self-worth and persist in specific beliefs independent of trauma or severity of BPD psychopathology. Pretzer's theory of BPD can be largely supported through Janoff-Bulman's world assumptive model. World assumptions of BPD patients can better be explained by the severity of BPD psychopathology than by the presence of trauma.     

Childhood sexual and physical abuse in adult patients with borderline personality disorder

Experiences of abuse and neglect were assessed in 24 adults diagnosed as having borderline personality disorder according to the Diagnostic Interview for Borderline Patients and in 18 depressed control subjects without borderline disorder. Significantly more of the borderline patients than depressed patients reported childhood sexual abuse, abuse by more than one person, and both sexual and physical abuse. There were no between-group differences for rates of neglect or physical abuse without sexual abuse. A stepwise logistic regression revealed that derealization, diagnostic group, and chronic dysphoria were the best predictors of childhood sexual abuse in this group of patients.     

Neuroimaging in borderline personality disorder

Neuroimaging has become one of the most important methods in the investigation of the neurobiological underpinnings of borderline personality disorder. Structural and functional imaging studies have revealed dysfunction in different brain regions which seem to contribute to borderline symptomatology. This review presents relevant studies using different methodologies: volumetry of limbic and prefrontal regions, investigations of brain metabolism under resting conditions, studies of serotonergic neurotransmission, and challenge studies using emotional, stressful, and sensory stimuli. Dysfunction in a frontolimbic network is suggested to mediate much, if not all of the borderline symptomatology.     

Multiple personality and borderline personality disorder

The authors offer their theory that multiple personality represents a "special instance" of borderline personality disorder, that the introjects are composed of a representation of the self, a representation of the object, and an affective bond.     

Fluoxetine in borderline personality disorder

1. 1. Twelve patients with borderline personality disorder and not suffering a major depression were treated with fluoxetine, a selective serotonin reuptake inhibitor, in an open label trial. All of the patients improved, and 75% were rated as much or very much improved.

2. 2. Treatment was generally very well tolerated, but careful dosage titration was important in some patients, especially to manage agitation.

3. 3. Improvement has been maintained with continued treatment throughout the follow-up period which ranged up to six months.

4. 4. Incidental findings suggest fluoxetine may also be of use in treating substance abuse, attention deficit hyperactivity disorder, late luteal phase dysphoria disorder, dysthymic and cyclothymic disorders, and seasonal pattern depression.

5. 5. These preliminary results support the hypothesis that borderline personality disorder may be related to a central scrotonergic deficit.

Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder

Objective

To examine the relationship between dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder (BPD).

Method

30 BPD patients completed the Wessex Dissociation Scale (WDS), Childhood Trauma Questionnaire (CTQ), General Health Questionnaire (GHQ), and Schema Mode Questionnaire (SMQ).

Results

The ‘Angry and Impulsive Child’ and ‘Abandoned and Abused Child’ modes uniquely predicted dissociation scores. Childhood trauma did not predict dissociation scores.

Conclusions

Findings support the schema mode model of BPD [Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioners guide. London: Guilford Press] and its emphasis on the role of dissociation. Clinically they support the emphasis on the identification and integration of dysfunctional parts of the personality in working with individuals diagnosed with BPD.     

Childhood trauma affects processing of social interactions in borderline personality disorder: An event-related potential study investigating empathy for pain

Objectives: Patients with borderline personality disorder (BPD) have difficulties in empathising with others and show disturbances in social interactions. Using a ‘Social Interaction Empathy Task’, we found that BPD patients judged neutral and psychologically painful conditions as more painful than healthy subjects. Here, we present the neural correlates underlying these differences in empathy for pain.

Methods: Female BPD patients and healthy controls completed the ‘Social Interaction Empathy Task’ during EEG recording. Event-related potentials (ERP) were analysed for an early anterior component and a late latency positivity. Empathic abilities were assessed using the Interpersonal Reactivity Index and early aversive experiences were measured by the Childhood Trauma Questionnaire (CTQ).

Results: ERPs in the patient group matched the behaviour results and correlated with the level of personal distress and CTQ. In addition, ERPs of patients were predicted by childhood maltreatment and stress.

Conclusions: Taken together, our findings indicate that the observed behavioural differences between patients with BPD and controls might be due to modulatory effects of empathic abilities on the evaluation of pain-related social stimuli, which are supposed to be based on childhood maltreatment.     

Childhood trauma and personality disorder: Toward a biological model

Cross-sectional and prospective associations of personality disorder with childhood trauma provide an important clue regarding the biological mechanism of personality disorder. In this review, empirical literature from several domains is summarized. These include relevant findings from behavioral genetics, preclinical models of early life parental care, and clinical translational studies of personality disorder. Identi.cation of the biological mechanism by which childhood trauma exerts an effect on personality disorder may require modi.cation of the conceptualization of personality disorder, either as a set of categories or dimensions.     

Epidemiology of borderline personality disorder

The limited epidemiological data available on borderline personality disorder suggest that the prevalence of the disorder is between .2 and 1.8 percent in the general community, 15 percent among psychiatric inpatients, and 50 percent among psychiatric inpatients with a diagnosis of personality disorder. No data on the incidence--the rate of new cases--of the disorder have been reported, and inferences about incidence based on prevalence rates are complicated by differences in the formal designation of personality disorders before and after DSM-III was issued. Current findings suggest that about 76 percent of borderline patients are female. Epidemiological study of borderline personality disorder has been hindered by the lack of a brief semistructured interview that can be used with large population samples and that does not require substantial clinical expertise. The authors discuss alternative research methods, including use of lay interviewers, recoding of existing data, telephone interviews, and self-report inventories.     

Comorbidity of borderline personality disorder

In a retrospective study of 180 inpatients with DSM-III borderline personality disorder (BPD), the degree and direction of psychiatric comorbidity were used to examine the extent to which BPD is a homogeneous entity with clearly defined boundaries. Ninety-one percent of patients with BPD had one additional diagnosis, and 42% had two or more additional diagnoses. Both patients with BPD and controls with other personality disorders had similar rates and directions of comorbidity. The two groups did not differ significantly in prevalence of affective disorder. The DSM-III BPD appears to constitute a very heterogeneous category with unclear boundaries, overlapping with many different disorders but without a specific association with any one Axis I disorder. Comorbidity in patients with BPD may reflect base rates of psychopathology rather than anything inherent to BPD. Future studies should control for comorbidity to ensure homogeneity of comparison groups.