Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder

OBJECTIVE: This study examined whether women with a history of early-onset sexual abuse or those with late-onset sexual abuse were more likely to meet diagnostic criteria for both borderline personality disorder and complex posttraumatic stress disorder (PTSD). METHOD: The Revised Diagnostic Interview for Borderlines and the Trauma Assessment Package were administered to 65 women from three outpatient clinics in a metropolitan area. Thirty-eight subjects met criteria for early-onset abuse, while 27 subjects met criteria for late-onset abuse. RESULTS: The diagnoses of both borderline personality disorder and complex PTSD were significantly higher in women reporting early-onset abuse than in those with late-onset abuse. The trauma variables sexual abuse and paternal incest were significant predictors of both diagnoses. CONCLUSIONS: In contrast to those with comorbid diagnoses, some women with a history of childhood sexual abuse may be extricated from the diagnosis of borderline personality disorder and subsumed under that of complex PTSD.     

Smaller stress-sensitive hippocampal subfields in women with borderline personality disorder without posttraumatic stress disorder

Background

Animal and human studies have suggested that hippocampal subfields are differentially vulnerable to stress, but subfield volume has not been investigated in patients with borderline personality disorder (BPD). Based on the putative role of stressful life events as vulnerability factors for BPD, we hypothesized that patients with BPD would exhibit reduced volumes for the stress-sensitive dentate gyrus (DG) and the cornu ammonis (CA) 3 subfields volumes, and that these volumes would be associated with traumatic childhood experiences.

Methods

All participants underwent 3 T magnetic resonance imaging. Hippocampal subfield volumes were estimated using an automated and validated segmentation algorithm implemented in FreeSurfer. Age and total subcortical grey matter volume were covariates. We assessed traumatic childhood experiences using the Childhood Trauma Questionnaire (CTQ).

Results

A total of 18 women with BPD and 21 healthy control women were included in the study. Only 1 patient had comorbid posttraumatic stress disorder (PTSD). The volumes of the left (p = 0.005) and right (p = 0.011) DG-CA4 and left (p = 0.007) and right (p = 0.005) CA2–3 subfields were significantly reduced in patients compared with controls. We also found significant group differences for the left (p = 0.032) and right (p = 0.028) CA1, but not for other hippocampal subfields. No associations were found between CTQ scores and subfield volumes.

Limitations

The self-reported CTQ might be inferior to more comprehensive assessments of traumatic experiences. The sample size was moderate.

Conclusion

The volumes of stress-sensitive hippocampal subfields are reduced in women with BPD without PTSD. However, the degree to which childhood trauma is responsible for these changes is unclear.     

Thyroid hormone alterations among women with posttraumatic stress disorder due to childhood sexual abuse.

BACKGROUND: Research on thyroid activity among male combat veterans with posttraumatic stress disorder (PTSD) has consistently shown elevations in total triiodothyronine (TT3) and inconsistent elevations of other thyroid variables. This study is the first large scale investigation of thyroid function in women with PTSD. METHODS: Thyroid function was measured in 63 women with PTSD due to childhood sexual abuse (PTSD-CSA) in comparison with a community sample of 42 women without current PTSD-CSA. Clinical measures included the Clinician Administered PTSD Scale (CAPS), the Evaluation of Lifetime Stressors, the Trauma Assessment for Adults and the Beck Depression Inventory. RESULTS: Women with PTSD-CSA showed significant elevations in Total T3 and the TT3/free thyroxine (TT3/FT4) ratio, the FT3/TT3 ratio, and modest reductions in thyroid stimulating hormone relative to our community sample. These findings could not be explained by the influence of prior trauma, lifetime PTSD or depressive symptoms. CONCLUSIONS: Altered thyroid activity, especially elevated Total T3 levels, was found in women with PTSD associated with childhood sexual abuse.     

Reduced amygdala and hippocampus size in trauma-exposed women with borderline personality disorder and without posttraumatic stress disorder

Background

Individuals with posttraumatic stress disorder (PTSD) display reduced hippocampus size and impaired cognition. However, studies on individuals with borderline personality disorder (BPD) are rare, and studies on trauma-exposed patients with BPD but without PTSD are lacking.

Methods

Twenty-four trauma-exposed women with BPD (10 with PTSD and 14 without) and 25 healthy controls underwent 3-dimensional structural magnetic resonance imaging of the amygdala and hippocampus and a clinical and neuropsychological investigation.

Results

Compared with controls, patients with BPD and PTSD displayed significantly reduced amygdala (34%) and hippocampus (12%) size and significantly impaired cognition. Trauma-exposed patients with BPD but without PTSD also showed significantly reduced amygdala (22%) and hippocampus (11%) size but normal cognition. Amygdala and hippocampus size did not differ significantly between patients with and without PTSD.

Limitations

The sample sizes of trauma-exposed groups are relatively small. A larger sample size may have revealed statistically significant differences in amygdala size between those with and without PTSD.

Conclusion

Our results demonstrate strong amygdala size reduction in trauma-exposed patients with BPD with or without PTSD, much exceeding that reported for trauma-exposed individuals without BPD. Our data suggest that BPD is associated with small amygdala size. Furthermore, evidence is increasing that amygdala and hippocampus size reduction is not only due to PTSD, but also to traumatic exposure.     

Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis

Background

Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients.

Methods

In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls.

Results

Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls.

Conclusions

Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.     

Physical and sexual abuse histories among children with borderline personality disorder.

OBJECTIVE: The purpose of the study was to determine whether a history of physical or sexual abuse is more common in children with borderline personality disorder than in other children evaluated in the same outpatient psychiatric clinic. METHOD: The authors contrasted rates of abuse in 44 children diagnosed with borderline personality disorder and in 100 comparison children. RESULTS: The borderline personality disorder group had a significantly greater prevalence of physical and combined physical/sexual abuse. Sexual abuse rates alone did not differ significantly between groups. CONCLUSIONS: The finding of greater abuse in the group with borderline personality disorder supports the hypothesis that a history of trauma is associated with the disorder.     

Disgust and implicit self-concept in women with borderline personality disorder and posttraumatic stress disorder

Disgust may be a key emotion and target for psychotherapeutic interventions in borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) at explicit and implicit-automatic levels. However, automatically activated disgust reactions in individuals with these disorders have not been studied. Disgust and its correlation with childhood abuse were assessed in women with BPD, but without PTSD; women with PTSD, but without BPD; women with BPD and PTSD; and healthy women. Disgust sensitivity, anxiety and depression were measured by self-report. Implicit disgust-prone (relative to anxiety-prone) self-concept was assessed using the Implicit Association Test. Women with BPD and/or PTSD reported more disgust sensitivity than controls. The implicit self-concept among patients was more disgust-prone (relative to anxiety-prone) than in controls. Women with BPD, with PTSD, or BPD and PTSD did not differ significantly in self-reported disgust levels or implicit disgust-related self-concept. Among women with BPD and/or PTSD, current psychiatric comorbidity (major depression, anxiety disorder, eating disorder, or substance-related disorder) did not affect disgust-related variables. More severe physical abuse in childhood was associated with a more anxiety-prone (less disgust-prone) implicit self-concept. Independent of psychiatric comorbidity, disgust appears to be elevated at implicit and explicit levels in trauma-related disorders. Psychotherapeutic approaches to address disgust should take implicit processes into account.     

The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder

A comorbid posttraumatic stress disorder (PTSD) aggravates symptoms, course of illness and social functioning of persons with borderline personality disorder (BPD). However, it is largely unclear how this effect is mediated. In 60 women with BPD of whom 23 had a comorbid current PTSD we investigated whether dysfunctional explicit and implicit emotions were associated with a comorbid PTSD. Shame and guilt proneness, anxiety, anger-hostility, and general psychopathology were assessed by self-report measures. Implicit anxiety-related self-concept was measured using the Implicit Association Test. Self-reported guilt proneness and general psychopathology, but not shame proneness or trait anxiety, were significantly higher in women with BPD and PTSD than in women with BPD alone. A comorbid PTSD was associated with a more anxiety-prone (relative to shame-prone) implicit self-concept as assessed by the Implicit Association Test. Self-reported guilt proneness and implicit anxiety may mediate the negative impact of comorbid PTSD on women with BPD.     

Hippocampus and amygdala volumes in patients with borderline personality disorder with or without posttraumatic stress disorder

Background

Several studies have investigated volumetric brain changes in patients with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Both groups exhibit volume reductions of the hippocampus and amygdala. Our aim was to investigate the influence of comorbid PTSD on hippocampus and amygdala volumes in patients with BPD.

Methods

We compared 2 groups of unmedicated female patients with BPD (10 with and 15 without comorbid PTSD) and 25 healthy female controls. We used T₁- and T₂-weighted magnetic resonance images for manual tracing and 3-dimensional reconstruction of the hippocampus and amygdala.

Results

Hippocampus volumes of patients with BPD and PTSD were smaller than those of healthy controls. However, there was no significant difference between patients with BPD but without PTSD and controls. Impulsiveness was positively correlated with hippocampus volumes in patients with BPD.

Limitations

Our study did not allow for disentangling the effects of PTSD and traumatization. Another limitation was the relatively small sample size.

Conclusion

Our findings highlight the importance of classifying subgroups of patients with BPD. Comorbid PTSD may be related to volumetric alterations in brain regions that are of central importance to our understanding of borderline psychopathology.     

Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder

Limited research has examined the clinical and functional impact of concurrent posttraumatic stress disorder (PTSD) in people with borderline personality disorder (BPD). Such information is particularly lacking for BPD clients with the most disabling symptoms: those who meet criteria for severe and persistent mental illness. We evaluated individuals with severe mental illness to assess whether PTSD in individuals with BPD was associated with more severe symptoms and impaired functioning than BPD alone and replicated these findings in an independent sample. In both the studies, the clients with PTSD and BPD reported significantly higher levels of general distress, physical illness, anxiety, and depression than those with BPD alone. Because individuals with both of these disorders are likely to require more intensive clinical services to reduce distress and improve functioning, work is needed to develop and evaluate interventions designed to address these comorbid conditions.     

Physical and sexual abuse in adolescent girls with borderline personality disorder

Recent investigations suggest that a history of childhood sexual abuse may be associated with borderline personality disorder. This study compares a group of female adolescents diagnosed as borderline with a control group for history of physical and sexual abuse. History of both forms of abuse, particularly sexual, distinguishes the two groups. Results point to the impact of repeated trauma on character structure, cognitive functioning, and Axis II symptomatology.     

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.     

The association of posttraumatic stress disorder,complex posttraumatic stress disorder,and borderline personality disorder from a network analytical perspective

BackgroundPosttraumatic Stress Disorder (PTSD), Complex PTSD, and Borderline Personality Disorder (BPD) share etiological risk factors and an overlapping set of associated symptoms. Since the ICD-11 proposal for trauma-related disorders, the relationship of these disorders has to be clarified. A novel approach to psychopathology, network analysis, allows for a detailed analysis of comorbidity on symptom level.MethodsSymptoms were assessed in adult survivors of childhood abuse (N = 219) using the newly developed ICD-11 Trauma-Questionnaire and the SCID-II. The psychopathological network was analyzed using the network approach.ResultsPTSD and Complex PTSD symptoms were strongly connected within disorders and to a lesser degree between disorders. Symptoms of BPD were weakly connected to others. Re-experiencing and dissociation were the most central symptoms.ConclusionsMental disorders are no discrete entities, clear boundaries are unlikely to be found. The psychopathological network revealed central symptoms that might be important targets for specific first interventions.     

Magnetic resonance imaging of hippocampal and amygdala volume in women with childhood abuse and borderline personality disorder

Borderline personality disorder (BPD) is a common disorder associated with emotional dysregulation and other symptoms that have been hypothesized to be related to dysfunction of limbic brain areas including hippocampus and amygdala. The purpose of this study was to measure hippocampal and amygdala volumes in BPD. Hippocampal and amygdala volumes were measured with magnetic resonance imaging (MRI) in 10 patients with BPD and 23 control subjects. Patients with BPD had a 21.9% smaller mean amygdala volume and a 13.1% smaller hippocampal volume, compared to controls. These findings are consistent with the hypothesis that alterations in the hippocampus and amygdala are associated with BPD.