Nontraumatic pathways to borderline personality disorder.

Clinicians who treat borderline personality disorder (BPD) generally assume that this disorder is caused by childhood abuse. This assumption is strongly supported in the BPD literature, which indicates that the majority of individuals with BPD have suffered emotional, physical, and sexual abuse. What is often missed or simply ignored in discussions of BPD is that this same body of research also suggests that a significant minority of borderline individuals have not suffered childhood abuse. This article reviewed the literature on the prevalence of childhood abuse and BPD, offered a number of hypotheses about nontraumatic pathways to BPD, and briefly considered treatment implications for nontraumatized BPD individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relationship Between Witnessing Parental Conflict During Childhood and Later Psychological Adjustment Among University Students: Disentangling Confounding Risk Factors.

The purpose of the current study was to examine in detail the association between witnessing domestic violence (DV) and long-term psychological adjustment. Important limitations of past research were addressed, including controlling for several associated risk factors. Special attention was paid to whether the perpetrator of the violence was the maternal or paternal figure, as well as to whether the witness to the violence was male or female. Participants completed measures examining DV witnessed, direct child abuse experienced, and current psychopathology. Following screening for physical and sexual abuse, a sample of 351 individuals was selected. Four groups of participants were compared. Results indicated that individuals who had witnessed either physical DV or major psychological DV had higher levels of psychopathology than individuals who reported witnessing minor psychological DV or controls. After controlling for direct psychological abuse experienced, witnessing DV remained a significant predictor of psychopathology for males but not for females. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of childhood sexual trauma in the etiology of borderline personality disorder: Considerations for diagnosis and treatment.

Highlights recent research findings that demonstrate a connection between severity and type of sexual abuse and presentation of borderline-like symptoms. Similarities are drawn between the type of symptoms that make up a posttraumatic stress disorder (PTSD) diagnosis, and those that compose borderline personality disorder (BPD). Neither the PTSD nor BPD diagnoses are completely adequate to address the conditions of psychiatric patients with sexual abuse histories. In PTSD, characterological dysfunction in response to severe abuse experiences is not represented in the diagnosis, while BPD attributes symptoms solely to characterological dysfunction without recognizing their adaptive nature in the face of childhood trauma. A more accurate and less stigmatizing diagnostic category for survivors of sexual abuse has a significant role in expanding the possibilities for successful treatment of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality characteristics: A betrayal trauma approach.

Borderline Personality Disorder (BPD) has been associated with both trauma and insecure attachment styles. Betrayal Trauma Theory proposes survivors of interpersonal trauma may remain unaware of betrayal in order to maintain a necessary attachment. This preliminary study reports on the relations between self-reports of betrayal trauma experiences and borderline personality characteristics in a college sample. Using multiple regression, betrayal was significantly associated with BPD characteristics. High-betrayal trauma was the largest contributor to borderline traits and medium-betrayal trauma was also a significant predictor. However, traumas of low betrayal were not associated with BPD features. These results stand even after controlling for gender. These findings suggest betrayal may be a key, and yet heretofore unaddressed, feature of borderline personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural relations between borderline personality disorder features and putative etiological correlates.

This study assessed the structural relations between borderline personality disorder (BPD) features and purported etiological correlates. Approximately 5,000 18-year-old nonclinical young adults were screened for BPD features, and 2 cohorts of participants (total N?=?421; approximately one half of whom endorsed significant borderline features) completed the laboratory phase of the study. Measures included self-report and interview-based assessments of BPD psychopathology, personality, psychopathology in biological parents, and childhood physical and sexual abuse. Significant relations between BPD features and purported etiological correlates of BPD were found. A multivariate model that included parental psychopathology, childhood abuse, and personality factors provided an adequate fit to the data and supported the contention that the personality traits disinhibition and negative affectivity underlie BPD features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violence in the lives of women having abortions: Implications for practice and public policy.

What do professional psychologists need to know to treat women who once had an abortion? Analyses of responses from 2,525 women revealed that women who reported an abortion were more likely than others to report symptoms of depression and lower life satisfaction. However, they were also more likely to experience rape, childhood physical and sexual abuse, and a violent partner. When history of abuse, partner characteristics, and background variables were controlled, abortion was not related to poorer mental health. This underscores the need to explore the effects of violence in women's lives to avoid misattributing psychological distress to abortion experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memories of abuse in borderline patients: true or false?

This review will examine issues related to the validity of memories of child abuse in patients with borderline personality disorder (BPD). A large body of research has shown that all memories are distorted by cognitive schema, and that "recovered memories" may be particularly unreliable. Empirical findings on trauma in BPD will be reviewed, as well as the difficulties in verifying trauma histories. Evidence will be examined suggesting that borderline patients have a distorted perception of interpersonal events. Clinical recommendations will be made for the evaluation of memories of abuse in patients with BPD.     

The National Child Traumatic Stress Network: Collaborating to improve the standard of care.

Mental health practitioners are often called upon to provide services to children, adolescents, and families in the aftermath of traumatic experiences such as child neglect, sexual or physical abuse, family/domestic violence, sexual assault, interpersonal violence, school and community violence, serious accidental injury, catastrophic medical illness, traumatic bereavement, or mass casualty events, including natural and man-made disasters. The National Child Traumatic Stress Network (NCTSN) was established in 2001 to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States. This article describes the development of the NCTSN, its structure, programs, and many of the products and resources--including online lectures, training programs and videos, and searchable databases of child trauma resources--available through the NCTSN Web site (www.nctsn.org) to assist professionals in providing state-of-the-art assessment, treatment, and services to these children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood abuse and current psychological functioning in a university counseling center population.

84 university counseling center clients (61 women and 23 men) self-reporting childhood physical, sexual, or emotional abuse (n?=?30) or no childhood abuse (n?=?54) completed 3 measures of psychological functioning. Multivariate analysis of variance revealed that clients reporting abuse were more depressed (with the mean Beck Depression Inventory score in the borderline clinical depression range), had more symptomatology (with the mean Global Severity Index of the Brief Symptom Inventory at about the average level of a psychiatric outpatient population), and scored higher on the Borderline Personality scale of the Millon Clinical Multiaxial Inventory (with the mean base-rate score near the cutoff score for presence of borderline personality features). 19 clients reporting emotional abuse only did not differ on any measure from 11 clients reporting sexual or multiple forms of abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between genetic anomalies of different levels and deviations in dermatoglyphic traits. Part 2: Dermatoglyphic peculiarities of females with Turner''s syndrome

After reviewing the literature on health effects of intimate violence, we report secondary analyses of responses of 439 black women who participated in the Commonwealth Fund's national survey on women's health. Lower income women were more likely to experience partner violence but not childhood abuse; and income group was related to self-esteem, depressive symptoms, and perceived health status. Childhood physical and sexual abuse and partner violence were intercorrelated; both abuse history and partner violence were related to greater risk for depressive symptoms, lower life satisfaction, and lower perceived health care quality. Partner violence was also related to lower self-esteem and perceived health status. Sexually abused women had more difficulties in interpersonal relationships, including lower perceived health care quality even with self-esteem and depressive symptoms controlled. Implications for prevention, training, and future research as well as methodological issues in research on violence against black women are discussed.     

The relationship between prior sexual abuse and reactions to sexual harrassment: Literature review and empirical study.

This article examines whether individuals who have had prior sexual abuse experiences, including sexual harassment (SH) and child sexual abuse, are hypersensitive to potential SH-related stimuli or overreact to social sexual experiences. Some psychologists and legal scholars suggest that previous sexual abuse or exposure to violence against women produces altered perceptions of current interactions and situations in those women. The review of the extant empirical literature examining such relationships and the findings presented here in an interrelated set of 5 studies provide little general or consistent support for a relationship between prior abuse experiences and current perceptions about SH. Caution is advised in judging either the veracity of an SH complaint or the objectivity of a potential juror's reaction to such a claim on the basis of her prior sexual abuse experiences. The literature review and empirical study lend weight to the irrelevance of such inquiries in judging credibility of SH complainants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems in differentiating sexually from nonsexually abused adolescent psychiatric inpatients by self-reported anxiety, depression, internalization, and externalization

To ascertain whether self-reported psychopathology differentiated sexually and nonsexually abused adolescents, the Beck Depression Inventory, Beck Anxiety Inventory, and the Achenbach Youth Self-Report were administered to 111 psychiatric inpatients between 13 and 17 years of age who were diagnosed with various psychiatric disorders. Data about 14 background and clinical characteristics that were purported to be associated with sexual abuse were also collected. Forty (67%) of the 60 girls reported sexually abusive experiences, whereas six (12%) of the 51 boys reported such experiences. None of the scales were correlated with sexual abuse in either sex, and a history of physical abuse was the only characteristic that was significantly correlated with sexual abuse for both sexes. Furthermore, none of the scales was correlated with identity of sexual abuser, age of first abuse, age of last abuse, number of abuses, days of abuse, penile insertion, and the reporting of the abuse to the authorities in the sexually abused girls.     

Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.     

Relationship of childhood sexual, physical, and combined sexual and physical abuse to adult victimization and posttraumatic stress disorder

OBJECTIVE: Prior research has suggested that women who experience childhood sexual abuse are at increased risk for sexual victimization and Posttraumatic Stress Disorder (PTSD) in adulthood. However, previous studies have paid insufficient attention to the overlap of childhood sexual and physical abuse. In the present study we disentangled the separate and combined effects of childhood sexual and physical abuse by comparing groups of participants who reported contact childhood sexual abuse only (SA), sequelae of childhood physical abuse only (PA), combined childhood sexual and physical abuse (CA), or no child abuse (NA). METHOD: A sample of 475 female college students completed measures of sexual and physical abuse in childhood (before age 15) and adulthood (after age 15), PTSD and trauma symptoms, and demographic variables. Of these participants, 27 were assigned to the SA group, 53 to the PA group, 31 to the CA group, and 211 to the NA group. RESULTS: The highest rate of adult sexual and/or physical victimization was reported by the CA group, followed by the PA group, with lower rates reported by the SA and NA groups. Using adult victimization as a covariate, the analyses revealed that the CA group reported significantly higher rates of PTSD and trauma symptoms compared to the NA group. CONCLUSIONS: The results suggest that prior reports of differences in rates of adult victimization and PTSD between women who experienced childhood sexual abuse and women who did not may be attributable to the inclusion of participants with a history of combined childhood sexual and physical abuse in childhood sexual abuse groups. The importance of separating physical and combined forms of victimization from sexual abuse is discussed.     

Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control.

M. R. Nash et al (see record 1993-33781-001) reported on the effects of controlling for family environment when studying sexual abuse sequelae. Sexual abuse history was associated with elevated MMPI and Rorschach scores in a sample of 105 women, but many of the reported differences disappeared when a composite Family Functioning Scale score was used as a covariate. The present article considers the findings of Nash et al in terms of the theoretical and statistical constraints placed on analysis of covariance (ANCOVA) and other partializing procedures. Because family dysfunction is not always causally antecedent to sexual abuse, and given the quasi-experimental quality of most abuse research, the use of covariate techniques to test hypotheses about the causal role of family environment in the impacts of sexual abuse may be ill advised. Analyses of a 2,964-S data set illustrate these concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

US double-blind, controlled trials of omeprazole and amoxycillin for treatment of Helicobacter pylori

OBJECTIVE: To identify environmental and psychosocial factors associated with receiving special education services. DESIGN: The 1992 Minnesota Student Survey, an anonymous, self-report survey. SETTING: Minnesota public schools. PARTICIPANTS: A total of 121848 adolescents in the 6th, 9th, and 12th grades. MAIN OUTCOME MEASURES: Emotional status and potential environmental risk factors including family structure, family substance use problems, family violence, and sexual abuse were compared between adolescents reporting a history of having been in classes for learning problems and a grade- and race-matched comparison group of adolescents who had never been in classes for learning problems. Comparisons were conducted separately for male and female respondents. RESULTS: Compared with adolescents who had never been in classes for learning problems, a significantly greater proportion of male and female students who had been in special education classes lived in single-parent and nontraditional households, indicated that a family member had an alcohol or other drug problem, had witnessed or experienced physical abuse, and reported a history of sexual abuse and poor emotional health. Most of these associations remained significant when simultaneously controlling for the other factors in logistic regression. Significant factors showed modest odds ratios in the multivariate analyses (<1.6), except for the emotional status variable. Students with a history of receiving special education services had from 6 to 14 times the odds of reporting poor emotional health. This association was strongest among the youngest adolescents. CONCLUSION: Several environmental stressors and psychosocial factors, most notably poor emotional health, are associated with a history of special class placement for learning problems.     

Reports of the childhood home environment in early-onset dysthymia and episodic major depression.

This study addressed 2 questions: (a) is early-onset dysthymia associated with reports of a disturbed childhood home environment; and (b) can adverse early experiences account, at least in part, for the differing clinical presentations of dysthymia and major depression? Participants included 97 outpatients with early-onset dysthymia, 45 outpatients with episodic major depression, and 45 normal controls. The early home environment was assessed blind to diagnosis using both interview and self-report measures. Early-onset dysthymia patients reported significantly more physical and sexual abuse and poorer relationships with both parents than normal controls. In addition, patients with dysthymia reported having received significantly poorer parenting than those with episodic major depression. The results could not be accounted for by mood state effects, comorbidity with borderline and antisocial personality disorder, or comorbid major depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk factors for adolescent substance abuse and dependence: Data from a national sample.

A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders- (4th ed.; American Psychiatric Association, 1994) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c) when effects of other variables were controlled, African Americans, but not Hispanics or Native Americans, were at approximately 1/3 the risk of substance abuse/dependence as Caucasians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality disorder from the perspective of general personality functioning.

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology.

Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)