Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls

Early maternal separation and the trajectory of borderline personality disorder symptoms

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

Borderline personality disorder: ontogeny of a diagnosis

OBJECTIVE

The purpose of this article is to describe the development of the borderline personality disorder diagnosis, highlighting both the obstacles encountered and the associated achievements.

METHOD

On the basis of a review of the literature, the author provides a chronological account of the borderline construct in psychiatry, summarizing progress in decade-long intervals.

RESULTS

Borderline personality disorder has moved from being a psychoanalytic colloquialism for untreatable neurotics to becoming a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Nonetheless, patients with this disorder pose a major public health problem while they themselves remain highly stigmatized and largely neglected.

CONCLUSIONS

Despite remarkable changes in our knowledge about borderline personality disorder, increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, and reimbursement agencies need to prioritize this need.

Familial resemblance of borderline personality disorder features: genetic or cultural transmission?

Borderline personality disorder is a severe personality disorder for which genetic research has been limited to family studies and classical twin studies. These studies indicate that genetic effects explain 35 to 45% of the variance in borderline personality disorder and borderline personality features. However, effects of non-additive (dominance) genetic factors, non-random mating and cultural transmission have generally not been explored. In the present study an extended twin-family design was applied to self-report data of twins (N = 5,017) and their siblings (N = 1,266), parents (N = 3,064) and spouses (N = 939) from 4,015 families, to estimate the effects of additive and non-additive genetic and environmental factors, cultural transmission and non-random mating on individual differences in borderline personality features. Results showed that resemblance among biological relatives could completely be attributed to genetic effects. Variation in borderline personality features was explained by additive genetic (21%; 95% CI 17-26%) and dominant genetic (24%; 95% CI 17-31%) factors. Environmental influences (55%; 95% CI 51-60%) explained the remaining variance. Significant resemblance between spouses was observed, which was best explained by phenotypic assortative mating, but it had only a small effect on the genetic variance (1% of the total variance). There was no effect of cultural transmission from parents to offspring.

Adolescents with cancer: how can we meet their specific needs in developing countries?

Cancer occurring in adolescents (10 to 19 years) is more than twice as common as cancer in children but has received less attention in South Africa. In the process of becoming adults, adolescents undergo major physical, psychological, and social changes. They manifest specific behaviors and have special emotional needs. Malignant disease and its treatment have the potential to disrupt seriously the processes of adolescence, whereas the emotional instability and the risk-prone behavior characteristic to this age may jeopardize the success of the treatment. A further disruption in the management of these patients, in South Africa, is the need to refer children over the age of 13 to the adult medicine service. Research done worldwide on transferring of adolescents with cancer and other chronic diseases to adult health care underscores the need for a structured and individualized transition. Whilst, in some developed countries, adolescent cancer units already function for years, the extent of the problem has not yet been evaluated in most developing countries, where cancer registers do not even exist. A few simple measures might improve substantially the outcome of cancer in adolescents in the developing world.

Borderline personality disorder and childhood trauma: evidence for a causal relationship

The debate over whether childhood trauma is a causative factor in the development of borderline personality disorder continues in the literature despite decades of research. This review examines this body of literature published from 1995 through 2007 to assess the strength of evidence for such a causal relationship. A unique conceptual approach was used, as we considered the literature in the context of Hill's classic criteria for demonstrating causation. Results of this review suggest that evidence supports the causal relationship, particularly if the relationship is considered as part of a multifactorial etiologic model. Directions for future research and clinical implications are discussed.

Association between childhood trauma and aggression in male prisoners

Childhood trauma and aggression were examined in 540 male prisoners. The Thus 540 male prisoners had a psychiatric interview, completed the Childhood Trauma Questionnaire (CTQ), and were assessed with the Brown-Goodwin Lifetime History of Aggression (BGHA) interview. There were significant correlations between CTQ scores and BGHA scores. Also prisoners with CTQ scores above the median had significantly higher BGHA scores than prisoners with CTQ scores below the median. Significantly more of the prisoners with CTQ scores above the median had more than one conviction, and significantly more had convictions as minors, and had exhibited violent behavior in prison. However, in logistic regression analyses that included possible confounding variables, CTQ scores related only to violence in prison while BGHA scores related to violent crime, having more than one conviction, conviction as a minor, and violence in prison. The relationship between CTQ and BGHA scores suggests the possibility that childhood trauma may be one determinant of aggression in prisoners.

The case for shifting borderline personality disorder to Axis I

Through reviewing what is known about the nature, course, and heritability of borderline personality disorder (BPD), we argue for a reconceptualization of this disorder that would lead to its placement on Axis I. Borderline personality disorder is a prevalent and disabling condition, and yet the empirical research into its nature and treatment has not been commensurate with the seriousness of the illness. We not only review empirical evidence about the etiology, phenomenology, and course of the disorder in BPD but we also address fundamental misconceptions about BPD that we believe have contributed to misunderstanding and stigmatization of the disease. Finally, we suggest future directions for research that might permit the identification of core features of this disorder, with a focus on the importance of naturalistic assessments and of assessments through the course of development.

Stressful life events and major depressive disorders

This study examined the relationship between stressful life events (SLE) and recurrent major depressive disorders. Three groups of 50 subjects were assessed: Patients with recurrent major depressive disorder with melancholic features; patients with borderline personality disorder; and healthy controls. Interviews for AXIS I and II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview Life Event Scale and the Coddington Life Events Schedule were used to measure life events and were confirmed with an interview. Beck Depression Inventory was also administered. The proportions of loss-related events in childhood and in the year preceding the first episode were higher in the depressed group than in the control groups during the same time period. Proportions of SLE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE differentiated the groups following the first depressive episode. The study's conclusion is that SLE play an important role in the onset of depressive disorders. There are specific kinds of SLE that occur in childhood and in the year preceding the first episode. SLE has a less significant role in the maintenance of this illness.

BPD's interpersonal hypersensitivity phenotype: a gene-environment-developmental model

This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.

A controlled study of Hostile-Helpless states of mind among borderline and dysthymic women

The aim of this study was to determine whether women with borderline personality disorder (BPD) are more likely than those with dysthymia to manifest contradictory Hostile-Helpless (HH) states of mind. A reliable rater blind to diagnosis evaluated features of such mental representations in transcripts of Adult Attachment Interviews from 12 women with BPD and 11 women with dysthymia of similar socioeconomic status (SES), all awaiting psychotherapy. In keeping with three hierarchical (non-independent) a priori predictions regarding the mental representations of women with BPD, the results were that (a) all those with BPD, compared with half the group with dysthymia, displayed HH states of mind; (b) those with BPD manifested a significantly higher frequency of globally devaluing representations; and (c) they exhibited a strong trend toward identifying with the devalued hostile caregiver (58% BPD vs. 18% dysthymic). In addition, significantly more BPD than dysthymic patients made reference to controlling behavior towards attachment figures in childhood. These findings offer fresh insights into the nature of BPD and extend previous evidence concerning affected individuals' patterns of thinking and feeling about childhood attachment figures.

Psychological distress in caretakers or relatives of patients with borderline personality disorder

BACKGROUND AND AIMS

Caregivers or relatives of mental patients often show increased levels of psychological distress. This study investigated whether this is also the case for caregivers of patients with borderline personality disorder.

METHODS

The Symptom Check List (SCL-90) was administered to 64 Dutch volunteers, who were either biologically related (parents or siblings) or biologically unrelated caregivers (partners or friends) of patients with borderline personality disorder.

RESULTS

The group of caregivers as a whole scored higher on all symptom dimensions of the SCL-90 than the general population. When controlling for caregiver sex and age, as well as for patient sex, there were no significant differences between the biologically related and unrelated caregiver groups on any dimension.

CONCLUSIONS

The results are in line with findings concerning distress in caregivers of patients suffering from personality disorders in general, posttraumatic stress disorder or schizophrenia. The mechanism behind the increased levels of distress in our sample is not clear, however. Either exposure to the problematic behaviour of the patient, selective mating or a combination of both might have been responsible for the effect.

Administration of antisense oligonucleotide against pro-opiomelanocortin prevents enduring hormonal alterations induced by neonatal handling in male mice

Early life events have been implicated in the programming of adult chronic diseases. Several investigations suggest that the role of early environment in influencing development mainly involves the hypothalamic-pituitary-adrenal axis. Therefore, we examined whether 1) daily neonatal handling, applied from birth to weaning induces HPA hormones alterations in mice lasting up to the adult age; and 2) if the administration of an antisense oligodeoxynucleotide versus pro-opiomelanocortin (As-POMC) prevents hormonal alterations observed in previously handled mice (Handled). In the adult phase (90 days), Handled are overweight and have higher basal plasma immuno-reactive (ir)-corticosterone and adrenocorticotropin (ir-ACTH), and higher pituitary ir-ACTH; while they have lower hypothalamic ir-ACTH and corticotropin-releasing hormone (ir-CRH) in comparison with the non-handled mice. As-POMC (0.05-0.1 nmol/g body weight per day) administered during the same period dose-dependently prevents the increase in body weight, in plasma ir-corticosterone, ir-ACTH, and pituitary ir-ACTH, also preventing the decrease in hypothalamic ir-CRH and ir-ACTH; while the mismatch oligonucleotide is nearly inactive. This data indicates that pharmacological treatment in neonatal life may have enduring effects, reducing the alterations in hormonal homeostatic programming mechanisms induced by early repeated handling.

Early traumatic life events, parental rearing styles, family history of mental disorders, and birth risk factors in patients with social anxiety disorder

OBJECTIVE

Childhood traumatic experiences, rearing styles, familial mental disorders and birth risk factors have been associated with the development of social anxiety disorder.

METHOD

Patients with social anxiety disorder (n=50) and healthy controls (n=120) were investigated using a retrospective interview with 203 questions.

RESULTS

The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including separation from parents, parents' marital discord, sexual abuse, familial violence, childhood illness, and other factors. On a 0-10 point 'severe trauma scale' patients had significantly higher mean scores (2.0; SD 1.28) than control subjects (0.82; SD 1.1; p<0.0001). Only 6 (12%) of the social phobic patients, but 63 (52.5%) of the controls did not report any severe traumatic events at all (chi2=24.0; p<0.0001). Compared to controls, patients described their parents' rearing styles as significantly more unfavourable. Patients reported higher rates of psychiatric disorders in their families in general, in particular anxiety disorders, depression, and suicidality. Birth risk factors did not differ between patients and controls. In a logistic regression model, the highest contribution was noted for familial anxiety disorders. Separation from parents also had a significant, but smaller influence. There was only a trend towards a significant contribution of childhood sexual abuse. Violence in the family, parental rearing styles and birth risk factors did not contribute significantly.

CONCLUSIONS

The present data suggest that the aetiology of social anxiety disorder is multifactorial and that familial mental disorders and separation experiences are the most important contributing factors.