A Systematic Review of the Association Between Early Childhood Trauma and Borderline Personality Disorder

Antecedents and risk factors for borderline personality disorder: Etiopathogenic models based on a multi-level meta-analysis

BACKGROUND

Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood.

METHODS

The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD.

RESULTS

The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other.

CONCLUSION

This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms.

Elevated testosterone and prosocial behavior in female patients with borderline personality disorder independent of social exclusion

OBJECTIVE

Borderline personality disorder (BPD) is marked by unstable relationships and fear of abandonment. Earlier studies suggest that patients with BPD are highly sensitive to social exclusion and show deficits in trust and cooperation. The hormone testosterone influences such prosocial behavior and regulates aggressive and caring behavior. Previous studies show elevated testosterone levels in female patients with BPD at baseline and after psychosocial stress, while results after social exclusion are missing.

METHOD

We investigated the effects of social exclusion on prosocial behavior (sharing and punishment) and salivary testosterone in female patients with BPD. Ninety-eight patients with BPD and 98 healthy females matched for menstrual cycle were randomly assigned to an overinclusion or exclusion condition of the virtual ballgame Cyberball. Afterwards, participants played two games in which they could share money with a fictional player ("dictator game") and accept or reject (= punish) offers from a player ("ultimatum game").

RESULTS

Female patients with BPD displayed higher testosterone levels than the control group before and after Cyberball. Social exclusion did not affect testosterone levels. Patients with BPD exhibited more prosocial behavior by sharing more money than controls and punished co-players for unfair offers equally often.

CONCLUSION

We replicated previous findings of elevated testosterone in female patients with BPD and showed that it is not affected by experimentally induced social exclusion. Regardless of social exclusion, patients with BPD showed more prosocial behavior, which may reflect a status-seeking strategy to secure their social standing.

Borderline personality features in relationship to childhood trauma in unipolar depressive and bipolar disorders

BACKGROUND

Childhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders.

METHODS

We included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory).

RESULTS

On average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features.

CONCLUSION

Given the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies.

Impact of congenital heart disease on personality disorders in adulthood

AIMS

Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by high risks for cardiovascular- and mental disorders. Personality disorders (PDs) are associated with adverse physical and mental health. Studies assessing PD prevalence in ACHD are lacking.

METHODS AND RESULTS

Personality disorder point prevalence was assessed in 210 ACHD by Structured Clinical Interview for Axis-II Personality Disorders (SCID-II) and compared to meta-analytical data from the general population (GP). Depression and anxiety were measured by self-report (Hospital Anxiety and Depression Scale, HADS) and clinician rating (Montgomery-Åsberg depression rating scale, MADRS). Childhood maltreatment was assessed with the Childhood Trauma Questionnaire and quality-of-life (QOL) with the World Health Organization QOL Scale. PD prevalence was markedly higher in ACHD compared to GP (28.1 vs. 7.7%). Particularly borderline (4.8 vs. 0.9%) and cluster C (i.e. anxious or fearful; 17.1 vs. 3.0%) PDs were overrepresented. PD diagnosis was associated with a surgery age ≤12 years (χ²(1) = 7.861, ϕ = 0.195, P = 0.005) and higher childhood trauma levels (U = 2583.5, Z = -3.585, P < 0.001). ACHD with PD reported higher anxiety (HADS-A: U = 2116.0, Z = -5.723, P < 0.001) and depression (HADS-D: U = 2254.5, Z = -5.392, P < 0.001; MADRS: U = 2645.0, Z = -4.554, P < 0.001) levels and lower QOL (U = 2538.5, Z = -4.723, P < 0.001).

CONCLUSION

Personality disorders, particularly borderline- and cluster C, are significantly more frequent in ACHD compared to GP and associated with depression, anxiety, and decreased QOL. Data from the GP suggest an association with adverse cardiometabolic and mental health. To ensure guideline-based treatment, clinicians should be aware of the increased PD risk in ACHD.

Personality disorders and their association with adverse childhood events

PURPOSE OF REVIEW

Theoretical models of personality disorders (PDs) highlight the role of adverse childhood experiences (ACEs) in the development and maintenance of personality pathology. This review presents recent studies on the associations between childhood adversity and PDs, while discussing mechanisms and factors that impact these relationships.

RECENT FINDINGS

Studies point to small to moderate associations between childhood adversity and cluster A, cluster B and cluster C PDs, and some research suggests that childhood adversity could be a predictor for the onset and development of personality pathology. Most research focuses on borderline PD, while research on other PDs is limited. Some mechanisms that explain these associations have been proposed, with the literature investigating emotion dysregulation, dissociation, avoidance or psychosocial dysfunction as mediators.

SUMMARY

The consistent associations between ACEs and PDs seems to point that childhood adversity could be a transdiagnostic risk factor for PDs, but research warrants further prospective investigations for causal conclusions, and calls for future research to investigate potential mediators and moderators more thoroughly.

Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial

INTRODUCTION

Evidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their clinical effectiveness and cost-effectiveness are unclear.

METHODS AND ANALYSIS

This is a multicentre, randomised, parallel-group, researcher-masked, superiority trial. Study participants will be aged 18 and over, have probable personality disorder and be treated by mental health staff in seven centres in England. We will exclude people who are: unwilling or unable to provide written informed consent, have a coexisting organic or psychotic mental disorder, or are already receiving psychological treatment for personality disorder or on a waiting list for such treatment. In the intervention group, participants will be offered up to 10 individual sessions of Structured Psychological Support. In the control group, participants will be offered treatment as usual plus a single session of personalised crisis planning. The primary outcome is social functioning measured over 12 months using total score on the Work and Social Adjustment Scale (WSAS). Secondary outcomes include mental health, suicidal behaviour, health-related quality of life, patient-rated global improvement and satisfaction, and resource use and costs. The primary analysis will compare WSAS scores across the 12-month period using a general linear mixed model adjusting for baseline scores, allocation group and study centre on an intention-to-treat basis. In a parallel process evaluation, we will analyse qualitative data from interviews with study participants, clinical staff and researchers to examine mechanisms of impact and contextual factors.

ETHICS AND DISSEMINATION

The study complies with the Helsinki Declaration II and is approved by the London-Bromley Research Ethics Committee (IRAS ID 315951). Study findings will be published in an open access peer-reviewed journal; and disseminated at national and international conferences.

TRIAL REGISTRATION NUMBER

ISRCTN13918289.

The impact of childhood trauma on Adolescent Depressive Symptoms: the Chain Mediating role of borderline personality traits and self-control

BACKGROUND

The adolescent depression associated with childhood trauma has been confirmed, but the underlying mechanisms remain unclear. This study aims to explore the chain-mediated role of borderline personality traits and self-control in the relationship between childhood trauma and adolescent depression.

METHODS

A cross-sectional study was conducted on 2,664 students from a senior high school through online questionnaires from October to December 2022 in Henan, China. Childhood Trauma Questionnaire-Short Form, Borderline Personality Dimension of Personality Diagnostic Questionnaire-4, Self-Control Scale, and Children's Depression Inventory were used to measure childhood trauma, borderline personality traits, and self-control.

RESULTS

The prevalence of depression in adolescents was 21.17%, while the prevalence of borderline personality was 12.00%. childhood trauma (r = 0.50, p < 0.001) and borderline personality traits (r = 0.60, p < 0.001) were positively correlated with adolescent depressive symptoms, while self-control was negatively correlated with depressive symptoms (r = - 0.50, p < 0.001). Borderline personality traits and Self-control both play a mediating role in childhood trauma and depressive symptoms, and the mediating effect values are 0.116 (95%CI = [0.098, 0.137]), and 0.022 (95%CI = [0.012, 0.032]) respectively. The chain mediating effect of borderline personality traits and self-control on the relationship between childhood trauma and depressive symptoms was significant (effect value: 0.034, 95%CI = [0.028, 0.042]).

CONCLUSIONS

Childhood trauma can predict depressive symptoms in adolescents due to the formation of borderline personality traits and the reduction of self-control. These findings are important for understanding the formation of personality traits, self-control abilities and coping strategies shaped by traumatic experiences in adolescents.

The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

Psychiatric risks for worsened mental health after psychedelic use

BACKGROUND

Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies.

METHODS

A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses.

RESULTS

We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05).

CONCLUSION

We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.

Resilience and Attachment in Patients with Major Depressive Disorder and Bipolar Disorder

BACKGROUND

Resilience represents one of the fundamental elements of attachment and has often been investigated in mood disorders. This study aims to investigate possible correlations between attachment and resilience in patients with major depressive disorder (MDD) and bipolar disorder (BD).

METHODS

106 patients (51 MDD, 55 BD) and 60 healthy controls (HCs) were administered the 21-item Hamilton Depression Rating Scale (HAM-D-21), the Hamilton Anxiety Rating Scale (HAM-A), the Young Mania Rating Scale (YMRS), the Snaith-Hamilton Pleasure Scale (SHAPS), the Barratt Impulsiveness Scale-11 (BIS-11), the Toronto Alexithymia Scale (TAS), the Connor-Davidson Resilience Scale (CD-RISC), and Experiences in Close Relationship (ECR).

RESULTS

MDD and BD patients did not significantly differ from each other according to the HAM-D-21, HAM-A, YMRS, SHAPS, and TAS, while they scored higher than HCs on all these scales. Patients in the clinical group scored significantly lower on CD-RISC resilience than HCs (p < 0.01). A lower proportion of secure attachment was found among patients with MDD (27.4%) and BD (18.2%) compared to HCs (90%). In both clinical groups, fearful attachment prevailed (39.2% patients with MDD; 60% BD).

CONCLUSIONS

Our results highlight the central role played by early life experiences and attachment in participants with mood disorders. Our study confirms the data from previous research showing a significant positive correlation between the quality of attachment and the development of resilience capacity, and supports the hypothesis that attachment constitutes a fundamental aspect of resilience capacity.

Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation

BACKGROUND

Borderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts.

METHODS

This cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED.

RESULTS

Linear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED.

CONCLUSIONS

Our results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.