Examining the relationship between childhood sexual abuse and borderline personality disorder: does social support matter?

The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary social support source in a sample of 290 female undergraduate students enrolled at a major southeastern university. Consistent with previous research, retrospective self-reports of childhood sexual abuse and low social support were both positively correlated with current borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the childhood sexual abuse occurred would moderate the relationship between childhood sexual abuse and borderline personality features. This moderation hypothesis was not supported in the current study, but post-hoc analyses reveal the need to further examine how we define social support following childhood sexual abuse. This research is a stepping stone toward the prevention of borderline personality disorder following childhood sexual abuse.     

Examining the Relationship between Childhood Sexual Abuse and Borderline Personality Disorder: Does Social Support Matter?

The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary social support source in a sample of 290 female undergraduate students enrolled at a major southeastern university. Consistent with previous research, retrospective self-reports of childhood sexual abuse and low social support were both positively correlated with current borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the childhood sexual abuse occurred would moderate the relationship between childhood sexual abuse and borderline personality features. This moderation hypothesis was not supported in the current study, but post-hoc analyses reveal the need to further examine how we define social support following childhood sexual abuse. This research is a stepping stone toward the prevention of borderline personality disorder following childhood sexual abuse.     

Relationship Quality and Stability in Couples When One Partner Suffers From Borderline Personality Disorder

The main goal of the present study was to examine and compare the psychosocial functioning of 35 couples including a woman diagnosed with borderline personality disorder (BPD) to that of a nonclinical control sample of 35 couples. The BPD status of women from the clinical group and the prevalence of personality disorder in their partner were ascertained through the SCID-II. Participants completed self-report measures of couple functioning. A majority of couples in which the woman suffered from BPD (68.7%) evidenced frequent episodes of breakups and reconciliations and, over an 18-month period, nearly 30% of these couples dissolved their relationship. Nearly half of the men involved in a romantic relationship with a woman suffering from BPD met criteria for one personality disorder or more. As compared with nonclinical couples, clinical couples showed lower marital satisfaction, higher attachment insecurity, more demand/withdraw communication problems, and higher levels of violence.     

Body-Related Emotions in Posttraumatic Stress Disorder Following Childhood Sexual Abuse

Traumatic experiences are associated with emotions such as anxiety, shame, guilt, disgust, and anger. For patients who have experienced child sexual abuse, these emotions might be triggered by perceptions of their own body. The aim of this study was to investigate the extent of the association of the body to traumatic experiences and to discern the emotions linked to trauma-associated body areas. Ninety-seven female participants were assigned to four groups: post-traumatic stress disorder following child sexual abuse with co-occurring borderline personality disorder, post-traumatic stress disorder following child sexual abuse without co-occurring borderline personality disorder, borderline personality disorder without post-traumatic stress disorder, and healthy controls. Participants rated 26 body areas regarding their association with trauma and 7 emotions. Emotions were assessed by questionnaires. Results suggest that specific areas of the body are associated with trauma and linked to highly aversive emotions. In post-traumatic stress disorder patients, the areas associated with highly negative emotions were the pubic region and inner thighs. Thus, the patient’s body may act as a trigger for traumatic memories.     

Characterization of psychiatrically hospitalized college students

Abstract

Objective: To characterize contemporary college students requiring psychiatric hospitalization. Participants and methods: Sociodemographic and diagnostic information was gathered retrospectively and analyzed from the electronic medical records (EMRs) of the consecutive inpatient hospitalizations of 905 college students admitted to a psychiatric inpatient unit. Results: Significantly more females compared to males experienced the following: more hospitalizations, more family and financial stressors, more depression, and less psychotic and bipolar disorder. The most frequent diagnosis was a depressive disorder, followed by bipolar disorder, psychotic disorder, and personality disorder, most frequently borderline personality disorder. Half of participants had comorbid diagnoses with substance abuse most common. More than two-thirds of students endorsed social or intimate relationship, academic, and family challenges as psychosocial stressors. In all, 15% of participants had repeat admissions. Conclusions: The present study provides demographic data from a sample of psychiatrically hospitalized college students. Findings can help improve screening and identification of decompensation in college students.     

Identifying Mental Disorder from the Faces of Women with Borderline Personality Disorder

Although appearance-based cues can help to diagnose physical illness, visual manifestations of mental disorder may be more elusive. Here, we investigated whether individuals could distinguish women with a serious mental disorder (borderline personality disorder) from demographically- and IQ-matched non-psychiatric controls. Participants rated mentally ill targets as more likely to have a mental disorder from photos more accurately than chance, despite not believing that such judgments were possible. The configuration of facial cues played an important role in these judgments, as interfering with the spatial relationships between facial features reduced participants’ accuracy to chance guessing. Further investigation showed similar results when participants rated the targets for specific mental disorders (borderline personality disorder, major depressive disorder) and rated the mentally ill targets as more depressed, angry, anxious, disgusted, emotionally unstable, distressed, and less happy. Moreover, the depression ratings significantly correlated with the targets’ actual depressive symptoms. Thus, individuals may be able to infer aspects of mental disorder from minimal facial cues.     

Severe borderlines and self psychology

This paper will discuss work with a woman diagnosed as having borderline personality disorder because of classic symptoms of intense unstable affect, recurrent suicidality, self-mutilation, and primitive defensive organization. Once a selfobject transference tie was established, the borderline symptoms remitted. Discussion of this case will focus on the clinical application of concepts from the field of psychoanalytic self psychology, particularly the concepts of self-object functions and intersubjectivity, in work with patients diagnosed as borderline.     

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.     

Confronting Myths and Stereotypes About Borderline Personality Disorder

SUMMARY

The clinician treating a patient with borderline personality disorder (BPD) is often faced with complicated challenges, from making and communicating an accurate diagnosis, to implementing an appropriate, informed plan for treatment. Myths and stereotypes about BPD, and the individuals who may carry the diagnosis, likely complicate effective recognition and treatment of the disorder. BPD has been a controversial diagnosis among clinicians since its inception, and it is poorly understood among the general public. Pressures to avoid an explicit exploration of the diagnosis stemming from myths and stereotypes about the disorder can come from a number of sources, including other clinicians, family members and patients themselves. The results of minimizing or ignoring the contribution of borderline pathology may be detrimental. Clinical decisions based on outmoded thinking about diagnosis, prognosis, treatment efficacy, and availability of resources may deny patients optimal care. Integrating current findings into consideration of a BPD diagnosis and design of appropriate treatment, free of misconceptions about the condition, may help limit the untoward effects associated with failure to appreciate elements of borderline personality.     

Where is the border? Current issues in the diagnosis and treatment of the borderline

Differential diagnosis of subtypes of individuals meeting criteria for borderline personality disorder has received only limited attention in the recent social work literature on the borderline. Whether the borderline disturbance is moderate or severe, the condition may overlap with several borders, suggesting that borderline personality disorders are a heterogeneous group of conditions. Discrimination between different subtypes is necessary in order to help clients obtain the optimum combination of treatments.     

Psychological Assessment through Performance-Based Techniques and Self-Reports: A Case Study of a Sexually Abused Girl at Preschool Age

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological battery including the Beck Anxiety Inventory, the Beck Depression Inventory, the Standard Progressive Matrices, Rorschach Ink Blots, and the Schema Mode Inventory. These investigations were useful in formulating both a diagnosis and a management plan. The girl fulfilled diagnostic criteria for a major depressive episode and borderline personality disorder. This combination of psychological testing may be useful in establishing an accurate multiaxial diagnosis and for understanding the behavioral and psychological sequelae of child sexual abuse in similar cases. The study further suggests that schema-focused therapy is a useful therapeutic tool for individuals who have suffered child sexual abuse at an early age and who have borderline personality disorder.     

Psychological assessment through performance-based techniques and self-reports: a case study of a sexually abused girl at preschool age

We investigated the implicit psychological and behavioral consequences of sexual abuse in an adolescent girl who suffered child sexual abuse at preschool age in this case report. We report the manifestations of this abuse on her personality and psychological functioning using a structured clinical interview and a comprehensive psychological battery including the Beck Anxiety Inventory, the Beck Depression Inventory, the Standard Progressive Matrices, Rorschach Ink Blots, and the Schema Mode Inventory. These investigations were useful in formulating both a diagnosis and a management plan. The girl fulfilled diagnostic criteria for a major depressive episode and borderline personality disorder. This combination of psychological testing may be useful in establishing an accurate multiaxial diagnosis and for understanding the behavioral and psychological sequelae of child sexual abuse in similar cases. The study further suggests that schema-focused therapy is a useful therapeutic tool for individuals who have suffered child sexual abuse at an early age and who have borderline personality disorder.     

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

The borderline/schizoid marriage: the holding environment as an essential treatment construct

The borderline/schizoid marital constellation is the prominent constellation among borderline patients on a long-term inpatient unit. Treatment of this marital constellation, in which each spouse has a severe personality disorder, requires application of the concept of the holding environment as an essential treatment construct, with the therapist as manager of the holding environment. This paper explicates the means of management. With the proposed treatment approach and a long-term treatment orientation, seemingly hopeless cases can improve.     

Adult somatic preoccupation and its relationship to childhood trauma

Somatic preoccupation has been associated with a variety of comorbid psychiatric conditions including childhood trauma, personality disorder, and depression. The current study was undertaken to simultaneously explore the inter-relationship of these psychiatric variables as conceptualized in a path model. Participants (N = 120), both men and women, seen for nonemergent health care in a resident-staffed internal medicine clinic, were given questionnaires exploring the presence of childhood trauma, borderline personality symptomatology, current depression, worry, and somatic preoccupation. With one exception, all simple correlation coefficients among study variables were relatively substantial. By sequencing variables into an a priori model and using a path analytic approach, several indirect and direct relationships among variables were evident. Most important, childhood trauma exhibited a direct effect on somatic preoccupation as well as indirect effects through borderline personality disturbance and current depression. These data suggest that childhood trauma may be a precursor for somatic preoccupation during adulthood.     

Personality Disorders Among Pathological Gamblers

The objective of this study was to investigate the prevalence of DSM-III-R diagnostic categories of personality disorders in pathological gamblers and to highlight the possible association between such disorders, psychological distress and selected forms of gambling. The Personality Disorders Questionnaire-Revised and a battery of psychometric measures were administered to a sample of 82 consecutive admissions to a behavioral treatment program for gambling problems at an impulse control disorders research unit in Sydney, Australia. Seventy-three percent of subjects were male. The total sample reported having gambled a mean of 15 years of which, on average, the last 6.4 years were associated with problems. Results indicated that the majority of subjects met diagnostic criteria for at least one Personality Disorder (93%), with an average of 4.6 personality disorders per subject. The majority of gamblers evidenced personality disorders from the Cluster B grouping with particularly high rates of borderline, histrionic, and narcissistic personality disorders which were found to be associated with high levels of impulsivity and affective instability. Antisocial personality disorder and narcissistic personality disorder were both found to be possible mediators of the severity of the problem gambling behaviours.     

Borderline Personality Disorder

SUMMARY

Our knowledge about borderline personality disorder (BPD) has taken some unexpected turns: BPD is less stable, it is more genetic, and it is more treatable than we would ever have imagined even 15 years ago. These developments have profound implications for understanding and treatment of individuals with BPD.     

An Evidence-Based Approach to Managing Suicidal Behavior in Patients with BPD

SUMMARY

This review will suggest an evidence-based approach to managing suicidal patients with borderline personality disorder (BPD). Many principles currently used in practice have little basis in empirical data. And some approaches used to manage chronic suicidality, particularly the emphasis on “safety,” may actually be counter-productive.     

A specific therapeutic approach to suicide risk in borderline clients

One of the most difficult clinical challenges facing social workers today is suicidal behavior in clients with borderline personality disorder. This article reviews the various types of suicidal behavior exhibited by these clients, including self-destructive behavior and overt suicide attempts. Management of these behaviors is essential if treatment is to be successful. Frameworks are offered for understanding and managing both kinds of behavior.