Elsevier

Psychiatry Research

Volume 134, Issue 2, 15 April 2005, Pages 169-179
Psychiatry Research

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

https://doi.org/10.1016/j.psychres.2003.07.008Get rights and content

Abstract

Patients with borderline personality disorder (BPD) were compared with a healthy control group with regard to traumatic life events during childhood. The patients (n = 66) and controls (n = 109) were investigated using a comprehensive retrospective interview with 203 questions about childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including sexual abuse, violence, separation from parents, childhood illness, and other factors. On a 0- to 10-point “severe trauma scale,” patients had significantly more severe traumatic events (mean score = 3.86, SD = 1.77) than control subjects (0.61, SD = 0.93). Only four (6.1%) of the BPD patients, but 67 (61.5%) of the controls did not report any severe traumatic events at all. Compared with controls, patients described the attitude of their parents as significantly more unfavorable in all aspects. Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality. Among birth risk factors, premature birth was reported more often in BPD subjects. In a logistic regression model of all possible etiological factors examined, the following factors showed a significant influence: familial neurotic spectrum disorders, childhood sexual abuse, separation from parents and unfavorable parental rearing styles. The present data support the hypothesis that the etiology of BPD is multifactorial and that familial psychiatric disorders and sexual abuse are contributing factors.

Introduction

Several studies have retrospectively investigated the history of developmental trauma in patients with borderline personality disorder (BPD). These studies compared patients with BPD with other psychiatric samples, e.g. with patients with depression (Ogata et al., 1990, Weaver and Clum, 1993), other personality disorders (Paris et al., 1994, Zanarini et al., 2000, Zweig-Frank et al., 1994), or mixed samples of psychiatric patients (Brown and Anderson, 1991, Herman et al., 1989, Ludolph et al., 1990, Soloff and Millward, 1983a, Spitzer et al., 2000, Yen et al., 2002). All of these studies, though not comparable because of the diverse control groups, consistently reported higher rates of childhood sexual abuse (especially incest), physical abuse, witnessing serious domestic violence, and emotional and physical neglect in BPD patients. This was also confirmed in subjects with “childhood BPD” (Goldman et al., 1992, Zelkowitz et al., 2001). In comparisons of various psychiatric disorders, BPD was the diagnosis most frequently associated with sexual abuse (Brown and Anderson, 1991, Sansone et al., 2002, Yen et al., 2002). Two studies with non-clinical subjects from representative surveys found that subjects who endorsed borderline features reported more childhood emotional, physical, and supervision neglect (Johnson et al., 2000, Trull, 2001).

To our knowledge, BPD patients have not yet been compared with a healthy control group with regard to childhood trauma. Although comparisons with other psychiatric disorders found a higher rate of environmental risk factors, these studies may have underestimated the relative association of these risk factors with BPD.

Family and twin studies also converge to support an underlying genetic component to the disorder. A number of studies investigating first degree relatives found higher rates of familiality in BPD patients than in controls (Baron et al., 1985, Loranger et al., 1982, Silverman et al., 1991, Soloff and Millward, 1983b, Zanarini et al., 1988), while one study found only a trend towards familiality (Reich, 1989) and another found an association only in patients with comorbid depression (Pope et al., 1983). Also, the offspring of borderline mothers are at high risk of psychopathology (Weiss et al., 1996).

Family studies do not disentangle genetic from environmental factors, as personality traits may also be transmitted via model learning (Bandura, 1971) or due to impaired parenting skills of parents with mood lability, impulsivity, or reality distortion. However, in a twin study with 221 pairs, the concordance for “definite” BPD was 35% in monozygotic and 7% in dizygotic pairs, suggesting a genetic component in BPD (Torgersen et al., 2000).

Finally, susceptibility to BPD might also be caused by fetal, perinatal or postnatal brain damage. Some studies have reported an association of BPD with organic brain lesions (Andrulonis et al., 1981, Andrulonis et al., 1982, van Reekum et al., 1993), pregnancy complications (Soloff and Millward, 1983a) or childhood attention deficit/hyperactivity symptoms (Fossati et al., 2002). Neuropsychological deficits have been demonstrated in adults (Torgersen, 1984) and children (Zelkowitz et al., 2001) with BPD. Brain-imaging studies found abnormalities in BPD patients (de la Fuente et al., 1997, Driessen et al., 2000, Herpertz et al., 2001, Lyoo et al., 1998, Soloff et al., 2000). In a number of investigations, abnormalities of neurobiological parameters have been found in BPD, including dopamine, serotonin, norepinephrine, acetylcholine, monoamine oxidase, hypothalamic–pituitary–adrenal axis or thyrotropin releasing hormone activity (Ajamieh and Ansseau, 2000, Korzekwa et al., 1993).

To our knowledge, the present study is the first comparison of patients with BPD and healthy control subjects with regard to childhood trauma, parental rearing styles, and familial psychiatric disorders in subject matched by age and sex.

Section snippets

Methods

Sixty-six outpatients with borderline personality disorder (DSM-IV) treated at the Department of Psychiatry and Psychotherapy at the University of Göttingen, the Landeskrankenhaus Göttingen, the Fachkrankenhaus für Psychiatrie und Neurologie Mühlhausen, and the Landeskrankenhaus Moringen, Germany were interviewed personally. Seven patients refused to take part in the study. Diagnoses were confirmed using the SCID (Structured Clinical Interview for DSM-IV; Wittchen et al., 1997), the German

Separation from mother during childhood

The significant differences between the reports of BPD patients and controls are presented in Table 1. Some of these findings lost statistical significance after application of the Bonferroni correction.

In the patient group, hospitalization of the mother during childhood was significantly more frequent. The mean age of the child at the beginning of a lengthy hospitalization of the mother and the duration of hospitalization were higher than in the control group, but these differences were not

Discussion

To our knowledge the present study represents the first comparison of borderline patients and healthy control subjects regarding childhood traumatic life events, parental rearing styles and attitudes, familial factors and birth risk factors. Comparisons with other psychiatric disorders may underestimate the association of these risk factors with BPD. Also, the contrast with a healthy control group allows assessment of the relative contribution of the various risks to the disorder by using

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