The authors compared patients with borderline personality disorder (BPD) with a healthy control group about childhood traumatic life events, parental attitudes, family history of mental illness, and birth risk factors. BPD patients reported more severe traumatic events and childhood traumatic experiences (i.e., sexual abuse, violence, separation from parents). Attitudes towards parents were significantly more negative in BPD patients. BPD patients also reported higher rates of mental illness in their families (i.e., anxiety disorders, depression, suicidality). More reports of premature birth were seen in BPD patients. Familial mental illness, childhood sexual abuse, separation from parents, and poor nurturing styles by parents appeared to be possible factors causing BPD.
Developmental trauma (i.e., incestual childhood sexual abuse, neglect) has consistently been reported at high rates in patients with both BPD and “childhood” BPD. Among various psychological disorders, BPD was most frequently associated with sexual abuse. Family and twin studies support the presence of genetic underpinnings to the disorder. Fetal, peri- or post-natal brain damage may also result in susceptibility to BPD. Brain abnormalities and neuropsychological deficits have been shown in patients with BPD.
The researchers used a DSM-IV structured clinical interview on 66 outpatients with BPD. Patients with severe medical illness and a history of schizophrenia or bipolar disorder were excluded. 109 people without mental illness were used as controls matched with patients for age and sex.
Traumatic childhood events
1. Separation from mother during childhood
Hospitalization of the mother, for longer periods of time, during childhood was more common in the BPD patient group.
2. Separation from father during childhood
In ~25% of the BPD patient group, fathers were imprisoned during childhood. Absence of the father for reasons outside of military service was also higher in this group.
3. Separation from both parents
Significantly more BPD patients reported being raised by people other than their own parents (e.g., aunts) or growing up in a foster home.
4. Parents' marital problems, separation, or divorce
Marital problems and divorce (though not significant) were reported more in BPD patients.
The severity of illnesses of siblings was higher in the control group, but siblings were sicker for longer in the BPD patient group.
6. Childhood illness
More BPD patients reported a major illness that lasted longer during childhood than controls. More and longer-lasting hospitalizations not caused by mental illness were reported more in BPD patients.
7. Physical handicaps
More BPD patients reported being physically handicapped or living with physically handicapped siblings.
8. Social environment
The average social class was higher in the control group and BPD patients reported more unemployment in mothers.
9. Violence in families
Familial, particularly the father beating children or the mother, violence reported significantly more in the BPD patient group.
10. Sexual abuse
Many of the BPD patients reported being sexually molested or abused during childhood, with the average age of it beginning being 6 years old. The childhood sexual abuse (CSA) being penetrative or non-penetrative was much more frequent in the BPD patient group. Most of the sexual abuse was done by a relative or acquaintance. Non-genital CSA occurred at the same rate among men and women (73.7% and 73.9%, respectively), but penetrative CSA was more frequent in women than men (66.7% v. 44%). Only two BPD patients received emotional support from a parent with regard to the abuse.
No particular age periods (0-4, 6-10, or 11-15 years) revealed patterns of traumatic event occurrence.
Parental attitude and rearing styles
Poor styles of nurturing as well as less care and affection from parents were shown by all BPD patients with one exception.
Psychiatric disorders in the family
Anxiety disorders, depression, and suicidality were the most common of reported disorders of first degree relatives of BPD patients. 6 BPD patients also directly reported the presence of “borderline” disorders among a relative. Alcohol abuse by fathers was higher in BPD patients.
Birth risk factors
BPD patients reported more premature birth than controls. There were no statistically significant differences in reports for other birth risk factors (i.e., mother’s age).
Studies comparing similar risk factors for BPD with other psychiatric disorders may result in an underestimation of the relationship between these factors with BPD. Hence, why this study used healthy controls for comparison. This study affirmed the association of BPD with disturbed family environments, as demonstrated by many other studies, but revealed startlingly high reports of childhood sexual abuse. BPD may then be a form of PTSD from sexual traumatization. The method used in this study may have overestimated the frequency of familial mental disorders as researchers used the descriptions of BPD patients who may have had a negatively skewed perspective on family members.