Development Of Borderline Personality Disorder Research Articles

Childhood trauma, midbrain activation and psychotic symptoms in borderline personality disorder.

Childhood trauma is believed to contribute to the development of borderline personality disorder (BPD), however the mechanism by which childhood trauma increases risk for specific symptoms of the disorder is not well understood. Here, we explore the relationship between childhood trauma, brain activation in response to emotional stimuli and psychotic symptoms in BPD. Twenty individuals with a diagnosis of BPD and 16 healthy controls were recruited to undergo a functional MRI scan, during which they viewed images of faces expressing the emotion of fear. Participants also completed the childhood trauma questionnaire (CTQ) and a structured clinical interview. Between-group differences in brain activation to fearful faces were limited to decreased activation in the BPD group in the right cuneus. However, within the BPD group, there was a significant positive correlation between physical abuse scores on the CTQ and BOLD signal in the midbrain, pulvinar and medial frontal gyrus to fearful (versus neutral) faces. In addition there was a significant correlation between midbrain activation and reported psychotic symptoms in the BPD group (P<0.05). These results show that physical abuse in childhood is, in individuals with BPD, associated with significantly increased activation of a network of brain regions including the midbrain in response to emotional stimuli. Sustained differences in the response of the midbrain to emotional stimuli in individuals with BPD who suffered childhood physical abuse may underlie the vulnerability of these patients to developing psychotic symptoms.

Recent advances in the developmental aspects of borderline personality disorder.

The aim of the current paper was to review the most recent advances in the developmental aspects of borderline personality disorder (BPD) over the last 3years to highlight the most significant trends in the field. In so doing, we identify and discuss two exciting new trends: (a) an emphasis on the biological basis of adolescent BPD and (b) empirical evidence in support of long-held theories of the development of BPD. Together, these trends suggest that for the first time, empirical findings are beginning to emerge in support of complex and reciprocal biology × environment interactions over timein the development of BPD. We discuss the emerging literature and highlight the translational impact of this work for the assessment and intervention of adolescent BPD.

Transgenerational Experiences of Childhood Adversities in the Development of Adolescent Borderline Personality Disorder

Introduction Previous research revealed substantial relations between the experience of childhood adversities and the development of borderline personality disorders (BPD) in adulthood. However, research about antecedents of adolescent BPD is still in its beginnings. Moreover, there is an ongoing controversy regarding transgenerational effects of childhood adversities and potential mediators. Objectives We aim to investigate transgenerational effects of parental childhood experiences on the development of adolescent BPD within the next generation. Hereby, we are focusing on the investigation of differential effects of maternal and paternal experiences of childhood adversities on adolescent BPD and on underlying mechanisms. Methods We consecutively recruited 91 female inpatients ( M age = 15.6 years) from the Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, as well as 87 mothers and 59 fathers. Childhood adversities were assessed for parents and adolescents with the German Childhood Experiences of Care and Abuse Questionnaire, adolescent BPD by means of structured clinical interviews (SKID II). Results Our results are in favor of a transgenerational effect of parental childhood adversities on the development of adolescent BPD. This effect turned out to be stronger for paternal than for maternal childhood adversities. Moreover, paternal childhood adversities revealed to be related to experiences of childhood adversities within the next generation. Conclusions Our results underline the importance of taking the family environment into consideration when developing prevention and treatment programs for adolescent BPD.

A Developmental Psychopathology and Neurobiological Model of Borderline Personality Disorder in Adolescence

The antecedents and risk factors and for developing borderline personality disorder (BPD) are now well documented, but there is a paucity of developmental models to understand the key processes through which they impact on the development of BPD in adolescents. In this article, we present a developmental psychopathology model of BPD in adolescence and link the difficulties adolescents with BPD have with impulsivity and self regulation, with risk factors such as genetic vulnerability, parenting and trauma. We propose a number of psychological processes through which these risk factors undermine personal and interpersonal functioning, and makes it particularly difficult to engage with the challenges of adolescence. These key psychological processes undermine the integration of the self, with extreme unintegrated affects and extreme representations of self and others, undermining the capacity to mentalize. We then make links to possible neurobiological underpinnings of the disturbances in affect, Theory of Mind and interpersonal difficulties in adolescents with BPD.

Effect of maternal autonomy and relatedness and borderline personality disorder on adolescent symptomatology.

Several theories propose a relationship between deficits in autonomy and relatedness and the development of borderline personality disorder (BPD). Empirical work supports relationships between maternal BPD and adolescent symptomatology, as well as between maternal autonomy and relatedness and adolescent symptomatology. However, no study has examined how individuals with BPD differ from normative comparisons on autonomy and relatedness, or whether mothers' BPD mediates the relationship between their autonomy and relatedness and their adolescents' symptomatology. We sampled 28 mothers with BPD and their adolescents aged 14-17 years, as well as 28 normative comparisons matched on demographic variables. We assessed BPD as a categorical diagnosis and along a continuum of self-reported borderline features. In a videotaped problem-solving interaction, controlling for current major depressive disorder, mothers with BPD were less likely to promote and more likely to inhibit relatedness, and they were marginally more likely to inhibit but equally likely to promote autonomy with their adolescents. Mothers' total borderline features mediated the relationship between mothers' promotion of autonomy plus relatedness and adolescent internalizing and externalizing symptoms (anxious depression, withdrawn depression, somatic problems, rule breaking, and aggression) and adolescent borderline features (affective instability and self-harm). Mothers' total borderline features also mediated the relationship between mothers' inhibition of autonomy plus relatedness and adolescent internalizing and externalizing symptoms (anxious depression, withdrawn depression, somatic problems, and aggression but not rule breaking) and adolescent borderline features (affective instability and self-harm). We discuss findings in terms of light shed on BPD and the effect of maternal BPD on adolescent development.

A framework for all seasons: Commentary on the special issue on mentalization in borderline personality disorder.

It is interesting to consider whether impairment in the capacity to mentalize might be a persuasive way to describe the core pathology in most patients with a personality disorder (PD). It has long been recognized that a dimensional approach to understanding PDs is more useful than the traditional categorical diagnostic model. Studies are pointing to an underlying general factor as a latent dimension of borderline personality disorder (BPD), perhaps reflecting shared or common genetic endophenotypes as risk factors for the development of BPD or other PDs. With regard to the focus on mentalizing in particular, however one thinks about impairment in mentalizing as a core reflection of personality pathology, it is helpful to drill down to deeper levels. In these pages, the authors do a remarkable job of unpacking, to the granular level, the many components of mentalization and the attachment process.

Neurobiological Findings in Youth with Borderline Personality Disorder

Abstract This review summarizes recent neurobiological research into youth with borderline personality disorder (BPD) to better delineate the biological factors involved in the development of this disorder. Psychobiological studies when BPD first becomes manifest are of particular interest, because there are fewer confounding factors (e.g., duration of illness, drug abuse, medication, other therapeutic interventions) at this time. This article focuses on recent findings in the field of neuroimaging, neuropsychology, neuroendocrinology, genetics, and pain perception, and it aims to integrate these findings in a developmental psychopathology model of BPD. In studies of clinical samples of adults with BPD, structural imaging studies revealed abnormalities predominantly in the frontolimbic areas. Disturbances in emotional information processing—particularly involving negative stimuli—may mediate affective dysregulation as a core feature of BPD. Genetic studies could reveal that the stability of BPD traits in youth is largely influenced by a combination of genetic and non-shared environmental factors. Hyporesponsiveness to a laboratory stressor indicates an enduring alteration of the hypothalamic–pituitary–adrenal axis. Findings of a higher pain threshold indicate that pain processing is already disturbed during the early stages of BPD, which could contribute to the initiation or maintenance of self-injurious behavior. All biological factors, together with environmental risk factors, may contribute to the core symptoms of BPD: severe emotional and behavioral dysregulation. Further research should investigate the development of BPD in youth by using longitudinal designs to determine whether the neurobiological factors are a cause, an effect, or an epiphenomenon of BPD.

The Interaction between Rejection Sensitivity and Emotional Maltreatment in Borderline Personality Disorder

Background: Borderline personality disorder (BPD) is a prevalent psychiatric disorder associated with significant distress, dysfunction, and treatment utilization. Though, theoretically, BPD is posited to arise from a combination of trait and environmental risk factors, few studies have tested trait-by-environment interactions in BPD. We investigated the roles of rejection sensitivity (RS) and childhood emotional neglect and abuse (ENA) as well as their interaction in BPD. Sampling and Methods: Eighty-five adults with a lifetime mood disorder who were recruited for outpatient studies in a psychiatric clinic were assessed for ENA using the Childhood Trauma Questionnaire and for RS with the Adult Rejection Sensitivity Questionnaire. BPD diagnoses were made by consensus using data collected on the Structured Clinical Interview for DSM-IV. Hierarchical logistic regression was used to test associations between RS, ENA, their interaction and BPD. Results: RS and ENA interacted to predict co-occurring BPD in our sample of mood-disordered patients, with the strength of the relationship between RS and BPD depending on the severity of ENA. In the context of little or no ENA, RS and BPD were more strongly related than when ENA was more severe. Conclusions: Our results extend previous findings suggesting RS and ENA are risk factors for BPD. They also provide preliminary support for contemporary theories of BPD positing trait-by-environment interactions in the development of BPD. Prospective studies are needed to confirm these findings.

Adolescent precursors of adult borderline personality pathology in a high-risk community sample.

Longitudinal studies of the exact environmental conditions and personal attributes contributing to the development of borderline personality disorder (BPD) are rare. Furthermore, existing research typically examines risk factors in isolation, limiting our knowledge of the relative effect sizes of different risk factors and how they act in concert to bring about borderline personality pathology. The present study investigated the prospective effects of diverse acute and chronic stressors, proband psychopathology, and maternal psychopathology on BPD features in a high-risk community sample (N = 700) of youth followed from mid-adolescence to young adulthood. Multivariate analyses revealed significant effects of maternal externalizing disorder history, offspring internalizing disorder history, family stressors, and school-related stressors on BPD risk. Contrary to expectations, no interactions between chronically stressful environmental conditions and personal characteristics in predicting borderline personality features were detected. Implications of these findings for etiological theories of BPD and early screening efforts are discussed.

Prospective associations between prenatal adversities and borderline personality disorder at 11-12 years.

The aetiological pathways to borderline personality disorder (BPD) remain only partly elucidated. Retrospective research indicates that prenatal adversity may be an important early risk factor in the development of BPD. This requires corroboration with prospective longitudinal studies. A community sample of 6050 mothers and their children (born between April 1991 and December 1992) were assessed. Maternal anxiety and depression and maternal alcohol and tobacco consumption were assessed during pregnancy (18 and 32 weeks gestation). Postnatal risks, including maladaptive parenting (suboptimal parenting and parent conflict), family adversity, maternal anxiety and depression and maternal alcohol and tobacco consumption, were assessed during early childhood. Internalizing and externalizing symptoms were assessed in late childhood. Trained psychologists interviewed children in late childhood to ascertain the presence of BPD (at least five probable/definite symptoms). In unadjusted analyses, all prenatal risk factors (i.e., maternal alcohol and tobacco consumption and maternal anxiety and depression) were significantly associated with BPD. Following adjustment for sex, birthweight and postnatal exposure to anxiety and depression respectively, maladaptive parenting, family adversity and child's internalizing and externalizing symptoms, prenatal anxiety at 18 weeks gestation [odds ratio (OR) 1.57, 95% confidence interval (CI) 1.18-2.09] and depression at 18 weeks (OR 1.59, 95% CI 1.08-2.32) and 32 weeks (OR 1.57, 95% CI 1.14-2.18) gestation remained significantly associated with BPD. This study provides prospective evidence of associations between prenatal adversities and BPD at 11-12 years. Prenatal anxiety and depression were independently associated with BPD, suggesting that they may exert direct effects on BPD during the prenatal period. This highlights the importance of programmes to reduce maternal stress during pregnancy.

Beliefs about unmet interpersonal needs mediate the relation between conflictual family relations and borderline personality features in young adult females.

BackgroundCentral to most theories of borderline personality disorder (BPD) is the notion that the family environment interacts with genetically-based vulnerabilities to influence the development of BPD, with particular attention given to risk conferred by conflictual familial relations. However, the extent to which family conflict may relate to the development of BPD via related interpersonal beliefs is currently unknown. This study sought to test the hypothesis that the concurrent relation between conflictual family relations and borderline features in female college students is explained by beliefs associated with real or perceived unmet interpersonal needs (captured by Joiner’s [2005] Interpersonal Psychological Theory, specifically thwarted belongingness and perceived burdensomeness).MethodThe sample included 267 female undergraduates ages 18–25 years (M = 20.86; SD = 1.80). Level of borderline personality features, unmet interpersonal needs, and family conflict were assessed.ResultsBivariate analyses revealed significant relations between both thwarted belongingness and perceived burdensomeness, conflictual family relations, and borderline features. Multivariate analyses revealed that thwarted belongingness and perceived burdensomeness both mediated the relation between family conflict and borderline personality features, thus supporting a multiple mediation model.ConclusionsThis cross-sectional study is a preliminary step towards confirming the broad theoretical hypothesis that conflictual family relations relate to beliefs about thwarted belongingness and perceived burdensomeness, which, in turn, relate to borderline personality pathology. Limitations and areas of future research are discussed.

Severity of borderline personality symptoms in adolescence: relationship with maternal parenting stress, maternal psychopathology, and rearing styles.

The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress has not been examined in this group. The current study examined 101 adolescents (14-19 years old) with BPD symptoms and their mothers. Assessments were made on severity of BPD symptoms, youth-perceived maternal rearing styles, and psychopathology and parenting stress in mothers. Multiple regression analyses were used to examine potential predictors of borderline severity. No correlation was found between severity of BPD symptoms in adolescents and parenting stress. Only youth-perceived maternal overprotection was significantly related to BPD severity. The combination of perceived maternal rejection with cluster B traits in mothers was significantly related to BPD severity in adolescents. This study provides a contribution to the disentanglement of the developmental pathways that lead to BPD.

Borderline personality features in childhood: the role of subtype, developmental timing, and chronicity of child maltreatment.

Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing, and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, had higher scores on each individual subscale, and were more likely to be identified as at high risk for development of BPD through raised scores on all four subscales. Chronicity of maltreatment predicted higher overall borderline feature scores, and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed.

The Impact of Self-Reported Childhood Trauma on Emotion Regulation in Borderline Personality Disorder and Major Depression

Early life stress is said to play a critical role in the development of borderline personality disorder (BPD) and major depressive disorder (MDD), but the underlying mediating factors remain uncertain. This study aimed to investigate self-reported childhood trauma, emotion regulation difficulties, and their associations in a sample of BPD (n = 49) and MDD (n = 48) patients and healthy control participants (n = 63). Multiple regressions were used to evaluate the impact of the quality and severity of self-reported childhood trauma on self-reported emotion regulation. The results supported an association between self-reported maltreatment experiences, especially emotional abuse and neglect, and emotion regulation difficulties. Additional analyses showed that emotion regulation difficulties influence the association between self-reported emotional abuse and acute symptomatology in the BPD subgroup. Emotion regulation difficulties may be 1 pathway through which early life stress, particularly emotional abuse, increases the risk for developing BPD symptomatology.

An Investigation of the Biosocial Model of Borderline Personality Disorder

We sought to test the Biosocial Theory of borderline personality disorder (BPD) that posits that borderline traits are due to emotional dysregulation, caused by the interaction between childhood emotional vulnerability and invaliding parenting. A total of 250 adults (76% female, median age = 32.06 years) from a nonclinical population completed self-report measures assessing current levels of borderline traits and emotional dysregulation. They also completed retrospective measures of childhood emotional vulnerability and parental invalidation. Invalidating parenting and emotional vulnerability independently predicted emotion dysregulation, but an interaction effect was not found. Having experienced validating parenting was found to be a protective factor for developing borderline traits but was not significantly related to emotional dysregulation. Data in this sample did not support the underlying genesis of BPD proposed by the Biosocial Theory and a model that more parsimoniously explains the development of BPD is proposed.

EPA-0900 – The role of attachment in the development of borderline personality disorder

Introduction Insecure attachment and the inability to identify emotions are seen as possible explanations for dysfunction of the emotional system in borderline personality disorder. There is a strong association between Borderline personality disorder and insecure attachment, and the attachment types that are most characteristic of these subjects are unresolved, preoccupied, and fearful. Previous studies have demonstrated that insecure attachment patterns, a trait disposition toward negative affect and impulsivity are associated with borderline personality disorder features. Aims This review aims to identify the relationship between attachment pattern during childhood and the development of borderline personality disorder in adulthood. Conclusion The high prevalence and severity of insecure attachments found in these subjects support the central role of disturbed interpersonal relationships in clinical theories of Borderline Personality disorder.

Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment.

Persistent problems in emotional regulation and interpersonal relationships in borderline patients can be understood as developing from difficulties in early dyadic regulation with primary caregivers. Early attachment patterns are a relevant causal factor in the development of Borderline Personality Disorder (BPD).Links between attachment issues, early history of neglect, and traumatic experiences, and symptoms observed in patients with BPD as per the DSM-5 classification (American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-5 (Fifth ed.). Washington, D.C; (2013)) are described in this article, while delineating possible pathways from attachment disruptions to the specific symptomatology of these patients. The theory of structural dissociation of the personality (TSDP) provides an essential framework for understanding the processes that may lead from insecure early attachment to the development and maintenance of BPD symptoms.Dyadic parent–child interactions and subsequent modulation of emotion in the child and future adult are considered closely related, but other factors in the development of BPD, such as genetic predisposition and traumatic experiences, should also be considered in conceptualizing and organizing clinical approaches based on a view of BPD as a heterogeneous disorder.

Application of EMDR Therapy for Borderline Personality Disorder

There is a growing interest in the use of eye movement desensitization and reprocessing (EMDR) therapy beyond posttraumatic stress disorder (PTSD) where its application is well established. With strong scholarly consensus that early traumatic and adverse life experiences contribute to the development of borderline personality disorder (BPD), EMDR would appear to offer much to the treatment of persons with BPD. However, given the specific characteristics of these clients, the application of EMDR therapy to their treatment can be challenging and necessitates several minor adaptations of the standard EMDR procedures for PTSD. This article provides an orientation to principles and strategies for safely and effectively preparing clients with BPD for EMDR therapy and for accessing and reprocessing the traumatic origins of BPD. Clinical examples are provided throughout.

Childhood adversity and borderline personality disorder

This article explores recent research in the field of childhood exposure to trauma and the development of borderline personality disorder in adolescence. Adolescence is a critical period of development. Exposure to trauma, specifically sexual abuse, prior to and during puberty has specific implications for personality development and heightens risk for borderline personality disorder. Elevated symptom levels in adolescence are likely to decline across adulthood, but social and vocational impairments remain. Impulsivity, difficulties in emotion regulation, and suicidality may characterize adolescent expression of borderline personality disorder, whereas negative affect and functional impairment are more stable features of the disorder. Preliminary findings in treatment models for adults have potential for benefit among adolescence. Further research is required to examine treatment effectiveness and efficiency. Greater attention to low-income and middle-income nations, which are disproportionately affected by adversity, is needed to determine cross-cultural validity and the impact of trauma in adolescent populations.

EPA-0151 – Study of the relationship between attachment styles and symptoms of borderline personality disorder: study on non-clinical samples

Many psychotic and personality disorders of children are the result of deprivation of maternal care or lack of reliability of a child with the attached individual. Since attachment problems are one of the features of borderline personality disorder, this study aims at studying the relationship between attachment styles and symptoms of borderline personality disorder in non-clinical samples. The present study was conducted as a survey and it was descriptive. Therefore, a sample of 300 individuals were randomly selected and tested. Participants responded to adult attachment styles and symptoms of borderline personality questionnaire. The data were analyzed using one way analysis of variance. The results revealed that people with avoidant attachment styles compared to those with secure attachment and ambivalent insecure attachment style got the highest score in borderline personality disorder symptoms. The results obtained in this study are somewhat consistent with this idea that environmental factors such as attachment styles have an important role in the development of borderline personality disorder also these findings are in accordance with with previous research in clinical samples and in line with the theory of attachment styles in borderline personality disorder are debatable.