A theoretical and empirical investigation into the relationship among borderline personality disorder, childhood abuse, and posttraumatic stress disorder

Sandra L. Phinney (1992)

This dissertation explores the interaction of borderline personality disorder (BPD), childhood abuse, and posttraumatic stress disorder (PTSD). Although historically BPD has been seen as deriving from developmental problems in separation-rapprochement or from biological deficits, an alternative conceptualization posits childhood abuse as an important etiological factor, and a combination diagnosis of BPD and PTSD as a useful way of understanding symptoms that have been integrated into personality structure. Considering at least a subtype of BPD as a complex traumatic character disorder and giving a combination diagnosis of BPD and PTSD allows more accurate description and more effective treatment. With a BPD diagnosis alone, resolution of the trauma does not occur; with a PTSD diagnosis alone, a rich heritage of theoretical and treatment considerations is ignored. Combining the diagnoses allows the strengths of both to be retained and offsets the negative associations to BPD alone. A combination of theoretical and empirical methods is utilized in an attempt to establish the foundation for the argument presented. The three bodies of knowledge about borderline personality disorder, childhood abuse, and posttraumatic stress disorder are first discussed. An empirical study is then presented that examines questions related to the overall hypotheses. The study compared 54 psychiatric inpatients, BPD and non-BPD, abused and nonabused, PTSD and non-PTSD, in order to differentiate among the groups on variables related to demographics, abuse histories, personality, and pathology. The results showed that in this population patients with BPD have a higher level of childhood abuse than other patients, that abused BPD patients meet criteria for PTSD, and that severity of abuse correlates with the presence of BPD. These findings lend support to the idea of interactive effects of the three factors and reinforce the conceptualization posited. Finally, the implications of an integrated conceptualization combining BPD, childhood abuse, and PTSD on professional and patient perceptions and on treatment is discussed. Giving a central place to the role of childhood abuse in the etiology of BPD and to its resolution in treatment offers new hope for management or recovery for these suffering people.