Specific type of childhood trauma and borderline personality disorder in Chinese patients

The impact of types of childhood maltreatment on the severity of PTSD and comorbid personality disorder symptoms

Background: Childhood maltreatment is associated with various psychiatric disorders, including post-traumatic stress disorder (PTSD) and personality disorders (PDs). Previous research has suggested that PTSD and PD are highly comorbid. However, the impact of different types of childhood maltreatment on the severity of PTSD and PD symptoms in a clinical population with PTSD/PD symptoms remains unclear.Objective: We aimed to clarify the role of (a) the overall severity and (b) the severity of subtypes of childhood maltreatment on the severity of (a) PTSD and (b) comorbid PD symptoms.Methods: Data was collected from participants (N = 197) seeking treatment for PTSD with comorbid PD symptoms at a trauma expertise centre in the Netherlands. We assessed childhood maltreatment using the Childhood Trauma Questionnaire-short form (CTQ-sf), PTSD severity with the Clinician-administered PTSD Scale for DSM-5 (CAPS-5), and PD severity with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Data were analyzed using linear and Poisson regression.Results: We found that emotional neglect was the most prevalent form of childhood maltreatment (80.7%), followed by emotional abuse (72.6%). Sexual and emotional abuse shared independent associations with the severity of PTSD. The overall maltreatment severity and emotional abuse were significantly associated with the severity of comorbid borderline PD symptoms. Sexual abuse was significantly associated with the severity of comorbid avoidant PD symptoms. None of the childhood maltreatment types were significantly associated with the severity of comorbid obsessive-compulsive PD symptoms.Conclusions: We demonstrated the relationship between childhood sexual and emotional abuse and PTSD severity in people with PTSD and comorbid PD symptoms. This has important implications since emotional abuse usually does not fulfil the A-criterion required for the diagnosis of PTSD. We recommend routinely assessing emotional abuse in trauma- and PD treatment, and investigating the effectiveness of adapting trauma treatment for emotional abuse.Trial registration: ClinicalTrials.gov identifier: NCT03833453.

The mediating role of the parietal-prefrontal white matter network between trauma experience and anxiety symptoms in individuals with borderline personality disorder: Findings from neuroimaging studies

BACKGROUND

Borderline personality disorder (BPD) is linked to impairments in white matter (WM) integrity, with traumatic experiences (TE) playing a key role in its development. As TE can affect brain structure, this study examined the parietal-prefrontal WM pathway, focusing on the superior longitudinal fasciculus (SLF), the longest association bundle, to explore WM integrity impairments and their link to BPD symptoms.

METHODOLOGY

The study included 90 women (47 with BPD, 43 healthy controls). Participants underwent psychopathology assessments and diffusion tensor imaging (DTI) to measure WM integrity. Mean fractional anisotropy (FA) values were calculated for SLF subdivisions (SLF I, II, III). BPD symptoms were evaluated using the Five-Factor Borderline Inventory.

RESULTS

Healthy controls showed significantly higher FA in the left SLF I and a trend toward higher FA in the left SLF III compared to BPD. Left SLF I FA mediated the link between trauma (e.g., sexual harassment, emotional/physical abuse) and BPD symptoms (despondence, fragility). Left SLF III FA mediated the relationship between sexual harassment and anxious uncertainty.

CONCLUSION

The SLF mediates the impact of TE on anxiety and depression in BPD, highlighting neurobiological mechanisms and potential research directions.

Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study

Introduction

This study investigates age-related differences in Borderline Personality Disorder (BPD) traits and childhood maltreatment (CM) experiences among adolescents, young adults, and older adults within a clinical sample.

Methods

A cross-sectional design was employed, involving 2029 outpatients aged 15-50 years from the Shanghai Mental Health Center. BPD traits were assessed using the Personality Diagnostic Questionnaire 4th Edition Plus (PDQ-4+), and CM experiences were evaluated using the Child Trauma Questionnaire Short Form (CTQ-SF). Participants were categorized into three age groups: adolescents (15-21 years), young adults (22-30 years), and older adults (31-50 years).

Results

Adolescents reported significantly higher frequencies of BPD traits and diagnoses compared to young adults and older adults (p=0.036). Specifically, identity disturbance and impulsivity were more pronounced in adolescents (p<0.001). Additionally, adolescents reported higher levels of emotional (F=15.987, p<0.001) and physical abuse (F=12.942, p=0.002), while older adults reported higher levels of emotional and physical neglect. Logistic regression analysis identified key BPD criteria and CM subtypes that differentiated adolescents from adults.

Discussion

The findings underscore the importance of age-specific interventions in treating BPD and addressing childhood maltreatment. Adolescents exhibit distinct patterns of BPD traits and CM experiences, necessitating tailored therapeutic approaches.

Personality disorders and their association with adverse childhood events

PURPOSE OF REVIEW

Theoretical models of personality disorders (PDs) highlight the role of adverse childhood experiences (ACEs) in the development and maintenance of personality pathology. This review presents recent studies on the associations between childhood adversity and PDs, while discussing mechanisms and factors that impact these relationships.

RECENT FINDINGS

Studies point to small to moderate associations between childhood adversity and cluster A, cluster B, and cluster C PDs, and some research suggests that childhood adversity could be a predictor for the onset and development of personality pathology. Most research focuses on borderline PD, while research on other PDs is limited. Some mechanisms that explain these associations have been proposed, with the literature investigating emotion dysregulation, dissociation, avoidance, or psychosocial dysfunction as mediators.

SUMMARY

The consistent associations between ACEs and PDs seems to point that childhood adversity could be a transdiagnostic risk factor for PDs, but research warrants further prospective investigations for causal conclusions, and calls for future research to investigate potential mediators and moderators more thoroughly.

Structural Equation Modeling of Childhood Trauma and Self-Stigma in Adult Inpatients with Borderline Personality Disorder

Purpose

Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic.

Patients and Methods

This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements - the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire - Short Form, the Clinical Global Impression - Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses.

Results

Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability.

Conclusion

Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.

The association between borderline personality disorder, childhood trauma, neuroticism, and self-rated or clinician-rated functional impairment in euthymic bipolar disorder-1 patients

Introduction

In this study, we mainly evaluated the associations of borderline personality disorder (BPD), neuroticism, and childhood trauma with the self-rated and clinician-rated overall functional impairment levels of adult euthymic patients with bipolar disorder-1 (BD-1). In addition, we compared patient and healthy control groups regarding the levels of of childhood trauma, neuroticism, BPD and functional impairment.

Methods

In total, 90 euthymic BD-1 patients and 90 healthy controls were enrolled. The Childhood Trauma Questionnaire-Short Form, the neuroticism subscale of the Eysenck Personality Questionnaire Revised-Abbreviated Form, the Borderline Personality Questionnaire, the Functioning Assessment Short Test, and the Sheehan Disability Scale were administered to the participants.

Results

The study revealed that the levels of BPD, neuroticism, emotional abuse, physical abuse, global childhood trauma, self-rated overall functional impairment, all the subdomains of self-rated functional impairment, clinician-rated overall functional impairment, and all the subdomains of clinician-rated functional impairment (except leisure time) were significantly higher in the patients than those in the healthy controls (p < 0.05). Clinician-rated functional impairment levels were significantly correlated with levels of BPD (r = 0.555, p<0.001), neuroticism (r = 0.429, p < 0.001), global childhood trauma (r = 0.391, p <0.001), and all subtypes of childhood trauma except sexual abuse. Self-rated functional impairment levels were significantly correlated with levels of neuroticism (r= 0.289, p = 0.006), physical neglect (r = 0.213, p = 0.044), and BPD (r = 0.557, p < 0.001). In the regression analyses, the self-rated overall functional impairment levels were only significantly associated with the BPD feature levels (β = 0.319, p < 0.001) and the clinician-rated overall functional impairment levels were only significantly associated with the BPD feature levels (β = 0.518, p < 0.001).

Conclusion

The present study's findings suggest that BPD features should be addressed in psychosocial interventions aimed at ameliorating functional impairment in patients with BD-1. Only BPD features were associated with self-rated and clinician-rated overall functional impairment levels in the regression analyses in the BD-1 patients. Performing self-rated and clinician-rated functional impairment assessments in the same clinical trial may give rise to relevant findings in the future.

Underdiagnosis of Posttraumatic Stress Disorder Among Outpatients With Personality Disorders in Clinical Practice Despite the Use of a Diagnostic Instrument

While existing literature suggests that posttraumatic stress disorder (PTSD) is frequently undetected in routine clinical practice, the detection rate of PTSD in patients with a personality disorder (PD) has not been investigated. This study examined the point prevalence of PTSD and frequency of trauma-focused treatment in 204 outpatients with a PD. Data were derived from electronic patient files. Compared to the mean weighted prevalence of PTSD in the literature, the Mini International Neuropsychiatric Interview Plus (MINI-Plus) found lower rates of PTSD for the entire sample (29.2%), but not separately for patients with borderline PD (BPD; 33.3%) and patients with other PDs (26.9%). In addition, PTSD diagnoses following intake were less prevalent for PD patients overall (18.6%), BPD patients (27%), and patients with other PDs (13.8%). The present study provides preliminary evidence that PTSD might be underdiagnosed and consequently unmanaged in PD patients in clinical practice, suggesting that the recognition of PTSD among patients with PD needs improvement.

Sex Differences in Personality Disorder and Childhood Maltreatment of Patients with Schizophrenia

Introduction

Despite numerous studies investigating personality disorder (PD) and childhood maltreatment (CM) characteristics in individuals with schizophrenia (SZ), there remains a scarcity of research focusing on sex differences in PD and CM within large samples of SZ patients.

Methods

A total of 592 participants (257 males, 335 females) were consecutively sampled from patients diagnosed with SZ at the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. PDs were assessed using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were evaluated using the Chinese version of the Child Trauma Questionnaire Short Form.

Results

Male patients exhibited a prominent self-reported trait of antisocial PD (t=1.972, p=0.049), while female patients demonstrated a notable emphasis on histrionic PD traits (t=-2.057, p=0.040). Structured interviews for PD diagnoses further indicated a higher comorbidity of schizotypal (χ2=4.805, p=0.028) and schizoid (χ2=6.957, p=0.008) PDs among male patients compared to female patients. Additionally, male patients reported a higher degree (t=2.957, p=0.003) and proportion (χ2=5.277, p=0.022) of experiences of physical abuse in their self-reported CM. Logistic regression analyses highlight distinct factors: higher antisocial PD traits and physical abuse are associated with male patients, while histrionic PD traits and emotional abuse are associated with female patients.

Discussion

These findings underscore the importance of recognizing and addressing sex-specific manifestations of personality pathology and the nuanced impact of CM in the clinical management of individuals with SZ. The study advocates for tailored interventions that consider the distinct needs associated with sex differences in both personality traits and CM experiences among SZ patients.

Childhood maltreatment and personality disorders in adolescents and adults with psychotic or non-psychotic disorders

Introduction

While the attention to personality disorders (PD) and childhood maltreatment (CM) has grown in recent years, there remains limited understanding of the prevalence and distinctions of PD and CM in clinical populations of Chinese adolescents in comparison to adults.

Methods

A total of 1,417 participants were consecutively sampled from patients diagnosed with either psychotic or non-psychotic disorders in the psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. The participants were categorized into two groups based on their age: adolescents (aged 15-21 years) and adults (aged 22-35 years). PDs were evaluated using a self-reported personality diagnostic questionnaire and a structured clinical interview, while CMs were assessed using the Chinese version of the Child Trauma Questionnaire Short Form.

Results

When comparing self-reported PD traits and CM between adolescents and adults, differences emerge. Adolescents, particularly in the psychotic disorder group, exhibit more pronounced schizotypal PD traits (p=0.029), and this pattern extends to non-psychotic disorders (p<0.001). Adolescents in the non-psychotic disorder group also report higher levels of emotional abuse (p=0.014), with a notable trend in physical abuse experiences compared to adults (p=0.057). Furthermore, the most prevalent PDs in the clinical sample are avoidant, borderline, and obsessive-compulsive PDs. Among patients with psychotic disorders, adolescents exhibit higher rates of schizoid, schizotypal, and obsessive-compulsive PDs compared to adults. Logistic regression analyses highlight distinct predictors for psychotic and non-psychotic disorders in adolescents and adults.

Discussion

The findings emphasize distinct differences in PDs and CMs between adolescent and adult groups, shedding light on their potential roles in psychotic and non-psychotic disorders.

The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults

OBJECTIVE

The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults.

METHOD

This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder.

RESULTS

The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores.

CONCLUSION

This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.

Adverse childhood experiences in patients with schizophrenia: related factors and clinical implications

The relationship between adverse childhood experiences (ACEs) and the development of psychotic symptoms is not well understood. Therefore, this study aimed to investigate the frequency and distribution of ACEs among patients with schizophrenia and their potential correlation with symptomatology and personality pathology. We conducted a cross-sectional study involving 571 patients with schizophrenia in Shanghai, China. Symptomatology was assessed using the Positive and Negative Symptoms Scale (PANSS) and personality pathology was assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). ACEs were assessed using the Child Trauma Questionnaire-Short Form (CTQ-SF). ACEs were highly prevalent, with 80.8% of the patients with schizophrenia reporting at least one ACE. The three most common types of ACE were physical neglect (69.8%), emotional neglect (28.2%), and emotional abuse (22.9%). For specific ACE, emotional abuse was significantly associated with PD traits, whereas emotional and physical neglect types of ACE was significantly associated with negative symptoms. A higher level of physical abuse was more commonly reported by men, younger individuals, and those with a higher level of antisocial PD traits. Higher levels of physical neglect were associated with more severe negative symptoms. ACEs are commonly observed in patients with schizophrenia. Therefore, it is strongly recommended that this clinical population be provided with a comprehensive assessment and individualized intervention for those exposed to specific ACEs.