Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T07:19:48.945Z Has data issue: false hasContentIssue false
  • English
  • Français

Abuse and Neglect in Childhood: Relationship to Personality Disorder Diagnoses

Published online by Cambridge University Press:  07 November 2014

Linda M. Bierer ,
Rachel Yehuda ,
James Schmeidler ,
Vivian Mitropoulou ,
Antonia S. New ,
Jeremy M. Silverman  and
Larry J. Siever
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Childhood history of abuse and neglect has been associated with personality disorders and has been observed in subjects with lifetime histories of suicidality and self-injury. Most of these findings have been generated from inpatient clinical samples.

Methods:

This study evaluated self-rated indices of sustained childhood abuse and neglect in an outpatient sample of well-characterized personality disorder subjects (n=182) to determine the relative associations of childhood trauma indices to specific personality disorder diagnoses or clusters and to lifetime history of suicide attempts or gestures. Subjects met criteria for ~2.5 Axis II diagnoses and 24% reported past suicide attempts. The Childhood Trauma Questionnaire was administered to assess five dimensions of childhood trauma exposure (emotional, physical, and sexual abuse, and emotional and physical neglect). Logistic regression was employed to evaluate salient predictors among the trauma measures for each cluster, personality disorder, and history of attempted suicide and self-harm. All analyses controlled for gender distribution.

Results:

Seventy-eight percent of subjects met dichotomous criteria for some form of childhood trauma; a majority reported emotional abuse and neglect. The dichotomized criterion for global trauma severity was predictive of cluster B, borderline, and antisocial personality disorder diagnoses. Trauma scores were positively associated with cluster A, negatively with cluster C, but were not significantly associated with cluster B diagnoses. Among the specific diagnoses comprising cluster A, paranoid disorder alone was predicted by sexual, physical, and emotional abuse. Within cluster B, only antisocial personality disorder showed significant associations with trauma scores, with specific prediction by sexual and physical abuse. For borderline personality disorder, there were gender interactions for individual predictors, with emotional abuse being the only significant trauma predictor, and only in men. History of suicide gestures was associated with emotional abuse in the entire sample and in women only; self-mutilatory behavior was associated with emotional abuse in men.

Conclusion:

These results suggest that childhood emotional abuse and neglect are broadly represented among personality disorders, and associated with indices of clinical severity among patients with borderline personality disorder. Childhood sexual and physical abuse are highlighted as predictors of both paranoid and antisocial personality disorders. These results help qualify prior observations of the association of childhood sexual abuse with borderline personality disorder.

Type
Original Research
Information
CNS Spectrums , Volume 8 , Issue 10: Personality Disorders , October 2003 , pp. 737 - 754
Copyright
Copyright © Cambridge University Press 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Cole, PM, Putnam, FW. Effect of incest on self and social functioning: a developmental psychopathology perspective. J Consult Clin Psychol. 1992;60:174–184.CrossRefGoogle ScholarPubMed
2.Johnson, JG, Cohen, P, Brown, J, Smailes, EM, Bernstein, DP. Childhood maltreatment increases risk for personality disorders during early adulthood. Arch Gen Psychiatry. 1999;56:600–606.CrossRefGoogle ScholarPubMed
3.Herman, JL, Perry, JC, van der Kolk, BA. Childhood trauma in borderline personality disorder. Am J Psychiatry. 1989; 146:490–495.Google ScholarPubMed
4.Zanarini, MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am. 2000;23:89–101.CrossRefGoogle ScholarPubMed
5.Raczek, SW. Childhood abuse and personality disorders. J Personal Disord. 1992;6:109–116.CrossRefGoogle Scholar
6.Luntz, BA, Widom, CS. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry. 1994;151:670–674.Google ScholarPubMed
7.MacMillan, HL, Fleming, JE, Streiner, DL, et al.Childhood abuse and lifetime psychopathology in a community sample. Am J Psychiatry. 2001;158:1878–1883.CrossRefGoogle Scholar
8.Zanarini, MC. Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am. 2000;23:89–101.CrossRefGoogle ScholarPubMed
9.Beitchman, JH, Zucker, KJ, Hood, JE, daCosta, GA, Akman, D, Cassavia, E. A review of the long-term effects of child sexual abuse. Child Abuse Negl. 1992;16:101–118.CrossRefGoogle ScholarPubMed
10.Ross-Gower, J, Waller, G, Tyson, M, Elliott, P. Reported sexual abuse and subsequent psychopathology among women attending psychology clinics: the mediating role of dissociation. Br J Clin Psychol. 1998;37(pt 3):313–326.CrossRefGoogle ScholarPubMed
11.Zanarini, MC, Yong, L, Frankenburg, FR, et al.Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis. 2002;190:381–387.CrossRefGoogle ScholarPubMed
12.Shea, MT, Zlotnick, C, Weisberg, RB. Commonality and specificity of personality disorder profiles in subjects with trauma histories. J Personal Disord. 1999;13:199–210.CrossRefGoogle ScholarPubMed
13.Carter, JD, Joyce, PR, Mulder, RT, Luty, SE. The contribution of temperament, childhood neglect, and abuse to the development of personality dysfunction: a comparison of three models. J Personal Disord. 2001;15:123–135.CrossRefGoogle Scholar
14.Rorty, M, Yager, J. Histories of childhood trauma and complex post-traumatic sequelae in women with eating disorders. Psychiatr Clin North Am. 1996;19:773–891.CrossRefGoogle ScholarPubMed
15.van der Kolk, BA, Perry, JC, Herman, JL. Childhood origins of self-destructive behavior. Am J Psychiatry. 1991;148:1665–1671.Google ScholarPubMed
16.Santa Mina, EE, Gallop, RM. Childhood sexual and physical abuse and adult self-harm and suicidal behavior: a literature review. Can J Psychiatry. 1998;43:793–800.CrossRefGoogle ScholarPubMed
17.Kessler, RC, Borges, G, Walters, EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Study. Arch Gen Psychiatry. 1999;56:617–626.CrossRefGoogle Scholar
18.Brown, GR, Anderson, B. Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry. 1991;14:55–61.Google Scholar
19.Silverman, AB, Reinherz, HZ, Giaconia, RM. The long term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996;20:709–723.CrossRefGoogle Scholar
20.Koenigsberg, HW, Anwunah, I, New, AS, Mitropoulou, V, Schopick, F, Sierver, L. Relationship between depression and borderline personality disorder. Depress Anxiety. 1999;10:158–167.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
21.Lipschitz, DS, Lipschitz, DS, Winegar, RK, et al.Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients. J Nerv Ment Dis. 1999;187:32–39.CrossRefGoogle ScholarPubMed
22.Brodsky, BS, Oquendo, M, Ellis, SP, Haas, GL, Malone, KM, Mann, JJ. The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry. 2001;158:1871–1877.CrossRefGoogle ScholarPubMed
23.Kaslow, NJ, Thompson, MP, Brooks, AE, Twomey, HE. Ratings of family functioning of suicidal and non-suicidal African-American women. J Fam Psych. 2000;14:585–599.CrossRefGoogle Scholar
24.Bernstein, DP, Fink, L, Handelsman, L, et al.Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1995;15:1132–1136.Google Scholar
25.Johnson, JG, Smailes, EM, Cohen, P, Brown, J, Bernstein, DP. Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study. J Personal Disord. 2000;14:171–187.CrossRefGoogle ScholarPubMed
26.Bifulco, A, Moran, PM, Ball, C, et al.Childhood adversity, parental vulnerability and disorder: examining inter-generational transmission of risk. J Child Psychol Psychiatry. 2002;43:1075–1086.CrossRefGoogle ScholarPubMed
27.Zweig-Frank, H, Paris, J. Predictors of outcome in a 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2002;43:103–107.CrossRefGoogle Scholar
28.Weissmann, M, Wind, T, Silvern, L. Parenting and family stress as mediators of the long-term effects of child abuse. Child Abuse Negl. 1994;18:439–453.Google Scholar
29.Pris, J, Zueig-Frank, H. A critical review of the role of childhood sexual abuse in the etiology of borderline personality disorder. Can J Psych. 1992;37:125–128.CrossRefGoogle Scholar
30.Bernstein, DP, Stein, JA, Newcomb, MD, et al.Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27:169–190.CrossRefGoogle ScholarPubMed
31.Spitzer, RL, Williams, JB, Gibbon, M, First, MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992;49:624–629.CrossRefGoogle ScholarPubMed
32.Pfohl, B, Blum, N, Zimmerman, M. A Structured Interview for the DSM-III-R Personality Disorders. Iowa City, Iowa: University of Iowa Press; 1989.Google Scholar
33.Bernstein, DP, Kasapis, C, Bergman, A, et al.Assessing axis II disorders by informant interview. J Personal Disord. 1997;11:158–167.CrossRefGoogle ScholarPubMed
34.Bernstein, DP, Stein, JA, Newcomb, MD, et al.Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27:169–190.CrossRefGoogle ScholarPubMed
35.Bernstein, DP, Fink, L. Childhood Trauma Questionnaire: A Retrospective Self-Report. San Antonio, Tex: Psychological Corp.; 1989.Google Scholar
36.Bernstein, DP, Ahluvalia, T, Pogge, D, Handelsman, L. Validity of the Childhood Trauma Questionnaire in an adolescent psychiatric population. J Am Acad Child Adolesc Psychiatry. 1997;36:340–348.CrossRefGoogle Scholar
37.Fink, LA, Bernstein, D, Handelsman, L, Foote, J, Lovejoy, M. Initial reliability and validity of the childhood trauma interview: a new multidimensional measure of childhood interpersonal trauma. Am J Psychiatry. 1995;152:1329–1335.Google ScholarPubMed
38.New, AS, Trestman, RL, Mitropoulou, V, Benishay, DS, Coccaro, EF, Siever, LJ. Serotonergic function and self-injurious behavior in personality disorder patients. Psychiatry Res. 1997;69:17–26.CrossRefGoogle ScholarPubMed
39.Bernstein, DP, Stein, JA, Handelsman, L. Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment. Addict Behav. 1998;23:855–868.CrossRefGoogle ScholarPubMed
40.Modestin, J, Oberson, B, Erni, T. Possible antecedents of DSM-III-R personality disorders. Acta Psychiatr Scand. 1998;97:260–266.CrossRefGoogle ScholarPubMed
41.Fossati, A, Madeddu, F, Maffei, C. Borderline personality disorder and childhood sexual abuse: a meta-analytic study. J Personal Disord. 1999;13:268–280.CrossRefGoogle ScholarPubMed
42.Weaver, TL, Clum, GA. Early family environments and traumatic experiences associated with borderline personality disorder. J Consult Clin Psychol. 1993;61:1068–1075.CrossRefGoogle ScholarPubMed
43.Ellason, JW, Ross, CA, Sainton, K, Mayran, LW. Axis I and II comorbidity and childhood trauma history in chemical dependency. Bull Menninger Clinic. 1996:60;39–51.Google ScholarPubMed
44.Cohen, P, Brown, J, Smailes, E. Child abuse and neglect and the development of mental disorders in the general population. Develop Psychopathol. 2001;13;981–999.CrossRefGoogle ScholarPubMed