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Prenatal adversity: a risk factor in borderline personality disorder?

Published online by Cambridge University Press:  10 December 2012

C. E. Schwarze ,
A. Mobascher ,
B. Pallasch ,
G. Hoppe ,
M. Kurz ,
D. H. Hellhammer  and
K. Lieb
C. E. Schwarze*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany Department of Clinical and Physiological Psychology, University of Trier, Germany
A. Mobascher
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
B. Pallasch
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
G. Hoppe
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
M. Kurz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
D. H. Hellhammer
Affiliation:
Department of Clinical and Physiological Psychology, University of Trier, Germany
K. Lieb
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
*
*Address for correspondence: Dr C. E. Schwarze, Ph.D., University Medical Center Mainz, Department of Psychiatry and Psychotherapy, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany. (Email: [email protected])
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Abstract

Background

Patients with borderline personality disorder (BPD) show a high prevalence of early adversity, such as childhood trauma. It has also been reported that prenatal adverse conditions, such as prenatal maternal stress, drug taking, tobacco smoking or medical complications, may be associated with an increased risk of mental disorders in the offspring. Prenatal adversity is investigated here for the first time as a potential risk factor in the diagnosis of BPD.

Method

A total of 100 patients with a DSM-IV diagnosis of BPD and 100 matched healthy controls underwent semi-structured interviews about the course of pregnancy, maternal stressors, birth complications and childhood trauma. Further information was obtained from the participants' mothers and from prenatal medical records.

Results

Borderline patients were significantly more often exposed to adverse intrauterine conditions, such as prenatal tobacco exposure (p=0.004), medical complications (p=0.008), prenatal maternal traumatic stress (p=0.015), familial conflicts (p=0.004), low social support (p=0.004) and partnership problems during pregnancy (p=0.014). Logistic regression analyses revealed that the reported prenatal risk factors accounted for 25.7% of the variance in BPD. Prenatal tobacco exposure [odds ratio (OR) 3.37, 95% confidence interval (CI) 1.49–7.65, p=0.004] and medical complications (OR 2.87, 95% CI 1.29–6.38, p=0.010) emerged as important predictors. After controlling for childhood adversity and parental socio-economic status (SES), prenatal risk factors predicted relevant borderline subdomains, such as impulsivity, affective instability, identity disturbance, dissociation and severity of borderline symptoms.

Conclusions

This study provides evidence of an association between prenatal adversity and the diagnosis of BPD. Our findings suggest that prenatal adversity may constitute a potential risk factor in the pathogenesis of BPD.

Keywords

Borderline personality disorderetiologyprenatal adversityprenatal maternal stressprenatal tobacco exposure.
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 6 , June 2013 , pp. 1279 - 1291
Copyright
Copyright © Cambridge University Press 2012 

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Arntz, A, van den Hoorn, M, Cornelis, J, Verheul, R, van den Bosch, WM, de Bie, AJ (2003). Reliability and validity of the borderline personality disorder severity index. Journal of Personality Disorders 17, 45–59.CrossRefGoogle ScholarPubMed
Bandelow, B, Krause, J, Wedekind, D, Broocks, A, Hajak, G, Ruther, E (2005). Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Research 134, 169–179.CrossRefGoogle ScholarPubMed
Barker, DJ (2004). The developmental origins of well-being. Philosophical Transactions of the Royal Society B: Biological Sciences 359, 1359–1366.CrossRefGoogle ScholarPubMed
Beauducel, A, Strobel, A, Brocke, B (2003). Psychometric properties and norms of a German version of the Sensation Seeking Scales, Form V [in German]. Diagnostica 49, 61–72.CrossRefGoogle Scholar
Beblo, T, Driessen, M, Mertens, M, Wingenfeld, K, Piefke, M, Rullkoetter, N, Silva-Saavedra, A, Mensebach, C, Reddemann, L, Rau, H, Markowitsch, HJ, Wulff, H, Lange, W, Berea, C, Ollech, I, Woermann, FG (2006). Functional MRI correlates of the recall of unresolved life events in borderline personality disorder. Psychological Medicine 36, 845–856.CrossRefGoogle ScholarPubMed
Bergman, K, Sarkar, P, O'Connor, TG, Modi, N, Glover, V (2007). Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1454–1463.CrossRefGoogle ScholarPubMed
Berlin, HA, Rolls, ET, Iversen, SD (2005). Borderline personality disorder, impulsivity, and the orbitofrontal cortex. American Journal of Psychiatry 162, 2360–2373.CrossRefGoogle ScholarPubMed
Bohus, M, Limberger, MF, Frank, U, Sender, I, Gratwohl, T, Stieglitz, RD (2001). Development of the Borderline Symptom List [in German]. Psychotherapie, Psychosomatik, medizinische Psychologie 51, 201–211.CrossRefGoogle ScholarPubMed
Brand, SR, Engel, SM, Canfield, RL, Yehuda, R (2006). The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant. Annals of the New York Academy of Sciences 1071, 454–458.CrossRefGoogle ScholarPubMed
Buss, C, Davis, EP, Shahbaba, B, Pruessner, JC, Head, K, Sandman, CA (2012). Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proceedings of the National Academy of Sciences USA 109, 1312–1319.CrossRefGoogle ScholarPubMed
Cottrell, EC, Seckl, JR (2009). Prenatal stress, glucocorticoids and the programming of adult disease. Frontiers in Behavioral Neuroscience 3, 19.CrossRefGoogle ScholarPubMed
de Weerth, C, van Hees, Y, Buitelaar, JK (2003). Prenatal maternal cortisol levels and infant behavior during the first 5 months. Early Human Development 74, 139–151.CrossRefGoogle ScholarPubMed
Distel, MA, Trull, TJ, Derom, CA, Thiery, EW, Grimmer, MA, Martin, NG, Willemsen, G, Boomsma, DI (2008). Heritability of borderline personality disorder features is similar across three countries. Psychological Medicine 38, 1219–1229.CrossRefGoogle ScholarPubMed
Ekblad, M, Gissler, M, Lehtonen, L, Korkeila, J (2010). Prenatal smoking exposure and the risk of psychiatric morbidity into young adulthood. Archives of General Psychiatry 67, 841–849.CrossRefGoogle ScholarPubMed
El Marroun, H, Jaddoe, VW, Hudziak, JJ, Roza, SJ, Steegers, EA, Hofman, A, Verhulst, FC, White, TJ, Stricker, BH, Tiemeier, H (2012). Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Archives of General Psychiatry 69, 706–714.CrossRefGoogle ScholarPubMed
Froehlich, TE, Lanphear, BP, Auinger, P, Hornung, R, Epstein, JN, Braun, J, Kahn, RS (2009). Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics 124, e1054–e1063.CrossRefGoogle ScholarPubMed
Harris, A, Seckl, J (2011). Glucocorticoids, prenatal stress and the programming of disease. Hormones and Behavior 59, 279–289.CrossRefGoogle ScholarPubMed
Harvey, PD, Greenberg, BR, Serper, MR (1989). The affective lability scales: development, reliability, and validity. Journal of Clinical Psychology 45, 786–793.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Heath, CJ, King, SL, Gotti, C, Marks, MJ, Picciotto, MR (2010). Cortico-thalamic connectivity is vulnerable to nicotine exposure during early postnatal development through alpha4/beta2/alpha5 nicotinic acetylcholine receptors. Neuropsychopharmacology 35, 2324–2338.CrossRefGoogle ScholarPubMed
Hellhammer, D, Hellhammer, J (eds) (2008). Stress. The Brain-Body Connection. Key Issues in Mental Health. Karger: Basel.Google Scholar
Hellhammer, D, Hero, T, Gerhards, F, Hellhammer, J (2012). Neuropattern: a new translational tool to detect and treat stress pathology I. Strategical consideration. Stress. Published online: 10 January 2012. doi:10.3109/10253890.2011.644604.CrossRefGoogle ScholarPubMed
Huijbregts, SC, van Berkel, SR, Swaab-Barneveld, H, van Goozen, SH (2011). Neurobiological and behavioral stress reactivity in children prenatally exposed to tobacco. Psychoneuroendocrinology 36, 913–918.CrossRefGoogle ScholarPubMed
Hultman, CM, Torrang, A, Tuvblad, C, Cnattingius, S, Larsson, JO, Lichtenstein, P (2007). Birth weight and attention-deficit/hyperactivity symptoms in childhood and early adolescence: a prospective Swedish twin study. Journal of the American Academy of Child and Adolescent Psychiatry 46, 370–377.CrossRefGoogle ScholarPubMed
Jacobsen, LK, Picciotto, MR, Heath, CJ, Frost, SJ, Tsou, KA, Dwan, RA, Jackowski, MP, Constable, RT, Mencl, WE (2007). Prenatal and adolescent exposure to tobacco smoke modulates the development of white matter microstructure. Journal of Neuroscience 27, 13491–13498.CrossRefGoogle ScholarPubMed
Jaspers, M, de Meer, G, Verhulst, FC, Ormel, J, Reijneveld, SA (2010). Limited validity of parental recall on pregnancy, birth, and early childhood at child age 10 years. Journal of Clinical Epidemiology 63, 185–191.CrossRefGoogle ScholarPubMed
Koenigsberg, HW, Fan, J, Ochsner, KN, Liu, X, Guise, KG, Pizzarello, S, Dorantes, C, Guerreri, S, Tecuta, L, Goodman, M, New, A, Siever, LJ (2009). Neural correlates of the use of psychological distancing to regulate responses to negative social cues: a study of patients with borderline personality disorder. Biological Psychiatry 66, 854–863.CrossRefGoogle ScholarPubMed
Leichsenring, F, Leibing, E, Kruse, J, New, AS, Leweke, F (2011). Borderline personality disorder. Lancet 377, 74–84.CrossRefGoogle ScholarPubMed
Lieb, K, Rexhausen, JE, Kahl, KG, Schweiger, U, Philipsen, A, Hellhammer, DH, Bohus, M (2004 a). Increased diurnal salivary cortisol in women with borderline personality disorder. Journal of Psychiatric Research 38, 559–565.CrossRefGoogle ScholarPubMed
Lieb, K, Zanarini, MC, Schmahl, C, Linehan, MM, Bohus, M (2004 b). Borderline personality disorder. Lancet 364, 453–461.CrossRefGoogle ScholarPubMed
Linnet, KM, Dalsgaard, S, Obel, C, Wisborg, K, Henriksen, TB, Rodriguez, A, Kotimaa, A, Moilanen, I, Thomsen, PH, Olsen, J, Jarvelin, MR (2003). Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. American Journal of Psychiatry 160, 1028–1040.CrossRefGoogle ScholarPubMed
Lobbestael, J, Arntz, A, Bernstein, DP (2010). Disentangling the relationship between different types of childhood maltreatment and personality disorders. Journal of Personality Disorders 24, 285–295.CrossRefGoogle ScholarPubMed
Lupien, SJ, McEwen, BS, Gunnar, MR, Heim, C (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience 10, 434–445.CrossRefGoogle ScholarPubMed
McGowan, PO, Sasaki, A, D'Alessio, AC, Dymov, S, Labonte, B, Szyf, M, Turecki, G, Meaney, MJ (2009). Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nature Neuroscience 12, 342–348.CrossRefGoogle ScholarPubMed
Minzenberg, MJ, Fan, J, New, AS, Tang, CY, Siever, LJ (2007). Fronto-limbic dysfunction in response to facial emotion in borderline personality disorder: an event-related fMRI study. Psychiatry Research 155, 231–243.CrossRefGoogle ScholarPubMed
Murgatroyd, C, Patchev, AV, Wu, Y, Micale, V, Bockmuhl, Y, Fischer, D, Holsboer, F, Wotjak, CT, Almeida, OF, Spengler, D (2009). Dynamic DNA methylation programs persistent adverse effects of early-life stress. Nature Neuroscience 12, 1559–1566.CrossRefGoogle ScholarPubMed
Nosarti, C, Reichenberg, A, Murray, RM, Cnattingius, S, Lambe, MP, Yin, L, Maccabe, J, Rifkin, L, Hultman, CM (2012). Preterm birth and psychiatric disorders in young adult life. Archives of General Psychiatry 1, 610–617.Google Scholar
Oberlander, TF, Weinberg, J, Papsdorf, M, Grunau, R, Misri, S, Devlin, AM (2008). Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses. Epigenetics 3, 97–106.CrossRefGoogle ScholarPubMed
Paus, T, Nawazkhan, I, Leonard, G, Perron, M, Pike, GB, Pitiot, A, Richer, L, Veillette, S, Pausova, Z (2008). Corpus callosum in adolescent offspring exposed prenatally to maternal cigarette smoking. NeuroImage 40, 435–441.CrossRefGoogle ScholarPubMed
Pawlby, S, Hay, D, Sharp, D, Waters, CS, Pariante, CM (2011). Antenatal depression and offspring psychopathology: the influence of childhood maltreatment. British Journal of Psychiatry 199, 106–112.CrossRefGoogle ScholarPubMed
Philipsen, A (2006). Differential diagnosis and comorbidity of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults. European Archives of Psychiatry and Clinical Neuroscience 256 (Suppl. 1), i42–i46.CrossRefGoogle ScholarPubMed
Phillips, DI (2007). Programming of the stress response: a fundamental mechanism underlying the long-term effects of the fetal environment? Journal of Internal Medicine 261, 453–460.CrossRefGoogle ScholarPubMed
Plant, DT, Barker, ED, Waters, CS, Pawlby, S, Pariante, CM (2012). Intergenerational transmission of maltreatment and psychopathology: the role of antenatal depression. Psychological Medicine 14, 1–10.Google Scholar
Radtke, KM, Ruf, M, Gunter, HM, Dohrmann, K, Schauer, M, Meyer, A, Elbert, T (2011). Transgenerational impact of intimate partner violence on methylation in the promoter of the glucocorticoid receptor. Translational Psychiatry 1, 1–6.CrossRefGoogle ScholarPubMed
Ruckinger, S, Rzehak, P, Chen, CM, Sausenthaler, S, Koletzko, S, Bauer, CP, Hoffmann, U, Kramer, U, Berdel, D, von Berg, A, Bayer, O, Wichmann, HE, von Kries, R, Heinrich, J (2010). Prenatal and postnatal tobacco exposure and behavioral problems in 10-year-old children: results from the GINI-plus prospective birth cohort study. Environmental Health Perspectives 118, 150–154.CrossRefGoogle ScholarPubMed
Rusch, N, Weber, M, Il'yasov, KA, Lieb, K, Ebert, D, Hennig, J, van Elst, LT (2007). Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder. NeuroImage 35, 738–747.CrossRefGoogle ScholarPubMed
Schlotz, W, Phillips, DI (2009). Fetal origins of mental health: evidence and mechanisms. Brain, Behavior, and Immunity 23, 905–916.CrossRefGoogle ScholarPubMed
Schmahl, C, Bremner, JD (2006). Neuroimaging in borderline personality disorder. Journal of Psychiatric Research 40, 419–427.CrossRefGoogle ScholarPubMed
Schmidt, RE, Gay, P, d'Acremont, M, Van der Linden, M (2008). A German adaptation of the UPPS Impulsive Behavior Scale: psychometric properties and factor structure. Swiss Journal of Psychology 67, 107–112.CrossRefGoogle Scholar
Seckl, JR, Holmes, MC (2007). Mechanisms of disease: glucocorticoids, their placental metabolism and fetal ‘programming’ of adult pathophysiology. Nature Clinical Practice. Endocrinology and Metabolism 3, 479–488.CrossRefGoogle ScholarPubMed
Slotkin, TA, MacKillop, EA, Rudder, CL, Ryde, IT, Tate, CA, Seidler, FJ (2007). Permanent, sex-selective effects of prenatal or adolescent nicotine exposure, separately or sequentially, in rat brain regions: indices of cholinergic and serotonergic synaptic function, cell signaling, and neural cell number and size at 6 months of age. Neuropsychopharmacology 32, 1082–1097.CrossRefGoogle ScholarPubMed
Soloff, PH & Millward, JW (1983). Developmental histories of borderline patients. Comprehensive Psychiatry 24, 574–588.CrossRefGoogle ScholarPubMed
Spitzer, C, Stieglitz, RD, Freyberger, HJ (2004). Questionnaire for Dissociative Symptoms. Manual for the short and long form (FDS-20 and FDS). Huber: Göttingen.Google Scholar
Swanson, JD, Wadhwa, PM (2008). Developmental origins of child mental health disorders. Journal of Child Psychology and Psychiatry 49, 1009–1019.CrossRefGoogle ScholarPubMed
Tebartz van Elst, L, Hesslinger, B, Thiel, T, Geiger, E, Haegele, K, Lemieux, L, Lieb, K, Bohus, M, Hennig, J, Ebert, D (2003). Frontolimbic brain abnormalities in patients with borderline personality disorder: a volumetric magnetic resonance imaging study. Biological Psychiatry 54, 163–171.CrossRefGoogle ScholarPubMed
Thapar, A, Harold, G, Rice, F, Ge, X, Boivin, J, Hay, D, van den Bree, M, Lewis, A (2007). Do intrauterine or genetic influences explain the foetal origins of chronic disease? A novel experimental method for disentangling effects. BMC Medical Research Methodology 7, 25.CrossRefGoogle ScholarPubMed
Torgersen, S, Czajkowski, N, Jacobson, K, Reichborn-Kjennerud, T, Roysamb, E, Neale, MC, Kendler, KS (2008). Dimensional representations of DSM-IV cluster B personality disorders in a population-based sample of Norwegian twins: a multivariate study. Psychological Medicine 38, 1617–1625.CrossRefGoogle Scholar
Toledo-Rodriguez, M, Lotfipour, S, Leonard, G, Perron, M, Richer, L, Veillette, S, Pausova, Z, Paus, T (2010). Maternal smoking during pregnancy is associated with epigenetic modifications of the brain-derived neurotrophic factor-6 exon in adolescent offspring. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 153B, 1350–1354.CrossRefGoogle ScholarPubMed
Toro, R, Leonard, G, Lerner, JV, Lerner, RM, Perron, M, Pike, GB, Richer, L, Veillette, S, Pausova, Z, Paus, T (2008). Prenatal exposure to maternal cigarette smoking and the adolescent cerebral cortex. Neuropsychopharmacology 33, 1019–1027.CrossRefGoogle ScholarPubMed
Van den Bergh, BR, Mulder, EJ, Mennes, M, Glover, V (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neuroscience and Biobehavioral Reviews 29, 237–258.CrossRefGoogle ScholarPubMed
van Os, J, Wichers, M, Danckaerts, M, Van Gestel, S, Derom, C, Vlietinck, R (2001). A prospective twin study of birth weight discordance and child problem behavior. Biological Psychiatry 50, 593–599.Google ScholarPubMed
Weaver, IC, Cervoni, N, Champagne, FA, D'Alessio, AC, Sharma, S, Seckl, JR, Dymov, S, Szyf, M, Meaney, MJ (2004). Epigenetic programming by maternal behavior. Nature Neuroscience 7, 847–854.CrossRefGoogle ScholarPubMed
Welberg, LA, Seckl, JR, Holmes, MC (2000). Inhibition of 11beta-hydroxysteroid dehydrogenase, the foeto-placental barrier to maternal glucocorticoids, permanently programs amygdala GR mRNA expression and anxiety-like behaviour in the offspring. European Journal of Neuroscience 12, 1047–1054.CrossRefGoogle ScholarPubMed
Weniger, G, Lange, C, Sachsse, U, Irle, E (2009). Reduced amygdala and hippocampus size in trauma-exposed women with borderline personality disorder and without posttraumatic stress disorder. Journal of Psychiatry and Neuroscience 34, 383–388.Google ScholarPubMed
Wilkinson-Ryan, T, Westen, D (2000). Identity disturbance in borderline personality disorder: an empirical investigation. American Journal of Psychiatry 157, 528–541.CrossRefGoogle ScholarPubMed
Wittchen, HU, Zaudig, M, Fydrich, T (2007). Structured Clinical Interview for DSM-IV [in German]. Hogrefe: Göttingen.Google Scholar
Wurmser, H, Rieger, M, Domogalla, C, Kahnt, A, Buchwald, J, Kowatsch, M, Kuehnert, N, Buske-Kirschbaum, A, Papousek, M, Pirke, KM, von Voss, H (2006). Association between life stress during pregnancy and infant crying in the first six months postpartum: a prospective longitudinal study. Early Human Development 82, 341–349.CrossRefGoogle ScholarPubMed
Zanarini, MC, Gunderson, JG, Marino, MF, Schwartz, EO, Frankenburg, FR (1989). Childhood experiences of borderline patients. Comprehensive Psychiatry 30, 18–25.CrossRefGoogle ScholarPubMed
Zanarini, MC, Williams, AA, Lewis, RE, Reich, RB, Vera, SC, Marino, MF, Levin, A, Yong, L, Frankenburg, FR (1997). Reported pathological childhood experiences associated with the development of borderline personality disorder. American Journal of Psychiatry 154, 1101–1106.Google ScholarPubMed
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