Associations Between Early Life Adversity, Reproduction-Oriented Life Strategy, and Borderline Personality Disorder

Abstract

ImportanceBorderline personality disorder (BPD) is often accompanied by a history of high-risk sexual behavior and somatic comorbidities. Yet, these features are most often considered in isolation and little is known about their underlying developmental pathways. Life history theory, a leading framework in evolutionary developmental biology, can help make sense of the wide range of behaviors and health issues found in BPD.ObjectiveTo examine whether the emergence of BPD is associated with the prioritization of immediate reproductive goals over longer-term somatic maintenance goals, a life strategy that can be viewed as a developmental response to adverse early life experiences, providing rapid reproductive benefits despite costs to health and well-being.Design, Setting, and ParticipantsThis study used cross-sectional data from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions in 2004-2005 (n = 34 653). Civilian, noninstitutionalized individuals in the US, 18 years or older, and those with and without a DSM-IV diagnosis of BPD were included. Analysis took place between August 2020 and June 2021.Main Outcomes and MeasuresStructural equation models were used to examine whether early life adversity was associated with the likelihood of a BPD diagnosis, either directly or indirectly through a life strategy whereby individuals trade somatic maintenance for immediate reproduction.ResultsAnalyses were performed on a sample of 30 149 participants (females: 17 042 [52%]; mean [SE] age, 48.5 [0.09]; males: 12 747 [48%]; mean [SE] age, 47 [0.08]). Of these, 892 (2.7%) had a diagnosis of BPD and 29 257 (97.3%) did not have BPD. Mean early life adversity, metabolic disorder score, and body mass index were significantly higher among participants with a diagnosis of BPD. In an analysis adjusted for age, individuals with BPD reported having significantly more children than those without BPD (b =0.06; SE, 0.01; t = 4.09; P < .001). Having experienced greater levels of adversity in early life was significantly associated with a greater risk of being diagnosed with BPD later in life (direct relative risk = 0.268; SE, 0.067; P < .001). Importantly, this risk was further increased by 56.5% among respondents who prioritized short-term reproductive goals over somatic maintenance (indirect relative risk = 0.565; SE, 0.056; P < .001). Similar patterns of associations were found in male and female individuals.Conclusions and RelevanceThe hypothesis of a reproduction/maintenance life history trade-off mediating the association between early life adversity and BPD helps make sense of the high dimensionality that characterizes the physiological and behavioral correlates of BPD. Additional studies are needed to confirm these results using longitudinal data.

Metabolic trade‐offs in childhood: Exploring the relationship between language development and body growth

“…Current models suggest that factors contributing to adversity vary in nature and do not necessarily correlate with each other (McLaughlin et al., 2021; Ellis et al., 2022) (Figure S2). Such emergent variables have been effectively modelled in prior studies using sums of z‐scored indicators (Baptista et al., 2023; Brumbach et al., 2009; Jacquet et al., 2019; Mell et al., 2018). Moreover, this composite scoring approach inherently assigns greater weight to more dispersed indicators, which represent rarer adverse events.…”

Therapeutic and Preventive Interventions in Adolescents with Borderline Personality Disorder: Recent Findings, Current Challenges, and Future Directions

“…From the study of a sample of more than 30,000 individuals, Baptista et al recently confirmed that early life adversity was significantly higher in participants with BPD [74]. Also, participants with BPD had more children, earlier first sexual intercourse, a history of sexually transmitted disease, a higher BMI, and more metabolic risk factors.…”

Evolutionary Inquiries Into the Origin and Nature of Mental Disorders

“…6 A crucial question for psychiatry is whether the concept of LHT, or its evolutionary psychological derivate, can be meaningfully applied to psychopathological conditions. In JAMA Psychiatry, Baptista and colleagues 7 report findings from a study into putative associations of early life adversity with the likelihood of a fast LHS in borderline personality disorder (BPD). To this end, a large cohort taken from the National Epidemiologic Survey on Alcohol and Related Conditions was examined in terms of indicators of reproduction (ie, number of children, number of marriages, age at first sexual intercourse, and history of sexually transmitted disease) traded against somatic maintenance and body repair (indicated by body mass index, perceived physical health, and metabolic risk factors).…”

“…6 Conversely, seen through the lens of LHT, faster LHS may even be associated with a greater risk of developing psychopathology in a dose-dependent manner but independent of diagnosis. 9 In spite of these limitations, the study of Baptista et al 7 demonstrates that theoretical frameworks, based on evolution by natural and sexual selection, can improve our understanding of the nature of psychopathological conditions. Importantly, LHT can fruitfully add to insights from attachment theory, which to date is the only evolution-based theory that has prevailed in psychiatry.…”