Self-reported impulsivity in women with borderline personality disorder: the role of childhood maltreatment severity and emotion regulation difficulties

Abstract

Background Childhood maltreatment, such as severe emotional, physical, and sexual abuse and neglect, has been linked to impulse control problems and dysfunctional emotional coping. In borderline personality disorder (BPD), a history of childhood maltreatment may worsen difficulties in emotion regulation, which may in turn give rise to impulsive behaviours. The aim of this self-report study was to investigate associations between childhood maltreatment severity, emotion regulation difficulties, and impulsivity in women with BPD compared to healthy and clinical controls. Methods Sixty-one female patients with BPD, 57 clinical controls (CC, women with Attention Deficit Hyperactivity Disorder and/or Substance Use Disorder, without BPD), and 60 female healthy controls (HC) completed self-report scales on childhood trauma (Childhood Trauma Questionnaire, CTQ), difficulties in emotion regulation (Difficulties in Emotion Regulation Scale, DERS), and impulsivity (UPPS Impulsive Behaviour Scale). A conditional process analysis was performed to investigate whether emotion dysregulation statistically mediated the effect of childhood maltreatment severity on impulsivity depending on group (BPD vs. CC vs. HC). Results Childhood maltreatment, particularly emotional maltreatment, was positively associated with impulsivity and emotion regulation difficulties across all groups. Difficulties in emotion regulation statistically mediated the effect of childhood maltreatment on impulsivity in BPD, but not in the other groups. Conclusion In the context of current conceptualizations of BPD and previous research, findings suggest that problems with emotion regulation may be related to a history of childhood maltreatment, which may in turn enhance impulsivity. Targeting emotion dysregulation in psychotherapy and discussing it in relation to childhood maltreatment can help decreasing impulsive behaviors in individuals with BPD. Given the correlational design of our study which does not allow causal conclusions, future studies have to employ prospective, experimental designs and include larger sample sizes to corroborate associations between childhood maltreatment, emotion dysregulation, and impulsivity. Electronic supplementary material The online version of this article (10.1186/s40479-019-0101-8) contains supplementary material, which is available to authorized users.

The role of environmental influences in the complex relationship between borderline personality disorder and attention-deficit/hyperactivity disorder: review of recent findings

“…These results indicate that, although severe forms of childhood maltreatment are present in multiple psychiatric disorders [32], there may be differences in prevalence even between disorders with very similar phenotypes such as BPD and ADHD. These results invite the question of whether the type of childhood trauma that has been associated with the development of BPD [5,21,33] may also increase the risk of this disorder in patients with childhood ADHD.…”

“…Therefore, even with the limited evidence available, it seems that the experience of emotional abuse in children diagnosed with ADHD may be a mediating factor that increases the risk of subsequent development of BPD in adulthood. ED has been indicated as a mediator between a history of childhood maltreatment and high impulsivity in women with BPD but not in ADHD [21]. Previously, the mediating effect of ED had been described in the relationship between childhood ADHD and adult BPD in a sample of adult women diagnosed with BPD [34].…”

“…The most widely studied environmental variables as possible etiological factors of psychiatric disorders are childhood maltreatment, especially in Personality Disorders (PD) [20]. In the specific case of BPD, the experience of traumatic events in childhood, especially those that can compromise emotional maturation, has been considered as a predisposing factor for the later expression of ED and impulsivity, which are considered relevant clinical components of BPD [5,21]. The relevance of childhood traumas in the development of ADHD is minor and has been associated mainly with cases that manifest ED [4,22].…”

Kindheitstraumatisierungen bei Patienten mit Borderline-Persönlichkeitsstörung

“…Missbrauch und Vernachlässigung stellen jedoch nicht nur generelle Risikofaktoren für die BPS dar, sondern wirken sich auch ungünstig auf die Symptomschwere und das Ausmaß an Komorbidität aus (McFetridge et al 2015;Quenneville et al 2020;Martín-Blanco et al 2014). Gerade Impulsivität und Schwierigkeiten in der Emotions-regulation als Kernmerkmale der BPS scheinen besonders eng mit Erfahrungen von emotionalen Misshandlungsformen in Kindheit und Jugend assoziiert zu sein (Quenneville et al 2020;Krause-Utz et al 2019;Martín-Blanco et al 2014). Allerdings bestätigen nicht alle Studien einen Zusammenhang zwischen Kindheitstraumatisierungen und Ausmaß der BPS-Symptomatik (Bungert et al 2015).…”

The Mediating Role of Impulsivity in the Relationship Between Suicidal Behavior and Early Traumatic Experiences in Depressed Subjects

“…Conversely, with regard to personality features, it has been shown that poor emotional regulation strategies, poor emotional cognition, behavioral impulsivity, and self-criticism the increase risk of suicidal behaviors ( 14 – 16 ). More specifically, it has been proposed that childhood trauma may constitute an environmental risk factor for the development of impulsivity and SA in patients with depression ( 17 ), with data suggesting that childhood trauma could be related with problems in emotion regulation, which may in turn enhance impulsivity ( 18 ). However, the evidence suggests that impulsivity traits are part of a developmental cascade that increases suicide risk in a subset of suicide (not all suicides are associated with impulsive-aggressive behaviors) ( 19 , 20 ), impulsivity being one of the most accepted endophenotypes when studying suicidal behavior ( 21 ).…”