The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective

Abstract

The role of childhood trauma in the development of borderline personality disorder (BPD) in young age has long been studied. The most accurate theoretical models are multifactorial, taking into account a range of factors, including early trauma, to explain evolutionary pathways of BPD. We reviewed studies published on PubMed in the last 20 years to evaluate whether different types of childhood trauma, like sexual and physical abuse and neglect, increase the risk and shape the clinical picture of BPD. BPD as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders). In such cases it tends to have a prolonged course, to be severe, and treatment-refractory. In comparison with subjects who suffer from other personality disorders, patients with BPD experience childhood abuse more frequently. Adverse childhood experiences affect different biological systems (HPA axis, neurotransmission mechanisms, endogenous opioid systems, gray matter volume, white matter connectivity), with changes persisting into adulthood. A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect).

Childhood trauma in bipolar disorder: new targets for future interventions

“…There is ongoing debate about the nosological status and boundaries between bipolar disorder and borderline personality disorder (BPD). Given that childhood trauma is common among both disorders, and affective instability is also a core feature of BPD, 9 targeting of affective instability may also be part of early interventions for BPD.…”

Does contemporary Western culture play a role in mental disorders?

“…Instead, clinical practice is focused on psychopharmacology, which probably mitigates the biological response to the stress produced by subjective suffering (32). Mental disorders can be related to the stress caused by our social relationships, cultural values, and collective beliefs, which could affect both typical and neurodiverse subjects (33)(34)(35)(36)(37)(38).…”

Dissociation, trauma, and borderline personality disorder

“…The severity of dissociation is correlated to the severity of traumatic experiences [ 23 , 28 , 29 ]. While trauma is an important risk factor for the etiology of BPD in individuals with genetic, temperamental neurobiological vulnerabilities [ 51 – 55 ], non-trauma related pathways are also involved [ 56 , 57 ]. Dissociation in BPD is closely linked to emotion dysregulation, disturbed identity, and relationship problems.…”