Research

PREVALENCE

BPD affects 2% of the general population ^[1]

15-20% of inpatients have BPD and 10% of psychiatric outpatients have BPD ^[1]

75% diagnosed with BPD are women ^[1]

QUOTES

‘Borderline personality disorder is a hurtful label for real suffering – time we changed it’.

Professor Jayashri Kulkarni – Professor of Psychiatry at the Monash Alfred Psychiatry Research Centre, Melbourne Australia.

‘Borderline Personality Disorder is unfairly discriminated against, and doesn’t get the attention that it deserves’.

Professor Andrew Chanen – Deputy Director, Research and Head, Personality Disorder Research at Orygen, Melbourne Australia.

‘Borderline Personality Disorder is a treatable condition. It is a myth that BPD is untreatable’.

A/Professor Sathya Rao Executive Clinical Director at Spectrum, Personality Disorder Service for Victoria, Eastern Health, Melbourne Australia.

CHILDHOOD TRAUMA PREVALENCE IN BORDERLINE PERSONALITY DISORDER

Herman, Perry & Van Der Kolk (1989) interviewed 21 people with BPD 81% gave histories of trauma, including physical abuse 71%, sexual abuse 68%, and witnessing serious domestic violence 62%.^[2]
Ogata (1990) interviewed 24 people with BPD and found 71% had experienced childhood sexual abuse and 42% had experienced physical childhood abuse.^[3]
A large scale study conducted by McFetridge (2015) found of 214 women admitted to hospital with BPD, 75% had previously reported a history of childhood sexual abuse.^[4]
In a study conducted by Paris (1997) of 135 people with BPD, 70% of females and 45% reported childhood sexual abuse.^[5]
Zanarini (1997) found of the 358 patients with borderline personality disorder studied, 91% reported having been abused, and 92% reported having been neglected.^[6]
Sack (2013) found in a study of 136 people with BPD that when including neglect and emotional violence as trauma categories, an extremely high prevalence of lifetime traumatic experiences was reported 96%. Experiences of sexual violence were reported by 48% for female and 28% of all male patients. Severe forms of physical violence were reported by 65% of all patients.^[7]
In a study of 33 people with BPD, Kingdon (2010) reported higher rates of childhood trauma, especially emotional abuse.^[8]
Graybar and Boutilier (2002) reviewed the empirical literature on BPD and various childhood traumas. They concluded that the reported rates of physical, sexual, and verbal abuse and neglect among people with BPD ranged from 60–80%.^[9]
Goodman and Yehuda (2002) reviewed a number of empirical studies and concluded that the frequency of the overall rate of childhood sexual abuse among BPD patients ranged from 40–70%.^[10]
In a large scale longitudinal study, Battle (2004) found 73% of people with BPD had experienced childhood abuse and 82% has experienced neglect.^[11]

BPD AND PTSD COMORBIDITY:

In a large scale data analysis by Pagura (2010) conducted on individuals with BPD, 30.2% were also diagnosed with PTSD.^[12]
Out of 100 people diagnosed with BPD, Greyner (2009) found 52 met the criteria for PTSD.^[13]
In a study conducted by Zanarini (2004), 58% of people diagnosed with BPD also met the criteria for PTSD.^[14]
Famularo (1991) evaluated 19 children ages 7 to 14 who had recently been clinically diagnosed as having BPD. 78.9% of these children reported significant traumatic experiences, with 36.8% fitting criteria for PTSD.^[15]
Sack (2013) found in a study of 136 people with BPD an overlap between BPD and PTSD at 79%.^[16]

EVIDENCED BASED TREATMENT FOR BPD:

Dialectical-Behavioral Therapy (DBT)
Mentalization-Based Therapy (MBT)
General Psychiatric Management(GMT)
Transference Focused Therapy (TFT)
Schema-Focused Therapy (SFT)
Cognitive Analytic Therapy (CAT)
Supportive Psychotherapy (SP)
Systems Training for Emotional Predictability and Problem Solving (STEPPS)
Cognitive Behaviour Therapy (CBT)
Acceptance and Commitment therapy (ACT)^[17]

SELF HARM and SUICIDE IN BPD:

Nock & Prinstein (2004) interviewed 89 people who self harmed and found the main reported reasons to be: to stop bad feelings, to punish themselves, to relieve feeling numb and empty and to feel something, even if it was pain.^[18]
75% of people with BPD attempt suicide and approximately 10% commit suicide.^[19]
Self-injury (cutting, burning, bruising, head-banging, biting) is seen in 75% of people with BPD.^[20]

SUBSTANCE ADDICTIONS AND BPD:

Alcohol and drug use is common among among people with BPD, with between 21 – 81% reporting a co-occurring substance use disorder.^[21]

PHYSICAL DISORDERS ASSOCIATED WITH BPD:

Driessen (2000) studied 21 female patients with BPD and a similar group of healthy controls. The people with BPD had nearly 16% smaller volumes of the hippocampus and 8% smaller volumes of the amygdala than the healthy controls.^[22]
Roberts (1996) found that survivors of childhood sexual abuse are more likely to suffer from: insomnia, gastrointestinal problems, obesity, chronic pain, headache, and somatization.^[23]
A study by Golding (2000) evaluated the prevalence and correlates of sexual abuse history among women seeking treatment for severe premenstrual syndrome (PMS). Out of 42 women interviewed, 95% reported a history of sexual abuse.^[24]

REMISSION

Zanarini’s study (2006) found 242 out of 290 people with BPD 88% went into remission (no longer meeting the criteria for BPD).^[25]
Gunderson’s study (2011) found 148 out of 175 people 85% with BPD remitted.^[26]

REFERENCES

[1]

Kaehler, L & Freyd, J, “Borderline Personality Characteristics: A Betrayal Trauma Approach”, Psychological Trauma: Theory, Research, Practice, and Policy 2009, Vol. 1, No. 4, 261–268.

[2]

Herman, J. Perry, J & Van Der Kolk, B., “Childhood Trauma in Borderline Personality Disorder”, American Journal of Psychiatry. 1989 Apr;146(4):490-5.

[3]

Ogata, S, Silk, K, Goodrich, S, Lohr, N, Westen, D & Hill, D., “Childhood sexual and physical abuse in adult patients with Borderline Personality Disorder”, American Journal of Psychiatry, Aug 1990 ;147(8):1008-13.

[4]

McFetridge, M, Milner, R Victoria, G, & Liat, L., “Borderline personality disorder: patterns of self-harm, reported childhood trauma and clinical outcome”, British Journal of Psychiatry Open Jul 2015, 1 (1) 18-20; DOI: 10.1192/bjpo.bp.115.000117.

[5]

Paris, J. 1997, “Childhood Trauma as an Etiological Factor in the Personality Disorders”, Journal of personality disorders, vol. 11, no. 1, pp. 34-49.

[6]

Zanarini, M.C., Williams, A.A., Lewis, R.E., R, B.R. & al, e. 1997, “Reported pathological childhood experiences associated with the development of borderline personality disorder”, The American Journal of Psychiatry, vol. 154, no. 8, pp. 1101-6.

[7]

Sack, M, Sachsse, U & Overkamo, B, Dulz, B., “Trauma-related disorders in patients with borderline personality disorders. Results of a multicenter study: Nervenarzt. 2013 May;84(5):608-14. doi: 10.1007/s00115-012-3489-6.

[8]

Kingdon DG, Ashcroft K, Bhandari B, Gleeson S, Warikoo N, Symons M, Taylor L, Lucas E, Mahendra R, Ghosh S, Mason A, Badrakalimuthu R, Hepworth C, Read J, Mehta R. “Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma”, 2010. J Nerv Ment Dis. Jun;198(6):399-403.

[9]

Graybar, S., & Boutilier, L, “Non traumatic pathways to borderline personality disorder” Psychotherapy: Theory, Research, Practice, Training, 2002, 39, 152–162

[10]

Goodman, M., & Yehuda, R, “The relationship between psychological trauma and borderline personality disorder. Psychiatric Annals”, 2002, 33, 337–345.

[11]

Battle, C. L., Shea, M. T., Johnson, D. M., Yen, S., Zlotnick, C., Zanarini, M. C., Sanislow, C. A., Skodol, A. E., Gunderson, J. G., Grilo, C. M., McGlashan, T. H., & Morey, L. C. (2004). “Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study”. Journal of Personality Disorders, 18(2), 193-211.

[12]

Pagura, J, Murray, B, Stein, B, James, M, Cox, B, Grant, B, Jitender, S, “Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population” Journal of Psychiatric Research, Volume 44, Issue 16, December 2010, Pages 1190–1198.

[13]

Greyner, B & Lewis, K, “Borderline personality or complex post traumatic stress disorder? An update on the controversy” Harvard Review Psychiatry. 2009;17(5):322-8. doi: 10.3109/10673220903271848.

[14]

Zanarini, M.C., Frankenburg, F.R., Hennen, J., D, B.R. & Silk, K.R. 2004, “Axis I Comorbidity in Patients With Borderline Personality Disorder: 6-Year Follow-Up and Prediction of Time to Remission”, The American Journal of Psychiatry, vol. 161, no. 11, pp. 2108-14.

[15]

Famularo, R, Kinscherff, R & Fenton, T, “Post traumatic stress disorder among children clinically diagnosed as borderline personality disorder”, Journal of Nervous Mental Disorders,. 1991 Jul;179(7):428-31.

[16]

[17]

A/Professor Sathya Rao – Executive Clinical Director at Spectrum, Personality Disorder Service for Victoria, Eastern Health.

[18]

Nock, M.K. & Prinstein, M.J. 2004, “A functional approach to the assessment of self-mutilative behaviour”, Journal of consulting and clinical psychology, vol. 72, no. 5, pp. 885-890.

[19]

Black, D. W., Blum, N., Pfohl, B., & Hale, N. (2004). Suicidal Behaviour In Borerline Personality Disorder: Prevalance, Risk Factors, Prediction and Prevention. Journal of Personality Disorders, 18(3), 226-39.

[20]

Gunderson, JG, Links, P: Borderline Personality Disorder: A Clinical Guide, 2nd ed. Washington, DC, American Psychiatric Press, Inc, 2008.

[21]

Lubman, D. I., Hall, K., Pennay, A., & Rao, S. (2011). Managing borderline personality disorder and substance use: An integrated approach. Australian Family Physician, 40(6), 376-81.

[22]

Driessen, M., Herrmann, J., Stahl, K., Zwaan, M. & al, e. 2000, “Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization”, Archives of General Psychiatry, vol. 57, no. 12, pp. 1115-22.

[23]

Roberts, S, “The sequelae of childhood sexual abuse: a primary care focus for adult female survivors”. Nurse Practioner. 1996 Dec;21(12 Pt 1):42, 45, 49-52.

[24]

Golding, M, Taylor, D, Menard, L & King, M, “Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome”, Journal of Psychosomatic Obstetrics & Gynaecology, Volume 21, Issue 2, 2000 Article DoiMeta DOI:10.3109/01674820009075612 pages 69-80.

[25]

Zanarini, M.C., Frankenburg, F.R., Hennen, J., D, B.R. & Silk, K.R. 2006, “Prediction of the 10-Year Course of Borderline Personality Disorder”, The American Journal of Psychiatry, vol. 163, no. 5, pp. 827-32.

[26]

Gunderson, J.G., M.D., Stout, R.L., PhD., McGlashan, T.H., M.D., Shea, M.T., Morey, L.C., PhD., Grilo, C.M., PhD., Zanarini, M.C., EdD., Yen, S., PhD., Markowitz, J.C., M.D., Sanislow, C., PhD., Ansell, E., PhD., Pinto, A., PhD. & Skodol, A.E., M.D. 2011, “Ten-Year Course of Borderline Personality Disorder: Psychopathology and Function From the Collaborative Longitudinal Personality Disorders Study”, Archives of General Psychiatry, vol. 68, no. 8, pp. 827.