Role of Sexual Abuse in the Etiology of Borderline Personality Disorder
Strochak, Richard D., American Journal of Psychotherapy
MARY C. ZANAMNI, ED.: Role of Sexual Abuse in the Etiology of Borderline Personality Disorder. American Psychiatric Press, Washington, DC, 1997, 247 pp., $40.00, ISBN 0-88048-496-9.
The forty-ninth book of the American Psychiatric Association's Progress in Psychiatry Series brings together eleven research studies in the area of childhood sexual abuse and the development of the Borderline Personality Disorder (BPD). This research, formerly presented in various symposia at APA's annual meetings, represents "second generation studies" of environmental factors in borderline syndromes. Nine of these studies conclude, in general, that: 1. physical and sexual abuse are relatively common in the childhood experiences of borderline patients; 2. physical abuse is not reported more often in borderline groups than it is in control groups; 3. sexual abuse is reported significantly more often by borderline groups than by control groups.
The two remaining studies reported findings somewhat in opposition to the general theme that childhood sexual trauma is linked with BPD. In Chapter 6, Zweig-Frank and Paris report no relationship between childhood sexual abuse and dissociation. In this study, the authors found no differences on the Dissociative Experiences Scale (DES) between subjects with caretaker abuse and subjects with non-caretaker abuse, whereas in earlier studies caretaker abuse had been strongly linked with the presence of dissociative mechanisms. Another study in this volume also has a different perspective. In Chapter 9, Kimble et al. investigate the relationship between "neurological vulnerability" and trauma in borderlines. They present evidence that borderline patients were significantly more likely than control subjects to have evidence of some sort of neurological vulnerability. This vulnerability substrate includes maternal alcohol/drug abuse, one or more CNS insults, childhood seizure disorders, and developmental speech/language impairments. Their findings indicate that a vulnerable neurological substrate was a stronger predictor of BPD than was a reported history of childhood sexual abuse.
Mary C. Zanarini, the Director of the McLean Study of Adult Development and the Laboratory for the Study of Adult Development at McLean Hospital in Boston, was a good choice for editor of this book. …