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Am J Psychiatry 1997; 154:1101-1106
Copyright © 1997 by American Psychiatric Association
Reported pathological childhood experiences associated with the development of borderline personality disorder
MC Zanarini, AA Williams, RE Lewis, RB Reich, SC Vera, MF Marino, A Levin, L Yong and FR Frankenburg
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02178, USA.
OBJECTIVE: The purpose of this study was to assess a full range of
pathological childhood experiences reported by patients with criteria-
defined borderline personality disorder and comparison patients with other
personality disorders. METHOD: The pathological childhood experiences
reported by 467 inpatients with personality disorders were assessed by
interviewers who used a semistructured research interview and were blind to
clinical diagnosis. RESULTS: Of the 358 patients with borderline
personality disorder, 91% reported having been abused, and 92% reported
having been neglected, before the age of 18. The borderline patients were
significantly more likely than the 109 patients with other personality
disorders to report having been emotionally and physically abused by a
caretaker and sexually abused by a noncaretaker. They were also
significantly more likely to report having a caretaker withdraw from them
emotionally, treat them inconsistently, deny their thoughts and feelings,
place them in the role of a parent, and fail to provide them with needed
protection. The borderline patients with a childhood history of sexual
abuse were significantly more likely than those without such a history to
report having experienced all but one of the types of abuse and neglect
studied. When all significant risk factors were considered together, four
were found to be significant predictors of a borderline diagnosis: female
gender, sexual abuse by a male noncaretaker, emotional denial by a male
caretaker, and inconsistent treatment by a female caretaker. CONCLUSIONS:
The results suggest that sexual abuse is neither necessary nor sufficient
for the development of borderline personality disorder and that other
childhood experiences, particularly neglect by caretakers of both genders,
represent significant risk factors.
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J. P. SALZMAN
Etiology of Borderline Personality Disorder
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November 1, 1998;
155(11):
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M. C. ZANARINI and F. R. FRANKENBURG
Drs. Zanarini and Frankenburg Reply
Am J Psychiatry,
November 1, 1998;
155(11):
1626a - 1626.
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Childhood Experiences in Borderline and Panic Disorders
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9 - 9.
[Full Text]
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