Interpersonal Trauma and Borderline Personality Disorder in Latino Patients Attending a Primary Care Clinic in New York City

Purpose: The relation between childhood physical and sexual trauma and Borderline Personality Disorder (BPD) has been the focus of extensive research in recent years. Although a large number of studies have documented higher rates of sexual and physical abuse among individuals with Borderline Personality Disorder (BPD), some studies failed to confirm the childhood trauma history as a unique predictor of BPD in adulthood. However, relatively few studies on BDP have included low-income Latino patients who tend to be exposed to more frequent and severe trauma compared to economically advantaged majority patients and typically receive most of their psychiatric care in primary care settings.

Method This study presents a secondary analysis of data collected by Dr. Neria and colleagues as part of an NIMH-funded study on the impact of the 9-11 terrorist attack on a primary care sample in a socioeconomically disadvantaged neighborhood of New York City (N=474). Trauma exposure was assessed with a modified version of The Life Events Checklist (LEC), BPD diagnosis with the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), and lifetime and current psychiatric diagnoses with structured clinical interviews (SCID-IV). Family history of psychiatric illness was assessed via patient self-report on mental health diagnoses given by a health professional. Age at which each type of trauma was first experienced was also assessed, allowing trauma exposure to be stratified by (1) whether or not it had occurred in childhood (before age 16) or in adulthood (after age 16), and (2) whether or not the trauma involved interpersonal trauma, defined as the occurrence of physical or sexual assault or abuse.

Results: BPD patients reported a higher number of traumatic events than No-BPD patients (BPD: M = 9.39, SD = 10.42; No-BPD: M =3.41, SD= 3.87; t (58) = 4.29, p <0.001). Exposure to sexual and physical assault/abuse was significantly and strongly associated with BPD diagnosis (childhood: X2 (1) = 32.35; adulthood: X2 (1) = 38.55, p <0.001). Even after adjusting for lifetime psychiatric diagnosis and family psychiatric history, patients reporting a lifetime history of sexual or physical assault/abuse were 5 times more likely to be diagnosed with BPD. Sexual abuse or assault before age 16 was associated with a 3-fold increase in likelihood of BPD. Conclusions and Implications. The current study demonstrates a strong association between interpersonal trauma and BDP, drawing attention to the importance of screening for BDP in Latino primary care patients who report having experienced interpersonal trauma in childhood or adulthood. Current studies suggest that half of BPD patients in primary care are not recognized by their primary care physician as having any emotional or mental health problems (Gross et al., 2002). Communication barriers and underreporting of symptoms are likely to contribute to an higher rate of undiagnosed cases among Latino primary care patients. Increased awareness of the prevalence of BPD among minorities receiving primary care and the high rates of trauma exposure in this population may enhance social workers' understanding, treatment, and referral of BDP patients.