A Systematic Review of the Role of Trauma in the Development of Borderline Personality Disorder

Background/Purpose:  The treatment and management of individuals with severe personality disorders, particularly the borderline personality sub-type (BPD), continues to be a significant challenge for the behavioral health care system, with such disorders creating a major illness burden for society. Symptoms of BPD usually begin during adolescence and, without appropriate treatment, can worsen and continue throughout adulthood. Such symptoms create considerable challenges to successful community adjustment, and include dysregulation of emotion (particularly negative affect), impulsivity, aggression, identity problems, significant interpersonal and occupational impairment, and increased risk for suicide. The etiology of borderline personality disorder (BPD), however, is continuously debated. Understanding the developmental trajectory of this disorder is essential in formulating early, effective intervention approaches. Previous research studies have shed light on a significant relationship between early childhood trauma and the development of BPD, although systematic review on the aforementioned topic remains absent. Therefore, we conducted this systematic review to explore the role that trauma plays in the developmental pathways to BPD.

Methods: This systematic review examines the extant body of literature focusing on trauma and BPD. A literature search was conducted in the databases Psychinfo and Medline, using the key term “trauma” combined with “borderline personality disorder”. Studies were included if they (1) measured the behavioral symptoms of BPD, (2) measured participants’ exposure to trauma (forms of trauma could include emotional, sexual, physical or a combination of traumas), and (3) examined the relationship between trauma and the behavioral symptoms of BPD. Demographic and clinical characteristics of participants were recorded and studies were organized according to whether a community or clinical sample was recruited. Additionally, information on study design was collected, and the outcomes of each study were recorded. After coding all the aforementioned characteristics and information, the studies were organized and analyzed via their various themes. 

Results: Our analysis identified the following themes: (1) the first grouping of studies  identifies trauma as a predictor of BPD by examining the univariate association; (2) the second group indicates a multifactorial etiology of BPD by exploring the multiple pathways among trauma and other risk factors; (3) the third grouping reports differential association between particular trauma types and BPD; and (4) the fourth grouping suggests that the severity and longevity of trauma is strongly associated with BPD symptomatology.

Conclusion and Implications: Results suggest that it may be useful to integrate trauma-informed intervention into the traditional therapies, such as Dialectical Behavior Therapy, used in treating trauma-related BPD symptoms, and it is essential to assess the presence of trauma in people presenting with BPD symptoms. Trauma related to sexual abuse and sexual concerns should be particularly addressed among BPD individuals and, finally, it is meaningful to assess the severity and longevity of traumatic experiences when determining which approach(es) will lead to optimal treatment outcomes.