Current Psychiatry Reports

, Volume 11, Issue 1, pp 63–68 | Cite as

Borderline personality disorder and childhood trauma: Evidence for a causal relationship

  • Jeffrey S. Ball
  • Paul S. Links


The debate over whether childhood trauma is a causative factor in the development of borderline personality disorder continues in the literature despite decades of research. This review examines this body of literature published from 1995 through 2007 to assess the strength of evidence for such a causal relationship. A unique conceptual approach was used, as we considered the literature in the context of Hill’s classic criteria for demonstrating causation. Results of this review suggest that evidence supports the causal relationship, particularly if the relationship is considered as part of a multifactorial etiologic model. Directions for future research and clinical implications are discussed.


Borderline Personality Disorder Personality Disorder Childhood Sexual Abuse Childhood Trauma Dialectical Behavior Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Lieb K, Zanarini MC, Schmahl C, et al.: Borderline personality disorder. Lancet 2004, 364:453–461.PubMedCrossRefGoogle Scholar
  2. 2.
    Zanarini MC, Frankenburg FR, Hennen J, Silk KR: Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years. J Clin Psychiatry 2004, 65:28–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Paris J, Zweig-Frank H: A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry 2001, 42:482–487.PubMedCrossRefGoogle Scholar
  4. 4.
    Paris J: Does childhood trauma cause personality disorders in adults? Can J Psychiatry 1998, 43:148–153.PubMedGoogle Scholar
  5. 5.
    Fossati A, Madeddu F, Maffei C: Borderline personality disorder and childhood sexual abuse: a meta-analytic study. J Personal Disord 1999, 13:268–280.PubMedGoogle Scholar
  6. 6.
    Hill AB: A Short Textbook of Medical Statistics, edn 11. Suffolk, United Kingdom: Hodder and Stoughton; 1984.Google Scholar
  7. 7.
    Laporte L, Guttman H: Traumatic childhood experiences as risk factors for borderline and other personality disorders. J Personal Disord 1996, 10:247–259.Google Scholar
  8. 8.
    Oldham JM, Skodol AE, Gallaher PE, Kroll ME: Relationship of borderline symptoms to histories of abuse and neglect: a pilot study. Psychiatr Q 1996, 67:287–295.PubMedCrossRefGoogle Scholar
  9. 9.
    Trull TJ: Structural relations between borderline personality disorder features and putative etiological correlates. J Abnorm Psychol 2001, 110:471–481.PubMedCrossRefGoogle Scholar
  10. 10.
    Golier JA, Yehuda R, Bierer LM, et al.: The relationship of borderline personality disorder to posttraumatic stress disorder and traumatic events. Am J Psychiatry 2003, 160:2018–2024.PubMedCrossRefGoogle Scholar
  11. 11.
    Helgeland MI, Torgersen S: Developmental antecedents of borderline personality disorder. Compr Psychiatry 2004, 45:138–147.PubMedCrossRefGoogle Scholar
  12. 12.
    Bandelow B, Krause J, Wedekind D, et al.: Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with borderline personality disorder and healthy controls. Psychiatry Res 2005, 134:169–179.PubMedCrossRefGoogle Scholar
  13. 13.
    Bradley R, Jenei J, Westen D: Etiology of borderline personality disorder: disentangling the contributions of intercorrelated antecedents. J Nerv Ment Dis 2005, 193:24–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Lobbestael J, Arntz A, Sieswerda S: Schema modes and childhood abuse in borderline and antisocial personality disorders. J Behav Ther Exp Psychiatry 2005, 36:240–253.PubMedCrossRefGoogle Scholar
  15. 15.
    Bornovalova MA, Gratz KL, Delany-Brumsey A, et al.: Temperamental and environmental risk factors for borderline personality disorder among inner-city substance users in residential treatment. J Personal Disord 2006, 20:218–231.PubMedCrossRefGoogle Scholar
  16. 16.
    Zanarini MC: Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin North Am 2000, 23:89–101.PubMedCrossRefGoogle Scholar
  17. 17.
    Battle CL, Shea MT, Johnson DM, et al.: Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. J Personal Disord 2004, 18:193–211.PubMedCrossRefGoogle Scholar
  18. 18.
    Yen S, Shea MT, Battle CL, et al.: Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. J Nerv Ment Dis 2002, 190:510–518.PubMedCrossRefGoogle Scholar
  19. 19.
    Cohen P, Crawford TN, Johnson JG, Kasen S: The children in the community study of developmental course of personality disorder. J Personal Disord 2005, 19:466–486.PubMedCrossRefGoogle Scholar
  20. 20.
    Johnson JG, Cohen P, Brown J, et al.: Childhood maltreatment increases risk for personality disorders during early adulthood. Arch Gen Psychiatry 1999, 56:600–606.PubMedCrossRefGoogle Scholar
  21. 21.
    Rogosch FA, Cicchetti D: Child maltreatment, attention networks, and potential precursors to borderline personality disorder. Dev Psychopathol 2005, 17:1071–1089.PubMedCrossRefGoogle Scholar
  22. 22.
    Silk KR, Lee S, Hill EM, Lohr NE: Borderline personality disorder symptoms and severity of sexual abuse. Am J Psychiatry 1995, 152:1059–1064.PubMedGoogle Scholar
  23. 23.
    Zanarini MC, Yong L, Frankenburg FR, et al.: Severity of reported childhood sexual abuse and its relationship to severity of borderline psychopathology and psychosocial impairment among borderline inpatients. J Nerv Ment Dis 2002, 190:381–387.PubMedCrossRefGoogle Scholar
  24. 24.
    Sansone RA, Songer DA, Miller KA: Childhood abuse, mental healthcare utilization, self-harm behavior, and multiple psychiatric diagnoses among inpatients with and without a borderline diagnosis. Compr Psychiatry 2005, 46:117–120.PubMedCrossRefGoogle Scholar
  25. 25.
    Graybar SR, Boutilier LR: Nontraumatic pathways to borderline personality disorder. Psychother Theory Res Pract Train 2002, 39:152–162.CrossRefGoogle Scholar
  26. 26.
    Zanarini MC, Frankenburg FR, Reich DB, et al.: Biparental failure in the childhood experiences of borderline patients. J Personal Disord 2000, 14:264–273.PubMedGoogle Scholar
  27. 27.
    Sabo AN: Etiological significance of associations between childhood trauma and borderline personality disorder: conceptual and clinical implications. J Personal Disord 1997, 11:50–70.PubMedGoogle Scholar
  28. 28.
    Katerndahl D, Burge S, Kellogg N: Predictors of development of adult psychopathology in female victims of childhood sexual abuse. J Nerv Ment Dis 2005, 193:258–264.PubMedCrossRefGoogle Scholar
  29. 29.
    Finkelhor D: Current information on the scope and nature of child sexual abuse. Future Child 1994, 4:31–53.PubMedCrossRefGoogle Scholar
  30. 30.
    Nahas Z, Molnar C, George MS: Brain imaging. In The American Psychiatric Publishing Textbook of Personality Disorders, edn 1. Edited by Oldham JM, Skodol AE, Bender DS. Arlington, VA: American Psychiatric Publishing; 2005:623–639.Google Scholar
  31. 31.
    Rinne T: The interference of sustained adverse childhood experiences and the development of borderline personality disorder: a neurobiological perspective. In Personality Disorders: Current Research and Treatments, edn 1. Edited by Reich J. New York: Routledge; 2005:75–103.Google Scholar
  32. 32.
    Schmahl C, Bremner JD: Neuroimaging in borderline personality disorder. J Psychiatr Res 2006, 40:419–427.PubMedCrossRefGoogle Scholar
  33. 33.
    Baird AA, Veague HB, Rabbitt CE: Developmental precipitants of borderline personality disorder. Dev Psychopathol 2005, 17:1031–1049.PubMedCrossRefGoogle Scholar
  34. 34.
    Figueroa EF, Silk KR, Huth A, Lohr NE: History of childhood sexual abuse and general psychopathology. Compr Psychiatry 1997, 38:23–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Goodman M, Yehuda R: The relationship between psychological trauma and borderline personality disorder. Psychiatr Ann 2002, 32:337–345.Google Scholar
  36. 36.
    Joyce PR, McKenzie JM, Luty SE, et al.: Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders. Aust N Z J Psychiatry 2003, 37:756–764.PubMedCrossRefGoogle Scholar
  37. 37.
    Levy KN: The implications of attachment theory and research for understanding borderline personality disorder. Dev Psychopathol 2005, 17:959–986.PubMedCrossRefGoogle Scholar
  38. 38.
    Livesley WJ: The structure and etiology of borderline pathology. In Personality Disorders: Current Research and Treatments, edn 1. Edited by Reich J. New York: Routledge; 2005:21–42.Google Scholar
  39. 39.
    Thatcher DL, Cornelius JR, Clark DB: Adolescent alcohol use disorders predict adult borderline personality. Addict Behav 2005, 30:1709–1724.PubMedCrossRefGoogle Scholar
  40. 40.
    Minzenberg MJ, Poole JH, Vinogradov S: Adult social attachment disturbance is related to childhood maltreatment and current symptoms in borderline personality disorder. J Nerv Ment Dis 2006, 194:341–348.PubMedCrossRefGoogle Scholar
  41. 41.
    Fruzzetti AE, Shenk C, Hoffman PD: Family interaction and the development of borderline personality disorder: a transactional model. Dev Psychopathol 2005, 17:1007–1030.PubMedCrossRefGoogle Scholar
  42. 42.
    Rutter M, Moffitt TE, Caspi A: Gene-environment interplay and psychopathology: multiple varieties but real effects. J Child Psychol Psychiatry 2006, 47:226–261.PubMedCrossRefGoogle Scholar
  43. 43.
    Bandelow B, Spath C, Tichauer GA, et al.: Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Compr Psychiatry 2002, 43:269–278.PubMedCrossRefGoogle Scholar
  44. 44.
    Kent A, Waller G: Childhood emotional abuse and eating psychopathology. Clin Psychol Rev 2000, 20:887–903.PubMedCrossRefGoogle Scholar
  45. 45.
    Hund AR, Espelage DL: Childhood emotional abuse and disordered eating among undergraduate females: mediating influence of alexithymia and distress. Child Abuse Negl 2006, 30:393–407.PubMedCrossRefGoogle Scholar
  46. 46.
    Moffitt TE, Capsi A, Rutter M: Strategy for investigating interactions between measured genes and measured environments. Arch Gen Psychiatry 2005, 62:473–481.PubMedCrossRefGoogle Scholar
  47. 47.
    Linehan MM: Cognitive-Behavioral Therapy for Borderline Personality Disorder. New York: Guilford Press; 1993.Google Scholar
  48. 48.
    Fetkewicz J, Sharma V, Merskey H: A note on suicidal deterioration with recovered memory treatment. J Affect Disord 2000, 58:155–159.PubMedCrossRefGoogle Scholar
  49. 49.
    McDonagh A, Friedman M, McHugo G, et al.: Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. J Consult Clin Psychol 2005, 73:515–524.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2009

Authors and Affiliations

  1. 1.Arthur Sommer Rotenberg Suicide Studies UnitSt. Michael’s Hospital, Shuter WingTorontoCanada

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