Şakir GICA, Bahar KAPLAN, Ayşe TERZİ ATAR, Medine Yazıcı GÜLEÇ, Hüseyin GÜLEÇ

Investigation of the effects of childhood sexual abuse on disease severity and cognitive functions in borderline personality disorder

Objective: The aim of this study is to investigate the effects of childhood sexual abuse (CSA) on decision-making, facial emotion recognition, and clinical presentation of borderline personality disorder (BPD). In addition, it was examined whether certain cognitive impairments could be worsened by the presence of CSA. Method: Eighteen sexually abused BPD patients, 18 patients with BPD without CSA, and 35 healthy controls were included in the study. The Borderline Personality Inventory (BPI) and the Childhood Trauma Questionnaire (CTQ) were administered to BPD patients. The Cambridge Neuropsychological Test Automated Battery (CANTAB), which is used to examine decision-making and emotional recognition, was administered to the patients and healthy controls. Results: In the emotion recognition test, the mean percentages of correct fear recognition were 33.5±14.6 for patients with CSA, 25.89±9.8 for patients without CSA, 26.8±7.4 for healthy controls. The mean percentage of correct fear recognition was higher in patients with CSA than in the other groups. There was no difference in the correct recognition of other emotions between the groups. The probability of risking a 10% chance of winning in patients with/without CSA and healthy controls averaged were 0.71±0.26, 0.33±0.28, and 0.25±0.20 respectively. The average risk-taking propability in patients with CSA was significantly higher than in other groups. A significant correlation was identified between BPI and CTQ scores. Conclusion: The present study supports the fact that CSA has significant effects on the clinical presentation and neurocognitive profiles of BPD.

PDF

___

1. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69:533-545.[CrossRef]

2. Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in borderline personality disorder: Prevalence, risk factors, prediction, and prevention. J Pers Disord 2004; 18:226-239. [CrossRef]

3. Duque-Alarcón X, Alcalá-Lozano R, González-Olvera JJ, Garza- Villarreal EA, Pellicer F. Effects of childhood maltreatment on social cognition and brain functional connectivity in Borderline Personality Disorder patients. Front Psychiatry 2019; 10:156.

4. Gunderson JG. Borderline personality disorder: Ontogeny of a diagnosis. Am J Psychiatry 2009; 166:530-539. [CrossRef]

5. Hastrup LH, Jennum P, Ibsen R, Kjellberg J, Simonsen E. Societal costs of borderline personality disorders: a matched-controlled nationwide study of patients and spouses. Acta Psychiatr Scand 2019; 140:458-467. [CrossRef]

6. Bornstein RF, Becker-Matero N, Winarick DJ, Reichman AL. Interpersonal dependency in borderline personality disorder: Clinical context and empirical evidence. J Pers Disord 2010; 24:109-127. [CrossRef]

7. Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: A meta-analysis. Acta Psychiatr Scand 2020; 141:6-20.

8. Martins CMS, de Carvalho Tofoli SM, Von Werne Baes C, Juruena M. Analysis of the occurrence of early life stress in adult psychiatric patients: A systematic review. Psychol Neurosci 2011; 4:219-227. [CrossRef]

9. de Aquino Ferreira LF, Queiroz Pereira FH, Neri Benevides AML, Aguiar Melo MC. Borderline personality disorder and sexual abuse: A systematic review. Psychiatry Res 2018; 262:70-77. [CrossRef]

10. Merza K, Gábor P, Ildikó Kuritárné S. The role of childhood traumatization in the development of borderline personality disorder in Hungary. Eur J Psychiatry 2015; 29:105-118 [CrossRef]

11. Carr CP, Martins CM, Stingel AM, Lemgruber VB, Juruena MF. The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. J Nerv Ment Dis 2013; 201:1007-1020. [CrossRef]

12. Winsper C, Lereya ST, Marwaha S, Thompson A, Eyden J, Singh SP. The aetiological and psychopathological validity of borderline personality disorder in youth: A systematic review and metaanalysis. Clin Psychol Rev 2016; 44:13-24. [CrossRef]

13. Turniansky H, Ben-Dor D, Krivoy A, Weizman A, Shoval G. A history of prolonged childhood sexual abuse is associated with more severe clinical presentation of borderline personality disorder in adolescent female inpatients - A naturalistic study. Child Abuse Negl 2019; 98:104222. [CrossRef]

14. Bazanis E, Rogers RD, Dowson JH, Taylor P, Meux C, Staley C, et al. Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychol Med 2002; 32:1395-1405. [CrossRef]

15. Dinn WM, Harris CL, Aycicegi A, Greene PB, Kirkley SM, Reilly C. Neurocognitive function in borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:329-341.

16. O'Leary KM, Brouwers P, Gardner DL, Cowdry RW. Neuropsychological testing of patients with borderline personality disorder. Am J Psychiatry 1991; 148:106-111. [CrossRef]

17. Ruocco AC. The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005;137:191- 202. [CrossRef]

18. Svaldi J, Philipsen A, Matthies S. Risky decision-making in borderline personality disorder. Psychiatry Res 2012; 197:112-118.

19. Daros AR, Zakzanis KK, Ruocco AC. Facial emotion recognition in borderline personality disorder. Psychol Med 2013;43:1953- 1963. [CrossRef]

20. Fertuck EA, Fischer S, Beeney J. Social cognition and borderline personality disorder: Splitting and trust impairment findings. Psychiatr Clin North Am 2018; 41:613-632. [CrossRef]

21. Kaplan B, Yazici Gulec M, Gica S, Gulec H. The association between neurocognitive functioning and clinical features of borderline personality disorder. Braz J Psychiatry 2020; 42:503- 509. [CrossRef]

22. Leichsenring F. Development and first results of the Borderline Personality Inventory: A self-report instrument for assessing borderline personality organization. J Pers Assess 1999; 73:45-63.

23. Aydemir O, Demet MM, Danaci AE, Deveci A, Taskin EO, Mizrak S, et al. Adaptation into Turkish, reliability and validity of Borderline Personality Inventory. Psychiatry in Türkiye 2006; 8:6-10. [Turkish]

24. Ozkurkcugil A, Aydemir O, Yildiz M, Esen DA, Koroglu E. Adaptation into Turkish and Reliability of Structured Clinical Interview for DSM-IV. Ilac ve Tedavi Dergisi 1999, 12:233-236. [Turkish]

25. Coşkunol H, Bagdiken I, Sorias S, Saygili R. Reliability of SCIDII (Turkish version) interview in personality disorders. Turkish Journal of Psychology 1994; 9:26-29.

26. Bernstein DP, Fink L, Handelsman L, Foote J, Lovejoy M, Wenzel K, et al. Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry 1994; 151:1132-1136. [CrossRef]

27. Sar V, Ozturk E, Ikikardes E. Validity and reliability of the Turkish Version of Childhood Trauma Questionnaire. Turkiye Klinikleri 2012; 32:1054-1063. [Turkish][CrossRef]

28. Luciana M, Nelson CA. Assessment of neuropsychological function through use of the Cambridge Neuropsychological Testing Automated Battery: Performance in 4- to 12-year-old children. Dev Neuropsychol 2002; 22:595-624.[CrossRef]

29. Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, et al. Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull 2012; 38:661-671. [CrossRef]

30. Dale O, Sethi F, Stanton C, Evans S, Barnicot K, Sedgwick R, et al. Personality disorder services in England: Finding from a national survey. BJPsych Bull 2017; 41:247-253. [CrossRef]

31. Hailes HP, Yu R, Danese A, Fazel S. Long-term outcomes of childhood sexual abuse: An umbrella review. Lancet Psychiatry 2019; 6: 830-839.[CrossRef]

32. Bradley R, Westen D. The psychodynamics of borderline personality disorder: A view from developmental psychopathology. Dev Psychopathol 2005;17:927-957. [CrossRef]

33. Séguin-Lemire A, Hébert M, Cossette L, Langevin R. A longitudinal study of emotion regulation among sexually abused preschoolers. Child Abuse Negl 2017; 63:307-316. [CrossRef]

34. Miano A, Grosselli L, Roepke S, Dziobek I. Emotional dysregulation in borderline personality disorder and its influence on communication behavior and feelings in romantic relationships. Behav Res Ther 2017; 95:148-157. [CrossRef]

35. Schoenleber M, Berghoff CR, Tull MT, DiLillo D, Messman- Moore T, Gratz KL. Emotional lability and affective synchrony in borderline personality disorder. Personal Disord 2016; 7:211- 220. [CrossRef]

36. Aaltonen KI, Rosenström T, Baryshnikov I, Karpov B, Melartin T, Suominen K, et al. Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients. Eur Psychiatry 2017; 44:53-60. [CrossRef]

37. Heim C, Shugart M, Craighead WE, Nemeroff CB. Neurobiological and psychiatric consequences of child abuse and neglect. Dev Psychobiol 2010; 52:671-690.[CrossRef]

38. Nemeroff CB. Neurobiological consequences of childhood trauma. J Clin Psychiatry 2004; 65(Suppl.1):18-28.

39. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci 2009; 10:434-445. [CrossRef]

40. Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What works in the treatment of borderline personality disorder. Curr Behav Neurosci Rep 2017; 4:21-30.[CrossRef]

41. Bohus M, Dyer AS, Priebe K, Krüger A, Kleindienst N, Schmahl C, et al. Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial. Psychother Psychosom 2013; 82:221-233. [CrossRef]

42. Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther 2014;55:7-17. [CrossRef]

43. Bountress K, Adams ZW, Gilmore AK, Amstadter AB, Thomas S, Danielson CK. Associations among impulsivity, trauma history, and alcohol misuse within a young adult sample. Addict Behav 2017; 64:179-184. [CrossRef]

44. Barker V, Romaniuk L, Cardinal RN, Pope M, Nicol K, Hall J. Impulsivity in borderline personality disorder. Psychol Med 2015; 45:1955-1964. [CrossRef]

45. Kulacoglu F, Solmaz M, Ardic FC, Akin E, Kose S. The relationship between childhood traumas, dissociation, and impulsivity in patients with borderline personality disorder comorbid with ADHD. Psychiatry and Clinical Psychopharmacology 2017; 27:393-402. [CrossRef]

46. Zegarra-Valdivia JA, Chino Vilca BN. Social cognition and executive function in borderline personality disorder: evidence of altered cognitive processes. Salud Ment 2019; 42:33-41. [CrossRef]

47. Dias-Ferreira E, Sousa JC, Melo I, Morgado P, Mesquita AR, Cerqueira JJ, et al. Chronic stress causes frontostriatal reorganization and affects decision-making. Science 2009; 325:621-625. [CrossRef]

48. Mello MF, Faria AA, Mello AF, Carpenter LL, Tyrka AR, Price LH. Childhood maltreatment and adult psychopathology: Pathways to hypothalamic-pituitary-adrenal axis dysfunction. Braz J Psychiatry 2009; 31 (Suppl.2):S41-48.

49. Masten CL, Guyer AE, Hodgdon HB, McClure EB, Charney DS, Ernst M, et al. Recognition of facial emotions among maltreated children with high rates of post-traumatic stress disorder. Child Abuse Negl 2008; 32:139-153. [CrossRef]

50. Beale JM, Keil FC. Categorical effects in the perception of faces. Cognition 1995; 57:217-239. [CrossRef]

51. Herrenkohl RC, Herrenkohl EC, Egolf BP, Wu P. The developmental consequences of child abuse: The Lehigh longitudinal study: In Starr RH, Wolfe DA (editors). The effects of child abuse and neglect: Issues and research. New York: Guilford Press, 1991, 57-81.

52. Ardizzi M, Martini F, Umiltà MA, Evangelista V, Ravera R, Gallese V. Impact of childhood maltreatment on the recognition of facial expressions of emotions. PLoS One 2015; 10:e0141732.

53. Wagner AW, Linehan MM. Facial expression recognition ability among women with borderline personality disorder: implications for emotion regulation? J Pers Disord 1999; 13:329-344. [CrossRef]