The Relationship Between Trauma & Borderline Personality Disorder

Untreated trauma can be a risk factor for several mental health disorders, including depression and posttraumatic stress disorder (PTSD). Many people don’t realize that a history of trauma is also common among people who have a complex mental health concern called borderline personality disorder.

What Is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a complex and often misunderstood mental illness. The two dominant characteristics of BPD are instability and impulsivity.

As described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who develop borderline personality disorder may have the following symptoms:

• Making frantic efforts to avoid being abandoned, even when there is no credible likelihood that this will occur.
• Having a history of intense but unstable relationships. An individual who has BPD will often alternate between idealizing and devaluing the person they are in the relationship with.
• Dramatic fluctuations in self-image and/or sense of self.
• Acting impulsively in at least two areas that have the potential to cause great harm. These areas include gambling with large amounts of money, extravagant spending, driving recklessly, eating excessively, abusing alcohol or other drugs, and having unsafe sex.
• Engaging in self-harm, continually making suicidal threats or gestures, or attempting to end their own lives.
• Exhibiting dramatic mood swings, which may include periods of anxiety, irritability, and dysphoria (a state of intense unease or dissatisfaction).
• Frequently having a feeling of inner emptiness.
• Getting into fights on a regular basis, lashing out with inappropriate anger, and otherwise being unable to control their temper.
• Experiencing paranoia (unwarranted fear of being persecuted or conspired against) or dissociation (feeling detached from their thoughts, feelings, and environment).

The symptoms of BPD typically begin to become apparent during young adulthood. To be accurately diagnosed with borderline personality disorder, a person must have five or more of the symptoms listed above.

About 75% of people who receive a diagnosis of borderline personality disorder are female. Researchers have not yet conclusively determined if this disorder is actually more common among women than among men, or if this statistic reflects a gender bias among the professionals who make these diagnoses.

Childhood Trauma & Borderline Personality Disorder

The DSM-5 reports that people with a parent or sibling who has borderline personality disorder are five times more likely than members of the general public to develop BPD. The resource also includes family history of addiction, antisocial personality disorders, depressive disorders, and bipolar disorder as among the risk and prognostic factors for developing BPD.

Though the DSM-5 includes a history of abuse or neglect as an associated feature that may support a diagnosis of borderline personality disorder, it does not include any type of trauma as a risk factor.

Many mental health experts disagree with this, arguing that a history of trauma – especially childhood trauma – is extremely common among people who are eventually diagnosed with BPD.

The connection between childhood trauma and borderline personality disorder was explored in a September 2021 review that was published in the journal Frontiers in Psychiatry. To conduct this review, a team from the University of Turin (Italy) School of Medicine, Department of Neuroscience, analyzed the results of 52 studies from the past 20 years. These studies ranged in size from 12 subjects to more than 7,000.

Highlights of the review team’s report include the following:

• Between 30%-90% of people with borderline personality have a history of being abused or neglected during childhood.
• Although BPD is typically not diagnosed until a person has reached adulthood, many early indicators of this disorder are present during childhood and adolescence.
• Early traumas appear to trigger several characteristics of BPD, including emotion dysregulation, affect instability, and self-destructive behaviors.
• The strongest predictors of borderline personality disorder symptoms in adolescents ages 14-19 are emotional and physical trauma during childhood, the loss of a parent, and exposure to poverty at a young age.
• Childhood sexual abuse is associated with increased rates of suicidal behaviors among young people who have symptoms of BPD.
• Children who had been physically maltreated were more likely to experience symptoms of BPD by age 12 than were individuals of the same age who had no history of child abuse.
• Children who were exposed to chronic bullying between the ages of 8-10 were more likely to have BPD symptoms at age 12 than were non-bullied children.

“We can conclude that the interaction of temperamental, environmental, and genetic factors with early traumatic experiences can promote [the] onset of BPD [at a] young age,” the team wrote.

Trauma & Borderline Personality Disorder in Adults

The University of Turin review that we discussed in the previous section focused on linking a history of childhood trauma with symptoms of borderline personality disorder in children and adolescents. But most people are not diagnosed with BPD until they have reached adulthood. Is a history of childhood trauma as common among adults who have BPD as it is among children and adolescents who have been exhibiting signs of this disorder?

According to a recent meta-analysis from the University of Manchester (U.K.), the rate of childhood trauma is 13 times higher among people who were diagnosed with borderline personality disorders than it is among people who have never struggled with mental illness. The University of Manchester team reached this conclusion after reviewing 42 studies from several nations.

The November 2019 article that announced the results of this meta-analysis also included the following statistics about childhood trauma among people with borderline personality disorder:

• Nearly half (48.9%) of people with borderline personality disorder reported being physically neglected during childhood.
• 5% of the studies’ subjects said they had been emotionally abused during childhood.
• 4% of those who participated in the BPD studies had a history of childhood physical abuse.
• 1% of the subjects had been sexually abused as children.

“During childhood and adolescence, our brain is still undergoing considerable development and we are also refining strategies to deal with the challenges of everyday life, and the negative feelings that come with them,” Filipo Varese, a member of the research team, said in the November 2019 article.

“In some people who have experienced chronic, overwhelming stress in childhood, it is likely that these responses do not develop in the same way. …” Dr. Varese added. “This can lead to various mental health difficulties, including the problems commonly seen in people who receive a diagnosis of BPD.”

Implications for Treatment

Since so many people with borderline personality disorder have histories of abuse, neglect, and other adverse experiences, healthcare providers that treat BPD must be prepared to help patients whose lives continue to be impacted by untreated trauma.   

Depending on the full scope of an individual’s needs, they may benefit from having services such as the following included in their treatment for borderline personality disorder:

• Dialectical behavior therapy (DBT) – Dr. Marsha Linehan established the principles of DBT while working with suicidal women in the 1970s. While doing this work, Dr. Linehan discovered that many of these women were living with borderline personality disorder as well as untreated trauma. Through the years, DBT has been successfully employed to treat other disorders, but it remains an effective element of care for people who need treatment for BPD and trauma.
• Trauma-focused cognitive behavioral therapy (TF-CBT) – TF-CBT was originally developed to treat children and adolescents who had been traumatized. It is now also used to help adults who have histories of untreated trauma.
• Prolonged exposure (PE) therapy – Prolonged exposure therapy is a type of cognitive-behavioral therapy that empowers people to respond in a healthy manner to traumatic memories or circumstances that remind them of the trauma.
• Eye movement desensitization and reprocessing (EMDR) therapy – Originally developed as a means of treating people who have PTSD, EMDR therapy is also now incorporated into treatment for people with borderline personality disorder who are struggling with the effects of untreated trauma.

At Crownview Psychiatric Institute, we offer these and a wide array of additional evidence-based therapies and adjunct support services to help adults who have borderline personality disorder, untreated trauma, and a host of other mental health concerns. If you believe that you or someone that you care about can benefit from our programming, please contact us today.