Self-reported abuse and biological measures in personality disorders
摘要
In order to evaluate the relationship of early trauma and borderline psychopathology, and the effect of trauma on biological correlates previously associated with borderline personality disorder (BPD), we studied 66 patients with DSM-III personality disorders. Subjects filled out the Childhood Trauma Questionnaire (CTQ). Baseline MHPG and cortisol were measured in 36 subjects, as elevations in MHPG/cortisol ratio have been reported in PTSD. As expected, subscales of abuse were intercorrelated: physical abuse correlated with physical neglect (r=0.49, n=66, p<0.001), sexual abuse correlated with physical abuse (r=0.47, n=66, p<0.001) and emotional neglect correlated with physical neglect (r=0.34, n=66, p<0.05). No gender differences were found in any scores of self-reported abuse, nor were there differences between BPD and other personality disorder in any abuse scores; however, the greater the total number of borderline criteria met by each subject, the higher the frequency of reported sexual abuse (r=0.3, n=66, p<0.02). Specifically, significant correlations with sexual abuse scores were found with the DSM borderline “self-mutilation” (r=0.28, n=66, p<0.02) and “anger” (r=0.31, n=66, p<0.01) criteria. A strong association was also found between suicide history and early physical abuse (chi square=6.1, df=1 p<0.02); in fact, all patients with a history of suicide attempt also had a history of physical abuse. In the subset of patients who also participated in biologic studies, there was an inverse correlation in women between baseline MHPG and sexual abuse, when controlling for irritability and assault (r0.54, n=10, p<0.08), an association that appeared to go in the opposite direction in men (r=0.30, n=18, p=ns). We controlled for irritability and assault in this analysis as these attributes may constitute genetic factors contributing to the likelihood of abuse. The gender differences in the relationship between MHPG levels and sexual abuse suggests that there may be gender specific interactions between early life trauma and stress response. No relationship was found between any score of reported abuse and MHPG/cortisol ratio. Overall, these results suggest that the presence of early abuse may influence the expression of some symptoms of borderline personality disorder and may explain some of the biological heterogeneity within personality disorders.