| Over the past decade, there has been a dramatic increase in interest in the etiologic primacy of childhood sexual abuse to adult psychopathology and diagnoses. A body of empirical literature points to the association of severe childhood trauma with both Borderline Personality Disorder (BPD) and Complex PTSD (CP). The goal of this study was to determine if borderline psychopathology can be seen primarily as resulting from early onset (i.e., ≤12 years of age) sexual abuse vs. late onset (i.e., ≥13 years of age) sexual abuse in a subset of women who met diagnostic criteria for both BPD and CP. The consideration of the diagnosis of CP for a subset of borderline patients informs treatment. Sixty-five women (≥18 years) comprised a convenience sample from three mental health outpatient clinics in a large metropolitan city: Thirty-eight were selected because they presented with a history of early onset sexual abuse, while 27 were selected because they presented with a history of late onset. Each participant was administered the Revised Diagnostic Interview for Borderlines, the Traumatic Antecedent Questionnaire, the Modified PTSD Symptom Scale, and the Structured Interview for Disorders of Extreme Stress. Furthermore, five qualitative questions generated additional information regarding sexual revictimization, attachment, dissociation, and the impact of trauma. Trauma variables including chronic duration of abuse, incest, bi-parental neglect, and sexual revictimization were significantly higher in women reporting early onset of sexual abuse than women reporting late onset of sexual abuse. Moreover, the diagnoses of BPD, lifetime and current CP, and both BPD and CP were significantly higher in women reporting early onset of sexual abuse as opposed to late onset abuse. The predictor variables sexual abuse and intrafamilial (paternal incest) were found to be significant in the prediction of BPD and both BPD and CP. Discriminant analysis showed the strongest relationship with sexual abuse in the prediction of current and lifetime CP. Two other predictor variables were found to be similarly strong, namely, bi-parental neglect and emotional abuse. The results suggest that a subset of women with a history of childhood sexual abuse who meet diagnostic criteria for BPD may be subsumed under the diagnostic category of CP. |
