Abstract
This study investigates the hypothesis that experiencing penetrative childhood sexual abuse causes Borderline Personality Disorder. Previous research indicates that sexual abuse puts children at higher risk of developing Borderline Personality Disorder in Adulthood. Borderline Personality Disorder, or BPD.
This disorder is characterized by “a pervasive pattern of impulsivity and unstable personal relationships, self-image, and affect, with recurrent suicidal or self-mutilating gestures or behavior; emotional instability; chronic feelings of emptiness, intense and inappropriate anger, in addition to stress-related paranoid ideation or dissociation.” By referencing several research studies on childhood sexual abuse and Borderline Personality Disorder, this study will attempt to link research findings from different research studies to demonstrate a causal or high-risk factor in child victims of sexual abuse to develop BPD in adulthood.
Introduction
Childhood sexual abuse is an issue that has gained unprecedented proportions in modern society, including the United States of America. However, it is important to be aware that such abuse never occurs in isolation since a child that has been abused is highly likely to experience negative psychological consequences. To analyze the effects childhood sexual abuse has on individuals, it is crucial to note that abuse is a traumatic experience which should not be regarded as a diagnosis or a disease.
Many children that have been sexually abused at a point in their development will experience moderate or severe symptoms of particular psychological disorders. Having experienced sexual abuse, a child is often surrounded by a sense of powerlessness that encourages the perception that it is very little he or she can do to control what had happened.
According to the Rape & Incest National Network, one out of three girls and one out of six boys under age eighteen has experienced a sexual assault. These numbers are staggering, but may only be the tip of the iceberg, as these assaults are not reported as frequently as they occur. This study aims to discover if there is a causal link between penetrative childhood sexual abuse and developing borderline personality disorder in adulthood. According to the Diagnostic & Statistical Manual, Borderline Personality Disorder is characterized by
“a pervasive pattern of instability of interpersonal relationships, self-image, and emotion and by marked impulsivity.”
As stated by Martin, Bergen, and Richardson (2004), the percentage of the reported incidences of psychiatric disorders linked to childhood sexual abuse that has been reported is forty-seven percent for men and fifty-six percent for women. The most common consequences of childhood sexual abuse range from substance abuse to post-traumatic stress disorder. However, the most damaging consequences are borderline personality disorder and dissociative identity disorder.
Personality disorders tend to present by late adolescence or in early adult years. It is basically a set of maladaptive coping behaviors that in childhood have the potential to change or evolve into a more healthy coping mechanism. When these behaviors continue into adulthood, they become more permanent, more damaging, and remain mal-adaptive. According to the American Psychiatric Association, women are three times as likely to be diagnosed with Borderline Personality Disorder than men are.
It has been hypothesized that early childhood trauma is one early high-risk factor for developing Borderline Personality Disorder in late adolescence-early adulthood. A very high number of Borderline patients report penetrative sexual abuse at some point in their childhoods. Borderline Personality Disorder is basically a set of maladaptive coping mechanisms carried over from childhood to adulthood and made permanent.
“The world of a BP, like that of a child, is split into heroes and villains. A child emotionally, the BP cannot tolerate human inconsistencies and ambiguities; he cannot reconcile anther is good and bad qualities into a constant, coherent understanding of another person. At any particular moment, one is either Good or EVIL. There is no in-between; no gray area….people are idolized one day; totally devalued and dismissed the next. Normal people are ambivalent and can experience two contradictory states atone time; BPs shift back and forth, entirely unaware of one feeling state while in the other. When the idealized person finally disappoints (as we all do, sooner or later) the borderline must drastically restructure his one-dimensional conceptionalization. Either the idol is banished to the dungeon, or the borderline banishes himself in other to preserve the all-good image of the other person. Splitting is intended to shield the BP from a barrage of contradictory feelings and images and from the anxiety of trying to reconcile those images. But splitting often achieves the opposite effect. The frays in the BP’s personality become rips, and the sense of his own identity and the identity of others shift even more dramatically and frequently (Borderline Personality Disorder Central [BPD Central], 2005).”
This research is important because the results can help us learn how to best devise interventions and treatment programs for our children who have been victimized. If the children had the proper help to not be at such high risk for developing BPD, they would live much more functional, happy lives, in addition to having fewer people diagnosed with BPD on public disability or assistance.
Research questions
The main question the research is supposed to answer is outlined in the title: Does penetrative childhood sexual abuse cause borderline personality disorder. The second question is what programs and interventions should be applied to children that have been subjected to sexual abuse. The last question the research is aimed to answer is linked to the differentiation of effect sexual abuse in childhood had on men and women.
Literature Review
Several empirical journal articles were reviewed to discover past research on the subject. Michael Bailey and Amy Shriver of Northwestern University did a study based on the reports of Psychologists responsible for treating Borderline Patients. They thought this was the best way to get valid information by Professionals who had already validated the self-reports of their patients and also had diagnosed them themselves with Borderline Personality Disorder.
In their initial questionnaires, they did not mention sexual abuse as causing BPD, but rather they simply requested participants for a study of personality traits with various forms of psychopathology. A total of twenty-two psychologists provided data which suggested that there was a link (although superficial) to BPD, and that further investigative research was called for (Bailey & Shriver, 1999).
An additional study investigating self-injury among teens with sex abuse histories was done in 2005, by Mireille Cyr and several associates. They examined the rates of self-harm (a behavior considered a red flag for Borderline Tendencies) in these teens and compared the rates to those discovered in the same set of teens 9 months later. The study concluded that there were definitely higher rates of self-injury or borderline tendencies in those who had abuse histories.
They also found that sexual abuse is five times as likely to be reported by self injuring teenagers than their non abused counterparts. The results show that 61 percent of sexually abused girls engaged in at least one type of self injurious behavior (only some of which were considered for the study.) (Cyr, McDuff, Wright, Theriault, & Cinq-Mars, 2005). “Similarly, Knlonsky et al (2003) found among more than 1900 military recruits, that those with deliberate self harm scored higher on all DSM-IV personality disorders except obsessive compulsive disorder” (Cyr et al., p. 53).
An additional study surveyed by Cyr found that in a study conducted in clinical settings, the group of self mutilators had 73 percent suffering from post traumatic stress, 40 percent from dissociation disorder, 37 percent from borderline personality disorder and 29 percent from multiple personality disorder or dissociative identity disorder.
Statistics from the BPD Central website show that people afflicted with borderline Personality Disorder comprise only 2% of the population, but a whopping 60% of all personality disorders. Of the 2% it comprises in the general population, 10% are mental health outpatients, 20% are psychiatric inpatients, 75% have been physically or sexually abused, and an astounding 75% of those diagnosed with the disorder are female (Borderline Personality Disorder Central [BPD Central], 2005)
These studies all provided inconclusive, yet strongly suggestive data that childhood sexual abuses can cause increased risk for Borderline Personality Disorder.
Methods
Materials
The materials used for research include literature on the childhood sexual abuse, its consequences, and complications for the future life of individuals. New and unique materials will include information attained from interviews and questionnaires given the study group in the course of their development. The questionnaires will include multiple choice questions on the way the interact with the society. The choice of the materials is justified for their effectiveness and accessibility – if compiled appropriately, questionnaires will give a researcher profound information on the effect childhood sexual abuse had on children’s development.
Participants
Potential subjects for this study would be selected based on reports to law enforcement. They would be selected based on age (six years to 12 years) and whether or not their abuse included penetration-vaginal, anal, or digital. Both male and female children would be selected, 40 of each sex, selected from different cities, countries and locales. Such a sample group was chosen on the basis of reported to law enforcement cases of childhood sexual abuse thus there is little threat to the external validity of the research results.
Ethical considerations
Informed consent would be obtained from parents of minor children, and histories would be taken from parents and law enforcement regarding abuse experiences of the children. Children with developmental delays, mental retardation, or IQ below average would be excluded from the study. This is necessary for the attained results to be as accurate as possible. A further ethical issue that will result from the research is linked to the fact that remembering the event of sexual abuse will be traumatic for the interviewed study groups. Thus, the questionnaires should be conducted in such a manner that there will be no present questions on sexual abuse.
Procedure
The statistical analysis used would be longitudinal analysis, or case study. This would involve observations obtained from participants over time. To contrast the research results, it will be beneficial to separate male and female sexual victims into separate sample groups. The children would be tracked over time until aged 20-25. They would be interviewed periodically during this time, the first interview occurring 5 years after the abuse is reported, and continuing every two years until age 25.
Questions about the abuse would not be asked. Instead, questions evaluating the subjects’ interpersonal skills, how they are doing in school and behavioral histories at home and in school. Once the participants reach age 13, the Diagnostic Interview for Borderlines would be administered as well, (without ever mentioning the disorder to the participants). Upon reaching age 25, a comprehensive psychological profile will be done on each participant, to get a well-rounded view of their current levels of functioning, and whether or not they meet the criteria for Borderline Personality Disorder. Thus, judging by the frequency of the conducted interviews over time, the timeframe of the research will span across 21 to 13 years depending on the age of the interviewed victims of childhood sexual abuse.
Since the study groups will be divided into two sample groups, a two-sample t-test will be conducted. It will be used to find out the differences in the questionnaire answers conducted with an interval of two years.
Equipment and staffing requirements
Questionnaires do not require any special equipment. However, space is needed to conduct the interviews, so the researcher will have to rent space in a building so that the questionnaires are completed by study groups together at the same time. To facilitate this process, help from a volunteer is needed.
Hypothesis testing
The hypothesis is tested with the use of qualitative research that implies questionnaires, observations, tests, and interviews, targeted at finding out whether sexual abuse in children causes borderline personality disorder in their further development.
Findings validation
The findings of the conducted research with the use of questionnaires will be validated through member checking since the conclusions were made with individuals who originally provided necessary information. Member checking will be conducted informally in the course of interviews and observations.
Expected Results
The expected results of the study support the initial thesis of a link between childhood sexual abuse and the borderline personality disorder. Due to the fact that childhood sexual abuse is an experience that rarely leaves no mark on the psychological integrity of an individual, additional psychological issues like depression or posttraumatic stress disorder are also expected to be detected.
The t-sample test that will involve two independent groups of participants, 40 males and 40 females will allow the study to see the differentiation between the effect childhood sexual abuse had on males and females separately. On the basis of the two-sample t-test, the differences between the 2-year survey will be evaluated. The expected results for both male and female participants is that the symptoms of the borderline personality disorder will differ between the surveys, improving as the time passes. However, it is expected that the individuals with additionally diagnosed depression and other psychological disorders will not experience improvements between the conducted surveys.
Discussion
Recognition of negative consequences of childhood sexual abuse is crucial when it comes to finding out the ways in which their effects can be managed and mitigated through appropriate intervention techniques. The link between childhood sexual abuse and borderline personality disorder suggests that violent and traumatic experiences rarely go unnoticed, especially in children. Symptoms of the borderline personality disorder developed as a result of sexual abuse may often be confused with depression thus the research aimed at specifically evaluating the borderline personality disorder implications through conducting the Diagnostic Interview for Borderlines.
A comprehensive psychological profile of each participant of the study will become instrumental in evaluating the differences in how male and female participants dealt with their negative childhood experience.
The conducted research implies that every victim of the childhood sexual abuse is an individual, and every experience is separate. For example, children aged 6 and 7 were not expected to have a lasting memory of their experience since many of them may not have understood that what was happening was abuse. In some cases of abuse, children are too young to be referred to a mental health specialist. Thus, the conducted research is valuable for its attempt to evaluate the psychological state of children at various stages of their lives up until they become fully developed grown-ups.
The last implication of the research is connected with the importance of dealing with borderline personality disorder not only in victims if childhood sexual abuse but in all individuals diagnosed with it. Further research may be linked to the exploration of social issues that childhood sexual abuse victims may experience in their future life. The psychological damages caused by sexual may become the basis of the future research of finding links between social behavior of abused children.
Conclusion
The severity of Borderline symptoms or pathology has been positively associated with the severity of childhood trauma. A direct causal relationship between sexual abuse and borderline personality has not been established. This is due to many factors, including the fact that many people who report severe sexual trauma in childhood do not go on to develop borderline personality disorder. Additionally, many studies rely on the self reporting of the Borderline participants, and the reports of abuse are not always verifiable, especially because Borderlines are typically manipulative and they interpret events in ways that may not be accurate.
In order to prevent this disorder from being so prevalent in the community, first there needs to be child abuse prevention done in the homes, for parents. Some of my research indicated a possibility that BPD resulted from a dour mixture of genetics and environment. Borderline parents have increased their children’s risk of developing the disorder simply based on the fact that the children are exposed to them.
The other prevention measure is simply to ensure that the child victims experiences are not swept under the rug. They require a team of interventionists, not just a therapist. The child, the child’s family, and the child’s everyday surroundings need to be examined, so that the best treatment plan, and safety plans can be determined.
References
Advocates For Youth (1995). Advocates for youth child abuse. Web.
Bailey, J., & Shriver, A. (1999). Does childhood sexual abuse cause borderline personality disorder. Journal of Sex & Marital Therapy, 25, 45-57.
Borderline Personality Disorder Central (2005). What is borderline personality disorder. Web.
Cyr, M., McDuff, P., Wright, J., Theriault, C., & Cinq-Mars, C. (2005). Clinical correlates and repetition of self-harming behaviors among female adolescent victims of sexual abuse. Journal of Child Sexual Abuse, 14.
Martin, G., Bergen, H., & Richardson, A. (2004). Sexual abuse and suicidality: Gender differences in a large community sample of adolescents. Child Abuse & Neglect, 28, 491–503.
Trippany, R. L., Helm, H. M., & Simpson, L. (2006). Trauma reenactment: rethinking borderline personality disorder when diagnosing sexual abuse survivors. Journal of Mental Health Counseling, 28, 95-110.