The role of different forms of adverse childhood experiences in borderline personality disorder: results from a network analysis including clinical and non-clinical populations.

BACKGROUND

Borderline Personality Disorder (BPD) has been associated with a range of adverse experiences, including emotional, physical, and sexual abuse, neglect, invalidation, bullying, and unpredictable environments during childhood and adolescence (ACE). While these different forms of ACE often co-occur, most research has examined them in isolation, leaving unclear their interrelations and specific significance for BPD psychopathology.

OBJECTIVE

This study investigates the level of different forms of ACE exposure in BPD and clinical controls, whether they are differentially related to the severity of BPD symptoms and how they are inter-related with each other.

METHODS

Cross-sectional data were collected from individuals diagnosed with BPD (n = 171), clinical controls (CC; n = 93), and non-clinical controls (NC; n = 73). BPD symptoms were measured using the BSL-23, while different types of ACE were assessed using the CTQ (abuse/neglect), ICES (invalidation), QUIC (unpredictability), and BSA (bullying). Graph-theoretical network analyses were conducted across groups to investigate associations between BPD symptom severity and ACE types, as well as interrelationships among ACEs. Data-driven community detection was applied to identify clusters of closely connected ACE types.

RESULTS

The BPD group showed higher ACE severity across all forms of ACE compared to CC and NC groups. Network analysis revealed unique associations between BPD symptom severity and emotional abuse, peer bullying, parental unpredictability, and lack of safety and security. Examination of interrelationships among ACE types resulted in a five-cluster solution demonstrating a complex pattern of unique associations.

CONCLUSIONS

This study advances our understanding of how different forms of ACE relate to BPD psychopathology and how they are interrelated with each other. The findings suggest that the impact of ACE extends beyond physical and sexual abuse to include relational and environmental adversities with relevance for BPD symptom severity in adulthood.