Childhood adversity, bonding and family functioning – is there a specific association with borderline personality disorder in adolescents?

Objective: Despite growing evidence on risk-factors of borderline personality disorder (BPD) in adults, there is a paucity of research on such specific characteristics of BPD in youth. Furthermore, studies on adolescence BPD in clinical setting are still rare. This study aimed to investigate adverse childhood experiences, parental bonding and family functioning in a sample of female adolescent inpatients with BPD, and to compare them with a clinical control group with mixed psychiatric diagnoses. Method: A consecutive sample of 91 female adolescents inpatients (ages 12-18 years) was recruited within a psychiatric university hospital. BPD was assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. The Childhood Experiences of Care and Abuse Questionnaire (CECA.Q) was used to assess childhood abuse history, the Parental Bonding Instruments (PBI) was used to evaluate the parent–child bonding, and the Family Assessment Device (FAD) was used to evaluate familial functioning perceived by the adolescent. Results: A history of childhood abuse and maltreatment was significantly (p = <.001) more common in patients with BPD compared to their clinical controls. Using univariate regression, significant associations were found for all adverse childhood experiences, except for physical abuse from mother. Univariate regression analyses also showed significant associations for all subscale of the FAD and PBI. In the stepwise logistic regression model (p < .001), experiences of sexual abuse (OR = 14.11, CI = 3.21 – 62.04), problematic General Functioning (OR = 9.38, CI = 2.23 – 39.44), and low Care from mother (OR = 7.35, CI = 1.88 – 28.80) remained in the best predictive model of BPD. Conclusion: The findings of this study emphasize the importance of considering familial variables and a broad variety of adverse childhood experience in the etiology of BPD in adolescence. They have important implications for family involvement in the treatment of adolescent BPD.