Childhood sexual abuse as a predictive factor for the prevalence of borderline personality disorder

Abstract

BACKGROUND: Childhood sexual abuse (CSA) is a major public health issue with devastating short- and long-term sequalae, including borderline personality disorder (BPD) (Cutajar et al., 2010; Fergusson et al., 2013). Prior research has demonstrated a link between childhood maltreatment and BPD, yet a dearth of focused evidence prevails in respect of CSA as a predictive factor for the causal prevalence of BPD in adolescents and adults. OBJECTIVE: The aim of this literature review was to assert CSA as a causal predictive factor for BPD diagnosis in adolescents and adults, and to explore CSA parameters which arbitrate this prognostication. The clinical inquiry was informed by the PEO framework, and read “is childhood sexual abuse a predictive factor for the prevalence of borderline personality disorder?’ METHODS: A methodical search strategy was conducted to retrieve the most relevant articles. The selection criteria applied included participants aged between 10 and 65 years old, who were diagnosed with BPD by credible diagnostic criteria, and who had a history of CSA. Only 8 articles fulfilled the selection criteria across three decades. These studies were appraised using the PRISMA Checklist (2), the STROBE Statement (5), and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series (1). RESULTS: CSA was inferred as a predictive factor for the causal prevalence of BPD, and several mediating factors were found to play a role in this association. Particularly, early onset and longer duration of CSA, genital fondling and penetration during CSA, and intrafamilial perpetrators of CSA were associated with a higher propensity for subsequent BPD diagnosis. CSA severity was linked with more severe clinical presentations of BPD, and suicidal behaviours were majorly prevalent amongst persons with co-occurring CSA history and BPD. CONCLUSION: CSA predicts subsequent BPD prevalence. The articles included in this literature review span across three decades, yet they all impart similar findings. Longitudinal research exploring the enduring effects of CSA on the long-term functioning of adult persons with BPD is warranted. Greater public and professional awareness on CSA is necessary to promote early disclosure and detection of CSA, BPD prophylaxis, and mitigation of this public health issue. Locally, specialist services such as emergency services to sexually abused minors and advanced provision of DBT, are required.