Traumatic Exposure And Posttraumatic Stress Disorder In Borderline, Schizotypal, Avoidant, And Obsessive-Compulsive Personality Disorders: Findings From The Collaborative Longitudinal Personality Disorders Study
Yen S, Shea MT, Battle CL, et al. ;
Commented by , 25 Sep 2002
Aim of the study
The aim of the study was to determine the relationship between traumatic exposure and/or Posttraumatic Stress Disorder (PTSD), and 4 specific DSM-IV personality disorders (PD): borderline personality disorder (BPD), schizotypal personality disorder (STPD), avoidant personality disorder (AVPD) and obsessive-compulsive personality disorder (OCPD).
Method
The study is part of the Collaborative Longitudinal Personality Disorders Study (CLPS). This study involves treatment clinics in four US sites. The CLPS is intended as a longitudinal, prospected study, but the results that are presented in the current paper are based on cross-sectional, retrospective data. The results are based on a sample of 653 participants.
Participants were evaluated for the presence of PD using the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Diagnoses of PD had to be confirmed by at least one of two other assessments procedures.
Participants were evaluated for the presence of PTSD using the Structured Clinical Interview for DSM-IV Axis I Disorders/Patient Version (SCID-I/P), and for exposure to traumatic events using the SCID Trauma Addendum.
Traumatic events were classified into 10 specific categories. Age of onset was assed for each traumatic event. Exposure in childhood (defined as occuring at age 17 or younger) was separated into sexual abuse and physical assault.
Participants meeting criteria for one of the four PDs were compared to a group of patients meeting criteria for major depressive disorder (MDD). MDD was assessed using the Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I/P).
Results
Rates of traumatic exposure were high in all four PD groups as well as in the control group. However, a significantly higher rate of BPD participants endorsed having experienced sexual traumas, including physical force/unwanted sexual contact and rape.
In addition, significantly earlier age of traumatic events, significantly higher rates of types of trauma, trauma of an assaultive nature, PTSD, childhood sexual abuse and childhood physical assault were found in the more severe PDs (BPD /STPD).
Discussion
The results give support to a growing number of findings linking severe PDs such as BPD and STPD to traumatic exposure, in particular to early onset traumatic events, and/or PTSD. The results also give support to a growing number of findings linking BPD to sexual traumas, including childhood sexual abuse.
The strengths of the study include comprehensive assessment of 4 personality disorders, exposure to traumatic events, and current and lifetime PTSD, in a larger clinical population.
The study presents at least two major limitations. First, the results concerning rates of PD are based on cross-sectional data; as such, it is not possible to discern whether the presence of a PD predisposed individuals to experience traumatic events or PTSD, or whether individuals experienced a change in personality in response to the traumatic event or PTSD. Second, traumatic events were assessed retrospectively.