The role of childhood traumatization in the development of borderline personality disorder in Hungary

Eu . J. Psychia . Vol. 29, N.° 2, (105-118) 2015 Keywo ds: Bo de line pe sonali y diso de ; Child- hood auma iza ion; Physical abuse; Sexual abuse; Emo ional abuse. The ole o childhood auma iza ion in he de elopmen o bo de line pe sonali y diso de in Hunga y Ka alin Me zaa,* Gábo Pappb Ildikó Ku i á né Szabó, PhDa aUni e si y o Deb ecen, School o Public Heal h, Depa men o Beha io al Sciences, Deb ecen bUni e si y o Deb ecen, Ins i u e o Psychology, Deb ecen HUNGARY ABSTRACT – Backg ound and Objec i es: The e is a g owing body o e idence sugges - ing he ole o childhood abuse in he e iology o bo de line pe sonali y diso de (BPD). S udies ound ha complex auma iza ion ela ed o BPD include emo ional/physical/sex- ual abuse and neglec . This s udy examines sel - epo ed expe iences o childhood auma- iza ion in Hunga ian inpa ien s wi h a diagnosis o bo de line pe sonali y diso de and e- eal which e iological ac o s a e mos s ongly associa ed wi h he de elopmen o BPD. Me hods: T auma ic childhood expe iences o 80 bo de line inpa ien s, 73 dep essed inpa ien s and 51 heal hy con ols we e assessed wi h he T auma ic An eceden s Ques- ionnai e and he Sexual Abuse Scale o Ea ly T auma In en o y. Resul s: Ad e se childhood expe iences (neglec , emo ional abuse, physical abuse, sex- ual abuse, wi nessing auma) we e mo e p e alen among bo de line pa ien s han among dep essed and heal hy con ols. Bo de line pa ien s epo ed se e e sexual abuse, cha ac- e ized by inces , pene a ion and epe i i e abuse. Sexually abused bo de line pa ien s ex- pe ienced mo e physical and emo ional abuse han bo de lines who we e no sexually abused. The s onges p edic o s o bo de line diagnosis we e sexual abuse, in a amilial physical abuse and neglec by he ca e ake s. Conclusions: O e all, ou esul s sugges ha a epo ed childhood his o y o abuse and neglec a e bo h common and highly disc imina ing o bo de line pa ien s in Hun- ga y as well. Recei ed: 1 Decembe 2014 Re ised: 3 Ma ch 2015 Accep ed: 9 Ap il 2015 106 KATALIN MERZA ET AL. Backg ound and objec i es The ole o childhood auma iza ion in he e iology o bo de line pe sonali y diso - de (BPD) has been a ocus o esea ch o mo e han 30 yea s1-4. No h Ame ican and Wes e n Eu opean s udies ha e p o ided a la ge body o e idence on he nume ous in- a amilial pa hological childhood expe i- ences, such as a his o y o physical, emo- ional, sexual abuse and neglec ha a e commonly epo ed by bo de line pa ien s1,4- 6. Mo e speci ically, 40-86% o subjec s wi h BPD ha e epo ed being sexually abused du ing hei childhood7-14, o a maximum o 94.7% epo ed by McLean and Gallop in 200315. Fu he mo e, 10-73% ha e epo ed being physically abused by pa en s o adul ca e ake s1,9,11,13,16,17 and 17-25% ha e e- po ed being physically neglec ed11,13. Th ee- qua e s o bo de line pa ien s ha e epo ed emo ional abuse and 70% ha e epo ed childhood emo ional wi hd awal13. In addi- ion, indings o a la ge numbe o s udies show ha childhood expe iences o bo h abuse and neglec a e signi ican ly mo e common among bo de line pa ien s han among compa isons wi h a diagnosis o Axis I o Axis II diso de s2,11-13,18. O all o he psychosocial ac o s, child- hood sexual abuse is conside ed o be he mos speci ic in he e iology o BPD19. Pa a- me e s o childhood sexual abuse highly dis- c imina e be ween abused BPD pa ien s and abused non-BPD pa ien s20,21. Bo de line pa- ien s compa ed o Axis I and II subjec s ha e epo ed he mos se e e pa ame e s o sexual abuse: signi ican ly highe in a- amilia a es (72%)15, no single inciden s o abuse (50%)11, mul iple pe pe a o s (35-79%)21,22, ea ly-on- se abuse (13-60%)8,10,12,17,19, use o o ce (93%)21 and pene a ion (33-44%)8,11,21. Al- hough s udies ha e ound ha 40-75% o bo de line pa ien s a e abused by a ull- ime adul ca e ake 9,23,24, epo ed childhood sex- ual abuse in bo de line samples is pe pe a ed no only by pa en s. Mo eo e , epo ing memo ies o sexual abuse by siblings, g and- a he s o o he amily membe s could, in some cases, be a ‘sc een’ o pa en al inces , which some may ind in ole able o ecall8. Howe e , sexual abuse is nei he neces- sa y, no su icien o he de elopmen o BPD13. A me a-analy ic s udy o he pub- lished li e a u e (con aining 19 No h-Ame - ican and wo Eu opean s udies) be o e 1999, conduc ed by Fossa i, Mededdu and Ma - ei25, has ound ha in Wes e n socie y he e is only a mode a e associa ion be ween child- hood sexual abuse and BPD diagnosis. Sex- ual abuse does no occu in a acuum, i oc- cu s in he con ex o o he o ms o abuse and dys unc ional pa en al beha io 26,27 and con ibu es o he de elopmen o BPD h ough in e ac ion wi h o he pa hological childhood expe iences4,5. Fo example, sex- ually abused BPD pa ien s a e mo e likely o epo physical neglec , emo ional wi h- d awal, and inconsis en ea men by ca e- ake s13. They usually come om dis u bed amilies which do no o canno p o ec hei child en and ail o mee hei needs2,8. Thus BPD pa ien s ha e also epo ed signi ican ly highe a es o psychia ic diso de s in hei amilies, especially anxie y diso de s, de- p ession, sepa a ion om pa en s, un a o - able pa en al ea ing s yles1, an isocial dis- o de s and subs ance use diso de 28,29. The indings o p e ious esea ches sugges ha s udies should assess a ange o pa hological childhood expe iences, a he han ocus solely on he p e alence o sexual abuse13. Ou side No h-Ame ica and Wes e n Eu- ope, only a limi ed numbe o s udies ha e ex- amined he ela ionship be ween childhood abuse and bo de line psychopa hology. Re- cen ly, esul s eme ging om s udies con- duc ed in Japan and China con ibu e o un- de s anding c oss-cul u al and cul u e-spe- ci ic aspec s o bo de line e iology30,31,32. Consis en wi h p io No h Ame ican and Wes e n Eu opean esea ch, bo h Japanese and Chinese s udies ha e ound ha expe i- ences o emo ional, physical, sexual abuse, emo ional and physical neglec a e mo e p e alen among BPD pa ien s han among non-BPD pa ien s30,31,33. In hese s udies, he epo ed a e o childhood sexual abuse among bo de line pa ien s was lowe han epo ed a es in No h Ame ica, a ibu ed by Huang30 o he lowe a e o epo ed sexual abuse in he gene al popula ion o China. In addi ion, in hese s udies only ou pa ien sam- ples we e used and he indings may no be gene alizable o mo e se e ely dis u bed in- pa ien s30. The se e i y o childhood sexual abuse was also g ea e among BPD pa ien s in China who had su e ed inces , pene a ion and epe i i e abuse30. Fu he mo e, Huang and colleagues30 used mul i a ia e analyses o examine he a iables which p edic BPD. The esul s in China e ealed ha a combi- na ion o sexual abuse, ma e nal neglec , ma- e nal physical abuse, and pa e nal an ipa hy we e signi ican p edic o s o BPD, bu none o hese a iables alone we e p edic i e o BPD30. In he Japanese s udy, emo ional abuse, emo ional neglec and pa e nal o e - p o ec ion we e signi ican p edic o s o BPD31. The au ho s ha e assumed he esul s e lec di e ences be ween pa en ing s yles in Wes e n coun ies and he Fa Eas , he la - e being mo e collec i is ic and he pa en ing s yle, mo e au ho i a ian, cha ac e ized by co- e ci e con ol and low esponsi eness31,32,34. Impo an ly, pa hological childhood expe i- ences a e jus a pa o he mo e complex bo - de line e iology. The mul i ac o ial model o he de elopmen o BPD sugges s ha he dis- o de esul s om he in e ac ion and ansac- ion o biological and en i onmen al ac- o s35,36. Examining biological ac o s is ou side he scope o his s udy. In summa y, childhood expe iences o abuse a e pa o a c oss-cul u al e iology o BPD in No h Ame ican and Wes e n Eu o- pean coun ies as well as he Fa Eas , bu he ela i e con ibu ion o pa icula o ms o childhood abuse o he de elopmen o his diso de seems o a y ac oss cul u es. A li e a u e sea ch has e ealed ha in Hunga y and in he Eu opean Pos -So ie s a es he e ha e been no s udies ha ha e in- es iga ed he ole o auma ic childhood expe iences in he de elopmen o BPD. The pu poses o his s udy a e o assess e o- spec i ely he sel - epo ed expe iences o childhood auma iza ion in Hunga ian inpa- ien s wi h a diagnosis o BPD and o de e - mine which e iological ac o s a e mos s ongly associa ed wi h he de elopmen o BPD. Fu he mo e, we seek o e eal he di - e ences be ween Hunga ian and No h-Ame - ican/Wes e n Eu opean bo de line samples in o de o unde s and he ela i e con ibu ions o e iological ac o s ha a e cul u e-speci ic and o he s ha a e c oss-cul u al. Hunga y and China bo h being coun ies wi h only el- a i ely ecen Pos -So ie his o ies, pa en s may no conside co po al punishmen as abuse and, he e o e, his pa en ing s yle may be co ela ed wi h highe p e alence o child physical abuse. We hypo hesized ha in ou s udy physical abuse as a cul u e-speci ic ac- o would inc ease he isk o BPD. Fu he - mo e, we assume ha he majo p edic o s (neglec , sexual abuse) o BPD in he Wes e n socie ies would also associa ed wi h he de- elopmen o BPD in Hunga y. In his s udy bo de line inpa ien s we e compa ed wi h dep essed inpa ien s and a g oup o heal hy indi iduals in he commu- ni y. The con ol g oups we e ini ially chosen, because in sexual abuse esea ch, ch onic de- p ession is o en seen as a long- e m esul o sexual abuse23,37,38 and because, BPD pa ien s a e a ely compa ed wi h a heal hy con ol g oup wi h ega d o childhood auma1. THE ROLE OF CHILDHOOD TRAUMATIZATION IN THE DEVELOPMENT... 107 Me hods Pa icipan s and p ocedu e The p esen s udy was conduc ed o e he pe iod om Janua y 2013 o June 2013. The s udy ollowed he e hics decla a ion o Helsinki and p io o da a collec ion he p ojec was app o ed by he Hunga ian Scien i ic and Medical E hics Commi ee (ETT-TUKEB). 171 inpa ien s we e ec ui ed om eigh Hunga ian psychia ic hospi als. All pa ien s we e ini ially sc eened o de e mine ha hey 1) we e be ween he ages o 18 and 50 yea s 2) had a leas an a e age le el o in ellec ual unc ioning and 3) had been gi en a de ini e o a p obable clinical diagnosis o bo de line pe sonali y diso de o majo dep essi e dis- o de by a senio psychia is . Pa icipan s we e excluded i hey had cu en symp oms o a his o y o 1) bipola mood diso de 2) majo psycho ic diso de o 3) cogni i e im- pai men . A e p o iding pa ien s wi h a comple e desc ip ion o he s udy, w i en in- o med consen was ob ained om each o hem. The Hunga ian e sion o S uc u ed Clinical In e iew o DSM-IV Axis I and Axis II diso de s (SCID-I-II)39,40 was hen adminis e ed o con i m he diagnosis o bo - de line pe sonali y diso de and majo de- p essi e diso de (MDD). 18 o 171 pa ici- pan s we e elimina ed by he diagnos ic in e iew: 14 because hey we e ound o ha e diso de s excluded om his s udy, as abo e, and 4 because hey me less han i e BPD diagnos ic c i e ia. Pa ien s who me a leas i e DSM-IV c i e ia o BPD on he SCID-II we e included in he bo de line co- ho . Pa ien s who me he diagnosis o ma- jo dep essi e diso de wi hou pe sonali y diso de s we e he non-bo de line dep essed con ols. The in e iews we e conduc ed by he i s au ho , a well- ained psychologis . Heal hy con ols we e ec ui ed o he s udy om employees o local companies in Deb ecen. Ou o a pool o 62 con ols 51 we e ee o psychia ic diso de s, as assessed by he SCID. Measu es Expe iences o childhood auma iza ion we e assessed by he T auma ic An eceden s Ques ionnai e (TAQ) including in he T auma Cen e Assessmen Package41. The TAQ is a 42-i em sel - epo ques ionnai e o ga he - ing in o ma ion abou he equency and se e i y o auma ic and adap i e expe i- ences and i has been used by many e- sea che s15,42. The p ocess o he ansla ion and adap a ion o TAQ o Hunga ian ollowed a s anda d p ocedu e acco ding o he guide- lines o sel -assessmen ins umen s. Analy- sis o he psychome ic p ope ies o he TAQ is cu en ly unde way, and p elimina y e- sea ch showed sa is ac o y alidi y and elia- bili y (wi h C onbach alphas o 0.683-0.923). In his s udy only 6 subscales o he TAQ we e used, selec ed o he pu pose o as- sessing auma ic o ad e se expe iences. These subscales co e neglec , sepa a ion, emo ional abuse and physical abuse by a ca e ake o amily membe , sexual abuse by an adul and wi nessing o domes ic iolence. These ad e se expe iences we e assessed a ou di e en de elopmen al pe iods: ea ly childhood (0-6 yea s), la ency (7-12 yea s), adolescence (13-18 yea s), and adul hood (o e 18 yea s). Responses can be sco ed 1 o 4, wi h 1 co esponding o ‘ne e o no a all’, 2 o ‘ a ely o a li le bi ’, 3 o ‘occa- sionally o mode a ely’, 4 o ‘o en o e y much’. Howe e , in his s udy he ype o childhood auma iza ion was analyzed as a dycho omic a iable ( auma ized – non- au- ma ized), because we aimed o compa e ou esul s wi h he esul s o p e ious s udies which also used dycho omic a iables. The cu -o poin was de e mined 2/3, hus sub- 108 KATALIN MERZA ET AL. jec s who sco ed 1 (‘ne e o no a all’) o 2 (‘ a ely o li le bi ’) in each i em we e con- side ed non- auma ized, and subjec s who sco ed 3 (‘occasionally o mode a ely’) o 4 (‘o en o e y much’) we e conside ed au- ma ized. The 2/3 cu -o poin was ini ially chosen o p e en he o e es ima ion o au- ma ic expe iences in he sample. P e ious s udies ha e indica ed ha he pa ame e s o childhood sexual abuse ha e a speci ic ela ionship wi h he bo de line di- agnosis and highly disc imina e abused BPD pa ien s and abused non-BPD pa ien s21. In iew o his, we aimed o examine he pa a- me e s o sexual abuse in de ail. In addi ion o he TAQ, he Sexual Abuse Scale o he Ea ly T auma In en o y (ETI)43 (wi h C on- bach alpha o 0.932) was used o assess child- hood expe iences o sexual abuse mo e ac- cu a ely. The p ocess o he ansla ion o ETI Sexual Abuse Subscale o Hunga ian language ollowed he s anda d p o ocol. Co ela ion analysis be ween he Sexual Abuse Scale o ETI and he sexual abuse subscale o TAQ showed ha he scales mea- su e he same cons uc ( = 0.88, p< 0.001). The ETI de ines sexual abuse as unwan ed sexual con ac pe o med solely o he g a - i ica ion o he pe pe a o , o he pu pose o domina ing o deg ading he ic im. This 15- i em scale ga he s in o ma ion abou e- quency, age a onse , use o o ce, ela ion- ship o he pe pe a o and na u e o sexual abuse a 4 de elopmen al s ages (simila o he de elopmen al s ages o he TAQ). All assessmen s we e done by he i s au- ho . Be ween-g oup compa ison o age in ol - ing con inuous da a we e compu ed by means o one-way analysis o a iance. Chi-squa e es s we e pe o med o compa e he e- quency dis ibu ions o ce ain demog aphic cha ac e is ics, auma ic expe iences and he na u e o sexual abuse be ween he pa ien and he con ol g oups. When cell sizes we e 5 o less Fische ’s exac es o p obabili y was used. Logis ic eg ession was used o es he esea ch ques ion ega ding he pos- sible p edic o s o BPD. A p alue less han 0.05 was conside ed s a is ically signi ican . The s a is ical analyses we e pe o med by he SPSS s a is ical package e sion 20.0. Resul s The inal sample consis ed o 204 pa ici- pan s, o whom 80 psychia ic inpa ien s we e in he BPD g oup, 73 psychia ic inpa ien s we e in he dep essed compa ison g oup and 51 people we e in he heal hy compa ison g oup. Table 1 p esen s he compa ison o de - mog aphic da a among he h ee g oups. To e alua e age di e ences among he g oups one-way analysis o a iance (ANOVA) was conduc ed. ANOVA e ealed signi ican di - e ences among he h ee g oups (F= 49.42, p< 0.001), he mean ages o he BPD g oup (30.5 ± 10.87 yea s) and o he heal hy com- pa ison g oup (33.6 ± 8.71) we e signi ican ly lowe han o he dep essed compa ison g oup (44.3 ± 5.91 yea s) acco ding o he esul s o he Tukey es . Chi-squa e es o he ca e- go ical da a showed signi ican di e ences in ma i al s a us ( χ 2= 88.72, p< 0.001) and employmen ( χ 2= 130.1, p< 0.001) among he g oups, wi h bo de line pa ien s less likely o be ma ied and mo e likely o be unem- ployed han compa ison subjec s. The g oups we e ound o be simila in sex dis ibu ion, wi h all g oups con aining signi ican ly mo e emales han males ( χ 2= 0.43, p= 0.808). The e we e no s a is ically signi ican di e - ences among he g oups o educa ion ( χ 2= 9.00, p= 0.061). THE ROLE OF CHILDHOOD TRAUMATIZATION IN THE DEVELOPMENT... 109 Table 2 compa es bo de line pa ien s and con ol subjec s on o e all a es o epo ed childhood auma iza ion, speci ically, ne- glec by ca e ake s, sepa a ion om ca e ak- e s, in a amilial emo ional and physical abuse, in a/ex a amilial sexual abuse and wi nessing amily iolence. A Chi-squa e es e ealed signi ican di e ences among he g oups o neglec ( χ 2= 35.88, p< 0.001), emo ional abuse ( χ 2= 34.36, p< 0.001), physical abuse ( χ 2=51.58, p< 0.001), sexual abuse ( χ 2=45.52, p< 0.001) and wi nessing auma ( χ 2=45.02, p< 0.001) be o e he age o 18. The e we e no signi ican di e ences among he g oups o sepa a ion ( χ 2= 5.19, p= 0.075). As seen in Table 3, subsequen compa isons indica ed ha he a es o child- hood neglec ( χ 2= 24.19, p< 0.001; χ 2= 31.63, p< 0.001), emo ional ( χ 2=17.47, p< 0.001; χ 2= 33.77, p< 0.001), physical ( χ 2 = 32.67, p< 0.001; χ 2 =35.78, p< 0.001), sex- ual abuse ( χ 2 = 20.42, p< 0.001; χ 2 = 37.07, p< 0.001) and wi nessing auma ( χ 2 =12.02, p< 0.001; χ 2 = 44.95, p< 0.001) we e sig- ni ican ly highe in he BPD g oup han in de- p essed and heal hy con ol g oups. 110 KATALIN MERZA ET AL. Table 1 Demog aphic cha ac e is ics o he bo de line and dep essed g oups. Analysis Demog aphic BPD Dep essed Heal hy cha ac e is ic (N = 80) (N = 73) (N = 51) χ 2P Age (Mean, SD)* 30.5 ± 10.87 44.3 ± 5.91 33.6 ± 8.71 <0.001 Sex Male 12 (15%) 13 (17.8%) 7 (13.7%) 0.43 (d = 2) 0.808 Female 68 (85%) 60 (82.2%) 44 (86.3%) Ma i al s a us Single 50 (62.5%) 6 (8.2%) 19 (37.0%) 88.72 (d = 8) <0.001 Ma ied 3 (3.8%) 42 (57.5%) 12 (24.0%) Common-law ma iage 10 (12.5%) 6 (8.2%) 16 (31.0%) Di o ced 14 (17.5%) 14 (19.2%) 2 (4.0%) Relic 3 (3.8%) 5 (6.9%) 2 (4.0%) Educa ion P ima y school o below 19 (23.8%) 13 (17.8%) 5 (9.8%) 9.00 (d = 4) 0.061 Seconda y school 51 (63.8%) 45 (61.6%) 30 (58.8%) Uni e si y 10 (12.5%) 15 (20.5%) 16 (31.4%) Employmen Unemployed 30 (37.5%) 14 (19.2%) 2 (3.9%) 130.1 (d = 12) <0.001 Disabled 13 (16.3%) 39 (53.4%) 0 (0.0%) Full- ime emloymen 6 (7.5%) 6 (8.2%) 26 (51.0%) Pa - ime employmen 6 (7.5%) 1 (1.4%) 2 (3.9%) Tempo a y employmen 4 (5.0%) 0 (0%) 1 (2.0%) S uden 16 (20.0%) 1 (1.4%) 19 (37.3%) O he 5 (6.3%) 12 (16.4%) 1 (2.0%) No e. * F = 49.42. Table 4 p esen s he p e alence o ad e se expe iences epo ed by he g oups a he h ee age pe iods, ea ly childhood (0-6 yea s), la ency (7-12 yea s) and adolescence (13-18 yea s). A Chi-squa e es indica ed signi ican di e ences among he g oups o neglec , emo ional, abuse, physical abuse, sexual abuse and wi nessing auma a each de elopmen al pe iod. The e we e no sig- ni ican di e ences among he g oups o sepa a ion a ea ly childhood and adoles- cence. Table 4 shows he subsequen com- pa isons o he g oups on he epo ed a es o childhood auma iza ion sepa a ely a each age pe iod. Chi-squa e es indica ed signi ican di e ences be ween he bo de - line and bo h con ol g oups on mos ypes o auma iza ion a each pe iod. Mo e speci - ically, a highe pe cen age o BPD pa ien s han dep essed and heal hy compa isons e- po ed ha ing expe ienced neglec , emo- ional abuse, physical abuse, sexual abuse and wi nessing auma a ea ly childhood, la- ency and adolescence. A signi ican ly highe pe cen age o bo de lines han dep essed con ols also epo ed sepa a ion du ing all h ee o hese pe iods. Howe e , a ea ly childhood and adolescence bo de line and heal hy g oups did no di e on epo ed a es o sepa a ion om ca e ake s. THE ROLE OF CHILDHOOD TRAUMATIZATION IN THE DEVELOPMENT... 111 Table 3 Subsequen compa isons o he g oups on epo ed a es o childhood auma iza ion. BPD s. Dep essed BPD s. Heal hy Type o auma iza ion χ 2 (d = 2) P χ 2 (d = 1) P Neglec 24.19 <0.001 31.63 <0.001 Sepa a ion 3.94 0.047 0.003 0.956 Emo ional abuse 17.47 <0.001 33.77 <0.001 Physical abuse 32.67 <0.001 35.78 <0.001 Sexual abuse 20.42 <0.001 37.07 <0.001 Wi nessing 12.02 <0.001 44.95 <0.001 Table 2 Repo ed a es o childhood auma iza ion in he bo de line g oup and he con ol g oups be o e he age o 18. Analysis Type o BPD Dep essed Heal hy auma iza ion (N = 80) (N = 73) (N = 51) χ 2P Neglec 69 (86.3%) 36 (49.3%) 20 (39.2%) 35.88 <0.001 Sepa a ion 64 (80.0%) 48 (65.8%) 41 (80.4%) 5.19 0.075 Emo ional abuse 70 (87.5%) 42 (57.5%) 20 (39.2%) 34.36 <0.001 Physical abuse 52 (65.0%) 14 (19.2%) 6 (11.8%) 51.58 <0.001 Sexual abuse 45 (56.3%) 15 (20.5%) 2 (3.9%) 45.52 <0.001 Wi nessing 62 (77.5%) 37 (50.7%) 9 (17.6%) 45.02 <0.001 112 KATALIN MERZA ET AL. Table 4 Compa isons o he g oups on epo ed a es o childhood auma iza ion in he h ee de elopmen al s ages. Analysis All G oups BPD s. Heal hy BPD s. Dep essed Type o auma iza ion BPD Dep essed Heal hy χ 2 χ 2 χ 2 (N = 80) (N = 73) (N = 51) (d = 2) P(d = 2) P(d = 1) P Neglec Ea ly childhood (0-6 yea s) 50 (62.5%) 27 (37.0%) 10 (19.6%) 24.92 <0.001 23.08 <0.001 9.94 0.002 La ency (7-12 yea s) 56 (70.0%) 34 (46.6%) 13 (25.5%) 25.38 <0.001 24.75 <0.001 8.65 0.003 Adolescence (13-18 yea s) 68 (85.0%) 34 (46.6%) 20 (39.2%) 35.43 <0.001 29.61 <0.001 25.36 <0.001 Sepa a ion Ea ly childhood (0-6 yea s) 32 (40.0%) 18 (24.7%) 19 (37.3%) 4.37 0.112 0.09 0.753 4.08 0.043 La ency (7-12 yea s) 48 (60.0%) 29 (39.7%) 29 (56.9%) 6.94 0.031 0.13 0.722 6.28 0.012 Adolescence (13-18 yea s) 61 (76.3%) 43 (58.9%) 32 (62.7%) 5.64 0.06 2.76 0.097 5.28 0.022 Emo ional abuse Ea ly childhood (0-6 yea s) 48 (60.0%) 20 (27.4%) 7 (13.7%) 32.98 <0.001 27.38 <0.001 16.43 <0.001 La ency (7-12 yea s) 59 (73.8%) 37 (50.7%) 13 (25.5%) 29.49 <0.001 29.30 <0.001 8.69 0.003 Adolescence (13-18 yea s) 68 (85.0%) 34 (46.6%) 20 (39.2%) 35.43 <0.001 29.61 <0.001 25.36 <0.001 Physical abuse Ea ly childhood (0-6 yea s) 34 (42.5%) 6 (8.2%) 0 (0.0%) 45.04 <0.001 29.27 <0.001 23.23 <0.001 La ency (7-12 yea s) 40 (50.0%) 10 (13.7%) 2 (3.9%) 43.14 <0.001 30.36 <0.001 22.86 <0.001 Adolescence (13-18 yea s) 47 (58.8%) 10 (13.7%) 6 (11.8%) 47.94 <0.001 28.54 <0.001 33.14 <0.001 Sexual abuse Ea ly childhood (0-6 yea s) 17 (21.3%) 4 (5.5%) 0 (0.0%) 18.08 <0.001 12.45 <.0001 8.02 0.005 La ency (7-12 yea s) 28 (35.0%) 7 (9.6%) 0 (0.0%) 31.42 <0.001 22.70 <0.001 13.97 <0.001 Adolescence (13-18 yea s) 42 (52.5%) 6 (8.2%) 2 (3.9%) 56.03 <0.001 32.95 <0.001 34.76 <0.001 Wi nessing Ea ly childhood (0-6 yea s) 45 (56.3%) 16 (21.9%) 3 (5.9%) 41.42 <0.001 34.03 <0.001 18.77 <0.001 La ency (7-12 yea s) 50 (62.5%) 22 (30.1%) 5 (9.8%) 39.61 <0.001 35.51 <0.001 16.05 <0.001 Adolescence (13-18 yea s) 55 (68.8%) 34 (46.6%) 8 (15.7%) 35.21 <0.001 35.13 <0.001 7.71 0.005 Table 5 compa es bo de line and dep essed pa ien s who epo ed childhood sexual abuse wi h espec o he pa ame e s o sexual abuse. In his sample 45 bo de line pa ien s and 15 dep essed compa isons epo ed ha - ing expe ienced sexual abuse be o e he age o 18. Fo pa ien s who had been abused by mo e han one pe pe a o , da a we e en e ed o he speci ic pe pe a o whose abuse would be expec ed o be mo e auma ic, ac- co ding o he Pa is & Zweig-F ank’s21 hie - a chy. A signi ican ly highe pe cen age o bo de line pa ien s han dep essed compa - isons epo ed childhood sexual abuse pe - pe a ed by a a he /male ca e ake ( χ 2 =5.93, p= 0.015). Mo eo e , he equency o mul- iple pe pe a o s was also highe among BPD pa ien s ( χ 2 = 9.27, p< 0.001). Mo e BPD pa ien s epo ed abuse by pe pe a o s amilia o hem ( χ 2 =0.86, p = 0.353), and by b o he s ( χ 2 = 0.69, p= 0.41), bu hese di - e ences we e no signi ican . Fu he mo e, he a e o childhood sexual abuse by a male s ange was signi ican ly highe in he de- p essed con ol g oup ( χ 2 = 4.69, p= 0.03). The e was a la ge, signi ican di e ence be- ween he g oups wi h espec o he na u e o childhood sexual abuse. The p e alence o THE ROLE OF CHILDHOOD TRAUMATIZATION IN THE DEVELOPMENT... 113 Table 5 Pa ame e s o childhood sexual abuse in he bo de line g oup and in he dep essed con ol g oup. Analysis Pa ame e s BPD (N = 45) Dep essed (N = 15) χ 2 (d = 1) P Pe pe a o Fa he /Male ca e ake 22 (48.9%) 2 (13.3%) 5.93 0.015 B o he 2 (4.4%) 0 (0.0%) 0.69 0.41 O he male 18 (40.0%) 4 (26.7%) 0.86 0.353 O he emale 2 (4.4%) 0 (0.0%) 0.69 0.406 Male s ange 13 (28.9%) 9(60.0%) 4.69 0.03 Mul iple 19 (42.2%) 0 (0.0%) 9.27 <0.001 Na u e Fondling 43 (95.6%) 13 (86.7%) 1.43 0.232 O al sex 23 (51.1%) 3 (20.0%) 4.43 0.035 Pene a ion 34 (75.6%) 3 (20.0%) 14.68 <0.001 Incomple e pene a ion 33 (73.3%) 6 (40.0%) 5.49 0.019 Anal pene a ion 2 (4.4%) 0 (0.0%) 0.69 0.406 F equency Single inciden 8 (17.8%) 9 (60.0%) 9.87 0.002 Mo e han once a yea 10 (22.2%) 5 (33.3%) 0.124 0.389 Mon hly 18 (40.0%) 1 (6.7%) 5.77 0.016 Weekly 5 (11.1%) 0 (0.00%) 1.82 0.178 Daily 4 (8.9%) 0 (0.00%) 1.43 0.232 Age a onse Ea ly childhood 0-6 yea s 17 (37.8%) 4 (26.7%) 0.61 0.435 La ency 7-12 yea s 18 (40.0%) 5 (33.3%) 0.212 0.646 Adolescence 13-18 yea s 10 (22.2%) 6 (40.0%) 0.182 0.178