Trauma and Personality Disorders

Trauma - DSM

“An element that is outside the range of normal human experience and that would be markedly distressing to almost anyone.”

General Effects of Trauma

• Physiological

  • Hyperarousal; physiological sensitivity to stress; shutdown

• Cognitive

  • Thoughts of evil in the world; self-blame; dissociation; “splitting”

• Emotional

  • Anger, depression, fear

• Behavioral

  • Withdrawal; avoidance; aggression

• Spirit/Self

  • Loss of dignity/self-respect; feelings of powerlessness; isolation/alienation

Borderline Personality Disorder

• A disorder of stability

• Marked in a variety of areas:

  • Interpersonal relationships

  • Self-image

  • Mood

• Must show five of the following:

  • Frantic efforts to avoid real or imagined abandonment

  • Intense interpersonal relationships which alternate between idealization and devaluation

  • Persistently unstable sense of self (idealization and devaluation)

  • Impulsivity in two areas that are self-damaging

  • Recurrent suicidal behavior or threats

  • Affective instability

  • Inappropriate and intense anger

  • Transient, stress-related paranoia

Dissociative Identity Disorder (Previously Multiple Personality Disorder)

• Characterized by the existence of two or more distinct personalities

  • At least two personalities may be able to take full control over person’s behavior

  • The personalities may or may not be aware of each other

  • Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness

Evidence Linking Trauma to BPD and DID

• A significant number of people with these disorders have histories of trauma

  • Research: 16% of adult males and 38% of adult females have been sexually abused

  • Among persons with BPD, >60% have been sexually abused

    • However, about 1.7% of population have BPD and DID is even less

• The DSM states that in nearly all cases, the disorder has been preceded by abuse (often sexual) or another severe emotional trauma in childhood

Factors That Increase the Traumatic Impact of SA

• Environment prior to abuse

  • Supportive versus unsupportive network

  • Emotional and physical neglect

• Nature of the Trauma

  • Degree of familiarity increases trauma

  • More traumatic if force/coercion used

  • More often/longer increases trauma

  • Number of perpetrators

• Initial Response

  • Parent

    • Unsupportive

    • Doesn’t cope well him/herself

  • Child

    • Internal, stable, global attributions

    • Social support

Personality Disorders