Although the conceptualization of the borderline personality and its causes remain unclear (Paris, 1994a, 1994b; Zanarini & Frankenburg, 1997), most empirical research shows a marked relationship between childhood trauma and borderline symptoms. Risk factors that differentiate borderline patients usually include loss, histories of sexual and physical abuse, severe neglect or emotional abuse, being witness to domestic violence, and parental substance abuse or criminality (Guzder, Paris, Zelkowitz, & Marchessault, 1996; Laporte & Guttman, 1996; Zanarini et al., 1997).
Of these, many studies suggest an especially significant relationship between childhood sexual abuse and the development of the borderline personality (see Paris, 1994b; Sabo, 1997; Zanarini & Frankenburg, 1997). To unravel factors that might contribute to abuse, Silk, Lee, Hill, and Lohr (1995) constructed an index of the severity. Cases were coded in terms of who abused the subject, how long the subject was abused, and whether penetration occurred. Results showed that ongoing sexual abuse in childhood was the best predictor of the severity of borderline symptoms, including parasuicide, chronic hopelessness and worthlessness, transient paranoia, regression in therapy, and an intolerance of being alone.
The authors speculate that severe, continuous sexual abuse affects the child's capacity to form satisfying, safe attachments. Children come to believe that others are "unsafe and interested only in their own gratification," leading to "a belief in a malevolent object world" (p. 1062). Sadly, Michael Stone's (1981) words still ring true today, almost two decades later:
I suspect there is another and purely psychogenic factor contributing to the excess of females among groups of borderline patients . . . the occurrence of incestuous experiences during childhood or adolescence. . . . Chronic victimization of this sort, by a father or an uncle, cannot help but have damaging effects upon the psychic development of a young girl. These effects will generally consist of impaired relationships with men, mistrust of men, inordinate preoccupation with sexual themes, impulsivity in the area of sex, and often enough, depression. (p. 14)
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