Writing Sample MA Thesis
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The document discusses research on the relationship between childhood trauma and the development of borderline personality disorder (BPD). It summarizes that research has found childhood trauma, such as abuse, neglect, parental loss or divorce, is very common in those diagnosed with BPD. Events like 9/11 that caused trauma through parental loss could potentially increase BPD diagnoses later in life. The document concludes that childhood trauma interrupts healthy attachment and increases the likelihood of a BPD diagnosis, though more research is still needed.
Writing Sample MA Thesis
- 1. Childhood Trauma and the Development of Borderline Personality Disorder. 1 Childhood Trauma and the Development of Borderline Personality Disorder. Joseph M. Finck Argosy University
- 2. Childhood Trauma and the Development of Borderline Personality Disorder. 2 Abstract The development of borderline personality disorder affects many persons and has been researched for years due to the prevalence in society. Research pertaining to the origin and cause of borderline personality is extensive, but all seem to have one element in common, childhood trauma. Throughout the research presented the correlation is made childhood trauma is an origin of borderline personality disorder, and may be the cause. Keywords: Borderline Personality Disorder, childhood, trauma.
- 3. Childhood Trauma and the Development of Borderline Personality Disorder. 3 Childhood Trauma and the Development of Borderline Personality Disorder. With the rising number of child abuse incidents being reported, approximately 80% of child abuse victims who are now over the age of 21 meet the criteria for at least one psychological disorder (Conti, 2011). In fact, research has identified that many individuals with borderline personality disorder report a history of childhood sexual abuse (Hong, Ilardi, and Lisher, 2011). According to Distel, Middeldorp, Trull, Derom, Willemsen, and Boostma (2011), being exposed to traumatic life events such as child assault, child sexual assault, or child neglect, may be related to an influence of the gene-environment interaction, changing the predisposition of persons and exacerbating the symptoms of borderline personality disorder. What then is the correlation between the abuse suffered as a child and the development of borderline personality disorder as a young adult? What does a forensic psychologist need to know when dealing with a person who has been diagnosed with BPD and now has committed a crime? When a person who has been diagnosed with BPD is incarcerated, what form of treatment provides he best outcome? Finally, when assessing childhood trauma cases should further analysis be conducted to predict if the child will develop BPD as an adult?
- 4. Childhood Trauma and the Development of Borderline Personality Disorder. 4 Emerging Themes or Patterns The characteristics of BPD include a pattern of negative affect parameters, lack of desire regulation, poor interpersonal connections, and poor self-identity (Lieb, Zanarini, Schmal, Linehan, & Bohus, 2004). However, the Diagnostic and Statistical Manual of Mental Disorders requires individuals to meet five of nine criteria for the diagnosis to be applied. Specifically, these criteria include: affective instability due to marked reactivity; inappropriate, intense anger or difficulty controlling anger; chronic feelings of emptiness; recurrent suicidal behavior, gestures, or threats or self-mutilating behavior; impulsivity in at least two areas that are potentially self-damaging; a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation; frantic efforts to avoid real or imagined abandonment; identity disturbance: markedly and persistently unstable self-image or sense of self; and transient, stress related paranoid ideation or severe dissociative symptoms (American Psychiatric Association, 2000). Although it is unclear what causes BPD, there have been many considerations for the causes. “When compared to other personality disorders, the BPD patients were significantly more likely to have been emotionally and physically abused by a
- 5. Childhood Trauma and the Development of Borderline Personality Disorder. 5 caregiver and sexually abused by a non-caregiver” (Commons Treloar & Lewis, 2009). Commons and Lewis (2009) have also identified developmental origins (e.g., parental loss), family history, or substance abuse disorders. Then of course there is Distel et al. (2011) who have suggested a genetic relationship. Regardless of the cause, a relationship exists between BPD and childhood trauma. The Diagnostic and Statistical Manual of Mental Disorders further defines the characteristics of BPD, indicating it “begins by early adulthood and present in a variety of contexts” (American Psychiatric Association, 2000, p. 706). Furthermore, BPD has been associated with increased incidents of suicide, as compared to other personality disorders. It has also been associated with a co-morbid or dual diagnosis of another mental health disorder. BPD patients have the need for substantive treatment, additional expenditure in both treatment costs, and disability payments for persons affected (Leichsenring, Liebing, Kruse, New, & Leweke, 2011). As evidenced by the increased security at airports, the wars in Iraq and Afghanistan with allegiance from many nations, the formation of the Department Homeland Security, and international security measures, the world has changed since the heinous and terroristic acts on September 11, 2001, herein
- 6. Childhood Trauma and the Development of Borderline Personality Disorder. 6 referred to as 9/11. The events that day resulted in parental loss for many children, resulting in a traumatic childhood event. The loss of a parent being a developmental origin would be supported through the research of Commons and Lewis (2009). This additional childhood trauma, for example from a single event such as 9/11, may have triggered an increase in diagnosis and treatment for BPD and other trauma related disorders such as Post Traumatic Stress Disorder (PTSD) (Halligan, 2008). While this paper is not focused solely on the children who are now young adults and who have been affected by the trauma of 9/11, future research may identify an increased prevalence in BPD among the children who suffered a parental loss as a developmental origin from the childhood trauma associated with an event of 9/11. Since the events of that day, childhood trauma has experienced national attention with evidence showing many children may suffer from PTSD because of such violence (Silva, et al., 2003). It is an important consideration for us that the diagnosis of BPD may increase based on the continued trauma throughout the decade, which has followed, and such a diagnosis may be inaccurately applied when the individual may have PTSD (Schwecke, 2009).
- 7. Childhood Trauma and the Development of Borderline Personality Disorder. 7 The United States Military refers to the Global War on Terrorism as “the long war” (J. Dippel, personal communication, 2008). This is significant as many children’s parents are now deployed to combat for significant periods of time and not available to fulfill their role to the children as parent. Also there have been natural disasters that have affected children in their development, consequently impacting their psychological health as they grow into adulthood (Halligan, 2008). Further exacerbating the characteristics of persons diagnosed with BPD is the sequence of emotions displayed by persons diagnosed with BPD. The sequence of emotion for a person with BPD revolves around “anxiety to anger, anxiety to sadness, and sadness to anxiety” (Reisch, Ebner-Priemer, Tschacher, Bohus, & Linehan, 2008, p. 42). Emerging Conclusions As evidenced, the diagnosis of BPD brings with it consequences, not only for the person diagnosed, but also for society, social connections, and interpersonal relationships. The diagnosis of BPD involves many aberrant behaviors, which have been depicted, but the cause or suspected cause has yet to be explored in detail. Commons and Lewis (2009) established a link of BPD to family history, suggesting that BPD may be transferred between the mother and child. Research findings on
- 8. Childhood Trauma and the Development of Borderline Personality Disorder. 8 this linkage indicated that there is between four times and twenty times the opportunity for a mother diagnosed with BPD to have a child who is later diagnosed with BPD (Stepp, Whale, Pilkonis, Hipwell, & Levine, 2012). The two main factors, which influence the development and later diagnosis of BPD, are issues which lead to a failure to develop early childhood attachment and trauma suffered as a child (Fonagy, Target, Gergely, Allen, & Bateman, 2003). To explore this further we must define problems in attachment. Fonagy, et al., identifies that both conditions could be combined into one and classified as trauma suffered as a child, which may include problems in childhood attachment. Furthering this point is commentary from Dr. James Slayton, a medical doctor and board certified psychiatrist, who stated “childhood trauma and neglect likely interrupts or arrests the development of healthy attachments and increases the likelihood of a diagnosis of BPD” (J. Slayton, personal communication, 2012). With divorce and familial discord increasing, the rate of children who suffer the trauma of the actions of their parents divorce is also increasing (Stobie & Tromski-Klingshirn, 2009). Trauma suffered as a child is much more common in persons diagnosed with BPD than persons not diagnosed (Distel et al., 2011). Finally, in a study in Japan, Igarashi, et al., found children who suffered trauma are more likely to be influenced into developing BPD and depression as
- 9. Childhood Trauma and the Development of Borderline Personality Disorder. 9 adults (Igarashi, Hasui, Uji, Nagata, & Kitamura, 2009). Igarashi et al. provided the study of 200 participants, all undergraduate students of Kyushu University in Japan, who were provided surveys about childhood experiences. The findings included the thought of more research being needed as the relatively small sample size depicted the possibility of trauma only being one influencing factor and a need to identify and research additional personality traits and their influence on the development of BPD is needed. However, the overall conclusion of Igragashi, et al., that childhood trauma and sexual abuse influence the development of BPD in adults (Igarashi, et al., 2009). Congruent Conclusions with Data Analysis The treatment strategies for BPD seem to be at least somewhat similar to what is utilized for other personality disorders caused by trauma. Roger’s Person Centered Therapy (PCT) has been explored as one such strategy. A secondary strategy involves the use of Dialectical Behavior Therapy (DBT). PCT “emphasize the importance of becoming aware of feelings and emotional information in order to label it and then to reflect on it to understand the significance of events and to identify new ways of acing in the light of this information” (Watson, 2006). The goal is to “help clients become aware of, label, and
- 10. Childhood Trauma and the Development of Borderline Personality Disorder. 10 differentiate their emotional experience” (Watson, 2006). Ultimately, this may promote a change in thoughts and feelings to expose new solutions that may not have been previously evident (Watson, 2006). DBT, however, focuses on four major elements, specifically “(a) promoting the motivation for change by detailed chain analyses, validation strategies, and management of reinforcement contingencies in individual therapy twice a week; (b) increasing target-oriented and appropriate behavior by teaching skills in a weekly group format training, fostering mindful attention and cognition, emotion regulation, acceptance of emotional distress, and interpersonal effectiveness; (c) ensuring the transfer of newly learned skills to everyday life by telephone coaching and case management; and (d) supporting therapists’ motivation and skills with a weekly consultation team” (Kliem, Kröger, and Kosfelder, 2010). Treatment includes an emphasis on reducing suicidal thoughts and self-harm. Treatment and training were provided to patient undergoing DBT to continue with outpatient therapy and reduce co-morbid Axis I diagnoses (Kliem, Kröger, and Kosfelder, 2010). While PCT has declined in use, one study compared PCT and DBT in terms of preventing suicidal behavior in BPD patients and showed some reduction in behaviors associated with BPD such as anger, anxiety, impulse related issues, and depression (Quinn, 2011). By preventing suicidal behavior, individuals were more likely to
- 11. Childhood Trauma and the Development of Borderline Personality Disorder. 11 receive beneficial treatment from the DBT with prolonged outpatient therapy in comparison to PCT, which does not promote solutions to the problem or modifications in behavior. The more prevalent treatment, DBT, has been the most accepted and utilized treatment in recent history pertaining to BPD and was initially proposed and researched by one of the landmark case study authors, Marsha Linehan. DBT is a form of Cognitive Behavior Therapy. DBT has been shown in studies to reduce suicidal behavior and also reduce and assist the patient diagnosed with BPD in controlling other aberrant behaviors (Bedics, Atkins, Comtois, & Linehan, 2012). Further, the pervasive treatment methods involve both group and individual therapy with a focus on utilizing DBT (J. Slayton, personal communication, 2012). Finally, DBT has the most significant positive findings through empirical research (Lieb, Zanarini, Schmal, Linehan, & Bohus, 2004). Gaps and Recommendations for Conducting Further Research While conducting this research, a gap was noticed in scholarly articles pertaining to the development of BPD in children who experienced parental loss from the tragic events of 9/11. Although studies indicated the presence of PTSD in children after 9/11, one researcher suggested some individuals may have been misdiagnosed with BPD, when in fact the
- 12. Childhood Trauma and the Development of Borderline Personality Disorder. 12 individuals have PTSD. Further analysis would be necessary in the form of longitudinal studies to determine if BPD will develop in the survivors, children, or victim’s families after 9/11. Direct and pervasive information pertaining to the most likely form of trauma, resulting in the development of BPD, is also warranted. While widely agreed trauma suffered in childhood may develop into BPD, why does it in some cases and why not in others? This is also a good place for additional scholarly research. Finally, the American Psychiatric Association needs to perform additional studies to examine the criteria for BPD, which can form based on diagnostic criteria which includes 256 possibilities given five out of nine are necessary. Does the number of possibilities create a broad diagnosis that can be tailored to specific types of BPD, such as there are with schizophrenia? Conclusion Through the literature review depicted in this thesis, the correlation between trauma suffered as a child and the development of BPD is fully established through valid and reliable scholarly research. The persons diagnosed with BPD have symptoms, creating issues not only for them but for the persons they have contact with in social, professional, and interpersonal settings. The cost to society is great and the
- 13. Childhood Trauma and the Development of Borderline Personality Disorder. 13 treatment methods effective as long as treatment is maintained and available if symptoms recur. A forensic psychological professional will have contact with persons who have been or should have been diagnosed with BPD. The treatment methods presented are both valid and reliability. Unfortunately, the research does not support the ability of a forensic professional to predict if a child who is physically, emotionally, and sexually abused is more likely to develop BPD.
- 14. Childhood Trauma and the Development of Borderline Personality Disorder. 14 References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Bedics, J.D., Atkins, D.C., Comtois, K.A., & Linehan, M.M. (2012). Treatment differences in the therapeutic relationship and introject during a 2-year randomized controlled trial of dialectical behavior therapy versus nonbehavioral psychotherapy experts for borderline personality disorder. Journal of Consulting and Clinical Psychology, 80, 66-77. Commons Treloar, A., & Lewis, A.J. (2009). Diagnosing borderline personality disorder: Examination of how clinical indicators are used by professionals in the health setting. Clinical Psychologist, 13, 21-27. Conti, S. (2011). Lawyers and mental health professionals working together: Reconciling the duties of confidentiality and mandatory child abuse reporting. Family Court Review, 49, 388-399. Distel, M.A., Middeldorp, C.M., Trull, T.J., Derom, C.A., Willemsen, G., & Boomsma, D.I. (2011). Life events and borderline personality features: The influence of gene-
- 15. Childhood Trauma and the Development of Borderline Personality Disorder. 15 environment interaction and gene environment correlation. Psychological Medicine, 41, 849-860. Fonagy, P., Target, M., Gergely, G., Allen, J., & Bateman, A. W. (2003). The developmental roots of borderline personality disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23, 412-459. Halligan, F.R. (2008). Youth and Trauma: War, murder, incest, rape, and suicide. J Relig Health, 48, 342-352. Hong, P.Y., Ilardi, S.S., & Lishner, D.A. (2011). The aftermath of trauma: The impact of perceived and anticipated invalidation of childhood sexual abuse on borderline symptomology. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 360-368. Igarashi, H., Hasui, C., Uji, M., Nagata, T., & Kitamura, T. (2009). Effects of child abuse history on borderline personality traits, negative life events, and depression: A study among university student population in Japan. Psychiatry Research, 180, 120-125. Kliem, S., Kröger, C., Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A
- 16. Childhood Trauma and the Development of Borderline Personality Disorder. 16 meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78, 936-951. Leichsenring, F., Liebing, E., Kruse, J., New, A.S., & Leweke, F. (2011). Borderline Personality Disorder. Lancet, 377, 74-84. Lieb, K., Zanarini, M.C., Schmahl, C., Linehan, M.M., & Bohus, M. (2004). Borderline personality disorder. Lancet, 364, 453-461. Quinn, A. (2011). A person entered approach to the treatment of borderline personality disorder. Journal of Humanistic Psychology, 51, 465-491. Reisch, T., Ebner-Priemer, U.W., Tschacher, W., Bohus, M., & Linehan, M.M. (2008). Sequences of emotions in borderline personality disorder. Acta Psychiatrica Scandinavica, 118, 42-58. Schwecke, L.H. (2009). Childhood sexual abuse, PTSD, and borderline personality disorder: Understanding the connections. Journal of Psychosocial Nursing and Mental Health Services, 47, 4-6.
- 17. Childhood Trauma and the Development of Borderline Personality Disorder. 17 Silva, R.R., Cloitre, M. Davis, L., Levitt, J., Gomez, S., Ngai, I., & Brown, E. (2003). Early intervention with traumatized children. Psychiatric Quarterly, 74, 333-347. Stepp S.D., Whalen, D.J., Pilkonis, P.A., Hipwell, A.E., & Levine, M.D. (2012). Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment, 3, 76-91. Stobie, M.R., & Tromski-Klingshirn, D.M. (2009). Borderline personality disorder, divorce and family therapy: The need for family crisis intervention strategies. The American Journal of Family Therapy, 37, 414-432. Watson, J. C. (2006). A reflection on the blending of person- centered therapy and solution-focused therapy. Psychotherapy: Theory, Research, Practice, Training, 43, 13-15.
- 18. Childhood Trauma and the Development of Borderline Personality Disorder. 18 Research Paper Questions 1) Is Post Traumatic Stress Disorder (PTSD) related to Borderline Personality Disorder (BPD) and if so how? 2) Are the diagnostic criteria to establish BPD too broad? (justify your response) 3) Besides Persons Centered Therapy (PCT) and Dialectical Behavior Therapy (DBT), which is a form of Cognitive Behavior Therapy (CBT), what significant styles of therapy would you suggest for persons diagnosed with BPD and why? (provide scholarly support for any additional therapy style suggested)