Examining the comorbidity of boderline personality disorder and posttraumatic stress disorder in a community sample

Title from PDF of title page (University of Missouri--Columbia, viewed on May 30, 2013).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Thesis advisor: Timothy J. Trull, PhDIncludes bibliographical references.M. A. University of Missouri--Columbia 2012."May 2012"Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD), both relatively prevalent disorders in our society, overlap and/or co-occur in ways that are not yet well understood, especially outside of clinical samples. Despite methodological and sampling differences among existing studies, ample evidence exists to suggest that this comorbidity is frequent and presents a variety of difficulties for the individual, the clinician, and the researcher. This comorbidity also raises many questions, most of which remain unanswered. The present study aimed to address some of these questions in a large, community sample. In particular, the question of the importance of childhood sexual abuse (CSA) as a potential etiological factor and predictor of general functioning was addressed, along with other important factors, such as gender and age. CSA has been a focus of prior clinical studies and theoretical literature, but empirical evidence to generalize this focus to the broader population has been lacking. Results from the present study suggest that, in the general population: this comorbidity is more deleterious than either BPD or PTSD alone; CSA should continue to be considered an important factor; and the factors of gender, age, and CSA exhibit interactions and main effects in the prediction of this comorbidity and its associated decrements in health-related functioning, calling for continued research as well as attention to these factors in the treatment context

A twin study of the common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and borderline personality disorder

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] The comorbidity of borderline personality disorder (BPD) and posttraumatic stress disorder is common and yet not well understood, particularly outside of treatment-seeking samples. It has been suggested that a shared genetic liability may account for some of the co-occurrence of these two disorders, yet no prior behavioral-genetic findings exist in the literature to directly support this suggestion. The present study aimed to fill this gap in the literature by utilizing data from the Childhood Trauma Study (CTS; Nelson et al., 2002; Nelson et al., 2006; Nelson, Lynskey, Heath, Madden, and Martin, 2010) to examine the common heritable contributions to low-risk trauma, high-risk trauma, posttraumatic stress disorder, and borderline personality disorder features in a general population twin sample. Structural equation modeling was employed to estimate the genetic and environmental influences on all four of these phenotypes, both individually and together, in a quadrivariate Cholesky decomposition model. Results provide preliminary behavioral-genetic support for the notion of the shared genetic liability across BPD and PTSD. Specifically, the estimated genetic correlation of the BPD features phenotype and PTSD phenotype was 0.57. Additional results from the characterization of trauma exposure in this sample as well as the univariate and quadrivariate twin models also largely supported hypotheses based on the extant BPD and PTSD literature

Common genetic contributions to high-risk trauma exposure and self-injurious thoughts and behaviors

Background: Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences. Methods: Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24–42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project. Results: The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [rG = 0.59, 95% confidence interval (CI) (0.37–0.81)] and women [rG = 0.56 (0.49–0.63)]. Unique environmental influences were modestly correlated in women [rE = 0.23 (0.01–0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females. Conclusions: Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma