RELATIONSHIP OF DISSOCIATION TO SELF-MUTILATION AND CHILDHOOD ABUSE IN BORDERLINE PERSONALITY-DISORDER

Objective: This study sought to document the prevalence of dissociativ e experiences in adult female inpatients with borderline personality d isorder and to explore the relationship between dissociation, self-mut ilation, and childhood abuse history. Method: A treatment history inte rview, the Dissociative Experiences Scale, the Sexual Experiences Ques tionnaire, and the Hamilton Depression Rating Scale were administered to 60 consecutively admitted female inpatients with borderline persona lity disorder as diagnosed by the Structured Clinical Interview for DS M-III-R Personality Disorders. Results: Fifty percent of the subjects had a score of 15 or more on the Dissociative Experiences Scale, indic ating pathological levels of dissociation. Fifty-two percent reported a history of self-mutilation, and 60% reported a history of childhood physical and/or sexual abuse. The subjects who dissociated were move l ikely than those who did not to self-mutilate and to report childhood abuse. They also had higher levels of current depressive symptoms and psychiatric treatment. Multiple regression analysis demonstrated that each of these variables predicted dissociation when each of the others was controlled for, and that self-mutilation was the most powerful pr edictor of dissociation. Conclusions: Female inpatients with borderlin e Personality disorder who dissociate may represent a sizable subgroup of patients with the disorder who are at especially high risk for sel f-mutilation, childhood abuse, depression, and utilization of psychiat ric treatment. The strong correlation between dissociation and self-mu tilation independent of childhood abuse history should alert clinician s to address these symptoms first while exercising caution in attribut ing them to a history of abuse.