BIOLOGICAL IMPLICATIONS OF CHILDHOOD SEXUAL ABUSE IN BORDERLINE PERSONALITY-DISORDER

This article explores which aspects of the clinical presentation of ps ychopathology in borderline personality disorder (BPD) might be though t to be most closely linked to a history of childhood sexual abuse (CS A), The article describes which particular types of sexual abuse exper iences are thought to be most prevalent in patients with BPD, and proc eeds to review our current understanding of the biological substrates that may be involved in the clinical picture of BPD. The article then turns to the concept of trauma, and examines what are thought to be th e biological underpinnings and/or reactions to trauma (particularly wi th respect to Post Traumatic Stress Disorder) and, by extension, to ov erwhelming and/or chronic stress, while making the logical assumption that childhood sexual abuse can be categorized most understandably as trauma, Finally, the article tries to integrate these observations by pulling together the commonalties of the biology of stress and trauma with the biology of BPD, in order to put forth an hypothesis as to the possible implications of a history of childhood sexual abuse upon the biology of BPD. The article concludes that the type and breadth of th e patient with BPD's hyperreactivity to the environment, which often m anifests itself as hypersensitivity in interpersonal situations, is pr obably mediated through noradrenergic mechanisms, and these processes may be most closely related to a history of CSA, On the other hand, im pulsivity, which is related to serotonergic mechanisms, is the major c onstitutional predisposition to BPD, regardless of whether or not ther e is a history of trauma. Combining environmental hyperactivity with i mpulsivity may lead to a clinical picture, often seen in BPD, where im pulsivity and self-destructive behavior is employed in order to deal w ith the stress, distress, and dysphoria of being hypersensitive to int erpersonal and other environmental stimuli.