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Prenatal adversity: a risk factor in borderline personality disorder?

Published online by Cambridge University Press:  10 December 2012

C. E. Schwarze ,
A. Mobascher ,
B. Pallasch ,
G. Hoppe ,
M. Kurz ,
D. H. Hellhammer  and
K. Lieb
C. E. Schwarze*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany Department of Clinical and Physiological Psychology, University of Trier, Germany
A. Mobascher
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
B. Pallasch
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
G. Hoppe
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
M. Kurz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
D. H. Hellhammer
Affiliation:
Department of Clinical and Physiological Psychology, University of Trier, Germany
K. Lieb
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Germany
*
*Address for correspondence: Dr C. E. Schwarze, Ph.D., University Medical Center Mainz, Department of Psychiatry and Psychotherapy, Untere Zahlbacher Straße 8, D-55131 Mainz, Germany. (Email: cornelia.schwarze@unimedizin-mainz.de)
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Abstract

Background

Patients with borderline personality disorder (BPD) show a high prevalence of early adversity, such as childhood trauma. It has also been reported that prenatal adverse conditions, such as prenatal maternal stress, drug taking, tobacco smoking or medical complications, may be associated with an increased risk of mental disorders in the offspring. Prenatal adversity is investigated here for the first time as a potential risk factor in the diagnosis of BPD.

Method

A total of 100 patients with a DSM-IV diagnosis of BPD and 100 matched healthy controls underwent semi-structured interviews about the course of pregnancy, maternal stressors, birth complications and childhood trauma. Further information was obtained from the participants' mothers and from prenatal medical records.

Results

Borderline patients were significantly more often exposed to adverse intrauterine conditions, such as prenatal tobacco exposure (p=0.004), medical complications (p=0.008), prenatal maternal traumatic stress (p=0.015), familial conflicts (p=0.004), low social support (p=0.004) and partnership problems during pregnancy (p=0.014). Logistic regression analyses revealed that the reported prenatal risk factors accounted for 25.7% of the variance in BPD. Prenatal tobacco exposure [odds ratio (OR) 3.37, 95% confidence interval (CI) 1.49–7.65, p=0.004] and medical complications (OR 2.87, 95% CI 1.29–6.38, p=0.010) emerged as important predictors. After controlling for childhood adversity and parental socio-economic status (SES), prenatal risk factors predicted relevant borderline subdomains, such as impulsivity, affective instability, identity disturbance, dissociation and severity of borderline symptoms.

Conclusions

This study provides evidence of an association between prenatal adversity and the diagnosis of BPD. Our findings suggest that prenatal adversity may constitute a potential risk factor in the pathogenesis of BPD.

Keywords

Borderline personality disorderetiologyprenatal adversityprenatal maternal stressprenatal tobacco exposure.
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 6 , June 2013 , pp. 1279 - 1291
Copyright
Copyright © Cambridge University Press 2012 

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