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Am J Psychiatry 1995; 152:1788-1792
Copyright © 1995 by American Psychiatric Association
Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder
BS Brodsky, M Cloitre and RA Dulit
Department of Psychology, Cornell University Medical Center, New York, USA.
OBJECTIVE: This study sought to document the prevalence of dissociative
experiences in adult female inpatients with borderline personality disorder
and to explore the relationship between dissociation, self- mutilation, and
childhood abuse history. METHOD: A treatment history interview, the
Dissociative Experiences Scale, the Sexual Experiences Questionnaire, and
the Hamilton Depression Rating Scale were administered to 60 consecutively
admitted female inpatients with borderline personality disorder as
diagnosed by the Structured Clinical Interview for DSM-III-R Personality
Disorders. RESULTS: Fifty percent of the subjects had a score of 15 or more
on the Dissociative Experiences Scale, indicating 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 more likely 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 predictor of dissociation. CONCLUSIONS: Female inpatients
with borderline personality disorder who dissociate may represent a sizable
subgroup of patients with the disorder who are at especially high risk for
self-mutilation, childhood abuse, depression, and utilization of
psychiatric treatment. The strong correlation between dissociation and
self-mutilation independent of childhood abuse history should alert
clinicians to address these symptoms first while exercising caution in
attributing them to a history of abuse.
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