Borderline Personality Disorder, Exposure to Interpersonal Trauma, and Psychiatric Comorbidity in Urban Primary Care Patients
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Publication Details
Output type: Journal article
Author list: Westphal M, Olfson M, Bravova M, Gameroff MJ, Gross R, Wickramaratne P, Pilowsky DJ, Neugebauer R, Shea S, Lantigua R, Weissman M, Neria Y
Publisher: Taylor and Francis Group
Publication year: 2013
Journal: Psychiatry (0033-2747)
Volume number: 76
Issue number: 4
Start page: 365
End page: 380
Number of pages: 16
ISSN: 0033-2747
eISSN: 1943-281X
Languages: English-Great Britain (EN-GB)
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Open access status: green
Full text URL: https://academiccommons.columbia.edu/doi/10.7916/kw4v-zr68/download
Abstract
Objective: Few data are available on interpersonal trauma as a risk factor for borderline personality disorder (BPD) and its psychiatric comorbidity in ethnic minority primary care populations. This study aimed to examine the relation between trauma exposure and BPD in low-income, predominantly Hispanic primary care patients. Method: Logistic regression was used to analyze data from structured clinical interviews and self-report measures (n = 474). BPD was assessed with the McLean screening scale. Trauma exposure was assessed with the Life Events Checklist (LEC); posttraumatic stress disorder (PTSD) was assessed with the Lifetime Composite International Diagnostic Interview, other psychiatric disorders with the SCID-I, and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report (SAS-SR). Results: Of the 57 (14%) patients screening positive for BPD, 83% reported a history of interpersonally traumatic events such as sexual and physical assault or abuse. While interpersonal trauma experienced during adulthood was as strongly associated with BPD as interpersonal trauma experienced during childhood, non-interpersonal trauma was associated with BPD only if it had occurred during childhood. The majority (91%) of patients screening positive for BPD met criteria for at least one current DSM-IV Axis I diagnosis and exhibited significant levels of functional impairment. Conclusion: Increased awareness of BPD in minority patients attending primary care clinics, high rates of exposure to interpersonal trauma, and elevated risk for psychiatric comorbidity in this population may enhance physicians' understanding, treatment, and referral of BPD patients.
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