Sometimes trauma, particularly repeated trauma, is considered to lead to long-term alterations in personality development, structure, and functioning. Some professionals postulate that personality disorders can develop. Some have proposed the concept of the "posttraumatic personality" to characterize these more pervasive and integrated forms of posttraumatic reactions. Allen (2001) cites that research has revealed a "global relationship between trauma and personality disorders." He states that patients with a diagnosis of Personality Disorder are more likely to report a history of childhood physical abuse, sexual abuse, or both. Borderline Personality Disorder (BPD) is the most common disorder found. He states, "Those with BPD were more likely to have experienced multiple abuses by multiple perpetrators and to have been abused by both parents. Sexual abuse, verbal abuse, physical abuse, and being adopted all contributed independently to the likelihood of a BPD diagnosis."
Gabbard (2000) cites that childhood maltreatment is considered an etiological factor in BPD. The symptoms of BPD include fears of abandonment, unstable and intense relationships, disturbance in identity, self-destructive behavior, recurrent suicidal and self-injurious behavior, unstable affect, feelings of emptiness, intense anger, transient psychosis, and dissociation (Allen, 2001). The causal or precise etiological relationship between trauma and BPD has not been fully delineated yet, but promising lines of research indicate that the same biological underpinnings of PTSD may be active in BPD. Marsha Linehan and colleagues' diathesis-stress model is considered a good model although it requires more empirical investigation.
When professionals think of treatment for BPD, many of them know that the treatment will be long, intense, very organized, and complex, and have a guarded prognosis. These thoughts may or may not be supported by research. Nonetheless, the treatment of BPD often takes the form of psychodynamic therapy. However, Kroll (1993) warns that overreliance on a psychodynamic model for BPD for etiology and treatment may detract from its connection to trauma and render treatment less effective overall. To date, the most comprehensive and empirically supported treatment for BPD is Linehan's cognitive-behavioral treatment for BPD.
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