The impact of sexual abuse on the defensive functioning of inpatients with borderline personality disorder.

The defensive functioning of patients suffering from Borderline Personality Disorder (BPD) has long been of interest to clinicians and mental health researchers. Theorists claim (Gunderson, 1984; Kernberg, 1975) and empirical research has demonstrated (Bond, 1990; Cooper, Perry, & Arnow, 1988; Leichsenring, 1999; Perry, 1988) that certain primitive defenses, including splitting, projection, projective identification, omnipotence, devaluation, denial, and idealization, occur in conjunction with BPD. Psychodynamic theorists postulate that compromised ego development resulting from trauma causes utilization of primitive defenses. Thus, the traumatic impact of sexual abuse (Price, 1993; Schetzy, 1990; Silk, Lee, Hill, & Lohr, 1995) and its high prevalence within borderline populations (Figueroa, Silk, Huth, & Lohr, 1997; Westen, Ludolph, Misle, Ruffins, & Block, 1990) raise the question of whether the type and intensity of abuse suffered mediates the quality of these patients' defensive functioning. This study expands the BPD literature by examining how inpatient borderlines' retrospectively reported histories of childhood sexual abuse relate to their defensive functioning. All forty-one study subjects carry a diagnosis of BPD, arrived at using the Diagnostic Interview for Borderlines (DIB) (Gunderson, Kolb, & Austin, 1981) Their sexual abuse histories were assessed via the Family Experiences Interview (FEI) (Ogata, 1989) or a chart review. Subjects' defensive functioning was measured using the Rorschach Defense Scales (RDS) (Cooper, Perry, & Arnow, 1988). Results indicate that the younger inpatient borderlines are at the time of their first reported sexual abuse, the higher the percentage of primitive defense mechanisms they use. In addition, inpatient borderlines who report sexual abuse by a first degree relative use a significantly higher percentage of more primitive defense mechanisms than borderlines who report abuse by more distant relatives or nonfamily members. Finally, younger reported age of first sexual abuse, longer reported duration of sexual abuse, reported presence of penetrating sexual abuse by a nuclear family member, and higher reported number of perpetrators are all predictive of poorer outcomes (i.e., higher proportion of primitive defenses and/or lower proportion of neurotic defenses) amongst inpatient borderlines. These findings highlight the presence of a robust relationship between quality of sexual abuse suffered and defensive functioning in borderline populations.Ph.D.Clinical psychologyPersonality psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132484/2/9963907.pd