The Correlation Between Sexual Abuse And Borderline Personality Disorder

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Abstract

The purpose of this research proposal is to highlight the correlation between the experience of sexual abuse and the development of emerging borderline personality disorder as a result. The sample is made up of 35 youth offenders in the main 6 medium-secure forensic units in England and Wales and were asked to take part in a questionnaire to collect the data needed for this study (Mental disorder, sexual abuse, caregiver etc,). The data was collected electronically from the units’ databases, and put into an excel spreadsheet in order to lay the data out neatly.

Introduction

Sexual Abuse towards children

Over the years, the definition of sexual abuse has varied tremendously. In the past, young girls from the age of nine and twelve were married off to older men and were often raped as a result. In ancient Rome, the sexual relationship between a boy and an adult was very common and would be seen as a method to make them into strong soldiers. Today, the relationship or sexually exploitative interaction between an adult and a child is seen as criminal and can sentence an individual to up to thirty years in prison, and a maximum of seven years if an individual concealed information about a child sex crime (McCarthy, 2018). There are three general interpretations of sexual abuse against children, and these are: “the child’s partner has a large age or maturational advantage over the child, the child’s partner is in a position of authority or in a caretaking relationship with the child, or the activities are carried out against the child using force or trickery” (Finkelhor, 1994 pg. 3). Although the definitions of sexual abuse may vary across cultures and history, these three conditions are considered to be the general view of western countries and play a role in the prevalence of sexual trauma in this study’s dataset- as it is seen as the main categories that lead the diagnosis of having undergone sexual abuse.

Emerging Borderline Personality Disorder

Borderline Personality Disorder was first officially recognised as a diagnosis in 1980, in the third edition of the ‘Diagnostic and Statistical Manual for Mental Disorders’ by the American Psychiatric Association. The disorder is described as ‘a group of people who don’t fit into both the psychotic or psychoneurotic category’ (Stern 1938), hence the term ‘borderline’, and the symptoms often include an “unstable self-image, rapid changes in mood, and a strong tendency towards suicidal thinking and self-harm…brief delusions and hallucinations may also be present.” (National Collaborating Centre for Mental Health UK, 2006). Although Emerging Borderline Personality Disorder is not limited to individuals with unstable families, it is more likely to develop in someone who has grown up with deprivation in relationships; this can include neglect, abuse and hostility.

Sexual Abuse and how it can lead to Emerging Borderline Personality Disorder

Trauma considered more personal than others, committed by caregivers and anyone else in the home environment, can cause more severe impacts than others; especially sexual abuse or neglect during the earlier years of childhood (The National Child Traumatic Stress Network, 2011; Cook et al, 2005; Van der Kolk and Courtios, 2005). Those having experienced physical abuse are more likely to experience psychological abuse (Briere J and Runtz, M.R, 1990) due to the numerous symptoms that could have developed as a result of the trauma, like reduced awareness of danger. It is this that makes the adolescents and children more likely to encounter the same abuse as an adult and puts them in more danger of forming complex mental health problems, an example of this being emerging Borderline Personality Disorder. In the year 2011, 1 in 20 children have experienced sexual abuse (Radford. L et al, 2011) and over 2,800 children were put under protection from sexual abuse in 2016 and 2017 (Child protection register and plan statistics for all UK nations, 2017).

This study will further advance the research on sexual abuse towards children and how that leads to emerging borderline personality disorder (BPD) by helping people discover more about the prevalence of said trauma and disorder, and by highlighting the close relationship these two elements have between each other. In a world where technology continues to improve year by year, it is important to outline the further steps the law should take to prevent sexual abuse and the development of personality disorders.

Literature Review

Sexual Abuse towards Children

During the last two decades, the prevalence of sexual abuse towards children has become less common, occurring less over the years (Radford, Corral, Bradley, Fischer, Bassett, Howat and Collishaw, 2011). According to their statistics, the rates of child maltreatment reported by those 18-24 were lower in 2009 than in 1998. This could be criticised, however, as those figures only represent those that have reported the maltreatment to the police. Those who remain unreported are glossed over and therefore these statistics can already be considered to be unreliable.

The sample used in the study was made up of 2,160 parents or guardians of children and young people under 11 years old, 2,275 young people between the age of 11 and 17 years old, and 1,761 young adults aged between 18 and 24 years old. Standardised and validated measures were used by Radford et al (2011) to support and protect the participants involved if necessary, creating a strong ethical framework.

In their findings, Radford et al (2011) found that 0.5% of the under 11s experienced sexual abuse, much lower than the 4.8% participants aged 11-17 and 11.3% of 18-24s who experienced the same trauma. Adolescent girls aged between 15 and 17 were reported to be the most likely victim to experience sexual abuse.

One limitation of the study is that the sample is very large and therefore too general. It is hard to control confounding variables that could affect the results, such as the environment the families may live in and the mental state of the parents/caregivers (as this could be a reason for possible maltreatment). Additionally, the data was collected through the reports of individuals, which can sometimes lack truth and give false statistics. Some participants could also have denied any sexual abuse, whether it was out of fear or misunderstanding, and therefore the findings used in this study could have overshadowed the figures of those cases left not reported.

The Emergence of Borderline Personality Disorder in Young Offenders

It is known that children go through many transitions during adolescence, ranging from behavioural, mental and physical progression. Due to the psychological differences between females and males, the development and characteristics of individuals may differ from others (Bradley, Conklin and Westen, 2005). In a study examining personality features characterising adolescent girls and boys with borderline personality disorder (BPD), Bradley et al (2005) randomly selected 249 doctoral-level clinicians to diagnose adolescent patients using Axis II rating scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A). The patients being diagnosed were aged from 14 to 18 years old, 84.9% of them being Caucasians, the rest being African-American or Hispanic. In order to identify a possible difference between the two genders, Bradley et al (2005) used the SWAP-200-A to provide an objective description of female and male adolescents meeting the DSM-IV criteria for BPD and used Q-factor analysis to see any natural groupings of female patients based on features shared in their personalities. As a reward for their participation, the clinicians contributing data received a token honorarium of $25.

In the findings, Bradley et al (2005) found that 25.3% were diagnosed with major depressive disorder, 24.3% with dysthymic disorder, 9% with oppositional defiant disorder, and 6.1% with conduct disorder; only 16.1% were diagnosed with ADHD. This shows that disorders like BPD is in the majority when it comes to mental health in adolescents. However, the question is whether the disorder is simply over-diagnosed by clinicians due to factors that could overlap into other disorders and lead to co-morbidity, or whether the diagnosis is truly correct. Bradley et al (2005) also seem to question this and state that several of the descriptors for BPD in the DSM Criteria are often used to describe “normal adolescents”, such as the “tendency to feel misunderstood, mistreated, or victimised”. Furthermore, the nature and expression of Borderline Personality Disorder in the study was clearly gendered, because the female patients showed more internalised and emotionally dramatic behaviour, whilst the male patients were more behaviourally disinhibited and often more aggressive. This shows that the criteria for BPD may differ across genders and therefore affect the diagnosis of the disorder.

One criticism of the study by Bradley et al (2005) was that they depended on one informant’s judgement, the clinicians. This could have several flaws, such as subjectivity and the question of the quality of their service. The clinicians could differ in performance rate, some being more professionally trained and experienced than others, which could affect the diagnosis and result in the end.

Sexual Abuse and how it leads to the emergence of Borderline Personality Disorder

The trauma of having undergone sexual abuse can often lead to the development of mental disorders in adolescents, due to the feeling of being unworthy and unwanted (Khadr, Clarke, Wellings, Villalta, Goddard, Welch, Bewley, Kramer and Viner, 2018). Using the sample of 491 adolescents aged 13 to 17, Khadr et al (2018) did a prospective study that looked at the impact of sexual trauma over a 2-year period. Interviews were done 6 weeks after the assault committed against the participant in order to collect sociodemographic data and psychological symptoms, alongside follow-up interviews 4-5 months after the assault. The main outcome of the follow-up interviews was the presence of psychiatric disorders, and STIs and pregnancies as well.

After the first interview, 88% of women were at risk for depressive disorder, which slightly decreased after the follow-up interviews, ending at 80%. These statistics show that adolescent females are vulnerable to psychiatric disorders and at risk for sexual assault, outlining the necessity for support after the assault. This would help prevent any severe trauma, and could lower the rates of mental disorders, especially depressive disorders such as BPD.

A limitation of this study is that the sample was 95% female, 4% male and 1% transgender. Although this may include a small variety of participants, it still lacks the ability to be generalised to genders other than female.

Another study that agrees with the idea of sexual abuse during childhood leading to mental disorders such as emerging borderline personality disorder was done by Cutajar, Mullen, Ogloff, Thomas, Wells and Spataro (2010). The sample used was made up of 2,759 forensic medical records of sexually abused children assessed between 1964 and 1995. This information was linked with a public psychiatric database between about 12 and 43 years later to examine the relationship it would have with figures closer to today’s date. There were multiple groups, the records of the sexually abused children and control subjects with the same age and gender groupings from the general population – these were randomly selected through the national electoral database.

In their findings, Cutajar et al (2010) found that 23.3% of those sexually abused came into contact with public mental health services, compared to only 7.7% of the control groups. It was calculated that the sexually abused children had a 3.65 times higher rate of contact, and that 7.83% had mental health disorders, such as psychosis, anxiety, and personality disorders. Even as the sexually abused children became adults, the rate of mental disorders was still higher compared to that of the general population.

The study has a very large sample and is therefore less likely to be able to control variables affecting the results, for example the participants’ understanding of sexual abuse. Furthermore, none of the sexually abused children were asked for consent, which can cause ethical issues for the researchers.

However, the study does confirm the idea that sexual abuse during childhood leads to mental disorders like emerging BPD in the future, and that a lack of treatment can result in severe developmental problems as the adolescents grow up.

Research Aim and Hypothesis

The aim of this Research is to explore the impact trauma has on young offenders, especially the mental disorders that could develop as a result of this trauma. To achieve this, 35 adolescent offenders were used as a sample, the data having been collected from a questionnaire taken by all of the patients.

The hypothesis that is trying to be tested in this research is that those who have experienced sexual abuse are more likely to suffer from emerging borderline personality disorder than those who have not been sexually abused. Therefore, the researcher will be looking at the impact of the trauma on the young offender, and whether it is the main reason for the mental disorder, or whether it is a factor that can be considered as one of many for the development of emerging borderline personality disorder.

Methods

Participants

The sample used in this study was made up of 35 adolescents ranging from the age of 14 to 18 years old, the average age being 17, who were committed to the main 6 medium-secure forensic units in England and Wales (London, Southampton, Northampton, Manchester, Newcastle and Birmingham). Overall, there were 9 females and 26 males, and 69% were white British, 20% Black British, 3% South Asian, 3% Mixed, 3% White Other and the last 3% Saudi Arabian.

Assessment

To collect the data necessary for the study, each participant was asked to undergo a questionnaire during the first week of their arrival. This questionnaire was made up of questions about the participants’ identity – such as their age, gender and the family’s mental health history – and their views about certain aspects in life in order to form qualitative data that could later be used in studies such as this one. The questions asked varied from being categorical, open and closed, allowing a variety of different information to be retrieved, and determined how troubled the patient was when arriving at the medium-secure forensic unit.

Design

There were no advertisements used to form a suitable sample, as the information was personal and unable to be generalised to the public population, so the process was more targeted and focused on only young offenders in England and Wales. The participants were appointed within subjects and all had to take part in the same questionnaire, preventing demand characteristics to make the results more reliable because no one was able to reveal any vital information to the other patients.

The dependent variable in this study will be whether the patient suffers from emerging borderline personality disorder, as it is the focus of the research. On the other hand, the independent variable will be whether the patient experienced sexual abuse as a child or not, since it is the only factor that will be changing. A confounding variable in this study may be the family’s history of mental health problems, as it could impact the patient genetically and play a role in their own disorder. The patients’ families could have also suffered from borderline personality disorder and therefore the individual may have been open to suffering from it since birth. One of the confounding variables that could have an effect on the results is the relationship/s with their caregiver, especially if it is a negative one. The patient wouldn’t have experience sexual abuse but would simply need to be neglected or endure maltreatment in general to become vulnerable to a mental disorder. This makes it difficult to see whether sexual abuse, or maltreatment in general, is the cause for emerging borderline personality disorder.

Procedure

The staff at the medium-secure units gave each of the participants a questionnaire at their arrival, giving them as much time as needed to answer each question. The results were collected from May to November 2016 and were electronically retrieved from personalised files in each of the 6 forensic units involved in the study. Using computers and authorised access, the retrospective data was collected and sorted into 10 categories: Patient Number, Gender, Age, Ethnicity, the family’s mental health history, whether they had experienced sexual abuse, if they had any mental health problems, caregiver, the placement they transferred from and their offence. There was no interaction between the researcher and the patients, since the results were retrieved two years after they were collected. To examine the relationship between sexual abuse and emerging borderline personality disorder, the researcher used correlational analysis to see whether there was a positive or negative correlation. In order to scrutinise the information correctly, excel was used.

Ethical Considerations

One ethical issue with this Research is that the sample is the most vulnerable portion of the population; the youth. There are many problems when it comes to earning the consent of the youth, as the researcher often has to go through the caregiver or, in this case, the staff at the forensic units in order to gain the efficient information.

The participants are also in the secure units without voluntarily having chosen to be there. They are committed under the Mental Health Act 2007, which is designed to “give health professionals the power…to detain, assess and treat people with mental disorders in the interests of their health and safety or for public safety.” (Simon Lawton-Smith, 2008 pg. 1). The patients have not voluntarily given up the information, as it is in the units’ databases and can be accessed with the permission of the suitable officials.

Bibliography

McCarthy, J., (2018). Attorney General announces significant increases in jail sentences for people who conceal child sexual abuse. Retrieved from https://www.theherald.com.au/story/5753281/increase-in-jail-sentences-for-people-who-conceal-child-sexual-abuse/
Finkelhor, D. (1994). Current Information on the Scope and Nature of Child Sexual Abuse. Retrieved from http://www.unh.edu/ccrc/pdf/VS75.pdf
Lawton-Smith, S. (2008). Mental Health Act 2007. Retrieved from https://www.kingsfund.org.uk/sites/default/files/briefing-mental-health-act-2007-simon-lawton-smith-kings-fund-december-2008.pdf
Bradley, R., Zittel-Conklin, C., Westen, D (2005). The borderline personality diagnosis in adolescents: gender differences and subtypes. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1469-7610.2004.00401.x
NICE Clinical Guidelines, No. 78. National Collaborating Centre for Mental Health (UK), Leicester (UK): British Psychological Society; 2009.
Stern A. Psychoanalytic investigation of and therapy in the borderline group of neuroses. Psychoanalysis Quarterly. 1938;7:467–489.
NCCMH. Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care. Leicester and London: British Psychological Society and Gaskell; 2006
Radford, L., Corral, S., Bradley, C., Fischer, H., Bassett, C., Howat, N., Collishaw, S., (2011). Child abuse and neglect in the UK today. Last revised: 2018. Retrieved from https://learning.nspcc.org.uk/media/1042/child-abuse-neglect-uk-today-research-report.pdf
Khadr, S., Clarke, V., Wellings, K., Villalta, L., Goddard, A., Welch, J., Bewley, S., Kramer, T., Viner, R., 2018. Mental and sexual health outcomes following sexual assault in adolescents: a prospective cohort study. Vol.2, Issue 9, P654-665. Retrieved from https://www.thelancet.com/journals/lancah/article/PIIS2352-4642(18)30202-5/fulltext
Cutajar, M.C., Mullen, P.E., Ogloff, J.R.P., Thomas, S.D, Wells, D.L., Spataro, J., (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Last revised: 2010. Retrieved from https://www.casa.org.au/assets/Documents/Cutajar-CSA-psychopathology-CAN-paper-proof-2010.pdf

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