The relationship between borderline personality disorder (BPD) and traumatic attachment and abuse in childhood is documented in numerous studies around the world. Over seventy per cent of these patients reported a childhood history of emotional abuse – that is frequent experiences of being shamed or humiliated, being frustrated by being given mixed messages, being put in impossible situations, having their thoughts and feelings denied.
The prevalence of retrospective reports of childhood sexual abuse among these patients suggests that sexual abuse is an important etiological factor; however there are several reasons to conclude that sexual abuse is neither necessary nor sufficient for the development of BPD. Although sexual abuse may not be a primary etiological factor in BPD, it may contribute to the development of BPD through interaction with other pathological childhood experiences, such as other forms of abuse and dysfunctional parental behaviour. They are more likely to have experienced multiple forms of abuse and the abuse they experience is more severe and chronic and related mostly to significant bi-parental failure.
Integration of the individual patient is the aim of psychotherapy – from a troubled state to one of health. It refers not only to integration of split off parts of the dissociated individual; it refers to the ability to regulate affect, to achieve impulse control; to achieve a capacity for trust and to generalize that to other relationships outside; to improve their day to day functioning; to be able to remember traumatic experiences without reliving them and fragmenting; to resolve disturbed relationships and integrate traumatic experiences into the fabric of their being; and develop reflective awareness and a sense of self.
In this paper I will describe the psychological changes that accompany integration, the social changes and the fact that brain changes occur in the psychotherapy of the patient with BPD.
