W-8 Personality Disorders and Childhood Trauma

Post#1 by Ashley Talkington- Personality Disorders and Childhood Trauma

What is one thing that stands out to you the most about ACE’s research?

The one thing that stands out to me the most about the ACEs research is the strong connection between adverse childhood events and brain development. Chronic stress is associated with hypertrophy and overactivity in the amygdala and orbitofrontal cortex, whereas comparable levels of adversity can lead to loss of neurons and neural connections in the hippocampus and medial prefrontal cortex (Shonkoff, et al., 2012).

Why is the ACEs assessment instrument/tool so important in psychiatric mental health care?

This assessment tool screen helps to identify children with adverse childhood events as well as providing early treatment and interventions for these patients. With the strong connection between ACEs and long-term health effects, it’s essential to start screening for these adverse events as early as possible in order to intervene and start treatment.

What are the barriers to responding to the ACEs research?

Some barriers to responding to the ACEs research are cultural differences within families. Some families may believe that it is against their culture to discuss with anyone else what happens in their home. This can make identifying these children difficult based on their cultural beliefs. There is also a stigma still around seeking mental health services which may prevent parents from seeking screening/treatment for their child. Another barrier is a family's socioeconomic status. If they do not have the resources to get the patient to be screened or the cost for treatment, it will not occur. Parental education is also a barrier as many of the parents have experienced adverse childhood events and may have thought that there was nothing wrong with what happened to them. Educating parents and socioeconomic assistance should be a priority in order to increase the amount of children screened and therefore increasing the amount of children able to get treatment.

Consider borderline personality as a biological response to trauma; what are the best options for treatment and why?

Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms (Geselowitz et al., 2020). In addition to the presence of HPA axis dysfunction, several studies have also proposed that childhood trauma can affect glutamatergic, serotonergic, dopaminergic and noradrenergic transmission, suggesting that BPD is the result of alterations in several interacting neurotransmitter systems (Cattane, et al., 2017). Dialectical behavior therapy (DBT) has received the most empirical support across multiple randomized and nonrandomized controlled trials (Comtois, et al., 2010). DBT has been shown to reduce problem behaviors and improve the functioning of individuals with borderline personality disorder, as well as to increase their retention in treatment and decrease their use of emergency rooms and inpatient units (Comtois, et al,. 2010). The term “dialectical” means the interaction of conflicting ideas (May, et al., 2016). Within DBT, “dialectical” refers to the integration of both acceptance and change as necessities for improvement (May, et al., 2016). Dialectical behavior therapy aims to address the symptoms of BPD by replacing maladaptive behaviors with healthier coping skills, such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance (May, et al., 2016). A randomized comparison of transference-focused psychotherapy, DBT, and dynamic supportive psychotherapy found that all groups showed improvement, although transference-focused psychotherapy and DBT were more effective for suicidality, transference-focused psychotherapy and supportive psychotherapy were more effective for anger and impulsivity, and transference-focused psychotherapy was more effective for irritability and assault (Comtois, et al., 2010).

Resources

Cattane, N., Rossi, R., Lanfredi, M., & Cattaneo, A. (2017). Borderline personality disorder and childhood trauma: exploring the affected biological systems and mechanisms. BMC psychiatry, 17(1), 221. https://doi.org/10.1186/s12888-017-1383-2

Comtois, K., Kerbrat, A., Atkins, D., Harned, M., & Elwood, L. (2010). Recovery From Disability for Individuals with Borderline Personality Disorder: A Feasibility Trial of DBT-ACES. Psychiatric Services, 61(11), 1106-1111. doi: 10.1176/ps.2010.61.11.1106

Geselowitz, B., Whalen, D., Tillman, R., Barch, D., Luby, J., & Vogel, A. (2020). Preschool Age Predictors of Adolescent Borderline Personality Symptoms. Journal Of the American Academy of Child & Adolescent Psychiatry, 60(5), 612-622. doi: 10.1016/j.jaac.2020.07.908

May, J., Richardi, T., Barth, K. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. Mental Health Clinician, doi: https://doi.org/10.9740/mhc.2016.03.

Shonkoff, J., Garner, A., Siegel, B., Dobbins, M., Earls, M., & Garner, A. et al. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129(1), e232-e246. doi: 10.1542/peds.2011-2663