Absorption and Depersonalisation Derealisation Link Childhood Trauma to BPD Severity and Show Strong Independent Predictive Effects for Various BPD Symptom Domains.

Abstract

Dissociative experiences are highly common in borderline personality disorder (BPD) and have been associated with childhood abuse and neglect. Only few studies so far differentiated between specific forms of psychoform and somatoform dissociation, childhood trauma, and BPD domains. This study aimed to simultaneously investigate how psychoform dissociation (depersonalization derealization, absorption, amnesia), somatoform dissociation, and childhood trauma (emotional, sexual, and physical abuse, and neglect) are linked to clinically assessed BPD core symptoms by reanalyzing a previously published data set. Previously, a sample of 450 adult psychiatric patients with BPD, somatic symptoms disorder, generalized anxiety disorder, and/or depressive disorders (68.7% female, 61.6% with clinically relevant BPD symptoms) underwent semi-structured clinician-administered interviews on BPD domains (Borderline Personality Disorder Severity Index, BPDSI) and completed the Traumatic Experiences Checklist, Dissociative Experiences Scale, and Somatoform Dissociation Questionnaire 20. Significant positive correlations between severity of childhood trauma, psychoform and somatoform dissociation, and BPD symptoms were found. In a multivariate regression model, absorption predicted eight out of nine BPD domains (all except suicidality). Suicidality was uniquely linked to depersonalization derealization. Bootstrapping path analysis revealed both a direct effect of childhood trauma on BPD symptom severity and small indirect effects through depersonalization derealization and absorption, but not through amnesia or somatoform dissociation. Findings highlight the importance of differentiating between specific symptoms of dissociation in relation to BPD domains, also in clinical practice. Dissociative absorption should receive greater scientific and clinical attention as an important dissociative symptom that may exacerbate psychopathology and BPD symptoms. Longitudinal research is needed to determine causal and mediating effects.