A critique of conceptual and treatment approaches to borderline psychopathology in light of findings about childhood abuse.

A series of recent research findings has begung to supply strong evidence of a highly significant correlation between borderline psychopathology and experiences of repeated childhood trauma including sexual abuse (especially incest), physical abuse, and the witnessing of severe domestic violence (Bryer et al. 1987; Herman et al. 1989; Western et al. 1990; Zanarini et al. 1989). The replication of these results with different research samples is in contrast to the inconsistent findings associated with earlier etiological theories, in which the roots of borderline pathology were variously linked to schizophrenic or affective illnesses (Akiskal 1981; Akiskal et al. 1985; Klein 1977; Perry 1985), to derailments in the separation-individuation process (Kernberg 1975, 1976; Mahler and Kaplan 1977; Masterson and Rinsley 1975), to actual early losses and separations (Bradley 1979; Paris et al. 1988; Soloff and Millward 1983a, 1983b), to severe empathic failures during the first years of life (Adler and Buie 1979), or to more general family-based pathologies (Frank and Hoffman 1980; Frank and Paris 1981; Grinker et al. 1968; Gunderson and Englund 1981; Gunderson et al. 1980; Links 1990; Walsh 1977; Zinner and Shapiro 1975). Not only do current findings regularly identify 50% to 80% of subjects as victims of childhood abuse and trauma, but also several studies show that factors such as age of onset, severity, and type of abuse reliably discriminate between borderline and other diagnostic groups (Herman et al. 1989; Zanarini et al. 1989).