Borderline personality disorder (BPD) is one of the most common personality disorders seen in the general population. Among multiple identified risk factors, one of the most influential elements is exposure to an adverse childhood experience in terms of emotional, physical, or sexual abuse. A cascade of neuromorphological and epigenetic changes occurs in response to these childhood stressors, which may have a strong link to the development of BPD. PubMed and Google Scholar were searched for articles relevant to child abuse and the development of BPD. The search was not restricted to any time frame or geographic location. Significant epigenetic and neuromorphological changes are seen with child abuse, contributing to the development of BPD. Chronic stressors lead to hypothalamic-pituitary axis (HPA) activation, releasing cortisol that acts on the prefrontal cortex, amygdala, and hippocampus, producing the behavioral patterns seen in BPD. Overstimulation of gray matter leads to permanent neuromorphological changes, which can be visualized in functional MRI/brain scans. Hypermethylation of messenger ribonucleic acid in various sites suggests the impact of child abuse on the genetic level. Interestingly, the prevalence of BPD is seen equally in both genders but is diagnosed more frequently in females because they tend to be more likely to seek help. Understanding the impact of early age life stressors into adulthood calls for serious focus on early diagnosis and intervention. This implies the need for more studies in patients with BPD with or without any childhood traumatic experience and a better understanding of the changes that occur biopsychologically and genetically in response to trauma.

Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.

Pakistan is one of those countries which are continuously struggling with providing essential primary healthcare services, especially in rural and underserved areas. To combat vaccine-preventable diseases, the Expanded Program on Immunization (EPI) has been active since 1978. Additionally, Lady Health Worker Program (LHWP) fits best with district health priorities of mother and child healthcare, family planning and National Immunization Days (NIDs). However, Pakistan faces many challenges. One is significant disparities in allocation and retention of LHW between provinces such as Punjab and Balochistan. Others are the lack of formal training and management of LHWs and a lack of immunization record system leading to vaccine wastage and broken logistics. How other low to middle-income countries (LMIC) are addressing these issues, is evident from Bangladesh and India. The Shasthya Shebika (SS) Program of Bangladesh is unique in having strategies for focused, structured training and retention of community health workers (CHWs) who receive small loans to establish funds, which they use to sell medical products to the community. To tackle the issue of lack of immunization data and vaccination wastage due to inadequate inventory, India has launched an Electronic Vaccination Intelligence Network (eVIN). The Ministry of Health, Pakistan has the potential to start a healthcare project to address the challenges mentioned above. The recommendations include allocation of 500 LHW (lady health workers) in the underserved district of Quetta in Balochistan with the implementation of retention strategies by funding LHW for small businesses, providing a formal educational structure and training and supervision of LHWs for innovative electronic immunization system. LHWs will have access to relevant educational materials and electronic devices such as tablets.

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