The mediating role of borderline personality features in the relationship between childhood trauma and psychotic-like experiences in a sample of help-seeking non-psychotic adolescents and young adults

Abstract

Objective:Psychotic-like experiences (PLEs) often occur across different non-psychotic disorders in adolescent and young adult population and are related to early trauma. However, the mechanisms of how exposure to early trauma shapes the risk of PLEs are unclear. In our study, we investigated whether borderline personality features and further non-psychotic symptoms, i.e. factors related to both PLEs and childhood trauma, may mediate the relationship between childhood trauma and PLEs.Methods:Two hundred inpatients aged 16–21 years who were treated due to non-psychotic disorders were included. PLEs were assessed with the Prodromal Questionnaire (PQ-16). Childhood Trauma was assessed with the Adverse Childhood Experience Questionnaire (ACE). Borderline personality features were assessed by using the Borderline-Symptom Checklist (BSL-23). Presence and frequency of depressive symptoms and anxiety were assessed by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7).Table 1Clinical characteristics (n = 200).Mean (SD)Male/female67/133Age18.72 (1.85)Clinical diagnosisDepressive disorder (F32.1, F32.2, F33.0, F33.1, F33.2)167 (83.5%)Anxiety disorder (F40.1, F41.0, F41.1, F41.2)51 (25.5%)ComorbiditiesPTSD26 (13.0%)Personality disorders (F60.30, F60.31, F60.4, F60.6, F60.7, F60.8, F61)124 (66.5%)Eating disorder (F50.0, F50.1, F50.2)19 (9.5%)Others (F42.1, F42.2, F45.1, F44.5, F90.0)33 (16.5%)Measures: The Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV) (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders II (SCID-II) were used to identify the clinical diagnoses.Results:A significant relationship between childhood trauma (ACE total score) and PLEs was found (ß = 0.30, 95% CI 0.247--0.659). In particular, emotional neglect (r = 0.298, p < 0.001) and sexual abuse (r = 0.264, p < 0.001) were significantly associated with PLEs. Borderline personality features fully mediated the relationship of childhood trauma and PLEs (ß = 0.12, 95% CI: -0.019--0.370). Anxiety and Depression showed a significant, but partial mediation of the relationship.Conclusion:Borderline personality features seem to be an important mediator of the relationship between childhood trauma and PLEs in adolescent patients with different non-psychotic psychiatric disorders. Theoretical and clinical implications are discussed.

The interplay between childhood trauma, cognitive biases, and cannabis use on the risk of psychosis in nonclinical young adults in Poland

“…The association between early traumatic experiences and PLEs has been shown both in population-based studies [8], as well as among help-seeking adolescents and young adults [9]. It has been shown that even after controlling demographic factors and comorbid mental disorders, the relationship between traumatic life events and PLEs is fairly significant with odds ratios ranging from 3 to 11 as presented by a recent meta-analysis [10].…”

“…Despite numerous studies showing the association between early trauma and PLEs/psychosis, the mechanisms by which trauma influences the development of psychotic symptoms remain unclear. Several models focusing on psychological and biological mechanisms have been suggested so far and various mediation models have been proposed linking childhood and adolescent trauma with PLEs in nonclinical samples, including different variables such as: perceived stress, external locus of control, negative self-schemas, negative other-schemas [8], cognitive biases [30][31][32], resilience [32], dissociation [8,33], depressive symptoms [34], selfdisturbances [30,31,35], insecure attachment styles [30], borderline personality features [9], and aberrant salience [36].…”

Terminology and assessment tools of psychosis: A systematic narrative review

“…Many reported the term as belonging outside of psychotic disorders . Definitions included ‘psychotic symptoms experienced by a part of the healthy population without frank disorder’, ‘subclinical psychotic phenomena like perceptual anomalies and delusion‐like experiences in the absence of manifest psychotic illness’, and ‘mild and/or transient forms of the experiences and symptoms reported by schizophrenia patients’ found among ‘psychosis‐prone individuals’ . Psychotic experiences and PLE have similarly been considered as psychotic symptoms ‘in an attenuated form’, and ‘experiences hallucinatory or delusional in nature but with reality testing remaining intact.’ PLE are also defined as ‘mild versions of psychotic symptoms’ .…”

ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L’Aquila Earthquake

“…iPQ-16 is a 16items self-report instrument that explores the presence/absence of 16 PLEs, including perceptual aberrations/hallucinations, unusual thought content/delusions, and two negative symptoms, and their associated psychological distress score on a four-point likert scale ranging from 0 to 48. Although the iPQ-16 was originally designed as a screening tool for individuals at Ultra-High Risk in help-seeking populations, several studies have used this instrument in non-help-seeking samples as a measure of PLEs (15,(23)(24)(25). We used the distress scale as recommended by Savill et al, (26) for non-help-seeking populations, using a cut-off of ≥11 as recommended by Pelizza et al (27) according to the Italian field test.…”