ABSTRACT
The term ‘childhood trauma’ encompasses a vast array of different experiences ranging from single traumatic events to systematic long-term abuse. What is traumatic for one individual isn’t necessarily so for another. Individual characteristics, the nature of the trauma and the surrounding environment all influence the eventual outcome. Not surprisingly the range of outcomes following on from the original trauma are extremely varied. I am going to concentrate on the management of borderline personality disorder (BPD), one possible outcome following childhood trauma especially pertinent to women, as most individuals who meet the criteria for BPD are female. There is strong, accumulating evidence showing that childhood abuse and neglect plays an important role in the onset of personality disorders (Johnson et al., 1999). The risk for sexual abuse is two to three times greater for females than for males (Finkelhor, 1979) and the prevalence of sexual abuse in the childhood histories of women with BPD is such that it cannot be ignored as an important possible aetiological factor. Not all women with BPD experienced childhood trauma and not all childhood trauma results in BPD in adult life, but the association between the two is undeniable. The reason for concentrating on this group of women is two-fold. Firstly, they present with severe problems that are difficult to manage successfully. Secondly, they represent a sizeable proportion of individuals involved with mental health services and tend to utilise a large amount of time and resources. Eleven per cent of all psychiatric outpatients and 19 per cent of psychiatric inpatients are estimated to qualify for a diagnosis of BPD (Wideger and Frances, 1989).
