From childhood trauma to functional impairment in borderline personality disorder: the mediating role of emotion dysregulation and impulsivity

Abstract

Borderline Personality Disorder (BPD) is characterized by severe psychosocial dysfunction and high rates of adverse childhood experiences. Emotion dysregulation and impulsivity are core BPD features that may mediate the impact of childhood trauma on functioning. A total of 203 outpatients with BPD (mean age = 24.4 years; 84.7% women) completed the Childhood Trauma Questionnaire (CTQ), Difficulties in Emotion Regulation Scale (DERS), Barratt Impulsiveness Scale (BIS-11), and Functioning Assessment Short Test (FAST). Associations between childhood trauma (CTQ total and subscales) and psychosocial functioning were examined, testing the serial mediating role of the two mediators (PROCESS Model 6; percentile bootstrapping, 5,000 resamples; adjusted for gender and age). CTQ total was associated with poorer functioning in the covariate-adjusted mediation model, with a significant direct effect. The total indirect effect through the mediators was significant, but no single pathway, including the serial CTQ → DERS → BIS-11 → FAST pathway, reached significance. Among trauma subtypes, emotional abuse and emotional neglect showed significant total and direct effects, and the serial pathway was significant for both neglect subtypes; sexual and physical abuse were not associated with functioning. When the five trauma subtypes were entered simultaneously, none showed a unique association. Childhood trauma is associated with poorer psychosocial functioning in BPD, partly through emotion dysregulation and impulsivity, although much remains unexplained. The absence of unique subtype effects points to the cumulative nature of childhood adversity (polyvictimisation). Being cross-sectional, these findings support trauma-informed therapeutic approaches only as hypotheses for future research.