Dawn M. Johnson

Gender differences in borderline personality disorder: findings from the collaborative longitudinal personality disorders study

A majority of the literature on borderline personality disorder (BPD) focuses on its occurrence in women or does not specifically assess for gender differences in clinical presentations. Some studies report that men with BPD may be more likely to be diagnosed with substance use disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial personality disorders (PDs). Additionally, women with BPD appear to be more likely to report histories of adult physical and sexual abuse and to meet diagnostic criteria for post-traumatic stress disorder (PTSD) and eating disorders. The purpose of the present study was to further examine gender differences in BPD. Using baseline data from the Collaborative Longitudinal Personality Disorders Study (CLPS), men and women who met criteria for BPD were compared on current axis I and II disorders, BPD diagnostic criteria, childhood trauma histories, psychosocial functioning, temperament, and personality traits. Men with BPD were more likely to present with substance use disorders, and with schizotypal, narcissistic, and antisocial PDs, while women with BPD were more likely to present with PTSD, eating disorders, and the BPD criterion of identity disturbance. Generally speaking, women and men with BPD displayed more similarities than differences in clinical presentations. The differences that did emerge are consistent with those found in epidemiological studies of psychopathology and therefore do not appear unique to BPD. Additionally, many gender differences traditionally found in epidemiological samples did not emerge in BPD subjects. For example, no difference was found in rates of major depressive disorder, a condition that is more prevalent in females. Thus, BPD pathology may be a prevailing characterization that can attenuate usual gender-based distinctions.

Clinical Features and Impairment in Women with Borderline Personality Disorder (BPD) with Posttraumatic Stress Disorder. (PTSD), BPD Without PTSD, and Other- Personality Disorders with PTSD.

The aims of this study were to examine differences in clinical features, impairment, and types of childhood traumas among women with borderline personality disorder (BPD), women with BPD and posttraumatic stress disorder (PTSD), and those with other personality disorders and PTSD. Using baseline data from the Collaborative Longitudinal Study of Personality Disorders, 186 women were divided into 3 groups (BPD+PTSD, BPD, PTSD), based on structured diagnostic interviews for Axis I and Axis II disorders and compared on selected clinical variables. The additional diagnosis of PTSD in borderline women did not significantly increase the degree of borderline pathology and psychiatric morbidity but did significantly increase general dysfunction and the occurrence of hospitalization. The additional diagnosis of BPD in women with PTSD significantly increased the features of suicide proneness and impulsiveness. Both groups of women with PTSD reported significantly more types of childhood traumas relative to borderline women without PTSD. Consistent with other research, the findings suggest that PTSD does not appear to alter the central features of BPD. The clinical implications of our findings are considered.

Cognitive behavioral treatment of PTSD in residents of battered women's shelters: results of a randomized clinical trial.

OBJECTIVE This study was designed to explore the acceptability, feasibility, and initial efficacy of a new shelter-based treatment for victims of intimate partner violence (IPV; i.e., Helping to Overcome PTSD through Empowerment [HOPE]). METHOD A Phase I randomized clinical trial comparing HOPE (n = 35) with standard shelter services (SSS) (n = 35) was conducted. Primary outcome measures included the Clinician-Administered PTSD Scale (CAPS; D. D. Blake et al., 1995) and the Conflict Tactic Scales-Revised (M. A. Straus, S. L. Hamby, S. Boney-McCoy, & D. B. Sugarman, 1996). Participants were followed at 1-week, 3- and 6-months postshelter. RESULTS Participants reported HOPE to be credible and indicated a high degree of satisfaction with treatment. Only 2 women withdrew from treatment. Both intent to treat (ITT) and minimal attendance (MA) analyses found that HOPE treatment relative to SSS was significantly associated with a lower likelihood of reabuse over the 6-month follow-up period (OR = 5.1, RR = 1.75; OR = 12.6, RR = 3.12, respectively). Results of hierarchical linear model analyses found a significant treatment effect for emotional numbing symptom severity in the ITT sample, t(67) = -2.046, p < .05, and significant treatment effects for effortful avoidance symptom severity, t(49) = -2.506, p < .05, and arousal symptom severity, t(49) = -2.04, p < .05, in the MA sample. Significant effects were also found for depression severity, empowerment, and social support. CONCLUSIONS Results support the acceptability and feasibility of HOPE and suggest that HOPE may be a promising treatment for IPV victims in shelter. However, results also suggest that modifications to HOPE may be required to improve treatment outcomes.

The Attenuating Effect of Empowerment on IPV-Related PTSD Symptoms in Battered Women Living in Domestic Violence Shelters:

Intimate partner violence (IPV) is associated with significant psychological distress, including posttraumatic stress disorder (PTSD). However, factors that attenuate the impact of IPV on PTSD remain largely unknown. Using hierarchical regression, this investigation explored the impact of resource acquisition and empowerment on the relationship between IPV and PTSD. Empowerment demonstrated greater relative importance over resource acquisition. Specifically, empowerment was found to attenuate the impact of IPV severity on PTSD at low and moderate levels of violence. The importance of fostering empowerment and addressing PTSD in addition to provision of resources in battered women is discussed.

Utilization of Mental Health Treatment and Other Services by Battered Women in Shelters

OBJECTIVE This study investigated the frequency and types of resources used by battered women in shelters, as well as factors that relate to greater use of mental health services and to seeking help from a greater number of resources. METHODS A total of 164 African-American (N=94) and white (N=70) battered women in two shelters were examined by using a series of clinical interviews and self-report measures that assessed posttraumatic stress disorder and other axis I pathology, mental health treatment and other service use, abuse severity, and lifetime trauma prevalence. RESULTS Results suggest that few of the women used available resources, especially mental health treatment, with African-American women less likely to use mental health treatment and criminal justice interventions. Additionally, possession of medical insurance and a greater number of types of prior trauma were significantly associated with greater help seeking. CONCLUSIONS Findings highlight the need for identifying barriers to battered womens access to resources, as well as the importance of assisting them in obtaining medical coverage.

Factors Influencing the Relationship Between Sexual Trauma and Risky Sexual Behavior in College Students

While the relationship between sexual trauma and risky sexual behavior (RSB) has received much attention, only a handful of studies have investigated the factors that protect victims of sexual trauma from developing this maladaptive pattern of behavior. The current study investigated the protective role of social support, quality and quantity, in developing RSB, through the mechanism of problematic substance use. Two hundred and seventy-five female college students completed a series of self-reports assessing sexual trauma, problematic substance use, social support quality and quantity, and RSB. The results indicated a positive relationship between sexual trauma severity and RSB. Further, this relationship was mediated by participants’ problematic substance use. Social support quality acted as a buffer against the relationship described above where quantity exacerbated this relationship. Implications will be discussed.

Correlates for legal help-seeking: contextual factors for battered women in shelter.

Legal redress can play a critical role in interrupting the pattern of domination and control inherent in intimate partner violence (IPV), yet it remains an infrequent strategy among battered women. The current study employed a contextual framework for investigating the correlates for engagement in the criminal justice system for a sample of 227 sheltered battered women. Results indicated that individual, relational, and system-level factors were all associated with two legal help-seeking behaviors: having a civil protection order and criminal prosecution. In particular, posttraumatic stress disorder (PTSD) symptomatology, social support, and prior experience with police officers were significant correlates for legal help-seeking. Results highlight the need for a coordinated community response to IPV, addressing both legal needs and psychological needs simultaneously.

Remission of PTSD after victims of intimate partner violence leave a shelter

Intimate partner violence (IPV) is a significant public health problem associated with high rates of posttraumatic stress disorder (PTSD). Few longitudinal studies have investigated IPV-related PTSD and we know of only 1 longitudinal study to date that has explored IPV-related PTSD in residents of battered womens shelters. The current report describes a prospective study of IPV-related PTSD in an initial sample of 147 residents of battered womens shelters. Baseline correlates of remission of IPV-related PTSD (i.e., PTSD and IPV severity, loss of personal and social resources, cessation of abuse, reunion with abuser, and length of shelter stay) over a 6-month follow-up period were investigated. Although findings are consistent with prior research suggesting a natural recovery of PTSD in IPV-victims, they also show that a significant number (46.8%) of women exhibit chronic PTSD. Participants whose PTSD remitted over follow-up had at baseline less severe IPV-related PTSD (partial η(2) = .104) and fewer loss of personal and social resources (partial η(2) = .095), and were less likely to reunite with their abuser after leaving the shelter than participants with chronic PTSD (3.3% and 22.4%, respectively). Clinical implications and limitations of findings are discussed.

PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.

Encouraging Legal Help Seeking for Victims of Intimate Partner Violence: The Therapeutic Effects of the Civil Protection Order

Civil protective orders (CPOs) are the most widely used justice system remedy for intimate partner violence (IPV), and were implemented to ensure safety and increase victim participation in the justice system. Limited data exists regarding the effectiveness of CPOs; however, theories of therapeutic jurisprudence argue that legal interventions in and of themselves can improve mental health outcomes. To test this hypothesis, we examined the effectiveness of having a CPO issued against ones abuser at improving the psychological sequelae of exposure to trauma. We used a longitudinal sample of female residents of battered womens shelters who had experienced IPV (N = 106; 55% African American). One-way analyses of variance using gain scores indicated that PTSD symptoms (effect size η(p)(2) = .16) and incidents of sexual revictimization (effect size η(p)(2) = .09) decreased from baseline to 6-months postshelter for women who had a CPO against their most recent abuser compared to women without a CPO. These results support theories of therapeutic jurisprudence, suggesting that having a CPO can improve mental health outcomes. Limitations and clinical implications of our findings are discussed, including arguing for a coordinated service system that incorporates both legal and psychological assistance to improve the mental health of victims of IPV.