A study shows that abuse and neglect can lead to subsequent personality disorders.

While sexual abuse during childhood has received wide attention in media and clinical reports, fewer clinical trials have evaluated the results of emotional abuse and neglect during childhood.

A team of German researchers led by psychotherapist Dr. J. Spiegel at Vivantes Hospital Urban, Berlin, sought to better define the long-term connection of emotional abuse and neglect during childhood and problems later in life (Eat Weight Disord. 2022. 27:131). The study investigated correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female inpatients 14 to 18 years of age who were currently receiving ED treatment.

Abuse and neglect and development of two EDs

CEN and CEA seem to be particularly important in the development of AN and BN (Psychopathol. 2012. 45:61). CEN is predominantly passive, and can be described as a lack of emotional affection or appreciation for a child. In CEA, a child is continuously hostilely rejected or devalued. Emotionally abused and neglected children are at increased risk for lower academic performance and lower IQs during childhood, and the effects of childhood maltreatment extend into later life.

The authors point out that CEN and CEA are also associated with an increased risk of developing a personality disorder (PD). For example, Johnson et al. found that CEA increased the risk for developing PDs (Compr Psychiatry. 2001. 42:16). Personality styles and PDs seem to play a central role in the development and maintenance of AN and BN, and have also been found to affect prognosis and treatment response. PDs are highly comorbid in AN and BN compared to those reported among healthy controls.

CEA is associated with borderline personality style in adolescent inpatients with binge-purging eating disorders (binge-purge type AN (AN-BP), and BN). Personality styles and PDs seem to play a central role in developing and maintaining AN and BN, and have been found to exacerbate prognosis and treatment response. PD comorbidity rates of 14.1% in patients with AN-R, 58.8% in those with AN-BP, and 48.0% in those with BN have been reported among adolescents. Significantly higher rates of comorbid borderline PDs have been found in BN and AN-BP patients (33.0 % and 29.4%, respectively) compared to AN-R patients (12%),

The study group

The authors recruited adolescents with EDs from a unit specializing in treating EDs at a child and adolescent psychiatry department. The study group included 128 female adolescents 14 to 18 years of age. Fifty-four participants had restricting-type AN (AN-R; 42.2%), and 33 had binge-purge type AN (AN-BP; 57.8%). Fifteen had BP-AN, and 18 had BN. Fifty healthy teens recruited from local high schools made up a control group.

CEN and CEA were assessed with the Childhood Trauma Questionnaire (CTQ), while the Personality Style and Disorder Inventory was administered to determine personality styles.

Differences emerged among the groups

Age differed significantly among the groups; individuals in the BP-ED group were the oldest. BMI and BMI percentiles were lowest among those with AN-R. Those in the BP-ED group had the most comorbidities, particularly mood disorders. This was reported regardless of the individual group.

Contrary to their original hypothesis, the authors did not find any association between CEN, CEA, and obsessive-compulsive personality style among the AN-R patients. Adolescent AN-R patients who had experienced CEA or CEN did not appear to develop compulsive behaviors as a strategy to regulate their emotions. However, these results contrasted with those reported in previous studies (for example, Comp Psychiatry. 2001. 42:16 and Am J Psychiatry. 1994. 151:1122). These inconsistencies may be due to methodological differences, such as the investigation of personality style vs. PD, or the focus on CEA and CEN vs. sexual and physical abuse, say the authors. In addition, the authors’ study focused on adolescents, while previous studies had only included adults. Moreover, previous studies overlooking and minimizing psychological problems appear to be more common in studies of patients with AN and AN-R than for those with BN (Am J Psychiatry. 2007. 164:108). Therefore, it is also possible that patients with AN-R scored lower on the CTQ subscales because they had denied traumatic experiences in childhood.

The study results also showed that abuse in childhood is associated with borderline personality style in adolescent inpatients with binge-purge EDS, including AN, BP-type, and BN. In addition, the authors found that living in a traumatic environment, such as one including CEA, may play a role in the development and maintenance of borderline personality styles and BP-ED. However, they add that longitudinal studies will be needed to investigate this potential association.

There were some study limitations. For example, the sample size was small, especially for the BP-ED subgroup. Also, CEN and CEA were assessed retrospectively with a self-report questionnaire rather than with clinical interviews. In addition, there was no information about the intensity, duration, or timing of CEN and CEA.

These findings highlight the impact of CEN and CEA upon the way people present in treatment settings, according to Dr. Spiegel and colleagues.