The Mediating Influence of Borderline Personality Organization on Opioid Use Disorder in Adolescents with Trauma Histories Allison Schwab.

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The Mediating Influence of Borderline Personality Organization on Opioid Use Disorder in Adolescents with Trauma Histories Allison Schwab

Adolescent Opioid Use OUD occurs in about 1% of adolescents aged 12-17 (APA, 2013) In 2015: 21,000 adolescents aged 12-17 used heroin (Center for Behavioral Health Statistics and Quality, 2016) About 6,000 adolescents had an opioid use disorder (CBHSQ, 2016) 48 opioid-related overdose deaths in people aged 14 and younger 715 opioid-related overdose deaths in people aged 15-24 (Rudd et al., 2016)

Personality Organization (Kernberg) Neurotic Borderline Psychotic Identity Integration + - Defensive Operations Reality Testing

Mediational Model / Hypotheses BPO (MV) Childhood Trauma (IV) OUD (DV)

Participants Clinical sample – teens recruited from three outpatient substance use treatment centers Nonclinical sample – teens from a public NYC high school

Measures Demographic Questionnaire Childhood Trauma Questionnaire (CTQ) Inventory of Personality Organization (IPO) Structured Clinical Interview for the DSM-5, Research Version: Module E (SCID-5-RV)

Significant Discussion Relationship between childhood trauma and OUD becomes insignificant if an individual does not have a BPO Previous research focuses on the relationship between BPO and self-mutilation as a self-harm mechanism as described by Kernberg (1987). Future Directions Exploration of the effectiveness of transference-focused psychotherapy on adolescents with OUD that have trauma histories. Treatment of OUD may be enhanced by targeting the identity diffusion and primitive defense aspect of BPO. In this type of therapy, one’s perceptions of the self, others, and affects or internal object relations are targeted with the goal of increasing control over behaviors, affects, and relationships (Normandin et al., 2015).

Nonsignificant Discussion No significant correlation between childhood trauma and BPO Design Limitations Sample size – Only about 15% of adults in the U.S. have at least one personality disorder and onset may not occur until early adulthood (APA, 2013); Personality disorder pathology is apparent in 3-5% of US adolescents (Normandin et al., 2015) Reliance on self-report Ill-defined child trauma variable

Nonsignificant Discussion (Cont.) Other possible mediators Genetic predisposition Exposure to drug use (family and peers) Childhood diagnoses of disruptive, impulse-control, or conduct disorders Unique cognitive, biological, and social changes and challenges of adolescence