Psychiatric Impact of Childhood Sexual Abuse: Life on the Borderline Survivors of Abuse – Access to Justice Information Seminar, 14 May 2004 Ian Curtis MBBS FRANZCP FAChAM

Borderland (author BV, with permission) The sand stings The Wind is Howling Of pain past. I know nothing The sand in my eyes Of pain present.

I just exist Ask me who “I” am No answer. Gritting sand Prevents looking where The I is. Can’t be heard The Wind is Howling Lonely and worse.

Isolate So as not to feel Contact causes hurt. The Wind is Howling When will I be Whole? (BV)

Prevalence of Borderline Features General population1-2%General population1-2% Outpatient mental health clinics10%Outpatient mental health clinics10% Psychiatric inpatient clinics20%Psychiatric inpatient clinics20% Special Clinic PopulationsSpecial Clinic Populations involving personality disorders30-60% involving personality disorders30-60%

The Damage

Aetiology Early life Physical and Sexual Abuse, Neglect, Hostile Conflict, and early Parental Loss/Separation are more common in the Childhood histories. (Source: Diagnostic and Statistical Manual Mental Disorders, 4 th Edition, p708)

General Behaviours of the Borderline AmbivalenceAmbivalence EmptinessEmptiness AngerAnger InstabilityInstability Impulsivity and RecklessnessImpulsivity and Recklessness Deliberate Self-HarmDeliberate Self-Harm ImmaturityImmaturity

Frantic efforts to avoid real or imagined abandonment

Ambivalence: alternating between extremes of idealisation and devaluation

Pattern of unstable and intense interpersonal relationships alternating between extremes of idealisation and devaluation

Identity disturbance: unstable self-image or sense of self

Hopeless-Helpless: chronic feelings of emptiness

Instability: affective instability due to a marked reactivity of mood

Anger Management Problems inappropriate, intense anger or difficulty controlling anger

Self-Harming: impulsivity in at least two areas that are potentially self-damaging (eg spending, sex, substance abuse etc)

Suicidality: recurrent suicidal behaviour, gestures, threats, self-mutilating behaviour

Psychotic Border: stress-related paranoid ideation or severe dissociative symptoms

And Drug Abuse Self-treatingSelf-treating Fill emptinessFill emptiness Isolate interpersonallyIsolate interpersonally Pseudo-closenessPseudo-closeness “Control emotions”“Control emotions” Obscure angerObscure anger Self-harmSelf-harm

Unique Difficulties BipolaritiesAmbivalence Embraced Failure (Abandoned Hope)

Abuse ImpairedOver AchievementAchievement

Vulnerability

Transition to Adulthood Failed StalledOver Compensated

Adult Outcomes SeriousAdult ImpairmentSuccess