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

2. Adolescent Opioid Use
OUD occurs in about 1% of adolescents aged (APA, 2013)
In 2015:
21,000 adolescents aged 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 (Rudd et al., 2016)

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

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

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

6. 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)

7. 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).

8. 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

9. 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