1. 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

2. 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.

3. 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.

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

5. 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%

6. The Damage

7. 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)

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

11. Frantic efforts to avoid real or imagined abandonment

12. Ambivalence: alternating between extremes of idealisation and devaluation

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

14. Identity disturbance: unstable self-image or sense of self

15. Hopeless-Helpless: chronic feelings of emptiness

16. Instability: affective instability due to a marked reactivity of mood

17. Anger Management Problems inappropriate, intense anger or difficulty controlling anger

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

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

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

21. 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

22. Unique Difficulties BipolaritiesAmbivalence Embraced Failure (Abandoned Hope)

23. Abuse ImpairedOver AchievementAchievement

24. Vulnerability

25. Transition to Adulthood Failed StalledOver Compensated

26. Adult Outcomes SeriousAdult ImpairmentSuccess