Structural Equation Modeling of Childhood Trauma and Self-Stigma in Adult Inpatients with Borderline Personality Disorder

Marie Ociskova,1,2 Jan Prasko,1– 4 Krystof Kantor,1,5 Jakub Vanek,1 Vlastimil Nesnidal,1 Kamila Belohradova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic; 2Jessenia Inc. Rehabilitation Hospital Beroun, Akeso Holding, MINDWALK, S.r.o, Beroun, Czech Republic; 3Department of Psychological Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic; 4Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, Czech Republic; 5Department of Child Psychiatry, University Hospital in Motol, Prague, Czech RepublicCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Hnevotinska 3, Olomouc, 779 00, Czech Republic, Email [email protected]: Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic.Patients and Methods: This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements – the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire – Short Form, the Clinical Global Impression – Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses.Results: Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability.Conclusion: Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.Keywords: borderline personality disorder, self-stigma, childhood trauma, depression, anxiety, disability