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Journal of Personality Disorders. 13(31,268-280. 1999
1999 The Guilford Press
BORDERLINE PERSONALITY DISORDER
AND CHILDHOOD SEXUAL ABUSE:
A META-ANALYTIC STUDY
Andrea Fossati, MD, Fabio Madeddu, MD, and Cesare Maffei, MD
A meta-analysis of the published literature was performed to evaluate the common effect size (r) of the association between childhood sexual abuse (CSA) and Borderline Personality Disor der (BPD). An online search from 1980 to 1995 was used to
gather published papers, r coefficient was used as an effect size
measure, and 21 studies were retrieved. A moderate pooled r (.279) for the association between CSA and BPD was observed. Pooled effect size estimates were also obtained for CSA parame ters. No significant effect of moderators was evidenced. The re
sults of this study did not support the hypothesis that CSA is a
major psychological risk factor or a causal antecedent of BPD.
During the last five decades, several authors have stressed the negative role
of human environment in the childhood of adult borderline subjects. Based
on clinical observation Stern ( 1 938) observed the presence of such factors as
parental fights, family disruption, lack of spontaneous maternal affect, ne
glect, rage at infant, and parental violence. More recently, as reviewed by
Paris (1994), several investigations have emphasized the role of distortions
in the separation-individuation process, early losses and separations, em
pathic failure, and widespread family pathology.
The clinical description of borderline pathology has changed over this time
span, shifting from a series of different conceptualizations and descriptions
and eventually becoming known as Borderline Personality Disorder (BPD)
(APA, 1980; Gunderson, Kolb, & Austin, 1981). This coincided with the rise of empirical research focused on childhood traumatic experiences in adult
development of BPD, with reference to sexual abuse in particular, as well as
physical abuse and neglect (Perry & Herman, 1993). It is possible that this
kind of research was influenced by the analogies between components of
From the Medical Psychology and Psychotherapy Unit, Istituto Scientifico Ospedale San
Raffaele. Department of Neuropsychiatric Sciences, University of Milan. School of Medicine, via
Stamira D'Ancona, 20, 20127 Milano, Italy.
A preliminary version of this article was presented at the 4th International Congress on the
Disorders of Personality. Trinity College, Dublin, Ireland, 21st-24th June 1995.
The authors thank Prof. Joel...