Borderline Features Mediate the Association between the Experience of Childhood Sexual Abuse and Opioid Misuse among Pregnant Women

The relationship between experiences of childhood sexual abuse and opioid misuse in adults is well documented, specifically among women, but less is known about this association in pregnancy. No studies to date have investigated processes that could be the target of interventions to help women with childhood sexual abuse histories better care for their infants. In the current study, we examined borderline personality disorder features as mediators which may explain the link between childhood sexual abuse and opioid misuse during pregnancy. We sampled N = 93 pregnant women: n = 55 were misusing opioids during their pregnancies and n = 38 were at high risk due to non-drug related medical factors. Frequency and severity of sexual abuse exposure prior to age 18 were assessed using the Maltreatment and Abuse Chronology of Exposure (MACE; Teicher & Parigger, 2015); borderline features (affective instability, identity disturbance, negative relationships, and self-harm/impulsivity) were assessed along a continuum using the Personality Assessment Inventory (PAI; Morey, 1991). We created a continuous opioid severity variable which ranged from 0 (negative urine assays for any drugs) to 3 (positive assays for unprescribed and/or illegal opiates) to measure participant outcomes. Findings indicated that total borderline features, as well as the individual features of identity disturbance, negative relationships, and self-harm/impulsivity were all mediators in the association between childhood sexual abuse and opioid misuse severity.