Borderline personality pathology, health behavior, and inflammation: Potential behavioral and biological mechanisms underlying childhood physical abuse and age-related disease

The frequent comorbidity of psychiatric and physical health conditions may be partially attributable to early life stress-related changes in inflammatory signaling and behavior (e.g., borderline personality pathology, health behaviors) that reciprocally maintain and enhance their effects on overall health. Using data from older adults (N=1,630) who participated in the ongoing longitudinal St Louis Personality and Aging Network (SPAN) study, we examined associations between childhood physical abuse, borderline personality pathology, inflammation markers (i.e., interleukin-6 [IL-6], C-reactive protein [CRP]), health behaviors, and physical health. Morning fasting serum IL-6 and CRP were assayed from a subset of participants (n=791). Borderline pathology factor scores were computed using interviews as well as self- and informant-reports across the course of the study. Physical health, health behaviors, and additional covariates (e.g., medication use) were also assessed. IL-6 was associated with higher BPD symptomatology, greater exposure to childhood physical abuse, worse physical health, and lower preventative health behaviors (all p values < 10-11). Similar findings for CRP emerged, though the association with childhood physical abuse was not robust to covariate inclusion. An integrated model suggests an indirect pathway between exposure to childhood physical abuse, greater BPD symptomology, reduced preventative health behaviors, elevated IL-6, and worse health outcomes (-0.07, p < .001).These findings suggest that physical abuse during childhood may be predictive of later poor physical health through behavioral (i.e., borderline pathology, reduced preventative health behaviors), and biological (i.e., inflammatory) pathways.