Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder
Elices et al. BMC Psychiatry
Exploring the relation between childhood trauma, temperamental traits and mindfulness in borderline personality disorder
Juan C. Pascual
Background: Deficits in mindfulness-related capacities have been described in borderline personality disorder (BPD). However, little research has been conducted to explore which factors could explain these deficits. This study assesses the relationship between temperamental traits and childhood maltreatment with mindfulness in BPD. Methods: A total of 100 individuals diagnosed with BPD participated in the study. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ-SF), temperamental traits were assessed using the Zuckerman-Khulman Personality Questionnaire (ZKPQ), and mindfulness capabilities were evaluated with the Five Facet Mindfulness Questionnaire (FFMQ). Results: Hierarchical regression analyses were performed including only those CTQ-SF and ZKPQ subscales that showed simultaneous significant correlations with mindfulness facets. Results indicated that neuroticism and sexual abuse were predictors of acting with awareness; and neuroticism, impulsiveness and sexual abuse were significant predictors of non-judging. Temperamental traits did not have a moderator effect on the relationship between childhood sexual abuse and mindfulness facets. Conclusions: These results provide preliminary evidence for the effects of temperamental traits and childhood trauma on mindfulness capabilities in BPD individuals. Further studies are needed to better clarify the impact of childhood traumatic experiences on mindfulness capabilities and to determine the causal relations between these variables.
Borderline personality disorder; Mindfulness; Childhood maltreatment; Temperament
Borderline personality disorder (BPD) is a severe
psychiatric condition marked by a pervasive pattern of emotional
dysregulation, impulsive behaviour, identity disturbances
and interpersonal conflicts . Previous publications have
established that the transaction between biological
temperamental predispositions and environmental factors
contribute to the development of the disorder [2–4]. BPD has
been described as an extreme and maladaptive variant of
1Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
2Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de
Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
Full list of author information is available at the end of the article
normal temperamental dimensions [1, 5, 6] such as
neuroticism, impulsiveness and aggression- hostility [1, 7]. In
parallel, other studies have revealed that certain contextual
factors such as adverse childhood experiences are also
related to BPD symptoms and its severity [8, 9].
Retrospective studies have found high rates of early traumatic
experiences in BPD, comprising 30 to 90 % of BPD cases
and including sexual, physical and emotional abuse
[10, 11]. Traumatic experiences and neuroticism are
also independent predictors of BPD severity . However,
it seems that the interaction between these factors (i.e.
neuroticism and adverse childhood experiences) is even
more complex, as it contributes not only to the severity
 but also to the development of the disorder .
In recent years, psychological treatments that include
mindfulness training have been increasingly used to treat
individuals with BPD with and without a history of early
trauma [13–15]. Moreover, it has been suggested that
improvements in the patient’s mindfulness capacities are a
common factor associated with the success of
evidencebased therapies for BPD . Mindfulness can be
described as a particular way to pay attention to the present
moment, in an inquiring and accepting manner, without
judging or reacting to the experience . The construct
of mindfulness encompasses several facets [18, 19]: (1) the
capacity to observe and notice the current experience; (2)
the ability to describe the experience (i.e., putting into
words or labelling the experience), (3) a non-judgemental
and non-evaluative stance (i.e., non-judging), (4)
non-reactivity to inner experience (i.e., allowing thoughts and
feelings to come without getting caught up in them) and
(5) acting with awareness (i.e., focusing on the present
activity instead of behaving mechanically). The inclusion of
mindfulness practices in BPD treatment is based on the
idea that individuals with BPD have a deficit in certain
important mindfulness capabilities and that this deficit is
associated with symptoms of the disorder [20, 21]. Indeed,
subjects with BPD display low levels of mindfulness
compared to healthy controls and other clinical populations
[22–24]. In addition, studies conducted by Wupperman
and colleagues [25, 26] suggest an inverse relation
between mindfulness and core characteristics of BPD,
To date, research on the relationship between
personality traits and the facets of mindfulness has mainly been
conducted in non-clinical samples. Strong, inverse
correlations between neuroticism and mindfulness  and
between impulsivity and two facets of mindfulness
(acting with awareness and non-judging) have been
reported . However, the influence of life-events on
mindfulness capabilities has not been sufficiently
explored. An exception to this is the study carried out
by Michal et al. , in which a significant and
negative correlation was found in a non-clinical
population between emotional maltreatment and mindful
attention and awareness. The inverse relation between
certain mindfulness facets and the severity of post
traumatic stress disorder (PTSD) symptoms also
suggest an association between traumatic experiences and
deficits in mindfulness capabilities [29–31].
Given the context described above, in this study we
explore the association between temperamental traits,
childhood maltreatment, and deficits in mindfulness
capacities in a sample of BPD individuals. Since
temperamental traits, especially neuroticism, appear to be
moderators of the relationship between childhood
maltreatment and psychopathology  as well as between
childhood maltreatment and BPD severity , we also
explored the role of temperamental traits as moderators
of the association between childhood maltreatment and
mindfulness. Based on the literature [27, 28], we
hypothesized that some temperamental traits (specifically,
neuroticism and impulsiveness) would be negatively associated
with mindfulness. We also expected to find neuroticism
to have a moderating effect on the association between
childhood trauma and mindfulness. Research on the
association between mindfulness and diverse childhood
maltreatment experiences is scant. Therefore, no a
priori hypotheses regarding the possible link between
specific facets of mindfulness and different types of
traumatic experiences were made.
A total of 133 participants were recruited from the
outpatient BPD unit at the Department of Psychiatry of the
Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).
Only data from participants meeting the inclusion
criteria were analysed, resulting in a final sample of 100
participants. Inclusion criteria were as follows: (1)
diagnosis of BPD according to DSM-IV criteria 
confirmed by two structured clinical interviews: Structured
Clinical Interview for DSM-IV Axis II Personality
Disorders (SCID-II)  and Revised Diagnostic Interview
for Borderlines (DIB-R) ; (2) age between 18 and
45 years; (3) no current co-morbidity with major
depression, bipolar disorder, psychotic disorders, or
substance dependence; (4) no severe physical conditions or
intellectual disability; and (5) no previous training in
To ensure an accurate BPD diagnosis, the Spanish
versions of two semi-structured clinical interviews were used.
The SCID-II  was used to assess personality disorders
according to DSM-IV criteria . The SCID-II has
shown adequate psychometric properties, including good
reliability between interviewers (kappa: 0.85). The DIB-R
 is a semi-structured interview to establish BPD
diagnosis over the last 2 years. The cut-off point of the
Spanish version is six (range: 0 to 10). Psychometric
properties are good: internal consistency (Cronbach’s
alpha = 0.89), sensitivity (0.81), and specificity (0.94).
The convergent validity with the diagnosis of the SCID-II
is moderate (kappa: 0.59).
To assess adverse childhood experiences the Childhood
Trauma Questionnaire – Short Form (CTQ-SF)  was
administered. The CTQ-SF contains 28 items and
retrospectively assesses childhood abuse and neglect across
five subscales described as follows: (a) sexual abuse:
sexual contact or conduct between a child under 18 years
of age and an adult or older person, (b) physical abuse:
bodily assaults on a child by an adult or older person
that entail a risk of, or resulted in, injury, (c) emotional
abuse: verbal assaults, humiliating or demeaning
behaviour directed toward a child by an adult or older person,
(d) physical neglect: the failure of caretakers to provide
for a child’s basic physical needs (food, shelter, clothing,
safety, and health care), (e) emotional neglect: failure of
caretakers to meet children’s basic emotional and
psychological needs, including love, belonging, support and
nurture. Items are rated on a 5-point Likert Scale from
“never true” to “very often true”. For each sub-scale a
cut-off point is provided in order to identify moderate –
severe cases . Across four diverse samples, all
subscales have shown a good internal consistency (Cronbach’s
alpha): sexual abuse (0.92 to 0.95), physical abuse (0.81 to
0.86), emotional abuse (0.84 to 0.89), physical neglect
(0.61 to 0.78) an emotional neglect (0.85 to 0.91) .
Temperamental traits were evaluated with the
Zuckerman–Kuhlman Personality Questionnaire (ZKPQ)
, a self-administered 99 item scale (true/false format)
based on the Alternative Five Factor Model. The ZKPQ
includes five temperamental traits from a psychobiological
perspective: Neuroticism–Anxiety (N-Anx), Impulsive–
Sensation Seeking (ImpSS), Aggression–Hostility
(AggHost), Activity (Act), and Sociability (Sy). Additionally,
an infrequency scale is provided to assess inattention
to the questionnaire. The Spanish version has shown
good psychometric properties, including good internal
consistency (Cronbach’s alpha ranging from 0.77 to
0.91), as well as satisfactory convergent, discriminant,
and consensual validity .
The Five Facet Mindfulness Questionnaire (FFMQ)
 was used as a mindfulness measure. The FFMQ is a
39-item questionnaire that evaluates mindfulness in five
facets: (1) observing (noticing or attending to external
and internal experiences -e.g., body sensations, thoughts
or emotions-), (2) describing (putting words to, or
labelling the internal experience), (3) acting with awareness
(i.e., focusing on the present activity instead of behaving
mechanically), (4) non-judging the inner experience (i.e.,
taking a non-evaluative stance towards thoughts or
emotions), and (5) non-reactivity to inner experience.
Participants are asked to rate the degree of concordance with
each statement on a five point-likert scale ranging from
one (never or very rarely true) to five (very often or
always true). Cronbach’s alpha from the Spanish version
ranges from 0.80 to 0.91 .
Study participants were evaluated at our unit during the
years 2013 and 2014. As part of our routine assessment,
diagnostic interviews were administered in two different
sessions. After BPD diagnosis was confirmed, patients
were invited to participate in the study. Prior to
inclusion, all subjects signed an informed consent in which
the study was explained and after that, completed
selfreport questionnaires. No remuneration (monetary or
otherwise) was given for participation. The study was
approved by the Ethical Research Committee at the
Hospital de la Santa Creu i Sant Pau.
Descriptive statistics were used to describe the
sociodemographic and clinical characteristics of the sample.
Pearson correlation analyses were carried out between
childhood maltreatment (CTQ-SF) and mindfulness
facets (FFMQ); and between personality traits (ZKPQ)
and mindfulness facets (FFMQ).
Multiple hierarchical regression analyses were used to
determine the single and interactive effects of childhood
trauma and temperamental variables on mindfulness
facets. Associations between demographic variables (age,
gender, and education level) and dispositional
mindfulness were also studied by means of Pearson correlations
and Student’s t-test to identify potential covariates for
inclusion in the regression models. To create interaction
terms and to account for multicolinearity, variables were
mean-centred . FFMQ subscales were entered as the
dependent variable; temperamental traits (ZKPQ
subscales) were entered in step 1, CTQ-SF subscales were
included in step 2, and interaction terms (temperamental
trait × type of abuse) in step 3.
Demographic and clinical characteristics of the sample
The majority of participants were women (88 %), with
an average age of 30.46 years (SD = 6.84). The mean
DIB-R score suggest that the severity of BPD was high
(M = 7.74, SD = 1.48). On the CTQ-SF subscales, the
frequency of severe forms of childhood maltreatment was
as follows: severe emotional abuse (63 %); severe
emotional neglect (51 %); severe sexual abuse (45 %); severe
physical neglect (35 %); and severe physical abuse
(20 %). Additional demographic and clinical
characteristics are presented in Table 1.
Correlations between childhood trauma and
temperamental traits with mindfulness facets
Zero-order associations among childhood trauma
(CTQSF), temperamental traits (ZKPQ), and mindfulness
facets (FFMQ) are shown in Table 2. Negative
associations were found between sexual abuse and acting with
awareness (r = −.25, p = .03), and non-judging (r = −.27,
p = .01). No other significant correlations were found
CTQ – SF subscales
CTQ-SF Childhood Trauma Questionnaire – Short Form, ZKPQ Zuckerman Kuhlman Personality Questionnaire, ImpSS impulsive-sensation seeking, N-Anx
neuroticism-anxiety, Agg-Host aggression-hostility, Act activity, Sy sociability, FFMQ Five Facet Mindfulness Questionnaire
*p < .05; **p < .01
Table 1 Demographic and descriptive characteristics of the
Marital status - married or cohabitating (%)
Childhood Trauma Questionnaire – Short Form (%)
Gender (% of females)
Currently employed (%)
Severe Emotional Abuse
Severe Sexual Abuse
Severe Physical Abuse
Severe Emotional Neglect
Severe Physical Neglect
Zuckerman-Kuhlman Personality Questionnaire
Impulsive-sensation seeking (ImpSS)
Five Facet Mindfulness Questionnaire
Acting with awareness
between the other CTQ-SF subscales and mindfulness
N-Anx correlated significantly and inversely with
several mindfulness facets: acting with awareness (r = −.49,
p = <.001), non-judging (r = −.53, p < .001=), and
nonreactivity (r = −.23, p = <.001). In addition, significant
but weaker correlations were found between ImpSS
and non-judging (r = −.27, p = .01).
Predictive effect of childhood trauma and temperamental
traits on mindfulness facets
Given that no associations were found between
demographic variables (age, gender, and education level) and
any of the mindfulness facets, these variables were not
included in the regression models. Moreover, since our
primary interest was to study the effects of both
childhood maltreatment and personality variables on
mindfulness capacity, regression analyses included only those
CTQ-SF and ZKPQ subscales that showed simultaneous
significant Pearson correlations (p < .05) with mindfulness.
The first model included non-judging as the dependent
variable, N-Anx and ImpSS in step 1, sexual abuse in
step 2, and interaction terms (N-Anx × sexual abuse
and ImpSS × sexual abuse) in step 3. Temperamental
traits, N-Anx and ImpSS, were significant predictors of
non-judging, explaining 32 % of variance. When sexual
abuse was added to the model, this increased the
percentage of explained variance to 35 %. Interaction effects did
not attain significance in the model. The second model
included acting with awareness as the dependent variable,
N-Anx in step 1, sexual abuse in step 2, and the
interaction term (N-Anx × sexual abuse) in step 3. N-Anx and
sexual abuse were significant predictors of acting with
Table 2 Associations between childhood trauma, temperamental traits and mindfulness facets
Acting with Awareness
awareness, explaining 27 % of the variance. No significant
effect of the interaction between N-Anx and sexual abuse
was found. Results of the regression analyses are shown
in Table 3.
The present study sought to investigate the association
between temperamental traits, different types of
childhood trauma, and various facets of mindfulness in a
sample BPD patients. Our results indicate that there is a
significant and negative association between N-Anx and
several mindfulness facets: acting with awareness,
nonjudging and non-reactivity and between impulsiveness
and non-judging. Additionally, five different types of
childhood maltreatment were assessed, but only sexual
abuse appears to be related with mindfulness deficits,
having a negative impact on acting with awareness and
increasing the judgmental stance towards inner and
outer experiences. Based on our findings, it appears that
temperamental traits might not play a role in
moderating the relationship between a history of sexual abuse
and mindfulness deficits. Overall, the present study
indicates that temperamental traits might have a greater
impact on mindfulness capacities than early traumatic
experiences in BPD patients.
As suggested by previous work, our results indicate
that neuroticism and impulsivity have a significant and
negative association with mindfulness facets [20, 27, 28,
40]. However to the best of our knowledge, ours is the
first study to test these associations in a BPD sample.
NAnx was a significant predictor of acting with awareness
and, together with ImpSS, it was also a significant
predictor of non-judging, indicating that higher scores on
these traits are related to greater difficulties in being
present-oriented and comprise a more judgemental and
evaluative stance towards the experiences, consistent
with BPD characteristics [21, 41].
In congruence with a previous study , it seems that
having a history of childhood sexual abuse compromises
the ability to act with awareness. Awareness difficulties
can be explained by the presence of trauma-related
thoughts and memories. In fact, a study involving adult
sexual abuse survivors who underwent mindfulness
treatment reported a decrease in re-experiencing and
avoidance of numbing symptoms and an increase in
mindfulness attention and awareness, suggesting a
possible relationship between these two aspects . Our
results also indicate an association between judgemental
information processing and sexual abuse. However, and
considering that a history of sexual abuse only increased
the explained variance in the regression analyses by a
small amount, it seems that –at least in our sample- the
impact of temperamental traits on mindfulness capacity
is stronger than the influence of sexual abuse. In any
case, the association between mindfulness facets and
sexual abuse highlights the relevance of addressing
mindfulness deficits during the treatment of BPD
patients with traumatic histories [13, 14, 43]. Some
interventional approaches combine exposure techniques
(targeting direct experience processing and fostering
awareness of the present experience) with mindfulness
practice (to increase acceptance and diminish
judgemental stances) [13, 43], and -in light of the present
resultsthis approach would seem to be relevant to the
treatment of trauma. Our findings suggest that not all types
of childhood maltreatment are related to mindfulness
facets in subjects with BPD. Even though sexual abuse
may entail more severe and far-reaching consequences
for BPD patients than other forms of abuse , the lack
of a significant association in our study between other
types of maltreatment and mindfulness facets was
unexpected. Nevertheless, other studies [30, 31, 44] have
found negative associations between mindfulness and
PTSD symptoms and one study reported an inverse
association between emotional maltreatment and awareness
. This difference between our study and others may be
due to methodological or patient sample differences;
however, further research in larger samples will be needed
Table 3 Hierarchical multiple regression analyses predicting FFMQ facets: non-judging (column A) and acting with awareness
Sexual abuse x N-Anx
Sexual abuse x ImpSS .01
−.45*** .32 .33*** Step 1
Acting with awareness
−.47*** .24 .25***
Sexual abuse x N-Anx
to better assess the relationship between childhood
maltreatment and mindfulness facets.
Considering previous research on the moderating role
of neuroticism in the psychopathology and BPD severity
[8, 12], we hypothesized that temperamental traits would
play a role in moderating the relationship between
traumatic experiences and mindfulness. Unexpectedly, we
did not find any moderating effect of temperamental
traits on acting with awareness or non-judging.
The present results should be interpreted in the
context of the study limitations. The most important
limitation is the cross-sectional design, which prevents us
from reaching any conclusion about the direction of the
associations. Second, the use of self-report measures to
assess the variables (particularly childhood trauma)
could have biased the results. Third, a comparison
between the BPD group and other clinical populations
would have been valuable to determine if the
associations found in this study are specific to BPD or not.
Our results provide preliminary evidence demonstrating
an association between certain temperamental traits and
childhood experiences with mindfulness in a sample of
individuals with BPD. It seems that, in individuals with
BPD, mindfulness deficits may be more closely
associated with high levels of neuroticism and impulsivity
rather than early traumatic experiences. Although these
findings should be taken with caution, it appears that
mindfulness-based interventions could offer a valuable
approach to treating emotionally-dysregulated
individuals with a history of trauma. This approach might not
only increase acceptance, but may also offer a possible
pathway to increase awareness while decreasing
avoidance symptoms. More research is needed to clarify the
relationship between early traumatic experiences and
mindfulness, as well as to determine the mechanism
underlying the efficacy of mindfulness-based treatments
for individuals with a history of traumatic experiences.
JS and JCP conceived and planned the study, and provide supervision with
the data analysis and interpretation. ME and CC analyzed the data and wrote
the manuscript. AMB, AFS and ER distributed questionnaires, as well as
commented on the last versions of the manuscript together with VP. MGF
reviewed the final version of the manuscript and contributed to the
interpretation of findings. All authors read and approved the final
This study was supported by Centro de Investigación Biomédica en Red de
Salud Mental (CIBERSAM) and by a grant from Instituto de Salud Carlos III
(PI10/00253 and PI11/00725). The first author (ME) was supported by a grant
from Facultad de Psicología (UdelaR). JS was supported by PROMOSAM:
Investigación en procesos, mecanismos y tratamientos psicológicos para la
promoción de la salud mental, (Red de Excelencia PSI2014-56303-REDT)
founded by Ministerio de Economía y Competitividad (2014).
1Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
2Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Centro de
Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
3Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de
Barcelona, Barcelona, Spain. 4Programa de Cognición. Instituto de
Fundamentos y Métodos en Psicología. Facultad de Psicología, Universidad
de la República, Montevideo, Uruguay. 5Departament de Psicologia Clínica i
de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.
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