Sensory Integration and Trauma in Clients with BPD

Exploring Common Ground: Borderline Personality Disorder and Sensory Processing Disorder*

( Brown, Shankar & Smith, 2009 – Progress in Neurology and Psychiatry)

In this article, the authors explore a novel and clinically relevant question: could individuals diagnosed with Borderline Personality Disorder (BPD) be experiencing difficulties similar to those seen in children with Sensory Processing Disorder (SPD)*?

Drawing from emerging literature in neuroscience and occupational therapy, Brown, Shankar and Smith suggest that sensory processing impairments may underpin some of the emotional and behavioural symptoms seen in BPD.

Emerging research increasingly recognises that early trauma and disrupted attachment may not only shape emotional development, but also impact the way sensory information is processed and integrated, potentially contributing to the characteristic patterns of dysregulation seen in individuals with BPD.

Background and Context

Ayres’ theory of Sensory Integration (SI) has long informed occupational therapy practice in paediatrics and learning disabilities. However, its relevance to mental health, particularly adult mental health, has received less attention.

Brown et al. consider whether these same patterns of sensory processing difficulty, such as hypersensitivity to touch, sound, or movement, or poor sensory discrimination, may also be present in individuals with BPD, many of whom have complex trauma histories.

Trauma and Sensory Processing

Many people diagnosed with BPD have experienced childhood trauma, neglect, or disrupted attachment relationships. These early experiences may interfere with typical neurodevelopment, including the brain’s capacity to organise and regulate sensory input.

The authors propose that sensory difficulties—such as feeling overwhelmed in busy environments, distress at certain sounds or textures, or difficulty calming down after sensory overstimulation—might help explain some of the core features of BPD, including:

Clinical Innovation in an Inpatient Setting

The paper describes an innovative pilot intervention in an acute adult inpatient unit, where strategies used with individuals diagnosed with SPD were trialled with service users diagnosed with BPD. These included:

• Sensory-based self-soothing techniques (e.g. weighted items, movement, tactile input)
• Environmental modifications to reduce sensory overload
• Sensory diets, sensory strategies and routines to support regulation

Early clinical impressions were promising, suggesting that addressing sensory needs may help individuals with BPD feel safer, more settled, and more able to participate in therapeutic activities.

Why This Work Is Important

This paper breaks new ground by:

• Extending the application of Sensory Processing Disorder frameworks into adult mental health
• Highlighting a possible link between sensory integration differences and emotional trauma
• Providing a rationale for the inclusion of sensory-informed occupational therapy interventions in psychiatric care for individuals with BPD

While further research is clearly needed, the authors’ work invites clinicians to consider the role of the body and the senses in emotional regulation and mental health — an area ripe for exploration within occupational therapy and beyond.

*NOTE: At the time of this paper’s publication, the term Sensory Processing Disorder (SPD) was increasingly used to describe difficulties in how sensory information is perceived, modulated, and responded to. Though not yet formally recognised by the DSM or ICD, SPD had gained significant clinical traction in paediatric OT practice, especially in the United States. (note added 2014)