The effect of maternal borderline personality on general and relational aggression in adolescents.

1. The effect of maternal borderline personality on general and relational aggression in adolescents. Scott A. Swan, Scott P. Campion, Chris D. Watkins, Lauren C. Price & Jenny Macfie University of Tennessee, Knoxville Presented at the biennial meeting of the Society for Research in Child Development; April, 2009; Denver, CO Abstract Borderline Personality Disorder (BPD) includes symptoms of self-harm and inappropriate angry outbursts towards others. The current study examines self-harm and aggression in adolescents at high risk for developing BPD themselves: offspring of women who have BPD. Adolescents aged 14-17, n=28, whose mothers have BPD were compared with normative adolescents, n=21, whose mothers do not have BPD. Also, adolescent aggression was examined relative to continuous measures of borderline features. Adolescents whose mothers have BPD displayed significantly more general aggression, more relational aggression, and more verbal aggression than did comparison adolescents. Furthermore, mothers’ borderline features significantly correlated with their adolescents’ general aggression, relational aggression, and verbal aggression. Results are discussed in terms of our understanding of the development of aggression, informing preventive interventions. Discussion Findings replicate results from a previous study (Barnow, et al., 2006), which found that mothers with BPD have children who are generally more aggressive. Because relational aggression was higher in those adolescents whose mothers have BPD, while verbal and physical aggression were not, BPD and relational aggression may share common etiological factors. Possibilities for such factors include maladaptive internal representations of self and other, or unique manifestations of emotional dysregulation, which could lead to the indirect expression of aggression through interpersonal mechanisms. Aggression in adolescents was correlated with mothers’ identity problems and self-harm. These traits and associated behaviors in mothers should be explored further in future research, as they may represent substantial risk factors for offspring, above and beyond overall psychological dysfunction. Self-harm, a risk factor strongly associated with BPD, was significantly correlated in adolescents with their mothers’ affective instability, and with marginal significance with mothers’ identity problems. These findings suggest that the intergenerational transmission of self-harm in this at-risk group may not occur directly, but rather through intermediary factors, such as mothers’ capacity for emotion regulation, or capacity to maintain consistent relationships with children. Results from this study have important implications for further research on family risk factors for relational aggression, and on efforts to appropriately target prevention and intervention for potentially aggressive adolescents. For example, adolescents whose mothers report identity problems and self-harm seem to represent an important high risk group for the development of relational aggression. Children at risk for developing aggression may be identified earlier by assessment of mothers’ identity problems and self-harm. Furthermore, interventions designed to treat or prevent relational aggression in children may be more effective if they target parent-child relationships, and mothers’ specific difficulties with identity and self destructiveness. Also, therapies intended to target an adolescent’s systems of self-other representations and emotion regulation (For example, Transference Focused Psychotherapy; Levy, et al., 2006) may be more effective in the treatment of adolescents who present with symptoms of relational aggression. • Hypotheses • 1. Higher general aggression and self-harm will be found in the group of adolescents with mothers who have been diagnosed with BPD, relative to normative comparisons. On specific aggression measures, relational aggression and verbal aggression will be higher in the at-risk group, but not physical aggression. • In the sample as a whole, relational and verbal aggression and self-harm in adolescents will correlate with mothers’ borderline features, particularly mothers’ identity problems and self-harm. • Results • Hypothesis 1 – Adolescent Aggression Differences by Mother’s BPD Diagnosis • As hypothesized, general self reported aggression was higher in the at-risk group of adolescents whose mothers have BPD (see Table 2). • As was also predicted, relational aggression was significantly higher in adolescents whose mothers have BPD, relative to normative comparisons. • However, verbal aggression scores were not significantly different between these two groups. • Physical aggression scores were not significantly different either, as was predicted. • Adolescent self-harm was higher with marginal significance in adolescents whose mothers have BPD, relative to the normative comparison group. • Hypothesis 2 – Adolescent Aggression & Mother’s Continuous Borderline Traits • As hypothesized, both adolescent relational aggression and adolescent verbal aggression significantly correlated with mothers’ borderline features in both groups, in addition to general aggression (see Table 3). • As predicted, relational aggression in adolescents was correlated with mothers’ borderline features, including identity problems and self-harm, but not affective instability or negative relationships. • Adolescents’ verbal aggression correlated significantly with the borderline features aggregate of the four subscales, but not identity problems as hypothesized. Adolescent verbal aggression was marginally correlated with mothers’ self-harm. • Furthermore, adolescent self-harm correlated with mothers’ affective instability, but not with mothers’ self-harm. However, adolescent self-harm was marginally significantly correlated with mothers’ identity problems. Introduction From the perspective of developmental psychopathology, the study of high risk groups can inform our understanding of normal development, the etiology of problem behaviors, and preventive interventions (Cicchetti & Toth, 1998). Offspring of mothers with mental illness comprise a high risk group for developing the same disorder. Despite the interpersonal nature of borderline personality disorder (BPD), only seven controlled studies have assessed children whose mothers have BPD (Barnow, Spitzer, Grabe, Kessler, & Freyberger, 2006; Crandell, Patrick, & Hobson, 2003; Feldman, et al., 1995; Hobson, Patrick, Crandell, Garcia-Perez, & Lee, 2005; Macfie & Swan, in press; Newman, Stevenson, Bergman, & Boyce, 2007; M. Weiss, et al., 1996). Features of BPD include affective instability, identity disturbance, volatile relationships, self-harm, and angry outbursts. Such behaviors suggest a particularly detrimental impact on offspring development, especially given the importance of stable and nurturing caregivers (Bowlby, 1988; Bretherton & Munholland, 1999; Lyons-Ruth, 1996; Macfie, 2009). Furthermore, the tendency for individuals with BPD to become aggressive towards the self and others (Critchfield, Levy, Clarkin, & Kernberg, 2008) suggests potentially heightened aggression and self harm in offspring as well (Zoccolillo, et al., 2005). Such transmission might occur via shared genetic and biological factors (Lyons-Ruth, et al., 2007; Torgersen, et al., 2000), interpersonal dynamics which shape internal representations of self and other (Bradley & Westen, 2005), or both (Gunderson & Lyons-Ruth, 2008). Previous research has already established higher levels of externalizing and impulsive behavior in the offspring of women with BPD (Margaret Weiss, et al., 1996). Barnow, Spitzer, Grabe, Kessler, & Freyberger (2006) also found higher levels of general aggression and conduct problems in children whose mothers were diagnosed with BPD. However, these studies examined offspring across broad bands of development, for example from preschool through late adolescence. Each developmental period needs to be examined separately. Moreover, studies only assessed BPD categorically, without continuous assessment of its features. Examination of component features of BPD may shed more light on the mechanisms by which risk is passed on to offspring. For example, a recent study of young children ages 4-7 (Macfie & Swan, in press) has found that among mothers’ borderline features, identity disturbance and self harm are associated both with children’s maladaptive representations of self and other, and with poor emotion regulation. Finally, studies have measured aggression only generally, without looking at different forms of aggression such as relational aggression or self-harm. Both are particularly relevant for the development of BPD, and may manifest differently than a more general aggregate form of aggression. Although aggression generally continues a trajectory of decline in adolescence, this marks a period of development when its consequences tend to be more severe. Self-harm begins to occur more frequently during adolescence, and clinical BPD often first surfaces at this age (Ludolph, et al., 1990). Moreover, clinicians only diagnose BPD dichotomously in cases of severe dysfunction, yet borderline features occur in a range of severity in both clinical and non-clinical populations. By examining the association between mothers’ borderline features and adolescent aggression, more might be learned about how particular aspects of BPD impact adolescent offspring. Furthermore, relational aggression has been empirically associated with borderline features including affective instability, identity disturbance, negative relationships, and self-harm in women (Werner & Crick, 1999). Also, relational aggression is more characteristic of the symptoms of BPD as compared to physical aggression. Additional examination of relational aggression and self-harm may bring more clarity to the developmental consequences of maternal BPD. This study advances existing research because participants were drawn from a tighter developmental window, adolescents from 14-17 years old, when the development of BPD is most likely to occur. Also, relational aggression and self-harm were assessed in addition to general aggression because of their relevance to the development of BPD. Additionally, self report measures were utilized for adolescents. Finally, associations between adolescent aggression and maternal borderline features were examined in addition to comparing two groups – adolescents whose mothers have BPD with adolescents whose mothers do not. • Participants • N=49 low SES adolescents, M = 15.6 years old (SD = 1.25); n = 28 adolescents had mothers diagnosed with BPD, n = 21 adolescents had mothers without BPD. • Groups matched on all demographic variables, except age and whether mother has a high school diploma; however, no significant correlations were found between these demographics and any of the dependent variables, therefore it was not necessary to control for either (see Table 1). • Mothers with BPD were recruited from inpatient and outpatient clinics, and from flyers in the community. Mothers without BPD were recruited from middle and high schools, after school programs, and from flyers in the community. References Achenbach, T. M. (1991). Manual for the Youth Self-Report and 1991 profile. 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New York, NY: The Guilford Press.  Measures Mother BPD Diagnosis – The Structured Clinical Interview for DSM-IV, Axis II Personality Disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997), was given to all mothers to diagnose or rule out BPD categorically. BPD Features – The self-report Personality Assessment Inventory (PAI; Morey, 1991; 1996), a continuous measure of borderline features, with subscales including affective instability, identity problems, negative relationships, and self-harm. The overall score for borderline features is calculated as the sum of scores on all subscale items. Adolescent General Aggression – The Aggression scale from the Youth Self Report (Achenbach, 1991), as a general measure of aggression. Sample aggression item: “I am mean to others.”  Relational, Physical, and Verbal Aggression – The self-report Children’s Social Behaviors Scale (Crick & Grotpeter, 1995), for scores of relational, verbal, and physical forms of aggression. Sample relational aggression item: “Some kids tell lies about a classmate so that the other kids won’t like the classmate any more. How often do you do this?” Sample verbal aggression item: “Some kids yell at others and call them mean names. How often do you do this?” Sample physical aggression item: “Some kids hit other kids at school. How often do you do this?”  Self Harm – The adolescent’s self-report score for self harm on the PAI (Morey, 1991; 1996), as described above. Sample self-harm item: “When I’m upset, I typically do something to hurt myself.”