Children of Mothers With Borderline Personality Disorder (BPD)
Children of Mothers With Borderline Personality Disorder (BPD)
Children of Mothers With Borderline Personality Disorder (BPD)
Copyright 2006 by the Department of Counseling & Clinical Psychology Teachers College, Columbia University ISSN 1088-4661
Borderline Personality Disorder (BPD) is a pervasive disturbance of personality that is marked by a pattern of unstable relationships, a history of impaired self image, identity problems, and recurrent, severe impulsivity that is present in a variety of psychosocial domains (American Psychological Association, 2000). It affects approximately 2% of the general population, about 10% of patients seen at outpatient health care clinics, and about 20% of psychiatric inpatients (APA, 2000; Paris, 1999). Researchers have long been interested in examining the familial patterns of BPD. Masterson (1976) once commented that the mother of any borderline is herself a borderline, and since then, research in this area has focused on the increased prevalence of psychopathology in biological families (e.g., Links, Steiner, & Huxley, 1988). Family members of those with BPD are at an increased risk for a myriad of psychopathological diagnoses. The prevalence rate of Borderline Personality Disorder is five times greater in first degree relatives of people with BPD than in the general population (APA, 2000; Links et al., 1988; Paris, 1999) with an even higher prevalence of subsyndromal phenomenology of the disorder in first degree relatives (Zanarini et al., 2004). Additionally, Substance Dependence, Antisocial Personality Disorder and recurrent mood disorders (primarily, unipolar depression) are commonly diagnosed within the family of origin (APA, 2000; Links et al., 1988). Nonetheless, despite the fact that approximately 75% of BPD sufferers are women, many of whom are in their child bearing years (APA, 2000), little attention has been paid to the psychosocial development of children whose mothers have BPD. It is hypothesized that children of mothers with BPD will suffer a myriad of psychosocial problems resulting from the mothers borderline symptomaCorrespondence concerning this article should be addressed to Andrea E. Lamont, 78 Maple Drive, Brewster, NY 10509; e-mail: ael2112@columbia.edu.
tology; however, there is very little empirical evidence to date that addresses the unique effects of a maternal diagnosis of BPD on a childs development. It is the aim of this paper to highlight the importance of and need for increased research focus on children of mothers with BPD. Scant research exists to validate the notion that essential features of Borderline Personality Disorder directly interfere with a parenting efficacy, despite the predictions of the attachment literature suggesting that maternal BPD should have negative ramifications for the developing child. For example, mothers with BPD, by the very nature of the disorder, display low levels of warmth, and high levels of intrusiveness and hostility. The mothers inability to display good enough parenting interferes with healthy child development. Likewise, Borderline Personality Disorder by its very nature interrupts the mothers ability to be emotionally available for her children. A mother with BPDs unresolved mental representations (from her own early childhood experiences) may act as ghosts in the nursery that impede the her ability to be fully present and emotionally available to her child (Hobson, Patrick, & Valentine, 1998; Hobson et al., 2005). It should be noted that psychosocial development of children with fathers with Borderline Personality Disorder is an equally important area of study. However, the focus shall be given to mothers with BPD due to the gender differences of the diagnosis and the uniqueness of the symbiotic relationship in infancy, as well as to be consistent with prior literature on BPD. This paper begins with a brief review of the literature on the diagnosis of Borderline Personality Disorder and the early experiences of adults with BPD. This review is followed by an exploration of the ways in which the characteristic features of the diagnosis may come into play within the mother-child relationship. An overview of the limited research on the development of children of mothers with BPD is then presented, and future directions are suggested.
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cial development in children of mothers with BPD. To date, the strongest research examining the psychosocial outcomes of these children is a small pilot study conducted by Weiss, Zelkowitz, Feldman, Vogel, Heyman, and Paris (1996). Weiss et al. (1996) confirmed that children of mothers with BPD, compared to children with mothers without BPD, had a significantly higher number of psychiatric diagnoses and scored higher on a global rating of impairment. The authors demonstrated that children of mothers with BPD are at an increased risk for developing impulse control disorders and borderline tendencies of their own. Even when childhood trauma was controlled for, significant group differences in functioning between children of mothers with and without BPD were found; approximately 20% of the variation in child functioning and 8% of the variation in borderline pathology was accounted for by maternal diagnosis alone. Weiss et al.s findings provide insight into the development of children of mothers with BPD. However, the study was limited by a small sample size and lack of attention to comorbid diagnoses, and it has not been replicated to date. These preliminary results point to the need for further research with larger sample sizes inclusive of mothers with comorbid diagnoses. The following section examines the attachment status of children raised by mothers with BPD and reviews the attachment literature in order to illuminate potential cognitive, interpersonal and affective problems in these children. may even face dissociative behaviors later in life (LyonsRuth & Jacobvitz, 1999; Van IJzendoorn et al., 1999).
Cognitive Development
There is little known about cognitive development in children of mothers with BPD specifically, but high levels of disorganized attachment status suggest that these children will face significant cognitive impairments. Attachment security with the primary caregiver is correlated with intellectual development and functioning of children in that responsiveness and attunement, maternal involvement, and emotional sensitivity support healthy cognitive development (see Crandell & Hobson, 1999 for a brief overview of the literature). Hence, a mother with BPDs intrusive insensitivity and unpredictability is bound to negatively affect a childs cognitive development. Crandell & Hobson (1999) conducted a study of intellectual functioning in children of mothers with a secure vs. insecure adult attachment status. They found that children of insecure mothers scored an average of 19 points lower on the Stanford-Binet test than children of secure mothers. Likewise, neurobiological studies reveal that disorganized children have increased levels of cortisol and decreased mental development (Hertsgaard, Gunnar, Erickson, & Nuchmias, 1995). Since most children of mothers with BPD display high levels of disorganization, it is reasonable to presume that children of mothers with BPD are significantly stressed children who are placed at a cognitive disadvantage (Holmes, 2005). It is likely that the attachment status of children of mothers with BPD mediates the relationship between the mothers psychopathology and the childs level of cognitive functioning.
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References
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed Text Revision). American Psychiatric Association: Arlington, VA. Cerel, J., Fristad, M. A., Weller, E. B., & Weller, R. A. (2000). Suicide-bereaved children and adolescents: II, Parental and family functioning. Journal of the American Academy of Child & Adolescent Psychiatry. 39, 437-444. Crandell, L. E., Fitzgerald, H. E., Whipple, E. E. (1997). Dyadic synchrony in parent-child interactions: a link with maternal representations of attachment relationships. Infant Mental Health Journal, 18, 247-264. Crandell, L. E., & Hobson, R. P. (1999). Individual differences in young childrens IQ: a social developmental perspective. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40, 455-464. Crandell, L. E., Patrick, M. P. H., & Hobson, R. P. (2003). Still-face interactions between mothers with borderline personality disorder and their 2-month-old infants. British Journal of Psychiatry, 183, 239-247. Davies, D. (2004). Child Development. New York: Guilford Press. Emerson, L. E. (2003). The experience of parental suicide: A heuristic inquiry. Dissertation Abstracts International: Section B: The Sciences and Engineering, 63(8B), 3910. Feldman, R., Zelkowitz, P., Weiss, M., Vogel, J., Heyman, M., & Paris, J. (1995). A comparison of the families of mothers with borderline and nonborderline personality disorders. Comprehensive Psychiatry, 36, 157-163. Glickauf-Hughes, C., & Mehlman, E. (1998). Nonborderline patients with mothers who manifest borderline pathology. British Journal of Psychotherapy, 14, 294-302. Golomb, A., Ludolph, P., Westen, D., Block, M. J., Maurer, P., & Wiss, F. C. (1994). Maternal empathy, family chaos and the etiology of borderline personality disor-
Future Directions
Children of mothers with BPD are a potentially disadvantaged group of children that are at risk for future psychopathology. However, as Crandell et al. (1997) demonstrated, attachment status is not completely stable, and children who are able to resolve early traumatic experiences are able to obtain an earned secure attachment status in adulthood. Adults with an earned secure status function comparably to adults who had secure attachment status as children (Crandell et al, 1997). These findings hold great promises for the prognosis of children of mothers with BPD. With adequate attention and intervention, there is hope that children of mothers with BPD will overcome the risks associated with this maternal psychopathology. Nonetheless, the long term psychosocial outcomes of children of mothers with BPD have thus far been neglected in empirical research. A few exploratory studies have
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