The Relationship Between Stress and Borderline Features in ...



The Relationship between Stress and Borderline Features in Adolescent Offspring of Mothers with

Borderline Personality Disorder.

Christopher D. Watkins, Scott P. Campion, Stevie N. Grassetti, Rebecca D. Trupe, Sean M. Holden, Adam R. Ferencei, & Jenny Macfie

Poster presented at the biennial meeting of the

Society for Research in Child Development, Montréal, QC

Abstract

Borderline personality disorder is a chronic and debilitating disorder that is characterized by affective instability, identity disturbance, troubled interpersonal relationships, and self-harming behaviors. The current study assessed psychosocial stress (past and current) and borderline features in adolescents who are offspring of mothers with BPD. Adolescents aged 14-17, n=28, were compared with normative adolescents, n= 28, whose mothers do not have BPD. Adolescents whose mothers had BPD reported more stress than comparisons. They also reported more affective instability, self-harm and total borderline features than normative comparisons. Mothers’ stress correlated with adolescents’ stress. Mothers’ total borderline features correlated with adolescents’ total borderline features, affective instability, and adolescent self harm. Results are discussed as increasing our understanding of BPD.

Introduction

Borderline Personality Disorder (BPD)

• BPD is a severe and chronic disorder characterized by self injurious/suicidal behavior, fear of abandonment, impulsivity, affective instability, inappropriate outbursts of anger, and intense and unstable relationships (American Psychiatric Association, 1994).

• A recent study finds 5.9% of the population have BPD (Grant, et al., 2008).

• 20% of psychiatric inpatients and 50% of outpatients are diagnosed with BPD. 8-10% of individuals with BPD commit suicide (American Psychiatric Association, 1994; Paris, 1993; Stone, 1990).

• Despite is prevalence and severity, BPD has not received as much empirical attention as other psychiatric disorders (Gunderson, 2009). The current study was designed to contribute to our understanding of BPD.

Developmental Psychopathology

• Studying groups at high risk of developing a disorder, such as the offspring of mothers with BPD, may uncover pathways to the disorder or reveal resilient factors, which may help inform preventative interventions (Sroufe & Rutter, 1984). Research suggests that offspring of mothers with BPD may be exposed to a combination of risk factors, which may place them at risk for the development of psychopathology (Loranger, Oldham, & Tulis, 1982; Torgersen, et al., 2000).

• Adolescents whose mothers have BPD are an interesting risk group to examine because difficulties related to BPD are similar to developmental tasks that are reworked in adolescence (Macfie, 2009; Sroufe, Egeland, Carlson, & Collins, 2005).

• Studying this risk group may inform preventive interventions and provide insight into the etiology of this disorder (Cicchetti & Hinshaw, 2003; Cicchetti & Toth, 1992).

BPD and Stress

• Research has shown an association between maternal stress and child psychopathology (Bakoula, Kolaitis, Veltsista, Gika, & Chrousos, 2009; Costa, Weems, Pellerin, & Dalton, 2006; Goodman & Gotlib, 1999). Stress is an important factor for mothers with BPD because individuals with this disorder report feeling more stress than those with other personality disorders (Zanarini, et al., 1998) and cope with stress less effectively than those without personality disorders (Bijttebier & Vertommen, 1999). Mothers with BPD are likely to have high levels of stress and it is important to understand how this may affect their offspring.

Adolescent Stress and Psychopathology

• Stressors are central to current etiological theories of adolescent psychopathology (Grant, McMahon, Duffy, Taylor, & Compas, 2009) and research has consistently found that stressful life experiences predict psychological problems in adolescents over time (Grant, Compas, Thurm, McMahon, & Gipson, 2004).

• Stress may be an important factor for the onset of psychopathology. In families with maternal depression, offspring with genetic vulnerabilities to depression only developed major depression when exposed to stressful life events (Caspi, et al., 2003). This has also been found when investigating the onset of schizophrenia in young adulthood (Tienari, et al., 2004).

• In spite of the potential significance of stressors for understanding and influencing the development of psychopathology, research on stress in adolescence has lagged behind similar research with adults (Grant, et al., 2009). Furthermore, there are few studies that focus on offspring of mothers with BPD and there are no studies that focus exclusively on adolescents in this risk group (Macfie, 2009). The current study was designed to fill this gap by assessing stress and its relationship to borderline features in adolescents whose mothers have BPD.

Current Study

• The current study assessed stress and borderline features in adolescents whose mothers have BPD

Hypothesis

1) Adolescents whose mothers have BPD would report more stress than would normative comparisons

2) Adolescents whose mothers have BPD would report more borderline features than would normative comparisons.

3) In the sample as a whole, mothers’ ratings of stress would positively correlate with their adolescents’ ratings of stress.

4) In the sample as a whole, adolescents’ ratings of stress would positively correlate with adolescent ratings of borderline features.

5) In the sample as a whole, mothers’ ratings of stress and borderline features would positively correlate with their adolescents’ ratings of stress and borderline features.

Methods

Participants

• N = 55 adolescents, average age 15 years, 5 months, SD = 1.20 months.

• n = 28 adolescents and their mothers with BPD, n = 26 normative mother-adolescent dyads.

• Groups were matched on maternal education, occupational status, income, adolescent age, race, and gender. See Table 1.

• Mothers with BPD were recruited from outpatient clinics, referred by their clinicians, and from posters placed in the community.

• Mothers without BPD were recruited from Boys and Girls Clubs, schools, and posters placed in the community.

Table 1. Sample characteristics

| Variable |Whole Sample |BPD |Comparison |t |

| |N = 55 |n = 28 |n = 27 | |

| |M (SD) |M (SD) |M SD) | |

|Adolescent Age (years) |15.41 (1.20) |15.21 (1.13) |15.61 (1.23) |1.25 |

|Mother’s Annual Income |24,588 (14,558) |22,509 (12,783) |26,667 (16,081) |1.59 |

|Mother’s Hollingshead Education & Occupation |36.10 (14.94) |33.80 (15.37) |38.37 (15.14) |1.11 |

|Index | | | | |

| | | | |χ2 |

|Single Mothers |29% |32% |26% |.61 |

|Adolescent’s Gender (Female) |50% |50% |50% |.61 |

|Minority Adolescents |7% |1% |11% |.30 |

|Hispanic Adolescents |4% |1% |1% |.78 |

Procedure & Measures

BPD Diagnosis.

• SCID-II Structured Clinical Interview (First et al., 1997). A structured interview was conducted with mothers after initial participant screening for all participants to assess BPD status (Yes/No).

Borderline Features

• The Personality Assessment Inventory (PAI; Morey, 1991). Mother’s and their adolescents rated themselves on borderline features. The borderline features of the PAI (PAI-BOR) is a well validated 24 item self report scale that reports features of borderline pathology historically associated with BPD. It is composed of four subscales—affective instability, identity problems, negative relationships, and self-harm. The PAI-BOR correlates highly with interview based BPD diagnostic criteria (Morey, 2007). In the current sample, mothers BPD diagnosis was significantly correlated with BOR, r =.70, p < .001 affective instability r = .61, p < .001, identity problems, r = .67, p < .001, negative relationships, r = .51, p < .01, and with self-harm, r = .51, p < .001.

Stress

• The Personality Assessment Inventory (PAI; Morey, 1991). Mothers and their adolescence rated themselves on psychosocial stress (current and lifetime). Ratings were summed to yield a single stress score. Stress items include: “My life is very unpredictable“, “Things are not going well in my family”, and “There isn’t much stability at home.”

Results

Hypothesis 1

• As hypothesized, adolescents whose mothers have BPD reported significantly higher stress than comparisons, t(53) = 3.46, p ................
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