Mothers with Borderline Personality Disorder and their Young Children: Caregiving, Fearful/disoriented Behavior and Role Reversal
Jenny Macfie, Chris D. Watkins, Jennifer M. Strimpfel, Christina G. Mena & Amineh Abbas
Poster presented at the April 2013 biennial meeting of the Society for Research in Child Development, Seattle WA
Abstract
This study assessed how maternal borderline personality disorder (BPD) affects the mother-child interaction in early childhood. A low-SES
sample of offspring of women with BPD age 4-7, n = 36, was compared with a normative comparison group, n = 34. We filmed mothers and
children solving puzzles and then reliably coded the video tapes. Compared with normative comparisons, and controlling for mood disorders,
mothers with BPD were significantly lower on a maternal caregiving composite (sensitivity, autonomy support, hostility reverse-scored), and
demonstrated more fearful/disoriented behavior and more role reversal with their children. In addition, self-reported maternal borderline
features (affective instability, identity disturbance and negative relationships) were negatively correlated with the maternal caregiving
composite and positively correlated with role reversal. Furthermore, maternal identity disturbance was positively correlated with maternal
fearful/disoriented behavior, and self-harm was marginally significantly correlated with maternal fearful/disoriented behavior.
Introduction
Individuals with borderline personality disorder (BPD) report more intense and frequent emotional pain than do individuals with other
personality disorders: anger, fear, and shame (Zanarini et al., 1998). How then might BPD affect a mother’s relationship with her child? This is
an important question because the prevalence for BPD is 5.9% in the general population (Grant et al., 2008), and it affects women almost
exclusively during their child-bearing years.
We know that mothers with BPD are more insensitively intrusive with their infants at 2 and 13 months and that these infants are mostly
disorganized in their attachment at 13 months (Crandell, Patrick, & Hobson, 2003; Hobson, Patrick, Crandell, Garcia-Perez, & Lee, 2005).
However, there is no research on mother-child interactions for mothers who have BPD beyond infancy. This is a serious omission because of the
importance of the development of a goal-corrected partnership between mother and child during early childhood (Bowlby, 1969/1982):
maternal BPD may make such a partnership challenging, with serious implications for the negotiation of future stage salient issues such as the
development of self-regulation, peer relationships and school functioning (Macfie, 2009).
We assessed BPD both as a categorical diagnosis and also along a continuum of self-reported borderline features. Controlling for maternal
mood disorders, we hypothesized that in interacting with their young children, (1) mothers with BPD would be lower on an adaptive caregiving
composite, higher on fearful/disoriented behavior and higher on role reversal with their children, than would normative comparisons; and that
(2) in the sample as a whole, mothers’ self-reported borderline features (affective instability, identity disturbance, negative relationships, and
self-harm) would be significantly negatively correlated with their adaptive caregiving, and significantly positively correlated with their
frightened/disoriented behavior, and role reversal.
Method
Participants:
The sample included n = 36 low-SES children age 4-7 whose mothers have BPD and n = 34 demographically matched normative
comparisons.
Measures:
Demographics were assessed with the Mt Hope Family Center Demographic Questionnaire (MHFC, 1995). There were no significant
differences between groups on demographic variables. See Table 1.
Mood disorders Current major depression, bipolar disorder and dysthymia were assessed with the SCID-I clinical interview (First,
Gibbon, Spitzer, & Williams, 1996); 41% of the BPD mothers and 0% of the comparisons were diagnosed with a current mood disorder.
Borderline personality disorder was assessed with the SCID-II clinical interview (First, Gibbon, Spitzer, Williams, & Benjamin, 1997).
Borderline features. Affective instability, identity disturbance, negative relationships, and self-harm were assessed with the selfreport Personality Assessment Inventory Borderline Features Scale (Morey, 1991).
Mother-child interaction. A maternal caregiving composite (sensitivity, autonomy support, hostility reverse-scored),
fearful/disoriented behavior (e.g., mother looks dazed or projects very alarming content onto the puzzle solving task), and role reversal (e.g.
child behaves as if he/she were the parent telling the mother what to do, or the mother behaves as if she was the child’s peer playing and
giggling together with no appropriate discipline),were coded reliably from 10-minute videotapes of puzzle-solving interactions using the
Qualitative Ratings of Parent/Child Interaction (Cox, February, 1997).
Results
Hypothesis (1). The overall test of group differences was significant using a MANCOVA, Wilks’s approximate F (3, 63) = 5.83, p < .001, η2 = .22,
observed power = .94. There were also significant univariate group differences for maternal caregiving, fearful/disoriented behavior and role
reversal. Mothers with BPD demonstrated less adaptive caregiving, more fearful/disoriented behavior, and more role reversal. See Table 2.
Hypothesis (2). Maternal affective instability, identity disturbance and negative relationships, were negatively correlated with the maternal
caregiving composite and positively correlated with role reversal. Identity disturbance was positively correlated with maternal
fearful/disoriented behavior, and self-harm was marginally significantly correlated with maternal fearful/disoriented behavior. See Table 3.
Discussion
The study finds that maternal BPD exerts a risk for offspring beyond infancy. Mothers with BPD may find that their symptoms affect their
moment-by-moment functioning with their child, making consistent and empathic care to support a goal-corrected partnership challenging.
Mothers with BPD not only displayed maladaptive caregiving, they also demonstrated fearful/disoriented behavior, and used the child to meet
their own needs in a role reversal. Without an adequate goal-corrected partnership, children may not have access to maternal support and
guidance as they try to regulate their own emotions and behavior, relate to peers and function in school. Along with the narratives of the childcaregiver relationship which mirror current findings at the level of representation (Macfie & Swan, 2009), the development of psychopathology,
including BPD, may be more likely for children whose mothers have BPD.
Indeed, maternal hostility in infancy and role reversal at 42 months, both included in the current study with BPD offspring, predicted BPD
symptoms at age 28 in a longitudinal study of a sample at risk due to poverty (Carlson, Egeland, & Sroufe, 2009). Furthermore, in the same
longitudinal study, disorganized attachment in infancy, found in offspring of women with BPD (Hobson et al., 2005), also predicted BPD
symptoms at age 28 (Carlson et al., 2009). Because of the increased risk of developing a full diagnosis of BPD in offspring compared to Carlson
et al.’s poverty sample, longitudinal study of offspring of women with BPD may further illuminate pathways to resilience vs. BPD. Longitudinal
study should also prove of unique interest to developmental psychopathologists seeking to understand more about how atypical development
informs normative development and vice versa. We may then be in a position to design preventive interventions for BPD.
References
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MHFC. (1995). Mt. Hope Demographic Interview. Unpublished manuscript. University of Rochester.
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Table 1.
Child age, child verbal abilities, and demographic differences between the BPD and normative comparison groups
Variable
Whole sample
BPD
Comparisons
t
N = 70
n = 36
n = 34
M (SD)
M (SD)
M (SD)
Child Age (years)
5.37 (0.90)
5.31 (0.90)
5.42 (0.90)
0.52
Verbal Ability (PPVT)
102.67 (13.65)
100.06 (15.05)
105.29 (11.74)
1.62
Family Yearly Income ($)
31,841 (27,855) 30,018 (19,192) 33,664 (34,633) 0.55
# Adults in Home
1.83 (0.78)
1.83 (0.79)
1.83 (0.79)
0.00
# Children in Home
2.47 (1.16)
2.63 (1.26)
2.31 (1.05)
1.13
λ2
Child Gender (girls)
50%
54%
46%
0.51
Child Minority Ethnic Background
11%
11%
11%
0.00
Mother Graduated High School or GED 89%
83%
94%
2.26
Mother Has Partner
77%
77%
77%
0.00
Table 2.
Group differences in mother-child interaction variables: univariate F-tests, effect size and
Mother-child interaction
Whole
BPD
Comparisons
variable
sample
N = 70
n = 36
n = 34
M(SD)
M(SD)
M(SD)
Maternal caregiving
5.73
4.08 (3.97)
7.47 (4.34)
composite
(4.46)
Mother-child role reversal
2.41
3.06 (1.45)
1.74 (0.93)
(1.39)
Maternal
1.29
1.47 (1.23)
1.09 (0.38)
fearful/disoriented
(0.93)
behavior
*p < .05; **p < .01; *** p < .001.
observed power
F(df)
η2
Observed
power
F(1, 65)
9.59**
.13
.86
15.41***
.19
.97
4.25*
.06
.53
Table 3.
Correlations between maternal borderline features and mother-child interaction variables
Maternal borderline features
Mother-child interaction variable
Affective instability Identity disturbance Negative relationships
Maternal caregiving composite
-.31**
-.34**
-.40***
Mother-child role reversal
.44***
.31**
.42***
Maternal fearful/disoriented behavior .19
.29*
.10
†
p < 10; *p < .05; **p ≤.01; *** p ≤.001.
Self-harm
-.11
.23†
.14