ACADEMIC ARTICLE: RISK OF MALTREATMENT IN CHILDREN AGE 4-6 ...
Risk of
Maltreatment in Children Age 4-6 Whose Mothers Have
Borderline
Personality Disorder
Elizabeth Reid, Scott Campion, Christopher Watkins, and Jenny
Macfie
Abstract
Because childhood maltreatment is a risk
factor for the development of borderline personality disorder (BPD), it is
important to know more about maltreatment in children at high risk for
developing the disorder themselves in early adulthood. Offspring of women with
BPD comprise such a risk group. The present research examined the experience of
maltreatment in a low-SES sample of preschool-aged children whose mothers have
BPD, n = 15, and normative
comparisons, n = 13. Children of mothers with BPD were significantly
more likely to have experienced maltreatment, specifically neglect, and greater
severity and chronicity of maltreatment than were comparisons. There were no
significant differences in the experience of physical abuse or sexual abuse.
Results are discussed in terms of possible precursors to the development of BPD
in this high-risk sample.
Introduction
•
Borderline
Personality Disorder (BPD) Symptoms of BPD include: suicide attempts,
self-harm (e.g., cutting), impulsivity (e.g., drug/alcohol abuse),
inappropriate angry outbursts, identity confusion, volatile emotions and stormy relationships.
•
The combination of angry, self-destructive,
care-seekers is extremely difficult for health care providers.
•
BPD affects 3% of women. 8-10% of both men and
women with BPD commit suicide.
•
Because treatment for BPD is challenging,
developmentally appropriate preventative interventions would be important
(Cicchetti & Hinshaw, 2003).
Developmental Psychopathology
•
From a developmental psychopathology perspective
(Sroufe & Rutter, 1984) in order to design preventive interventions for
BPD, more needs to be known about the etiology of BPD in a high-risk group. One
such high-risk group is the children of BPD mothers.
•
The current research thus examines one possible
precursor to BPD, childhood maltreatment, in a high-risk group: children age
4-6 whose mothers have the disorder.
Maltreatment in the Etiology of BPD
•
The intergenerational transmission of
maltreatment is approximately 33%: One third of maltreated children grow up to
go on to maltreat their own children (Egeland, Jacobovitz, & Sroufe, 1988).
•
Retrospective studies of women with BPD report
experience of childhood maltreatment
(Herman, Perry, & van der Kolk, 1989,
Zanarini, Frankenburg, Reich, Marino, Lewis,
Williams, & Khera, 2000). It is therefore
important to know what proportion of mothers
with BPD go on to maltreat their own
children, increasing the risk of their developing BPD themselves when they grow
up.
•
Prospective rather than retrospective studies
are needed, however, to demonstrate etiological effects of maltreatment on the
development on BPD.
•
Previous research on children of BPD mothers
within a wide age span-- from preschool to the late teen years-- suggested that
these children had not experienced more trauma (defined to include maltreatment)
than had comparisons (Weiss, Zelkowitz, Feldman, Vogel, Heyman, & Paris,
1996). However, the definition of trauma
was very broad and the comparison group was also very high risk: comprising
children of mothers with other personality disorders, making the detection of
significant differences unlikely.
Gaps in Research
•
To date there has been no research on
maltreatment per se in offspring of mothers with BPD. This is an important
omission because of the salience of maltreatment in the etiology of BPD.
•
Such research needs to comprise children in the
same developmental period in order to assess the effect on child development.
Current Study
•
The current study assesses
maltreatment (sexual abuse, physical abuse, and neglect), severity, and
chronicity of maltreatment in offspring, age 4-6, of mothers with BPD in
comparison with children of mothers without BPD.
Hypotheses
• Compared
with normative comparisons, children of mothers with BPD would experience:
(1)
more maltreatment overall.
(2)
more of each subtype of maltreatment: sexual abuse,
physical abuse, and neglect.
(3)
greater severity and chronicity in their experience of
maltreatment
Method
Participants
•
N = 28
mothers with children ages 4-6 years old
•
n = 15
mothers with BPD and n = 13 mothers
without BPD and their respective preschool age children.
•
Mothers with BPD were recruited from local
outpatient clinics and referred by their therapists.
•
Comparison mothers were recruited from Boys and
Girls clubs, posters placed in the community, and local schools
•
Groups were matched on socioeconomic status
(low), age, race, and other demographic characteristics (see table 1).
Table 1.
Characteristics of the sample.
|
Variable |
M (SD) |
M (SD) |
M (SD) |
t |
|
Household Yearly Income |
31,567
(24,552) |
35,096
(24,499) |
27,495
(24,950) |
0.81 |
|
Child’s Age |
5.37 (0.74) |
5.38 (0.78) |
5.37 (0.73) |
0.79 |
|
|
% |
% |
% |
|
|
Mother Completed High School |
93 |
93 |
92 |
0.38 |
|
Mother Single |
32 |
33 |
31 |
0.17 |
|
Child Gender (girls) |
54 |
53 |
54 |
0.04 |
|
Child Minority |
14 |
13 |
15 |
0.48 |
*No group differences were significant.
Procedures & Measures BPD diagnosis
•
SCID-II Interview (First, Gibbon, Spitzer, Williams & Benjamin,
1997). This structured interview was
conducted after initial participant screening and was used to determine BPD
status of the mother.
Maltreatment Information
•
Maltreatment
Interview (Ciccheeti, Toth & Manly, 2002). This interview was conducted to establish the
presence of maltreatment of the child as reported by the mother.
•
Department
of Children’s Services (DCS) Maltreatment Records. With the mother’s written consent, DCS
provided information regarding whether an investigation was opened for each
child. If there was an investigation
conducted, DCS provided details of the case, specifically the date the case was
opened, the type of maltreatment, the perpetrator, and whether it was founded
or not.
•
Maltreatment
Coding System (Cicchetti et al, 2002).
This system was used to categorize maltreatment into subtypes, assess
severity, and the developmental period that the maltreatment occurred.
o The maltreatment event was defined as physical abuse,
sexual abuse, and/or neglect.
•
Physical abuse is any physical action toward the
child (ex: hitting, cutting, throwing)
•
Sexual abuse is physical action toward the child
of a sexual nature (ex: molestation, groping, vaginal or anal penetration)
•
Neglect is the absence of appropriate care
and/or supervision (ex: leaving child unsupervised or with an inappropriate
supervisor, leaving child in unsafe environment, not providing adequate
nourishment, keeping child out of school)
o
If maltreatment is found, it was assessed for
severity using a 1 - 3 rating scale.
•
Low rating (1): minor maltreatment events (ex:
minor bruising, small scratches and abrasions, inappropriate display of
genitals, leaving child with inappropriate supervisor).
•
Medium rating (2): moderate maltreatment events
(ex: cuts requiring minor stitches, large bruising, molestation and groping,
child left unattended for short period of time).
•
High rating (3): severe maltreatment events (ex:
hospitalization, broken bones, sexual penetration, child left unattended in
dangerous environment).
o
If maltreatment found, it was assessed for
developmental period
•
Infant: ages 0 - 2 years
•
Toddler: 2 - 3 years
•
Preschooler: 3 - 6 years
o
Chronicity was assessed by counting the number
of developmental periods that maltreatment occurred by subtype
o
Interrater reliability was assessed on 20% of
the total sample. For the categorical variables, kappas were conducted. For the continuous variables, interclass
correlations were conducted.
•
Maltreatment overall k = 1.00, physical abuse k =
0.80, sexual abuse k =
1.00, and neglect k = 1.00.
•
Severity of physical abuse Ri = 0.94, severity of sexual abuse Ri = 1.00, and severity of neglect Ri = 1.00.
•
Chronicity of physical abuse Ri = 0.93, chronicity of
sexual abuse Ri = 1.00,
and chronicity of neglect Ri =
1.00.
Results
•
Hypothesis
(1).
o
As hypothesized, children whose mothers had BPD
experienced more maltreatment than did comparisons, χ2 (1, N = 28) = 4.18, p < .05
•
Hypothesis
(2).
o
As hypothesized, children whose mothers had BPD
experienced significantly more neglect than comparisons, χ2
(1, N = 28) = 7.48, p < .01
o
However, there were no significant differences
for physical abuse, χ2 (1, N = 28) = 0.36, p > .10, or for sexual abuse, χ2 (1, N = 28) = 1.87, p >
0.10.
•
Hypothesis
(3).
o
As hypothesized, children whose mothers had BPD
experienced significantly more severe maltreatment events than comparisons t (26, N = 28) = 2.49, p <
0.05.
o
As hypothesized, children whose mothers have BPD
experienced maltreatment events over a longer period of time (e.g., higher
chronicity) t (26, N = 28) = 2.11, p < 0.05.
Table 2. Effect of maternal BPD on the experience of
maltreatment.
Variable % %
χ2
|
Overall Maltreatment |
79 |
93 |
62 |
4.18* |
|
Neglect |
43 |
67 |
15 |
7.48**
|
|
Physical Abuse |
29 |
33 |
23 |
0.36 |
|
Sexual Abuse |
7 |
13 |
0 |
1.87 |
|
|
M (SD) |
M (SD) |
M (SD) |
t |
|
Severity |
2.11
(1.23) |
2.60
(0.83) |
1.54(1.39) |
2.49* |
|
Chronicity |
1.54
(1.14) |
1.93
(1.03) |
1.08
(1.12) |
2.11* |
* significant p < 0.05
**significant p < 0.01
Discussion
Current Findings and Implications
•
Children age 4-6 of mothers who had BPD were
more likely to have been maltreated, particularly neglected, than were children
of mothers who do not have the disorder.
•
This significant finding for neglect suggests
that symptoms of BPD may cause mothers to be both emotionally and physically
unavailable to their offspring, which may have deleterious consequences for
future development.
•
There were no significant differences for sexual
abuse, although all children who had experienced sexual abuse were within the
BPD group. This may be due to the young age of the participants (i.e., sexual
abuse is more likely to happen at a later developmental stage).
•
There were no significant differences for
physical abuse.
•
The maltreatment that children of mothers with
BPD experienced was found to be more severe and more chronic than
comparisons. This may be due to BPD
mother’s inability to cope with the demands of a child, which may cause the
mother to be harsher and begin the maltreatment earlier than comparisons.
•
The small sample size limited power to detect
significant differences. However, results clearly suggest that children of
mothers who have BPD are at risk themselves for experiencing maltreatment.
•
Because maltreatment is implicated in the
etiology of BPD the present research emphasizes the high level of risk of
children of mothers with BPD. As these offspring develop they may, in addition,
become more vulnerable to other subtypes of maltreatment.
References
Cicchetti, D. and
Hinshaw, S. P. 2003. Editorial.
Prevention and intervention science:
Contributions to
developmental theory. Development and Psychopathology. 15. 667-672.
Cicchetti, D., Toth, S. L., and Manly, J. T.
2002. Maltreatment classification
interview.
Unpublished manuscript. University of
Rochester.
Egeland, B., Jacobvitz, D., and Sroufe,
L.A. 1988. Breaking the cycle of abuse.
Child Development. 59. 1080-1088.
First, M. B.,Gibbon, M., Spitzer, R. L.,
Williams, J. B. W., and Benjamin, L. S. 1997. Structured clinical interview for
DSM-IV Axis II personality disorders: SCID-II. American Psychiatric Press.
Washington, DC.
Herman, J. L., Perry, J. C., and van der
Kolk, B. A. 1989. Childhood trauma in
borderline personality disorder. American Journal of Psychiatry. 146.
490-495.
Sroufe, L. A. and Rutter, M. 1984. The domain of developmental psychopathology.
Child Development. 55. 17-29.
Weiss, M., Zelkowitz, P., Feldman, R. B.,
Vogel, J., Heyman, M., and Paris, J. 1996.
Psychopathology in offspring of mothers with borderline personality
disorder. Canadian Journal of Psychiatry. 41. 285-290.
Zanarini, M. C., Frankenburg, F. R., Reich,
D. B., Marino, M. F., Lewis, R. E., Williams, A. A., and Khera, G. S. 2000. Biparental failure in the childhood
experiences of borderline patients. Journal of Personality Disorders. 14.
264-273.
* This
research was supported by funding from the National Institute of Mental Health
to Dr. Jenny Macfie [5R03MH077841-01].
†This poster
was presented at the Society for Research in Child Development biannual
conference in April 2007. If you would
like additional information, please contact Jenny Macfie at macfie@utk.edu or
visit our website at http://web.utk.edu/~macfie
Comments
Post a Comment