Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-15T22:58:21.679Z Has data issue: false hasContentIssue false

Borderline personality features in childhood: The role of subtype, developmental timing, and chronicity of child maltreatment

Published online by Cambridge University Press:  22 July 2014

Kathryn F. Hecht*
Affiliation:
University of Minnesota Institute of Child Development
Dante Cicchetti*
Affiliation:
University of Minnesota Institute of Child Development University of Rochester Mt. Hope Family Center
Fred A. Rogosch
Affiliation:
University of Rochester Mt. Hope Family Center
Nicki R. Crick
Affiliation:
University of Minnesota Institute of Child Development
*
Address correspondence and reprint requests to: Kathryn F. Hecht or Dante Cicchetti, Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455; E-mail: hecht022@umn.edu or cicchett@umn.edu.
Address correspondence and reprint requests to: Kathryn F. Hecht or Dante Cicchetti, Institute of Child Development, University of Minnesota, 51 East River Road, Minneapolis, MN 55455; E-mail: hecht022@umn.edu or cicchett@umn.edu.

Abstract

Child maltreatment has been established as a risk factor for borderline personality disorder (BPD), yet few studies consider how maltreatment influences the development of BPD features through childhood and adolescence. Subtype, developmental timing, and chronicity of child maltreatment were examined as factors in the development of borderline personality features in childhood. Children (M age = 11.30, SD = 0.94), including 314 maltreated and 285 nonmaltreated children from comparable low socioeconomic backgrounds, provided self-reports of developmentally salient borderline personality traits. Maltreated children had higher overall borderline feature scores, had higher scores on each individual subscale, and were more likely to be identified as at high risk for development of BPD through raised scores on all four subscales. Chronicity of maltreatment predicted higher overall borderline feature scores, and patterns of onset and recency of maltreatment significantly predicted whether a participant would meet criteria for the high-risk group. Implications of findings and recommendations for intervention are discussed.

Type
Regular Articles
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment studies with borderline patients: A review. Harvard Review of Psychiatry, 12, 94104.Google Scholar
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.Google Scholar
Ball, J. S., & Links, P. S. (2009). Borderline personality disorder and childhood trauma: Evidence for a causal relationship. Current Psychiatry Reports, 11, 6368.Google Scholar
Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In Cicchetti, D. & Toth, S. L. (Eds.), Child abuse, child development and social policy (pp. 773). Norwood, NJ: Ablex.Google Scholar
Battle, C. L., Shea, M. T., Johnson, D. M., Yen, S., Zlotnick, C., Zanarini, M. C., et al. (2004). Childhood maltreatment associated with adult personality disorders: Findings from the collaborative longitudinal personality disorders study. Journal of Personality Disorders, 18, 193211.Google Scholar
Beauchaine, T. P., Klien, D. N., Crowell, S. E., Debridge, C., & Gatzke-Kopp, L. (2009). Multifinality in the development of personality disorders: A Biology × Sex × Environment interaction model of antisocial and borderline traits. Development and Psychopathology, 21, 735770.Google Scholar
Belsky, D. W., Caspi, A., Arseneault, L., Bleidorn, W., Fonagy, P., Goodman, M., et al. (2012). Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. Development and Psychopathology, 24, 251.Google Scholar
Bemporad, J. R., Smith, H. F., Hanson, G., & Cicchetti, D. (1982). Borderline syndromes in childhood: Criteria for diagnosis. American Journal of Psychiatry, 139, 596602.Google ScholarPubMed
Blaney, P. H. (1986). Affect and memory: A review. Psychological Bulletin, 99, 229246.Google Scholar
Bolger, K. E., Patterson, C. J., & Kupersmidt, J. B. (1998). Peer relationships and self-esteem among children who have been maltreated. Child Development, 69, 11711197.Google ScholarPubMed
Bowlby, J. (1969). Attachment. New York: Basic Books.Google Scholar
Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London: Routledge.Google Scholar
Bradley, R., Jenei, J., & Westen, D. (2005). Etiology of borderline personality disorder: Disentangling the contributions of intercorrelated antecedents. Journal of Nervous and Mental Disease, 193, 2431.CrossRefGoogle ScholarPubMed
Bradley, R., & Westen, D. (2005). The psychodynamics of borderline personality disorder: A view from developmental psychopathology. Development and Psychopathology, 17, 927.CrossRefGoogle ScholarPubMed
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology & Psychiatry, 47, 372394.Google Scholar
Carlson, E. A., Egeland, B., & Sroufe, L. A. (2009). A prospective investigation of the development of borderline personality symptoms. Development and Psychopathology, 21, 13111334.Google Scholar
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 25, 525531.Google Scholar
Cicchetti, D., & Barnett, D. (1991). Attachment organization in maltreated preschoolers. Development and Psychopathology, 3, 397411.CrossRefGoogle Scholar
Cicchetti, D., & Blender, J. A. (2006). A multiple-levels-of-analysis perspective on resilience: Implications for the developing brain, neural plasticity, and preventive interventions. Annals of the New York Academy of Sciences, 1094, 248258.Google Scholar
Cicchetti, D., & Crick, N. R. (2009). Precursors and diverse pathways to personality disorder in children and adolescents. Development and Psychopathology, 21, 683685.Google Scholar
Cicchetti, D., & Dawson, G. (2002). Multiple levels of analysis. Development and Psychopathology, 14, 417420.CrossRefGoogle ScholarPubMed
Cicchetti, D., & Manly, J. T. (1990). A personal perspective on conducting research with maltreatment families: Problems and solutions. In Brody, E. & Sigel, I. (Eds.), Family research: Vol. 2. Families at risk (pp. 87133). Hillsdale, NJ: Erlbaum.Google Scholar
Cicchetti, D., & Olsen, K. (1990). Borderline syndromes in childhood: An organizational developmental psychopathology perspective. In Lewis, M. & Miller, S. (Eds.), Handbook of developmental psychopathology (pp. 355370). New York: Plenum Press.CrossRefGoogle Scholar
Cicchetti, D., Rogosch, F. A., Gunnar, M. R., & Toth, S. L. (2010). The differential impacts of early physical and sexual abuse and internalizing problems on daytime cortisol rhythm in school-aged children. Child Development, 81, 252269.Google Scholar
Cicchetti, D., Toth, S. L., & Manly, J. T. (2003). Maternal Maltreatment Classification Interview. Unpublished manuscript, Mt. Hope Family Center.Google Scholar
Cicchetti, D., & Valentino, K. (2006). An ecological transactional perspective on child maltreatment: Failure of the average expectable environment and its influence upon child development. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder, and adaptation (2nd ed.). Hoboken, NJ: Wiley.Google Scholar
Crick, N. R., Murray-Close, D., & Woods, K. (2005). Borderline personality features in childhood: A short-term longitudinal study. Development and Psychopathology, 17, 10511070.Google Scholar
Crowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan's theory. Psychological Bulletin, 135, 495510.Google Scholar
Cullerton-Sen, C., Cassidy, A. R., Murray-Close, D., Cicchetti, D., Crick, N. R., & Rogosch, F. A. (2008). Childhood maltreatment and the development of relational and physical aggression: The importance of a gender-informed approach. Child Development, 79, 17361751.Google Scholar
De Clercq, B., De Fruyt, F., Van Leeuwen, K., & Mervielde, I. (2006). The structure of maladaptive personality traits in childhood: A step toward an integrative developmental perspective for DSM-V. Journal of Abnormal Personality, 115, 639657.Google ScholarPubMed
Egeland, B., & Sroufe, L. A. (1981). Developmental sequelae of child maltreatment. New Directions for Child Development, 11, 7792.Google Scholar
English, D. J., Upadhyaya, M. P., Litrownik, A. J., Marshall, J. M., Runyan, D. K., Graham, J. C., et al. (2005). Maltreatment's wake: The relationship of maltreatment dimensions to child outcomes. Child Abuse and Neglect, 29, 597619.Google Scholar
Fonagy, P. (2000). Attachment and borderline personality disorder. Journal of the American Psychoanalytic Association, 48, 11291146.CrossRefGoogle ScholarPubMed
Geiger, T. C., & Crick, N. R. (2001). A developmental psychopathology perspective on vulnerability to personality disorders. In Ingram, R. E. & Price, J. M. (Eds.), Vulnerability to psychopathology: Risk across the lifespan (pp. 5799). New York: Guilford Press.Google Scholar
Hill, J., Stepp, S. D., Wan, M. W., Hope, H., Morse, J. Q., Steele, M., et al. (2011). Attachment, borderline personality, and romantic relationship dysfunction. Journal of Personality Disorders, 25, 789805.Google Scholar
Herman, J. L., Perry, J. C., & Van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490495.Google Scholar
Hesse, E., & Main, M. (2000). Disorganized infant, child, and adult attachment: Collapse in behavioral and attentional strategies. Journal of the American Psychoanalytic Association, 48, 10971127.Google Scholar
Holmes, J. (2003). Borderline personality disorder and the search for meaning: An attachment perspective. Australian and New Zealand Journal of Psychiatry, 37, 524531.CrossRefGoogle ScholarPubMed
Holmes, J. (2004). Disorganized attachment and borderline personality disorder: A clinical perspective. Attachment & Human Development, 6, 181190.Google Scholar
Jaffee, S. R., & Maikovich-Fong, A. K. (2011). Effects of chronic maltreatment and maltreatment timing on children's behavior and cognitive abilities. Journal of Child Psychology and Psychiatry, 52, 184194.Google Scholar
Johnson, J. G., Bromley, E., Bornstein, R. F., & Sneed, J. R. (2006). Adolescent personality disorders. In Wolfe, D. A. & Mash, E. J. (Eds.), Behavioral and emotional disorders in children and adolescents: Nature, assessment, and treatment (pp. 463484). New York: Guilford Press.Google Scholar
Johnson, J. G., Bromley, E., & McGeoch, P. G. (2005). The role of childhood experiences in the development of adaptive and maladaptive personality traits. In Oldham, J. M., Skodol, A. E., & Bender, D. S. (Eds.), The American Psychiatric Publishing textbook of personality disorders (pp. 209223). Washington, DC: American Psychiatric Publishing.Google Scholar
Johnson, J. G., Cohen, P., Brown, J., Smailes, E. M., & Bernstien, D. P. (1999). Child maltreatment increases risk for personality disorders across early adulthood. Archives of General Psychiatry, 56, 600606.Google Scholar
Johnson, J. G., Smailes, E. M., Cohen, P., Brown, J., & Bernstien, D. P. (2000). Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: Findings of a community-based longitudinal study. Journal of Personality Disorders, 14, 171187.Google Scholar
Jonson-Reid, M., Kohl, P. L., & Drake, B. (2012). Child and adult outcomes of chronic child maltreatment. Pediatrics, 129, 839845.Google Scholar
Joyce, P. R., McKenzie, J. M., Luty, S. E., Mulder, R. T., Carter, J. D., Sullivan, P. F., et al. (2003). Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders. Australian and New England Journal of Psychiatry, 37, 756764.Google Scholar
Lenzenweger, M. F. (2008). Epidemiology of personality disorders. Psychiatric Clinics of North America, 31, 395403.Google Scholar
Lenzenweger, M. F., & Cicchetti, D. (2005). Toward a developmental psychopathology approach to borderline personality disorder. Development and Psychopathology, 17, 893898.Google Scholar
Lenzenweger, M. F., & Willett, J. B. (2009). Does change in terperament predict change in schizoid personality disorder? A methodological framework and illustration from the longitudinal study of personality disorders. Development and Psychopathology, 21, 12111231.Google Scholar
Levy, K. N. (2005). The implications of attachment theory and research for understanding borderline personality disorder. Development and Psychopathology, 17, 959.Google Scholar
Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. Lancet, 364, 453461.Google Scholar
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
Liotti, G. (2000). Disorganized attachment, models of borderline states and evolutionary psychotherapy. In Bailey, K. G. & Gilbert, P. (Eds.), Genes on the couch: Explorations in evolutionary psychotherapy (pp. 232256). New York: Brunner–Routledge.Google Scholar
Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. Attachment in the Preschool Years, 1, 121160.Google Scholar
Manly, J. T. (2005). Advances in research definitions of child maltreatment. Child Abuse & Neglect, 29, 425439.Google Scholar
Manly, J. T., Cicchetti, D., & Barnett, D. (1994). The impact of subtype, frequency, severity, and chronicity of child maltreatment on social competence and behavior problems. Development and Psychopathology, 6, 121143.Google Scholar
Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D. (2001). Dimensions of child maltreatment and children's adjustment: Contributions of developmental timing and subtype. Development and Psychopathology, 13, 759782.Google Scholar
Marshall, D., & English, D. (1999). Survival analysis of risk factors for recidivism for child abuse and neglect. Child Maltreatment, 4, 287296.CrossRefGoogle Scholar
Morey, L. (1991). Personality Assessment Inventory. Odessa, FL: Psychological Assessment Resources.Google Scholar
Nakash-Eisikovits, O., Dutra, L., & Westen, D. (2002). Relationship between attachment patterns and personality pathology in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 11111123.Google Scholar
Paris, J. (1997). Antisocial and borderline personality disorders: Two separate diagnoses or two aspects of the same psychopathology? Comprehensive Psychiatry, 38, 237242.Google Scholar
Paris, J. (2005). Recent advances in the treatment of borderline personality disorder. Canadian Journal of Psychiatry, 50, 435441.Google Scholar
Posner, M. I., Rothbart, M. K., Vizueta, N., Levy, K. N., Evans, D. E., Thomas, K. M., et al. (2002). Attentional mechanisms of borderline personality disorder. Proceedings of the National Academy of Sciences, 99, 1636616370.Google Scholar
Putnam, K. M., & Silk, K. R. (2005). Emotion dysregulation and the development of borderline personality disorder. Development and Psychopathology, 17, 899.Google Scholar
Radke-Yarrow, M., Campbell, J. D., & Burton, R. V. (1970). Recollections of childhood: A study of the retrospective method. Monographs of the Society for Research in Child Development, 35, iii–83.Google Scholar
Rogosch, F. A., & Cichetti, D. (2005). Child maltreatment, attention networks, and potential precursors to borderline personality disorder. Development and Psychopathology, 17, 10711089.Google Scholar
Rogosch, F. A., & Cichetti, D., & Aber, J. L. (1995). The role of maltreatment in early deviations in cognitive and affective processing abilities and later peer relationship problems. Development and Psychopathology, 7, 591609.CrossRefGoogle Scholar
Sedlak, A., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., et al. (2010). Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress. Washington DC: US Department of Health and Human Services.Google Scholar
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school age children: The development and validation of a new criterion Q-sort scale. Development and Psychopathology, 33, 906916.Google Scholar
Shiner, R. L. (2009). The development of personality disorders: Perspectives from normal personality development in childhood and adolescence. Development and Psychopathology, 21, 715734.Google Scholar
Skodol, A. E., Gunderson, J. G., Pfohl, B., Eidiger, T. A., Livesley, W. J., & Siever, L. J. (2002). The borderline diagnosis: Part 1. Psychopathology, comorbidity and personality structure. Biological Psychiatry, 51, 936950.Google Scholar
Swartz, M., Blazer, D., George, L., & Winfield, L. (1984). Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorders, 4, 257272.Google Scholar
Thornberry, T. P., Ireland, T. O., & Smith, C. A. (2001). The importance of timing: The varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Development and Psychopathology, 13, 957979.Google Scholar
Tomko, R. L., Trull, T. J., Wood, P. K., & Sher, K. J. (2013). Characteristics of borderline personality disorder in a community sample: Comorbidity, treatment utilization, and general functioning. Journal of Personality Disorders, 27, 117.Google Scholar
Toth, S. L., Cicchetti, D., MacFie, J., Maughan, A., & Vanmeenen, K. (2000). Narrative representations of caregivers and self in maltreated pre-schoolers. Attachment & Human Development, 2, 271305.Google Scholar
Trull, T. J., Stepp, S. D., & Durett, C. A. (2003). Research on borderline personality disorder: An update. Current Opinion in Psychiatry, 16, 7782.Google Scholar
Weaver, T., & Clum, G. (1993). Early family environments and experiences associated with borderline personality disorder. Journal of Consulting and Clinical Psychology, 61, 10681075.CrossRefGoogle ScholarPubMed
Werner, N. E., & Crick, N. R. (1999). Relational aggression and social-psychological adjustment in a college sample. Journal of Abnormal Psychology, 108, 615–623.Google Scholar
Widiger, T. A., De Clercq, B., & De Fruyt, F. (2009). Childhood antecedents of personality disorder: An alternate perspective. Development and Psychopathology, 21, 771791.Google Scholar
Widiger, T. A., & Frances, A. J. (1989). Epidemiology, diagnosis, and comorbidity of borderline personality disorder. In Tasman, A., Hales, R. E., & Frances, A. J. (Eds.), Review of psychiatry (Vol. 8, pp. 824). Washington, DC: American Psychiatric Press.Google Scholar
Widiger, T. A., & Weissman, M. M. (1991). Epidemiology of borderline personality disorder. Hospital and Community Psychiatry, 42, 10151021.Google Scholar
Widom, C. S., Czaja, S. J., & Paris, J. (2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of Personality Disorders, 23, 433446.CrossRefGoogle ScholarPubMed
Widom, C. S., Raphael, K., & DuMont, K. (2004). The case for prospective longitudinal studies in child maltreatment research: Commentary on Dube, Williamson, Thompson, Felitti, & Anda (2004). Child Abuse & Neglect, 28, 715722.Google Scholar
Zanarini, M. C. (2000). Childhood experiences associated with the development of borderline personality disorder. Psychiatric Clinics of North America, 23, 89101.Google Scholar
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2012). Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: A 16 year prospective follow-up study. American Journal of Psychiatry, 169, 476483.Google Scholar
Zanarini, M. C., Frankenburg, F. R., Ridolfi, M. E., Jager-Hyman, S., Hennen, J., & Gunderson, J. G. (2006). Reported childhood onset of self-mutilation among borderline patients. Journal of Personality Disorders, 20, 915.Google Scholar