Preschooler Emotion Regulation in the Context of Maternal Borderline Personality Disorder

Borderline personality disorder is a serious mental illness characterized by extreme
emotions, chaotic interpersonal relationships, suicidal behaviors, and a poor sense of self.
Offspring of mothers with Borderline Personality Disorder (BPD) are at an elevated risk for
developing mental illness across the lifespan. Difficulty managing emotions are a hallmark
feature of BPD, and yet the ability to do so is necessary for responding effectively to
childrens' emotions. This process is called maternal emotion socialization, which has a major
impact on how children develop their own emotion regulation (ER) skills. ER develops rapidly
during preschool and deficits in preschool ER are recognized as underlying future mental
disorders. This proposal will test a model examining the extent to which maternal ER and
emotion socialization impact child ER, which may be a significant pathway by which mental
health problems are transmitted to offspring of mothers with BPD. This proposal will leverage
Dialectical Behavior Therapy (DBT) Skills training, a robust and effective method for
improving ER as a tool to change maternal ER in mothers with BPD. By completing multiple
assessments of biobehavioral markers of child and mother ER, this study is poised to uncover
a potentially modifiable pathway by which these offspring are at risk. Specifically, the
investigators propose to conduct a stratified randomized controlled trial of DBT Skills for
mothers with BPD who have preschoolers. A total of 300 dyads (initial child age: 36-54
months) will be collected in Eugene, Oregon and Pittsburgh Pennsylvania, with 100 pairs in
each of three groups: children who have mothers with BPD who receive DBT Skills, children who
have mothers with BPD who receive Family Services as Usual, and children who have
non-disordered mothers, matched on income, with this final group only participating in
assessments (as to quantify normative ER growth). All children will be assessed 4 times every
2-months, with the first assessment occurring prior to treatment assignment. Investigators
will use a biobehavioral laboratory battery to measure child ER, assessing emotion
understanding, strategy use, attention regulation and inhibitory control, and parasympathetic
regulation. In mothers, a similar multi-method approach to assess emotion acceptance,
strategy use, recognition, and parasympathetic regulation will be employed. Finally, during
each laboratory assessment, there will be observations of mother's ability to effectively
respond to children in the context of child negative emotions. Growth curve modeling will
chart child ER trajectories for all 3 groups so that investigators can compare child ER
growth as a function of: group status (DBT Skills vs. Family Services as Usual vs. income
matched, non-disordered controls), changes in maternal ER, and changes in maternal emotion
socialization. Findings from this proposal will identify a modifiable pathway by which
offspring of mothers with BPD are at risk, determine the extent to which child ER can be
restored by treating mothers, and will be the first DBT Skills trial to measure outcomes in
offspring.

Inclusion Criteria:

- Have a child who is 3 years old; have custody of child; endorse at least 3 symptom
criteria of BPD in which one symptom must be affective instability and uncontrollable
anger; have a verbal IQ of at least 70

Exclusion Criteria:

- Does not have custody of child; child has known developmental disabilities; mother is
psychotic; mother has suicidal ideation + an active plan; mother has low verbal IQ