2. Personal Statement
My quest to become a counseling psychologist began over 25 years ago when I
was diagnosed with Major Depressive Disorder. I began to read everything I
could about mental disorders and found I had a true passion for helping
individuals with mental illness. My formal education in psychology began 17
years ago. I received an Associate’s Degree in psychology from a local
community college. During my attendance, I worked as a volunteer atMy quest
to become a counseling psychologist began over 25 years ago when I was
diagnosed with Major Depressive Disorder. I began to read everything I could
about mental disorders and found I had a true passion for helping individuals
with mental illness. My formal education in psychology began 17 years ago. I
received an Associate’s Degree in psychology from a local community college.
During my attendance, I worked as a volunteer at a children’s shelter. I attended
college when I could while working full time and raising a special-needs child.
Parenting my son cemented my dedication to the field of mental health. In April,
2011, I will earn my bachelor’s degree in psychology from Argosy University.
Part of my undergraduate studies was done at the University of Texas at Austin,
where I was able to take a counseling course in the education department. My
grades in all psychology classes and my counseling class have been excellent
throughout my college experience. I am a member of both the American
Psychological Association and the National Society of Collegiate Scholars.
2
3. Personal Statement cont’d.
Since beginning my education at Argosy University in 2009, I have been on the
President’s list honor role twice.
Currently, I plan to go to graduate school in order to obtain a master’s degree in
counseling psychology. After completing my master’s and the required
internship, I will take state certification tests for Licensed Professional Counselor
and Licensed Marriage and Family Therapist. I would like to pursue my
doctorate degree in the future. However, my main goal at this time is to become
certified to practice counseling psychology as soon as possible.
In 2009, I joined the National Alliance on Mental Illness. At that time I wrote a
letter to the local president expressing an interest in volunteer opportunities. I
was trained as a NAMI Connections support group facilitator in 2009 and began
a support group in January of 2010. The group is a structured group for anyone
with a diagnosis of mental illness, and its focus is on being in and remaining in
recovery. In April of 2010, I was certified as a state facilitator trainer for NAMI
Connections. In February of 2011, I was asked to sit on NAMI’s Consumer
Networking Committee. My experience with NAMI has further enforced my belief
that I have a calling for working with those with psychological issues.
3
4. Personal Statement cont’d.
My strengths lie in interpersonal communication skills, empathy, honesty and
reliability. Despite my own diagnosis, I was able to maintain a job with the same
employer for 26 years. Being a clerical worker honed my written communication
skills Working with a diverse population in an international business has
improved my interpersonal communication. Living with a diagnosis of depression
has given me insight into a side of mental illness that many therapists never
experience, and I feel that this is a great advantage in understanding clients. I
have empathy for anyone dealing with life’s difficulties, and I understand the
importance of helping people help themselves. Parenting a child with impulse
control and communication issues has taught me new ways of communicating in
a straightforward, non-confrontational manner.
In my opinion, I am very well suited to the role of counseling psychologist. I have
struggled through financial and personal difficulties to obtain my education in the
field. Although it has taken me over 15 years to obtain my bachelor’s degree, I
have persevered with the single goal of helping other in mind. I am able to be
warm and welcoming to people in my support group, and they leave with a
feeling of renewed hope and empowerment. This leads me to believe I will be
able to develop a therapeutic client-therapist relationship with those I counsel.
My sense of humor, a firm belief in the resiliency of the human spirit, and sheer
dedication will also be of great help in this area.
4
5. Resume
Margaret Cronk
8000 Decker Lane, Apt. 1821
Austin, Texas 78724
(512) 465-2822 (Home)
(512-997-5859) (Cell)
Mags628@yahoo.com
Objective
Admission to graduate school for Master of Arts in Counseling
Personal Information
Date of birth: 6/28/1952
Place of birth: Baytown, Texas
Citizenship: United States
Gender: Female
5
6. Resume cont’d.
Education
Argosy University Online (2010-2011)
Bachelor of Arts in Psychology
GPA 3.98
University of Texas at Austin (1970-1972,
1999-2000)
French major 1970-1972
Psychology major 1999-2000
Austin Community College (1992-1998)
Associate of Arts in Psychology
Related Coursework
Counseling (University of Texas Education Department)
6
7. Resume cont’d.
Memberships
American Psychological Association (2010, 2011)
National Society of Collegiate Scholars (2010)
National Alliance on Mental Illness (2009-2011)
National Alliance on Mental Illness Consumer Networking Committee (2011)
Argosy University Students Group (LinkedIn) (2011)
Evolution of IT Group (LinkedIn) (2011)
Certifications
NAMI Connections facilitator
NAMI Connections facilitator trainer for the State of Texas
Honors and Achievements
National Society of Collegiate Scholars (2010)
Argosy University President’s Honor Roll (Spring, 2010; Summer, 2010)
7
8. Resume cont’d.
Work Experience
Correspondence and Reports Assistant, Western Electric Co./AT&T Network
Systems/Lucent Technologies, Inc. (1972-1998) Administrative assistant duties
including clerical work, extensive computer work, setting up billing and recovery
for light-guide production section.
Volunteer Work
Austin Children’s Shelter (1992)
NAMI Connections support group facilitator (2009-2011)
NAMI Connections state facilitator trainer (2010-2011)
Relevant Life Experience
Mother of special needs child (1989-2011)
Panel to address mental health providers (2006)
Stabilized Major Depressive Disorder and PTSD (in recovery, 1985-2011)
Dialectical Behavior Therapy (2007)
8
10. Reflection
Over the time I have spent at Argosy University, I have come to realize that
psychology is truly the field I should be in. The concepts and theories seem to
come easily to me, and my fascination with the field has increased many-fold.
My professors have been very encouraging and seem impressed with my work. I
believe that this all indicates that I have a calling in the field of psychology.
My strengths in this area are interpersonal communication, empathy, open-
mindedness, acceptance, and knowledge of counseling theory and
psychopathology. My weaknesses are in the area of research and
industrial/organizational theory.
10
11. Table of Contents
Cognitive Abilities: Critical Thinking and
Information Literacy
Research Skills
Communication Skills: Oral and Written
Ethics and Diversity Awareness
Foundations of Psychology
Applied Psychology
Interpersonal Effectiveness
11
13. Borderline Mothers
Much has been written in recent years about borderline personality
disorder since Marsha Linehan’s development of an effective treatment in the
early 1990’s. Less has been written about the effects of living with a parent with
this disorder. This paper will address the current literature on the psychological
effects on children with mothers who are diagnosed with BPD.
The research shows that the expression of certain BPD symptoms by
mothers put their children at risk for developing psychological, behavioral, and
social difficulties later on in life. One of these symptoms is splitting, in which the
mother sees the child as all ―good‖ or all ―bad‖, or visualizes her own ―bad‖
parent in the child (Newman & Stevenson, 2005, p. 388). Other symptoms are
feelings of inadequacy in a parenting role or helplessness (Newman, Stevenson,
Bergman, & Boyce, 2007, p. 604), as anger, fear, or despair. inability to read a
child’s ―cues‖ (Crittenden & Newman, 2010, p. 434), identity confusion, self-
harm or suicidal tendencies (Macfie & Swan, 2009, pp . 1004-1005), and
difficulties with regulating emotions such as anger, fear, or despair.
When a mother acts upon these symptoms of her disorder, she can
express her illness in many ways. In trying to engage with an infant, her actions
may be particularly ―intense, inconsistent, and often self-oriented‖ (Hobson,
Patrick, Hobson, Crandell, Bronfman, & Lyons-Ruth, 2009, p. 326). One study
13
14. Borderline Mothers
showed that, even in therapy, these mothers may feel jealous of the attention
their children receive, and may repeatedly bring the focus back to their own
situations and needs (Newman & Stevenson, 2008, p. 512). Also, the mother
may practice what is called ―intrusive insensitivity‖ (Macfie & Swan, 2009, p.
995) in which she continually tries to engage when the child does not want to
(Hobson, Patrick, Crandell, Garcia-Perez, & Lee, 2006, p. 338). She may
respond to the child with anxiety, negative emotions, and even anger (Newman,
Stevenson, Bergman, & Boyce, 2007, p. 599). Because of her insecurities and
the stress the cause the mother, she may take on an over-controlling and
punitive authoritarian parenting style (Newman, Stevenson, Bergman, & Boyce,
2007, p. 604). The research shows that these mothers can also tend to be over-
protective (Barnow, Spitzer, Grabe, Kessler, & Freyberger, 2006, p. 865) overly
possessive of their children (Conroy, Marks, Schacht, Davies, & Moran, 2010, p.
290).
Children of mothers with borderline personality disorder have been shown
to have more psychiatric disorders than children of mothers with other
personality disorders (Herr, Hammen, & Brennan, 2008, p. 452). In infancy,
14
15. Borderline Mothers
these children tend to exhibit a ―disorganized attachment‖ pattern with their
mothers (Hobson, Patrick, Hobson, Crandell, Bronfman, & Lyons-Ruth, 2009, p.
328). This means that they are not securely attached to their mothers and they
may even fear her. Sometimes this leads to reluctance to engage with strangers
or indiscriminate attachment to inappropriate others. Later in childhood, the
children may exhibit aggressive (Hobson, Patrick, Hobson, Crandell, Bronfman,
& Lyons-Ruth, 2009, p. 329) or defiant (Newman, Stevenson, Bergman, &
Boyce, 2007, p. 604) behavior, low self-esteem (Barnow, Spitzer, Grabe,
Kessler, & Freyberger, 2006, p. 865), shame (Macfie & Swan, 2009, p. 993),
confusion between reality and fantasy (Macfie & Swan, 2009, p. 993), fear of
abandonment, and poor emotion regulation (Macfie & Swan, 2009, p. 1004-
1005). They may also find themselves in the role of parent to their mothers
(Macfie & Swan, 2009, p. 993). In adolescence, they may find themselves
lacking the confidence to make friends and suffering from chronic stress from
the relationship with their mothers (Herr, Hammen, & Brennan, 2008, p. 462).
Adulthood for the children of mothers with BPD can be especially challenging.
As adults, they are vulnerable to developing BPD themselves, since the disorder
15
16. Borderline Mothers
is thought to come from a combination of genetic vulnerability plus an
―unsupportive environment‖ (Macfie & Swan, 2009, p. 995). They are also more
vulnerable to developing post-traumatic stress disorder (Macfie & Swan, 2009,
p. 1006) or dissociative symptoms (Hobson, Patrick, Hobson, Crandell,
Bronfman, & Lyons-Ruth, 2009, p. 329).
Overwhelmingly, the research shows that children of mothers with BPD are
at risk. Future research could be done on the question of whether these children
are more at risk from genetic vulnerability or environment. Studies could be
done using children of mothers who were diagnosed with BPD, but had
successfully completed Dialectical Behavior Therapy or another therapy
designed to treat BPD. Would the adaptations mothers made in therapy lessen
the risks to the child? If the results showed what I expect them to show, they
would stress the risks and the importance of making sure people diagnosed with
BPD get the therapy they need for their own sake and that of their children.
16
17. Borderline Mothers
References
Barnow, S., Spitzer, C., Grabe, H. J., Kessler, C., & Freyberger, H. J. (2006).
Individual characteristics, familial experience, and psychopathology in children of
mothers with borderline personality disorder. Journal of the American Academy
of Child & Adolescent Psychiatry, 45(8), 965-972.
Conroy, S., Marks, M. N., Schacht, R., Davies, H. A., & Moran, P. (2010). The
impact of maternal depression and personality disorder on early infant care.
Social Psychiatry and Psychiatric Epidemiology, 45(3), 285-292.
Crittenden, P. M., & Newman, L. (2010). Comparing models of borderline
personality disorder: Mothers' experience, self-protective strategies, and
dispositional representations. Clinical Child Psychology and Psychiatry, 15(3),
433-451.
Herr, N. R., Hammen, C., & Brennan, P. A. (2008). Maternal borderline personality
disorder symptoms and adolescent psychosocial functioning. Journal of
Personality Disorders, 22(5), 451-465.
Hobson, R. P., Patrick, M. P. H., Hobson, J. A., Crandell, L., Bronfman, E., & Lyons-
Ruth, K. (2009). How mothers with borderline personality disorder relate to their
year-old infants. The British Journal of Psychiatry, 195(4), 325-330.
17
18. Borderline Mothers
Hobson, R. P., Patrick, M., Crandell, L., Garcia-Perez, R., & Lee, A. (2006).
Personal relatedness and attachment in infants of mothers with borderline
personality disorder. Development and Psychopathology, 17(2), 329-347.
Macfie, J., & Swan, S. A. (2009). Representations of the caregiver-child relationship
and of the self, and emotion regulation in the narratives of young children whose
mothers have borderline personality disorder. Development and
Psychopathology, 21(3), 993-1011.
Newman, L. K., Stevenson, C. S., Bergman, L. R., & Boyce, P. (2007). Borderline
personality disorder, mother-infant interaction and parenting perceptions:
Preliminary findings. Australian and New Zealand Journal of Psychiatry, 41(7),
598-605.
Newman, L., & Stevenson, C. (2005). Parenting and borderline personality disorder:
Ghosts in the nursery. Clinical Child Psychology and Psychiatry, 10(3), 385-394.
Newman, L., & Stevenson, C. (2008). Issues in infant-parent psychotherapy for
mothers with borderline personality disorder. Clinical Child Psychology and
Psychiatry, 13(4), 505-514.
18
20. Complex PTSD
Abstract
Complex PTSD is indeed a complex diagnosis encompassing years of
childhood abuse. In many ways it is similar to borderline personality disorder.
This study compares the use of forgiveness therapy and Dialectical Behavior
Therapy as a treatment for complex PTSD. The participants are 45 women who
have been diagnosed with complex PTSD and were referred by clinicians. They
were randomly assigned in groups of 15 to either an intervention or a control
group. Projected results are that DBT is the more effective therapy.
Literature Review
At this time, post-traumatic stress disorder is a popular topic in the world of
psychological research. It has been recognized that PTSD comes in more than
one form. The most familiar form is that suffered by war veterans. However,
there is another, very insidious form of PTSD that is difficult to treat. This type is
called ―complex PTSD‖ and results from prolonged abuse such as one would
suffer from being prisoner of war, or suffering chronic domestic abuse or child
abuse (U.S. Department of Veterans Affairs, 2010). A leading researcher in the
field of child abuse and trauma, Bessel van der Kolk calls this condition
20
21. Complex PTSD
―developmental trauma disorder‖ (Van der Kolk, 2005), and its symptoms closely
resemble those of borderline personality disorder.
The current study focuses on victims of chronic abuse during childhood.
Treatments for PTSD are numerous, and some have proven to have limited
therapeutic effects on subjects suffering from complex PTSD. However, a
definitive treatment for complex PTSD is more problematic because of the long-
standing and persistent difficulties suffered by victims of chronic childhood
abuse. This study will compare the short-term efficacy of forgiveness therapy
and Dialectical Behavior Therapy for subjects with a history of chronic child
abuse, with the hypothesis that DBT is the more effective of the two.
―Forgiveness is believed to be a mechanism through which individuals can
experience increases in hope and positive emotions and relief from negative
emotions, cognitions, and behaviors‖ (Lundahl, Taylor, Stevenson, & Roberts,
2008, p. 465). In forgiveness therapy, the subject mentally revisits instances of
abuse, discusses how unfair the treatment was, grieves for losses caused by the
abuse, and rebuilds a positive attitude toward the abuser in the interest of
―finding meaning‖ in the experience (Reed & Enright, 2006, p. 921). The meta-
analysis published by Lundahl et al. analyzed results from 17 studies of
forgiveness therapy in which other therapeutic techniques were used as a
21
22. Complex PTSD
source of comparison. In all of these studies, the results showed that
forgiveness therapy was more effective for the populations studied. However,
the authors stated that the results were not ―uniform‖ and appeared to be
―influenced by participant characteristics and program characteristics ― (Lundahl,
Taylor, Stevenson, & Roberts, 2008, p. 476).
A study conducted by Reed and Enright (2006) compared forgiveness
therapy to an ―alternative therapy‖ which included practicing anger validation,
assertiveness, and building interpersonal communication skills. The subjects
were women who had suffered emotional abuse from their husbands.
Participants were given the Enright Forgiveness Inventory before and after
treatment (Reed & Enright, 2006, p.922). There was more improvement in
forgiveness therapy participants than in those who received alternative therapy.
The conclusion was that forgiveness therapy is effective in treating women who
had suffered emotional abuse from a partner but were out of the relationship at
the time of the study. Because this type of abuse can be chronic and long-term,
there is a possibility that forgiveness therapy might be effective in cases of
chronic child abuse, also.
22
23. Complex PTSD
In contrast, Dialectical Behavior Therapy focuses on current issues and
difficulties. While not discounting past experience, there is no revisiting of the
past, grieving for losses, or trying to frame the abuser in a new light. Giving
meaning to suffering is less of an issue than just the acceptance that the
suffering happened and moving forward with new skills. These include learning
how to tolerate distress and practicing mindfulness in order to avoid mentally
reliving instances of abuse (Lynch, Chapman, Rosenthal, Kuo, & Linehan,
2006). Although DBT was originally used to treat people with borderline
personality disorder, the techniques are being used to treat diverse disorders. A
research study performed in 2007 indicated that DBT was indeed useful in the
treatment of problems associated with complex PTSD (Wagner, Rizvi, &
Harned, 2007, p. 399). The reasoning for performing this study was that over
75% of people diagnosed with borderline personality disorder self-report
childhood abuse (Wagner, Rizvi, & Harned, 2007, p. 392), and many of the
symptoms of borderline personality disorder are the same as those of complex
PTSD. These include the inability to regulate emotions, chronic fear of
abandonment which results in distrust of others or excessive clinging to others,
risk-taking behavior, and feelings of worthlessness or powerlessness (Tyrka,
Wyche, Kelly, Lawrence, & Carpenter, 2009, p. 286). Because of the multiple
23
24. Complex PTSD
facets of complex PTSD, the Wagner, Rizvi, and Harned study (2007) stated
that it is not clear whether DBT is a definitive treatment for complex PTSD.
Forgiveness therapy is attracting attention in certain areas, and it has shown
to be effective in some populations who have suffered abuse. However, on light
of the similarities between borderline personality disorder and complex PTSD,
the possibility that DBT is a more effective treatment of complex PTSD than
forgiveness therapy exists. Some propose that borderline personality disorder is
actually a trauma disorder (Wagner, Rizvi, & Harned, 2007, p. 392), although the
compilers of the DSM-IV do not recognize it as such. In comparing some of the
techniques of each type of therapy, the current study is an attempt to shed light
on some of the principles which might be helpful in the treatment of complex
PTSD.
Participants
The participants of this study are 45 women who have been diagnosed with
complex PTSD resulting from childhood trauma. The women are all over the age
of 25 and are living away from the source of their trauma. The population was
chosen from clinician referrals. Populations that have been excluded are men,
those with PTSD from combat, practicing drug and alcohol addicts, those who
24
25. Complex PTSD
have suffered trauma in adulthood only, and those suffering from other disorders
which include hallucinations. Of the 45 women, 30 are Caucasian, 6 are African-
American, 7 are Hispanic, and 2 are of other ethnicity. These figures were
derived from percentages of the overall population of the United States
(Population Reference, 2011). 39 of the women are between the ages of 25 and
64, and the remaining 6 women are over the age of 64.
Instruments
The Global Assessment of Functioning (GAF) (The Washington Institute) will
be administered to all participants before and after intervention. The GAF is a
100 point scale which determines levels of psychological, social, and
occupational functioning. It helps determine how much a person’s disorder
affects functioning day to day.
The Enright Forgiveness Inventory (Reed & Enright, 2006, p. 922) will be
administered to participants at the beginning and end of intervention. This
inventory indicates where a participant is in the process of forgiving the
perpetrator of abuse.
25
26. Complex PTSD
The PTSD Checklist (PCL) (Wagner, Rizvi, & Harned, 2007, p. 396) will be
administered to all participants before intervention. The civilian form of this
checklist (PCL-C) is useful in determining if PTSD actually is present, and can
be used on ―any population‖ (U.S. Department of Veterans Affairs, 2010).
Procedure
The participants will be randomly assigned to 3 groups, each consisting of
15 participants. The control group will receive no intervention. The other two
groups will participate in twice weekly group therapy sessions lasting 2 hours for
a period of 6 weeks. One group will participate in forgiveness therapy, and the
other group will participate in Dialectical Behavior Therapy. Both intervention
groups will be led by qualified licensed therapists. Those who participate in
forgiveness therapy will focus on the elements of reviewing abuse, grieving for
the losses which came from the abuse, and establishing a new viewpoint of the
abuser. Those who participate in DBT will focus on accepting the fact of the
abuse, mindfulness exercises, and building skills to move forward. At the end of
the six week period, all groups will be retested on the Enright Forgiveness
Inventory and the Global Assessment of Functioning to determine the amount of
progress made from the interventions.
26
27. Complex PTSD
Results
The first statistical test which will be given will be the civilian form of the
PTSD Checklist (PCL-C) (Wagner, Rizvi, & Harned, 2007, p. 396). This will
determine whether all participants meet the criteria for PTSD. Although they are
all being treated for complex PTSD, this checklist will establish a criterion upon
which their being used for the research is based. This test is a ―17-item self-
report‖ (U.S. Department of Veterans Affairs, 2010) with 5 possible answers to
each item. Each answer carries a score of 1-5. Therefore possible scores on this
test range from 17-85. It is broken into three categories: B questions (1-5), C
questions (6-12) and D questions (13-17). In order to show that the scores are
significant for a diagnosis, 1 B question, 3 C questions, and 2 D questions must
be rated in the category of ―moderately‖ or above (U.S. Department of Veterans
Affairs, 2010). Only participants who meet this criterion will participate in the
study. The second test will be the Enright Forgiveness Inventory (EFI) (Reed &
Enright, 2006, p. 922). This is a 60- item self report with questions involving 6
areas of forgiveness (Reed & Enright, 2006, p. 922). Scores range from 60 to
360 with the high scores indicating ―high levels of forgiveness‖ (Reed & Enright,
2006, p. 922). This inventory will be given before and after intervention. The
third test will be the Global Assessment of Functioning (GAF) ( (The Washington
Institute). This is a 100 point scale with higher scores indicating higher levels of
27
28. Complex PTSD
global functioning. This will also be administered before and after intervention. In
order to determine the statistical significance of the EFI and the GAF by t-test, I
would determine standard deviation from individual test scores. Then I would
square these scores to find the variance. I would then divide the variance by the
number of test scores minus 1 (in this case 44). Then I would add these results
and take the square root of that result in order to find the value of t. For the
difference in test scores to be statistically significant, they would have to exceed
the value of t. To compare the two intervention groups’ scores, I would look at
the difference in statistical significance on each instrument.
Discussion
I expect that the results of this study will show gains for both groups
receiving intervention in the areas of forgiveness and global functioning. I think
the group receiving the forgiveness therapy will score higher on the Enright
Forgiveness Inventory (EFI) (Reed & Enright, 2006, p. 922) than the group
receiving Dialectical Behavior Therapy. I would also expect the group receiving
DBT to score higher on the Global Assessment of Functioning (GAF) (The
Washington Institute). I think the difference in scores on the GAF will be much
28
29. Complex PTSD
more statistically significant than the scores on the EFI. In this case, it would
appear that better coping skills, higher self-esteem, acceptance, and
mindfulness as exemplified in DBT carry their own implications for forgiveness
without having to review and grieve over the instances of abuse or trying to find
meaning in suffering as espoused by forgiveness therapy. There are areas
where the two therapies overlap. However, I think that focusing on the present
and moving on with the future rather than focusing on the abuse and trying to
find meaning in it would be shown to cause better global functioning in the
participants.
Two areas which could affect internal validity that are of particular concern
are hypothesis guessing (Argosy, 2011, p. 1) and attrition (Argosy, 2011, p.2).
The therapies could give enough information to the participants for them to be
able to answer questions in the final testing stage in a way they think is
expected rather than answering honestly. In other words, the participants may
have guessed what gains they were expected to make from having the
interventions. This indicates that one flaw in my design is that reports of skills
demonstrated during therapy need to be obtained from the therapists involved in
giving the interventions. With these reports, it can be shown what skills the
participants have actually incorporated rather than those they ―think‖ they were
29
30. Complex PTSD
expected to learn. Attrition is a concern because both of the therapies involve
practicing tasks that participants may find unpleasant or uncomfortable. Having
to review instances of abuse may be more than some of them can handle,
causing them to drop out of forgiveness therapy. Having to try to accept what
has happened to them and realize it cannot be changed or undone might be too
difficult for some of the participants in DBT to deal with. Either intervention could
have a high attrition rate. One confounding variable might be if the participants
are still in therapy with outside therapists during the time of the experiment. If
this were the case, it would be impossible to determine if gains were made using
the interventions or in the other therapy. Therefore, I should require that the
participants not take part in any other therapy during the time of the experiment.
This study could only be generalized to the female population of those with
complex PTSD who are in therapy. This has implications for the external validity
of the research. However, if the findings were significant enough, the study
might lead to research with larger, more diverse populations.
If the findings were as I expected them to be, this could begin a
breakthrough in the treatment of complex PTSD. Since so many of the
symptoms are the same as borderline personality disorder, Dialectical Behavior
Therapy might be the way to go in treating complex PTSD. Unlike other forms of
30
31. Complex PTSD
PTSD, this disorder is not the result of a single trauma. Therefore, it is to be
expected that the treatment would be more intensive and lengthy in this type of
PTSD. There are several areas for future research such as whether forgiveness
is really necessary in order to move past chronic abuse. Also, there might be
renewed interest in determining whether borderline personality disorder is
indeed a trauma-related disorder. Much of the therapy involved in treating PTSD
at this time involves desensitization to triggering events through repeated
exposure. However, many people with complex PTSD have already blocked off
their emotions to such a degree that this may not be the optimal treatment.
There might also be research done on whether the techniques used in
forgiveness therapy actually retard rather than aid the healing process in abuse
survivors.
31
32. Complex PTSD
References
Lundahl, B. W., Taylor, M. J., Stevenson, R., & Roberts, K. D. (2008). Process-based
forgiveness interventions: A meta-analytic review. Research on Social Work Practice, 18(5),
465-478.
Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., & Linehan, M. M. (2006).
Mechanisms of change in dialectical behavior therapy: Theoretical and empirical
observations. Journal of Clinical Psychology, 62(4), 459-480.
Population Reference Bureau. (2011). Population Characteristics. In Data by geography> United
States> Summary (Population statistics). Retrieved from
http://www.prb.org/Datafinder/Geography/Summary.aspx?region=72®ion_type=3
Reed, G. L., & Enright, R. D. (2006). The effects of forgiveness therapy on depression, anxiety,
and posttraumatic stress for women after spousal emotional abuse. Journal of Consulting
and Clinical Psychology, 74(5), 920-929.
Tyrka, A. R., Wyche, M. C., Kelly, M. M., Lawrence, H. P., & Carpenter, L. L. (2009). Childhood
maltreatment and adult personality disorder symptoms: Influence of maltreatment type.
Psychiatry Research, 165(3), 281-287.
U.S. Department of Veterans Affairs. (2010). How does short-term trauma differ from chronic
trauma? In Complex PTSD (Symptoms). Retrieved from
http://www.ptsd.va.gov/professional/pages/complex-ptsd.asp
32
33. Complex PTSD
Van der Kolk, B. A. (2005). Developmental Trauma Disorder. Psychiatric Annals, 35(5),
Psychology Module, 401.
Wagner, A. W., Rizvi, S. L., & Harned, M. S. (2007). Applications of dialectical behavior therapy
to the treatment of complex trauma-related problems. Journal of Traumatic Stress, 20(4),
391-400.
The Washington Institute. (n.d.). Global Assessment of Functioning (GAF)Scale. In On-Line
Training and Assessment (Description of GAF). Retrieved from
http://depts.washington.edu/washinst/Resources/CGAS/GAF%20Index.htm
33
34. Communication Skills: Oral and Written
Attachment and Parenting Styles as
Precursors of Borderline Personality
Disorder
Margaret Cronk
Argosy University
August 18, 2010
34
35. Attachment and Parenting Styles
Abstract
The purpose of this literature review is to provide insight into the possible
connection between childhood attachment patterns, parenting styles, and the
development of Borderline Personality Disorder in adolescence or adulthood.
Included are criteria for the comparisons, physical findings, results of studies on
attachment patterns, and anecdotal information concerning parenting styles.
Implications of the review are that insecure attachment in infancy and
authoritarian, abusive, invalidating, or neglectful parenting can put children at
higher risk for developing BPD.
Introduction
The unprecedented success of Marsha Linehan’s Dialectical Behavior
Therapy in treating Borderline Personality Disorder (BPD) has brought this
disorder to the forefront of research since the early 1990’s. Once thought to be
virtually ―untreatable‖ (Gunderson, 2009), BPD is beginning to lose this label and
some of the stigma which has been attached to the disorder due to the
groundbreaking efforts of Linehan and others in the field of Cognitive/Behavioral
Therapy. However, while much research has been done in the analysis of the
symptoms and possible causes of BPD, information concerning preventive
35
36. Attachment and Parenting Styles
measures for this disorder has only become prevalent since 2000. Further
research into the causes of BPD needs to be addressed, and dissemination of
information to the general public concerning the inherent risks of dysfunctional
attachment patterns and parenting styles is vital in breaking the chain of abuse
and ―poisonous pedagogy‖ (Miller, 1983/2002) which has existed for
generations. To stress the importance of such measures, the statistics
concerning BPD are that it exists in as much as 5.9% of the general population
(Grant et al., 2009), 69%-80% of those with BPD attempt suicide or have
parasuicidal behavior and ideation ( Linehan et al., 2006), and approximately 9%
succeed in committing suicide (Linehan et al., 2006). Self reports have indicated
that up to 70% of those with BPD have been physically or sexually abused
during childhood, and there is a comorbidity rate of 30% between BPD and
PTSD ( post-traumatic stress disorder) (Gunderson, May, 2009). This paper will
focus on the role of caregiver attachment and parenting styles, including what
Linehan calls the ―invalidating environment‖(Linehan, 1993) which includes
trauma and abuse, in order to show a connection between them and
development of BPD in adolescence or adulthood.
36
37. Attachment and Parenting Styles
History
In 1978, Mary Ainsworth published her research findings on what was called
―the strange situation‖ (Ainsworth, Waters, & Wall, 1978). This study was done
to assess differences in infant attachment patterns which were then put into the
categories of ―securely attached‖, ―insecure avoidant‖, ―insecure resistant‖, and
―insecure disorganized‖ (Ainsworth, Waters, & Wall, 1978). Ainsworth’s
assumption was that attachment patterns in infancy would affect psychological
development later in life. Although there are claims that this study had some
culture bias (Santrock, 2009), Ainsworth’s categories will be used for the
purpose of the literature review.
In his widely acclaimed work, A Secure Base: Clinical Applications of
Attachment Theory (1988), John Bowlby stated, ―All of us, from the cradle to the
grave, are happiest when life is organised [sic] as a series of excursions, long or
short, from the secure base provided by our attachment figures.‖ The
implications of his work were that secure attachments formed in childhood were
the basis of life-long social competence and happiness, and that insecure
attachment patterns had consequences in relationships and sense of self in
adulthood (Bowlby, 1988/2005). For the purpose of this review, Bowlby’s work
as well as Erik Erikson’s stages will support the importance of attachment and
―trust vs. mistrust‖ (Jenks, 2005).
37
38. Attachment and Parenting Styles
The focus of attachment and parenting on BPD will address the following BPD
symptoms: problems often seen in those with BPD:
Difficulty regulating emotions
Lack of a stable sense of self
Feelings of emptiness
Relationship difficulties
Physical Implications
One of the most persuasive issues in the argument for the connection
between BPD and attachment/parenting styles is the physical evidence found
through neuroimaging of the brain. This type of research has found that some
structures in the brain are involved in the development of the sense of self,
emotion regulation, development of empathy , and what Peter Fonagy (2007)
calls mentalization which is the ability to understand or ―mentalize‖ oneself and
others through behavior (Fonagy, Gergely, & Target, 2007). These structures
include the anterior cingluate cortex, prefrontal cortex, superior parietal lobe,
hippocampus, and amygdala. Further, affection appears to activate reward
centers in the anterior hypothalamus which are important in the forming of
38
39. Attachment and Parenting Styles
attachments and in emotion regulation (Fonagy et al., 2007). Insecure
attachment is also linked to overactivation of areas of the amygdala which have
to do with fear of losing or being able to trust a caregiver (Fonagy et al., 2007).
Many of these same brain areas continue to develop after birth, and healthy
development depends on interaction with caregivers (Santrock, 2009). Fonagy
(2007) also touched on the research showing that trauma, neglect, and lack of
stimulation can affect the expression of genes and the development of brain
structures.
In 2003, a study of brain structures through neuroimaging was conducted
to determine anatomical differences in the brains of female test subjects
diagnosed with BPD from those of a control group. It was found that the women
with BPD had a 6.2% smaller frontal lobe volume (Johnson, Hurley, Benkelfat,
Herpertz, & Taber, 2003). Johnson cited a study of activity in different parts of
the brain when the subjects were introduced to slides showing ―aversive or
neutral scenes‖ (Johnson et al., 2003). In this study, there was more of an
increase in the activity of the amygdala and anterior cingulate regions of the
brain in those with BPD than in the control group. In addition, the article cited a
study in which the volumes of the hippocampus and amygdala of those with
BPD had been measured, and there was a 16% decrease in the hippocampal
volume and an 8% decrease in the volume of the amygdala (Johnson et al.,
2003).
39
40. Attachment and Parenting Styles
The main implication in comparing the Fonagy and Johnson articles is that the
particular areas of the brain involving emotion regulation and social bonding are
the same areas in which those with BPD have abnormalities. While this may be
accounted for to an extent by genetic vulnerability, the knowledge that
experiences do affect the healthy development of the brain and the expression
of genetic traits leads to a conclusion that experience may play as large a role in
the development of BPD as does genetics.
Attachment Patterns
Human infants are born with certain instincts which enhance their changes
of survival. Crying is one of the most important of these because it allows the
infant to signal to caregivers when there is discomfort, hunger, or fear in the
infant’s environment. When a caregiver is responsive to the cries of the child
and supplies what is needed to comfort and insure the safety and health of the
child, a bond is formed between the child and the caregiver. This is the stage
which Erikson calls ―trust vs. mistrust‖ (Jenks, 2005). When there is consistent
and responsive care given to the child, it is possible to develop trust in the
caregiver and the environment. This produces what Ainsworth has called
―secure attachment‖ (Ainsworth, Waters, & Wall, 1978). The child learns that
40
41. Attachment and Parenting Styles
he/she can make an impact on the environment, which gives him/her the belief
that the world is a safe, secure, nurturing place to live. Children with secure
attachment patterns have a positive outlook on life, are more adaptable to life’s
changes, and regulate emotions and behaviors well (Jorgensen, 2006).
However, when caregivers are inconsistent, negligent, invalidating, or punitive in
responding to a child’s needs, secure attachment is not produced, and the child
can have problems developing a sense of his/her own self-worth and efficacy,
internalizing emotion regulation learned from consistent ―attachment-figure
availability‖ (Mikulincer, Shaver, & Pereg, 2003), and is suspicious or confused
as to the probability that the environment will meet his/her needs. In order to get
his/her needs met, a child with an insecure attachment pattern develops what
Mikulincer et al. (2003) describes as ―hyperactivating‖ or ―deactivating‖
strategies to compensate for the lack of secure attachment. The hyperactivating
strategy coincides with Ainsworth’s ―insecure resistant‖, or anxious attachment
in that children who use these strategies often step up behavior in order to gain
the caregiver’s attention. These behaviors include clinginess and then fighting
against the caregiver when attention is given. Deactivating strategies coincide
with Ainsworth’s ―insecure avoidant‖ attachment in which a child avoids contact
with the caregiver due to fear of punishment or consistently frustrating
interactions with the caregiver (Mikulincer et al., 2003). In cases where there is
41
42. Attachment and Parenting Styles
no intervention to improve the attachment process, the survival strategies
formed in infancy and early childhood can be repeated with any potential
attachment figure over the life-span.
In those who have BPD, the same sorts of insecure attachment patterns can
be seen in their adult attachments. People with BPD are ―anxious‖ in that they
constantly fear abandonment (American Psychiatric Association, 2000), and that
they use clinging and controlling strategies to make sure partners stay with
them. They are ―insecure resistant‖ (Ainsworth, et al., 1978) in that they fluctuate
between thinking a potential attachment figure is perfect, or totally bad, and tend
to swing between pushing people away and clinging to them. This coincides with
the DSM diagnostic criterion for BPD which says that those with BPD tend to
either ―idealize‖ or ―devalue‖ their attachment figures (American Psychiatric
Association, 2000).
Research has shown two differing opinions on the type of attachment issues
people with BPD face. One study performed in 2004 closely linked BPD with the
anxious, or ―fearful‖, attachment style (Meyer, Pilkonis, & Beevers, 2004).
However, this study included only testing of responses to pictures of faces and
the subjects’ interpretation of those faces in terms of emotions. Other studies
have proposed that BPD is more closely associated with ―insecure disorganized‖
(Ainsworth, Waters, & Wall, 1978) attachment (Lyddon & Sherry, 2001). Lyddon
42
43. Attachment and Parenting Styles
and Sherry stated that "individuals with a borderline personality style exhibit a
unique, unstable, and dynamic personality structure that tends to shift among
the various insecure attachment dimensions, creating a disorganized profile‖. In
support of this theory, Agrawal et al. cited a study done by Karlen Lyons-Ruth in
which a correlation was found between the ―disorganized/disoriented‖
attachment styles and the ―fearful/avoidant‖ styles exhibited by adults with BPD
(Agrawal, Gunderson, Holmes, & Lyons-Ruth, 2004). Regardless of the type of
insecure attachment involved, it appears that a majority of those with BPD have
had attachment difficulties. In a study cited by Agrawal et al. (2004), 93% of test
subjects self-reported insecure attachments in childhood.
There is also research to support the fact that symptoms of BPD begin in
childhood for many who suffer from the disorder. A study conducted in 2004
showed that, in a sample of 9 to 19 year-olds, the prevalence of BPD was 11%
(Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004). According to Lieb et al.
(2004) ―research suggests that borderline personality disorder, or at least some
of its symptoms, begins in the late latency period of childhood‖. This is a clear
indication that certain causes of or triggers for the disorder appear in early
childhood, leading to the conclusion that insecure attachment may be that cause
or trigger.
43
44. Attachment and Parenting Styles
Comparing the articles on attachment styles and BPD, the prevailing results
seem to be that the overwhelming majority of those with BPD test and self-report
as having had insecure attachments in childhood. While there are detractors of
this notion who say that the correlations found were too small to be statistically
significant (Levy, 2005), the majority of the literature found supports the idea
that people with BPD form insecure attachments in early childhood which carry
over into their adult interactions.
Parenting Styles
Marsha Linehan (1993) suggested that BPD is, in part, caused by what she
termed the ―invalidating environment‖ in which some children grow up (Linehan,
1993). Invalidation encompasses many issues such as emotional, physical, and
sexual abuse; treating the child as if his/her thoughts or feelings are unimportant
or irrelevant; inconsistency in parenting; and high emotional reactivity within the
home environment. Because the important qualities needed to build a strong
sense of self such as ―emotional consistency and predictability, over time and
similar situations‖ (Linehan, 1993) are not present, the child fails to develop the
sense of self and the emotional regulation required to succeed in future
44
45. Attachment and Parenting Styles
interactions. The child begins to doubt his/her own perceptions of him/herself
and of the environment. When this happens, healthy ego integrity is in jeopardy.
This can lead to developing symptoms which coincide with the DSM criteria for
BPD which have to do with having ―identity disturbance: markedly and
persistently unstable self-image or sense of self‖ and ―affective instability due to
a marked reactivity of mood‖ (American Psychiatric Association, 2000).
Peter Fonagy (2008) reported some startling evidence concerning abuse
and trauma in childhood. It was found that, while trauma and abuse had
profound impact on a child, the family’s role in mediating and dealing with the
trauma or abuse held more implications for development of BPD (Fonagy &
Bateman, 2008). When the family invalidates the child’s experience of trauma or
abuse by acting as if it never happened or belittling the child’s perceptions, there
can be dire consequences in the child’s sense of self and trust in his/her own
view of reality. One study cited by Fonagy and Bateman (2008) reported that
84% of test subjects ―reported biparental neglect and abuse with emotional
denial‖, or, in other words, complete disregarding of a child’s role in family
interactions. Fonagy’s article went on to state that there were many reports of
instances in which parents were over-involved with each other and under-
involved with the child (Fonagy & Bateman, 2008). This leads to speculation
about the consequences for children of growing up in a codependent
environment.
45
46. Attachment and Parenting Styles
Alice Miller (1983, 2002) proposed that not only did individual parenting
styles have an effect on the continued emotional health of children, but that the
parenting styles accepted by society can have an equal effect. She termed
society’s accepted norms for parenting as ―poisonous pedagogy‖ (Miller,
1983/2002). Her theory was that accepted practices which were targeted at the
convenience of the parents or the expectations of society rather than the welfare
of the child could cause psychological problems throughout the life-span.
Among these practices are physical punishment, which Miller considers abuse,
and authoritarian parenting, in which a child is expected to obey the parent
under any circumstances. Miller drew an analogy with the accepted parenting
style in Germany during the early part of the 20th century. Because the accepted
style of the day was very patriarchal and authoritarian, the Germans were
brought up being told what to do, when, and how to do it (Miller, 1983/2002).
Therefore, when Hitler rose to power, he had an easy mark in that the German
people were looking for a strong father figure to tell them what to do. Although
this analogy seems a bit extreme, if one looks at how many atrocities were
committed because orders came from authority figures, it is certainly plausible.
The implications here are that the people could not make their own decisions
and break out of the pattern in which they were raised. For a child raised in an
authoritarian, abusive environment, the consequences are conceivably the
same. The child might not be able to live autonomously without someone
46
47. Attachment and Parenting Styles
determining what he/she should do and, in effect, creating an identity for
him/her. People with BPD notoriously seek an identity through their connections
with others, desperately seek partners, and experience feelings of emptiness
when not in the company of those who supply an identity for them. Thomas
Fuchs (2007) states that, ―in fact, their personality often changes dramatically
depending on who they are with. They seem to adopt different identities at
different times‖ (Fuchs, 2007). This indicates problems with individuation or the
knowledge and acceptance of oneself as separate from significant others which
should have been established in early childhood.
Less than 3 generations ago, parents were admonished never to pick up a
baby when it was not being fed for fear of ―spoiling‖ the child (Richards, 1974).
Pamphlets on child-rearing distributed during the late 1920’s and 1930’s
advocated never kissing, hugging, or holding a child on the lap, keeping a baby
on a strict feeding schedule (even waking the child to feed), and using spanking
or other aversive techniques to ―train‖ a child (Richards, 1974). Many adhered to
these rules, and because people tend to parent the way they were parented,
some of these practices are still in evidence today. In this manner, ―poisonous
pedagogy‖ (Miller, 1983/2002) is passed from generation to generation unless
parents become aware of the damaging consequences of their parenting styles
and make a change. It is easy to see why a child raised in the ways mentioned
could have psychological problems throughout life.
47
48. Attachment and Parenting Styles
Comparing the three sources of information above, it is evident that some
parenting styles may lead to insecure attachments in early childhood. ―It is a
prerequisite for the normal individuation process and development of identity
that others of significance respect, recognize and validate the young person's
developing individuality and identity‖ (Jorgensen, 2006). Therefore, any
parenting technique which is overly controlling, punitive, neglectful, inconsistent,
abusive, or discounts a child’s feelings and need for independence interferes
with the healthy development of attachments and psychological functioning.
Conclusion
Social interaction in infancy and early childhood, especially those
interactions with primary attachment figures, sets the stage for ego
development, emotion regulation, and social functioning over the lifetime. When
these interactions are repeatedly unhealthy or dysfunctional, a child fails to
develop ego integrity, internalize a healthy model for self-care, self-soothing,
emotion regulation, and effective ways of interacting with others. It has been
shown that secure attachment can positively affect the developing brain and the
expression and interaction of genes, while insecure attachment can interrupt or
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49. Attachment and Parenting Styles
―short-circuit‖ this development. More research needs to be done in order to
support the idea that these elements cause or trigger BPD. This can be
problematic due to the fact that longitudinal studies of children with insecure
attachment cannot be performed as this would involve leaving a child in an
unhealthy situation. However, it is clear that insecure attachment patterns in
childhood and dysfunctional parenting can produce specific difficulties in social
functioning as an adult, and that these are expressed in ways which meet some
of the criteria for BPD. It is also evident that these elements can produce
psychological difficulties, no matter how these are diagnosed.
49
50. Attachment and Parenting Styles
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(2), 94-104.
Ainsworth, M. D. S., Waters, E., & Wall, S. (1978). Patterns of attachment: A- psychological
study of the strange situation. Hillsdale, N.J: Lawrence Erlbaum Associates, Inc.
American Psychiatric Association. (2000). Borderline personality disorder. Diagnostic and
statistical manual of mental disorders (IV ed.)
Bowlby, J. (2005). A secure base: clinical applications of attachment theory (Rev. ed.). New
York: Routledge. (Original work published 1988)
Fonagy, P. & Bateman, A. (2008). The development of borderline personality disorder—A
mentalizing model. Journal of Personality Disorders, 22(1), 4-21
Fonagy, P., Gergely, G., & Target, M. (2007). The parent–infant dyad and the construction of the
subjective self. Journal of Child Psychology and Psychiatry, 48(3/4), 288-328.
Fuchs, T. (2007). Fragmented selves: Temporality and identity in borderline personality
disorder. Psychopathology, 40(6), 379-387.
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M.,
... Ruan, W. J. (2009). Prevalence, correlates, disability, and comorbidity of DSM-IV
borderline personality disorder: Results from the Wave 2 national epidemiologic survey on
alcohol and related conditions. Journal of Clinical Psychiatry, 69(4), 533-545.
Gunderson, J. G. (May, 2009). Borderline personality disorder: Ontogeny of a diagnosis. The
American Journal of Psychiatry, 166, 530-539.
50
51. Attachment and Parenting Styles
Jenks, C. (Ed.). (2005). Childhood: Critical concepts in sociology. New York: Routledge.
Johnson, P. A., Hurley, R. A., Benkelfat, C., Herpertz, S. C., & Taber, K. H. (2003).
Understanding emotion regulation in borderline personality disorder: Contributions of
neuroimaging. The Journal of Neuropsychiatry and Clinical Neurosciences, 15(4), 397.
Jorgensen, C. R. (2006). Disturbed sense of identity in borderline personality disorder. Journal of
Personality Disorders, 20(6), 618-644.
Levy, K. N. (2005). The implications of attachment theory and research for understanding
borderline personality disorder. Development and Psychopathology, 17(4), 959-986.
Levy, K. N., Meehan, K. B., Weber, M., Reynoso., J., & Clarkin, J. F. (2005). Attachment and
borderline personality disorder: Implications for psychotherapy. Psychopathology 38 (2), 64-
74.
Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline
personality disorder. The Lancet, 364(9432), 453-461.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New
York: The Guilford Press.
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L., Korslund,
K.E., Tutek, D.A., Reynolds, S.K., & Lindenboim, N. (2006). Two-Year randomized
controlled trial and follow-up of Dialectical Behavior Therapy vs therapy by experts for
suicidal behaviors and borderline personality disorder. Archives of General Psychiatry,
63(7), 757-766.
Lyddon, W. J., & Sherry, A. (2001). Developmental personality styles: An attachment theory
conceptualization of personality disorders. Journal of Counseling and Development, 79(4),
405.
51
52. Attachment and Parenting Styles
Meyer, B., Pilkonis, P. A., & Beevers, C. G. (2004). What's in a (neutral) face? Personality
disorders, attachment styles, and the appraisal of ambiguous social cues. Journal of
Personality Disorders, 18(4), 320-336.
Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The
dynamics, development, and cognitive consequences of attachment related strategies.
Motivation and Emotion, 27(2), 77-0102.
Miller, A. (2002). For your own good: Hidden cruelty in child-rearing and the roots of violence
(4th ed.). New York: Farrar, Straus, and Giroux. (Original work published 1983)
Richards, M. P. M. (1974). The integration of a child into a social world. London: Cambridge
University Press.
Santrock, J. W. (2009). Life-Span development (12th ed.). New York: McGraw-Hill.
52
55. Table of Contents
1. Title 10. Physical findings
2. Company logo 11. Brain chart
3. Table of contents 12. Physical cont’d.
4. Introduction 13. Attachment patterns
5. Introduction cont’d. 14. Parenting styles
6. Focal question 15. Conclusion
7. BPD statistics 16. References
8. Statistics cont’d. 17. References cont’d
9. Importance of statistics
55
56. .
Introduction
Borderline Personality Disorder
A serious mental illness which pervades all areas of life
Once thought to be virtually “untreatable” (Gunderson, 2009)
Symptoms include problems with self-esteem, emotion
regulation and sustaining relationships
Since the early 1990’s treatment with Dialectical Behavior
Therapy has shown great promise
56
57. Introduction cont’d.
Further research into the causes of BPD needs
to be addressed, and dissemination of
information to the general public concerning
the inherent risks of dysfunctional attachment
patterns and parenting styles is vital.
57
58. Focal question:
Do parenting styles and childhood
attachment patterns contribute to the
risk of developing Borderline
Personality Disorder?
58
59. BPD Statistics
It exists in as much as 5.9% of the general
population (Grant et al., 2009)
In a sample of 9 to 19 year-olds, the prevalence of
BPD was 11% (Lieb, Zanarini, Schmahl, Linehan, & Bohus,
2004)
59
60. Statistics cont’d.
69%-80% of those with BPD attempt suicide or have
parasuicidal behavior and ideation ( Linehan et al., 2006)
Approximately 9% succeed in committing suicide (Linehan
et al., 2006)
Up to 70% of those with BPD have been physically or
sexually abused during childhood (Gunderson, 2009)
60
61. Importance of Statistics
Because of the prevalence of BPD, the high suicide
rates involved, and the possible appearance of
symptoms at an early age, attention needs to be
given to the risks of developing the disorder and
preventive measures that might lower those risks.
61
62. Literature findings
Physical:
Postnatal brain development continues into
adulthood and is strongly connected with
experience (Santrock, 2009).
Some of the structures which continue to develop
are the prefrontal cortex, the amygdala, and the
hippocampus (Fonagy, Gergely, & Target, 2007).
62
64. Findings cont’d.
Some of the same structures are identified by
neuroimaging of those with BPD as having abnormalities.
6.2% decrease in frontal lobe volume (Johnson, Hurley,
Benkelfat, Herpertz, & Taber, 2003)
16% decrease in hippocampal volume (Johnson et al., 2003)
8% decrease in volume of the amygdala (Johnson et al., 2003)
64
65. Findings cont’d.
Attachment patterns:
Studies have shown a correlation between BPD and insecure
attachment patterns (Meyer, Pilkonis, & Beevers, 2004) (Lyddon &
Sherry, 2001).
The overwhelming majority of those with BPD self-report
insecure attachments in childhood.
In one study, 93% of test subjects were found to have had insecure
attachments (Agrawal, Gunderson, Holmes, & Lyons-Ruth, 2004).
65
66. Findings cont’d.
Parenting styles:
Parenting issues found to make a possible contribution to mental illness :
Abuse
Neglect
Inconsistency
Overly controlling, punitive, authoritarian parenting
Invalidation of a child’s feelings or experiences
These styles of parenting inhibit development of the sense of self,
emotion regulation, and social functioning.
66
67. Conclusions
Although much research remains to be done on the effects
of attachment patterns and parenting styles on the
development of BPD, it appears that these two elements
can have a strong effect in the development of mental
illness. This is a call to parents to be aware of and
responsive to the needs of a child rather than their own
convenience or the expectations of society.
67
68. 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(2), 94-104.
American Health Assistance Foundation. (2010). Anatomy of the brain.
Retrieved from http://www.ahaf.org/alzheimers/about/
understanding/anatomy-of-the-brain.html
DeVito, D., Shamberg, M., Sher, S., & Dahl, L. (Producers), & DeVito, D. (Director). (1996). Matilda. United States: TriStar
Pictures
Fonagy, P., Gergely, G., & Target, M. (2007). The parent–infant dyad and the construction of the subjective self. Journal of Child
Psychology and Psychiatry, 48(3/4), 288-328.
Gibran, K. (1996). The Prophet. Hertfordshire, England: Wordsworth Editions Limited. (Original work published 1923).
Grant, B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., Smith, S. M., ... Ruan, W. J. (2009). Prevalence,
correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 national
epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(4), 533-545.
Gunderson, J. G. (May, 2009). Borderline personality disorder: Ontogeny of a diagnosis. The American Journal of Psychiatry, 166,
530-539.
Johnson, P. A., Hurley, R. A., Benkelfat, C., Herpertz, S. C., & Taber, K. H. (2003). Understanding emotion regulation in borderline
personality disorder: Contributions of neuroimaging. The Journal of Neuropsychiatry and Clinical Neurosciences, 15(4), 397.
68
69. References cont’d.
Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The
Lancet, 364(9432), 453-461.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guilford
Press.
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L., Korslund, K.E., Tutek, D.A.,
Reynolds, S.K., & Lindenboim, N. (2006). Two-Year randomized controlled trial and follow-up of Dialectical
Behavior Therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of
General Psychiatry, 63(7), 757-766.
Lyddon, W. J., & Sherry, A. (2001). Developmental personality styles: An attachment theory conceptualization of
personality disorders. Journal of Counseling and Development, 79(4), 405.
Meyer, B., Pilkonis, P. A., & Beevers, C. G. (2004). What's in a (neutral) face? Personality disorders, attachment styles, and
the appraisal of ambiguous social cues. Journal of Personality Disorders, 18(4), 320-336.
Santrock, J. W. (2009). Life-Span development (12th ed.). New York: McGraw-Hill.
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70. Foundations of Psychology
A Hypothetical Counseling
Session
Counseling Theories, Module 2,
Assignment 2
Margaret Cronk
May 19, 2010
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71. A Hypothetical Counseling Session
Because I am a firm believer in Carl Rogers’ idea of ―unconditional positive
regard‖ (Seligman, 2006, p. 171), the skills I would use when meeting a new
client would display my belief in this theory. I would present myself as warm,
friendly, open, concerned, and accepting of the client, no matter what his/her
situation. If I were successful in creating the mood for the therapy in this way, I
believe a client would be apt to return for more counseling sessions.
The initial anxieties and discomforts one would experience when meeting a
new client are not much different from meeting any new person. There is
always an initial concern about how the other person will perceive you and
whether you are communicating effectively with the person. However, there is
also the issue of being a ―counselor‖ who is seen as having expertise and
authority. I believe that I would try to put the client at ease by acknowledging
that all new encounters are uncomfortable to some degree for both parties. I
would also let the client know that I considered myself a regular person who just
happens to have training and work in this field. By acknowledging these points,
I feel that the client would be more open to sharing his/her concerns with me.
The most difficult part about informing a client about confidentiality would be
explaining the cases in which I would have to breach that confidentiality. Some
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72. A Hypothetical Counseling Session
people would see comments about being a ―risk to themselves or others‖ as an
assumption that they have these problems. I would have to be very clear that I
am not assuming that they are in such a state, but I have to inform them of their
rights and my own limitations as a counselor.
The main goal of therapy from a Psychoanalytic approach would be to create
balance among the id, ego, and superego (Seligman, 2006, p. 57). The ego
would need to be strengthened to ―mediate‖ messages from the id and superego
in order to function successfully in life. This would be achieved through the
development of healthy, mature defense mechanisms which allow the client to
view and deal with life in a realistic, flexible manner (Seligman, 2006, p. 57). In
order to do this, the therapist would initiate a relationship with the client in which
the therapist has a certain amount of ―anonymity‖ and does not interact much
with the client. The clinician would use transference in which a client attributes
to the therapist characteristics of someone in their lives and treats the therapist
as if he/she really has these attributes. Another technique is free association in
which the client says whatever comes to mind, thus leading to uncovering deep-
seated emotion. A fourth technique is abreaction in which the client recalls
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73. A Hypothetical Counseling Session
incidents and the emotions connected to them and works through those
emotions. The therapist would then analyze and interpret information the client
has uncovered and help the client to find better ways of dealing with issues
(Seligman, 2006, pp. 58-60).
The goal of Adlerian therapy would be to help a client see where their own
faulty thought processes cause problems with behaviors and attitudes. Adler’s
theory was that people caused much of their own suffering due to these faulty
ideas. The therapist would help the client to adjust his/her ideation to a more
realistic, functional process which would change his/her behaviors (Seligman,
2006, p. 76). According to Seligman (2006), the relationship the therapist would
build with the client would be one of ―shared goals, as well as mutual trust and
respect‖. This would entail much more interaction and revelation of self on the
part of the therapist than would Freudian techniques. There would be much
more focus on the present than the past in Adlerian therapy. The therapist
would assess and analyze the client’s lifestyle, ―family constellation‖, birth order,
dreams, early recollections, priorities, and behavior (Seligman, 2006, pp. 78-80).
This information would then be summarized in order for the therapist to offer
education and suggestions designed to help the client ―reorient‖ their thinking
and behaviors so that they will become more healthy and functional (Seligman,
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74. A Hypothetical Counseling Session
2006, pp. 80-81). Finally the therapist would provide reinforcement for positive
changes a client has made and continue to provide education and insights
(Seligman, p. 81).
During Freudian therapy a client is likely to recover memories that had been
long suppressed, along with the emotions connected to those memories. This
would provide an opportunity to explore how their perceptions and behaviors
might have added to the distress caused by these memories. The client would
also have an opportunity to link his/her reactions to events in their pasts with
maladaptive ways in which he/she deals with the present. There also some
comfort in the anonymity of the therapist in this type of counseling which makes
it easier for transference to occur (Seligman, 2006, p. 58). The client might feel
that he/she is indeed dealing with the people and events from the past rather
than the therapist.
I believe that Adlerian therapy can give a client a sense of empowerment.
With its focus on how people’s thought processes can cause pain and
maladaptive behaviors (Seligman, 2006, p. 76) it gives hope that these things
can be changed. The supportive, interactive relationship with the therapist can
go a long way toward giving a client the feeling that it is a collaborative effort
rather than something he or she needs to tackle alone. This type of therapy can
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75. A Hypothetical Counseling Session
help a client focus more on the present than the past, and can avoid having to
relive extremely painful memories. There is a lot of encouragement used in this
type of counseling which can help with building self-esteem in a client.
I believe that the goals of Freudian and Adlerian therapy are basically the
same. They both seem designed to produce functional, healthy, mature thought
processes and behaviors in people whose histories indicate a lack of these
traits. While Freud uses the idea of the balance of id, ego, and superego, the
quest for mental health from the perspective of understanding emotions,
thoughts and behaviors is very similar to Adler’s theories.
References:
Seligman, L. (2006), Theories of Counseling and Psychotherapy: Systems,
Strategies, and Skills, (2nd edition), Upper Saddle River, N.J.: Pearson
Education, Inc.
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76. Applied Psychology
Integration: To Mix or Match?
Margaret Cronk
Argosy University, Counseling
Theories, M8, Assessment 4
June 24, 2010
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77. Integration: To Mix or Match?
Although I am a strong supporter of using an integrated approach to therapy,
I believe that all therapists should use Carl Rogers’ client-centered therapy
(Seligman, 2009, p. 171) as a basis for setting up the initial client-therapist
relationship. I believe that empathy and unconditional positive regard
(Seligman, 2009, p. 171) are the best ways to inspire trust between the client
and the therapist and to establish a feeling of ―comradeship‖ so that the client
feels that the therapist is totally with the client in therapy and has what is best for
the client at heart at all times. My reasoning in this ties in closely with Carl
Rogers’ comment ―Experience is, for me, the highest authority. The touchstone
of validity is my own experience. No other person’s ideas, and none of my own
ideas, are as authoritative as my experience. It is to experience that I must
return again and again, to discover a closer approximation to truth as it is in the
process of becoming in me‖ (Seligman, 2009, p. 171). I have been seeing my
therapist off and on for the last 19 years. Our relationship has many facets, but
his constant unconditional positive regard and empathy has facilitated my
therapy experience in more ways than I can count. He has been, in turn,
mother, father, friend, ―boss‖, peer, team member (along with my psychiatrist
and me), role-model, and now mentor and cheerleader in my quest to become a
counselor. He has not aspired to be any of these things for himself, but his
attitude toward me has made me willing to make changes and undertake
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78. Integration: To Mix or Match?
challenges that I would not have dreamed of if I had not had the security and
trust in his attitude toward me. He has set the bar for the way I believe ALL
people should be treated (not just therapy clients), and I have been able to
integrate empathy and acceptance into almost all of my interactions with others.
A good, effective therapist is, in my opinion, one of the true ―lovers‖ in this world.
On the other hand, I believe that no therapist should staunchly follow one
theory of therapy or one set of techniques or interventions. No two clients are
the same. There is an infinite variety of presenting conditions and situations.
For a therapist to be able to help as many clients as possible, I believe he/she
should be well-versed in a variety of theories and techniques. For example, a
client dealing with the loss of a loved one may not have cognitive distortions,
dysfunctional behaviors, emotion regulation problems, or some of the other
issues addressed by the various therapies. They may simply need to
understand the stages of grief, what stage they are in, and be giving coping
mechanisms to help them get through that stage. Situational depression and
Major Depressive Disorder, while having many of the same symptoms, might
need to be addressed differently. Deep-seated, long-term difficulties need a
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79. Integration: To Mix or Match?
different treatment or approach than issues that are happening in the present
and are caused by environmental factors. If I came to a therapist for help with
environmental stress, and he/she started trying to delve into my childhood
(immediately, at any rate), I might be tempted to find another therapist!
According to Seligman (2009, p. 26) the personal and professional
characteristics of as successful counselor are as follows:
• Characterized by strong interpersonal skills, including patience, warmth, caring,
a sense of humor, and friendliness (Najavits & Weiss, 1994)
• Genuine, sincere, and authentic; able to make appropriate self-disclosures,
provide useful feedback, and acknowledge their mistakes and limitations
• Emotionally stable, mature, and responsible
• Well-adjusted and fulfilled, self-aware, with positive and realistic self-esteem,
good relationships, a sense of direction, and a rewarding lifestyle
• Able to acknowledge their mistakes and limitations
• Capable of high levels of thinking and conceptualizing
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80. Integration: To Mix or Match?
• In possession of good insight into themselves and others
• Aware of, sensitive to, and respectful of multicultural characteristics and
differences
• Engaged in and appreciative of the value of personal and professional growth
and learning
• Ethical, objective, and fair
• Flexible and open to change and new experiences, willing to take reasonable
risks
• Affirming and encouraging of others
• Clear and effective in both oral and written communication
To this I would add that they are able to separate their own needs in the
therapeutic relationship
from those of their clients.
The main advantage of practicing within the framework of one specific theory
is that the clinician does not have to develop skills and techniques involved in
other theories. He/she is able to have confidence in their knowledge of a
particular theory and the techniques involved and therefore can become a sort
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81. Integration: To Mix or Match?
of ―expert‖ in that one theory of counseling. If a client has knowledge of the
particular theory, it might give them a sense of security to know that their
therapist is trained and capable of using that theory. I do not see a great many
advantages to the client in seeing this type of therapist unless they fit the
stereotype a certain theory will fit. The disadvantages of this sort of practice are
that the clinician does not have a wide range of techniques and interventions,
and it does not allow for much flexibility in treatment. Therefore, the number of
people who will be effectively treated is limited.
There are obvious advantages to using an integrated approach to therapy,
the main one being that ―they bring flexibility to the treatment process, enabling
clinicians to tailor their work to specific clients and concerns in an effort to find a
good fit between treatment and client‖ (Seligman, 2009, p. 436). Therefore, the
diversity of those clients can be addressed and taken into consideration in
therapy (Seligman, 2009, p. 436), and the number of clients that can be
successfully treated can be increased. The disadvantages of an integrated
approach are that the clinician has to have expertise in a variety of treatment
theories and techniques (Seligman, 2009, p. 435), and that it is more difficult to
make therapy coherent and relevant (Seligman, 2009, p. 435). A therapist using
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82. Integration: To Mix or Match?
this approach would need to be able to carefully integrate theories and
techniques and make plans for therapy concerning each particular client
(Seligman, 2009, p. 435). To summarize, in my opinion, the advantages to
espousing one particular theory lie more on the side of the clinician, and the
advantages to an eclectic approach lie more on the side of the client.
If I were a therapist there are many techniques I would borrow from the
different therapeutic approaches we have studied. I see my therapeutic
approach as coming in stages. First and foremost would be Carl Rogers’ client-
centered therapy in order to set up the therapeutic alliance, and this would
continue throughout the therapy sessions. The second stage would be
immediate symptom relief techniques which would be behavioral in nature.
Mindfulness exercises (being in the moment) which also follows Carl Rogers’
goals, relaxation techniques as used in behavioral therapy, minor behavior
changes (involving homework), and focusing on the now as used in several of
the therapies we have studied. The reasoning behind using these strategies is
that I believe people can change behaviors more easily than cognitions, and that
they are perhaps more willing to change behaviors. However, this might not
apply in cases of addiction where I believe cognitive changes precede many
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83. Integration: To Mix or Match?
behavioral changes. Those cases I will leave to the angels who have more
patience and empathy than I do with addiction. I also believe that a client who
successfully uses behavioral techniques and feels relief from immediate
symptoms is more willing to stay in therapy and has trust that a therapist can
help him/her. Depending on the presenting problem, behavioral techniques and
changes might be all the client needs. Therefore, the therapy would be fairly
brief. However, for those with underlying cognitive difficulties, the behavioral
changes could make changes in their belief systems and cognitions in order to
open the path for use of cognitive/behavioral therapy as espoused by Linehan
and Meichenbaum (Seligman, 2009, p. 372). This would constitute the third
stage of my approach, if needed, and would borrow elements of narrative and
family systems therapy.
An example of how I would integrate traditional cognitive/behavioral therapy
and narrative therapy would be in a case where a client is having difficulty
seeing more than one side of a situation. I would use reframing as used in
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84. Integration: To Mix or Match?
behavioral therapy (Seligman, 2009, p. 296) in the form of asking the client to
imagine him/herself as another person in the situation and telling a story about
their viewpoint. This might help him/her ―decenter‖ (Seligman, 2009, p. 293) and
realize that there are other possible reasons, viewpoints, and elements involved
in a particular situation. Realizing this might help a client change their
perception of what has happened.
References
Seligman, L. (2009). Theories of Counseling and Psychotherapy: Systems,
Strategies, and Skills (2nd ed.). Upper Saddle River, N.J: Pearson Education,
Inc.
Najavits, L. M., & Strupp, H. H. (1994). Differences in the effectiveness of
psychodynamic
84
85. Ethics and Diversity Awareness
Sally’s Depression
Margaret Cronk
Argosy University
October 24, 2010
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86. Sally’s Depression
In responding to the psychologist’s question about Sally’s memory loss, I
would state that, in my opinion, Sally has been dissociating from her childhood
trauma. Dissociation can involve loss of memory and a sensation of ―lost time‖
(Elzinga, Phaf, Ardon, van Dyck, 2003). This may be an attempt on Sally’s part
to deny that the abuse she suffered actually occurred. Dissociation can serve
as a sort of buffer against remembering traumatic events or triggers that set off
memories of the trauma. It can been observed in people with dissociative
disorders such as Dissociative Identity Disorder, but it can also be observed in
people with PTSD (Hopper, Frewen, van der Kolk, Lanius,2007). Elzinga et al
(2003) state that people who dissociate may continue to have emotional
reactions to a trauma even without being able to remember the event. This
could account for Sally’s anxiety.
The antidepressants may not have helped Sally much because there is no
underlying neurotransmitter imbalance associated with her depression. If her
depression is purely situational, or caused by environmental factors rather than
a brain abnormality, antidepressants may lift her mood a bit, but they would not
change the environmental factors of her depression or help her to deal with
them.
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87. Sally’s Depression
The first ethical issue I would consider in giving educational and referral
services would be client confidentiality. Protection of privacy and confidentiality
are large issues in the APA code of ethics (American, 2010). Therefore any
information I would give a client regarding education or referrals about his/her
disorder would be done in a private session. This would also cover some
diversity issues because certain ethnic or cultural groups view psychological
services as a source of shame or embarrassment. In referring clients to other
services, I would be concerned with finding agencies that had experience in
dealing with the client’s specific ethnic and cultural needs. The referrals given to
a client should be as individual as the techniques one uses in therapy.
Sensitivity to diversity is essential in building a good therapist/client
relationship. Each person is different in some way from everyone else, and a
therapist needs to be able to communicate that he/she understands this and
appreciates and respects those differences. This is stated in the APA code of
ethics as ―In their work-related activities, psychologists do not engage in unfair
discrimination based on age, gender, gender identity, race, ethnicity, culture,
national origin, religion, sexual orientation, disability, socioeconomic status, or
any basis proscribed by law‖ (American, 2010). The burden of educating
him/herself on the culture of clients also falls to the therapist.
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88. Sally’s Depression
As I understand it, informed consent means that a therapist tells a client
what the therapy entails, fees, confidentiality issues, and when that
confidentiality must be broken for legal purposes. If research is the goal, the
researcher has to explain the experiment and any risks involved. (American,
2010) Also, if the therapist is in training or has a supervisor, the client must be
given the name of the person legally responsible for the therapy (American,
2010). The signing of a consent form is important protection for both the client
and the therapist. It is like a contract between them. If the therapist breaks part
of that contract, a client might sue. If a client insists that he/she was never told
about certain aspects of the therapy, the therapist has it in writing that the client
was indeed informed.
According to the American Medical Association (2010), the ethics of
confidentiality are much the same as the APA’s. Patient information is not
supposed to be shared unless there is express consent from the patient.
Circumstances under which you can release information about hospital
patients to someone else are if there is signed consent by the patient to reveal
that information or if the patient is deemed to be a threat to him/herself or
someone else (American, 2010). Information can also be shared if there is
abuse involved in the case, either directed toward the patient or perpetrated by
the patient (American, 2010).
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Editor's Notes
Until the early 1990’s BPD was considered untreatable. People with this diagnosis often have other mental illnesses such as depression or substance abuse. Some therapists would refuse to treat those with BPD, finding them “difficult” clients with little prospect for improvement. In recent years, an effective therapy has been found in Dr. Marsha Linehan’s Dialectical Behavior Therapy. Far from being “untreatable”, many who suffer from BPD are living healthy, fulfilling lives.
Although much research has been done on the symptoms and possible contributing factors to BPD, risk factors have only become an important research topic since 2000. Findings indicate that one’s environment can contribute to the symptoms of BPD. Two of the risk factors that are being discussed are childhood attachment and parenting styles.
Do parenting styles and childhood attachment patterns contribute to the risk of developing Borderline Personality Disorder? The aim of this presentation is to show how this might be possible and to alert parents to the risks they may be able to minimize.
BPD exists in as much as 5.9% of the general population. While this figure seems small, when looking at the percentage of people with BPD in mental hospitals, the numbers are much greater. Of those diagnosed with personality disorders, 33% of outpatients and 63% of inpatients have BPD (Linehan, 1993). The prevalence of this disorder and the young age at which symptoms may appear clearly indicates the importance of research into treatment and minimizing risk.
The suicide rates for those with BPD are almost 9 times as high as those in the general population. Although physical and sexual abuse are not diagnostic criteria for BPD, a majority of those with the disorder have experienced such abuse. Note that this statistic does not include other forms of abuse such as emotional, verbal, and psychological abuse often suffered in childhood by people who develop BPD.
Research has shown that BPD is a major mental health issue. Because many people who have the disorder experience repeated hospitalizations, it is also a major financial drain. It is important to treat this disorder to lower or completely erase the need for hospital care.
The prefrontal cortex, amygdala, and hippocampus continue to develop after birth. These are involved in the development of a sense of self, emotion regulation, and empathy for others. Healthy development of these parts of the brain is strongly influenced by the relationship of a child to his/her primary caregiver. Brain development depends on learning from the behavior of others.
The areas involved have to do with the very basic formation of personality. This is where the “fight or flight” responses come from when one is in danger. When a child lives in constant fear, these areas “learn” to be over-active leading to an inability to differentiate true danger from any minor stressors. Imagine feeling like you needed to run for your life every time something negative occurs. Many with BPD experience these feelings daily.
Although here is some evidence to suggest that genetics plays a part in the development of BPD, the fact that the same parts of the brain which continue to develop after birth are abnormal in those with BPD is a good indication that environment may play a large part.
Currently, the main attachment pattern associated with BPD is a “disorganized” pattern in which a child fluctuates between clinging to his/her caregiver, and pushing away when attention is received. Adults with BPD can exhibit a similar pattern in relationships where they change from one minute to the next from being overly attached to someone and fearing abandonment to doing all they can to alienate the same individual. It is a combination of an intense desire for intimacy and an equally intense fear of intimacy linked with low or nonexistent self-esteem.
Abuse comes in many forms, and most of us have experienced abuse of some kind in our lives. In the case of BPD, abuse appears to occur repeatedly and most often at the hand of those who are trusted or are necessary to a child’s well-being. Neglect can take many forms, but the most insidious of these is failure to be responsive to a child’s needs whether they be for food and shelter or for love, protection, or validation. Inconsistent parenting is just that. Waking up every day not knowing “who” your caregiver is going to be, what the rules are, what you might be punished or rewarded for leaves a child with the question, “Who amI supposed to be today?” When a parent tries to control every aspect of a child’s life, the child fails to develop problem solving skills and always looks for someone to tell them what to do. Punishment has been shown to be ineffective in changing behaviors. Rewarding successes and encouraging changing behaviors works better in the long-run. Authoritarian parenting can be summed up in a quotation from the movie “Matilda” (DeVito, 1996) in which the child is told by different adults, “I’m big, and you’re little. I’m smart, and you’re stupid. I’m right, and you’re wrong, and there’s nothing you can do about it.” This attitude fosters a sense of helplessness and hopelessness in a child. How many times have you heard or read about a child who accuses someone of abuse, and his/her parent says, “That did NOT happen!”? How many times have you heard parents say to a child, “you shouldn’t feel that way” or “you have no reason to be unhappy”? This is invalidation. It makes a child doubt his/her own perceptions and, therefore, doubt his/her own reality.
In short, it is important to make parenting about your child and not about your preferences or your convenience, what your mother or father or society would say. Even if your child has genes that make them vulnerable to BPD or any other disorder, adjust yourself to fit your child and not the other way around. To quote Kahlil Gibran’s “On Children”,“Your children are not your children.They are the sons and daughters of Life's longing for itself.They come through you but not from you,And though they are with you yet they belong not to you.You may give them your love but not your thoughts, For they have their own thoughts.You may house their bodies but not their souls,For their souls dwell in the house of tomorrow, which you cannot visit, not even in your dreams.You may strive to be like them, but seek not to make them like you.For life goes not backward nor tarries with yesterday.You are the bows from which your childrenas living arrows are sent forth.The archer sees the mark upon the path of the infinite, and He bends you with His might that His arrows may go swift and far.Let your bending in the archer's hand be for gladness;For even as He loves the arrow that flies, so He loves also the bow that is stable.”
People with borderline personality disorder (BPD) can have difficulties with “black and white” thinking , or “splitting”. Mothers with BPD can see their children as all “good” or all “bad”. They also can have doubts about their ability to be parents. Because they may have trouble interpreting their own emotions, they tend to be poor at interpreting the emotions and cues of their children. Self-harm, suicidal and para-suicidal ideation and actions are common in BPD. Those with the disorder may also have difficulty regulating emotions such as anger, depression, or anxiety. When a mother expresses these symptoms, she may appear to her child to be inconsistent and unpredictable.
These mothers can express one, a combination, or all of these attitudes during a short time frame. To make things more confusing for the child, the mother may be nurturing and loving at times, also. In some cases, the self-orientation of the mother leads to a “role reversal” in which the child is made the care-taker for the mother.
Children of mothers with BPD may have a “disorganized” attachment to their mothers. They may alternate between clinging to the mother and pushing her away. It can be clearly seen that the effects of having a mother with untreated BPD can be serious and cause problems for a child from infancy through adulthood without intervention. Women who have been diagnosed with BPD should be made aware of the risks to their children that their disorder presents in order to engage in therapy designed to alleviate the symptoms.
