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Prospective study of family adversity and maladaptive parenting in childhood and borderline personality disorder symptoms in a non-clinical population at 11 years

Published online by Cambridge University Press:  05 April 2012

C. Winsper
Department of Psychology, University of Warwick, Coventry, UK
M. Zanarini
McLean Hospital, Harvard Medical School, Belmont, USA
D. Wolke*
Department of Psychology, University of Warwick, Coventry, UK Division of Mental Health and Wellbeing (Warwick Medical School), University of Warwick, Coventry, UK
*Address for correspondence: D. Wolke, Ph.D., Department of Psychology, University of Warwick, Coventry CV4 7AL, UK. Email:



Retrospective studies have consistently indicated an association between maladaptive parenting and borderline personality disorder (BPD). This requires corroboration with prospective, longitudinal designs. We investigated the association between suboptimal parenting and parent conflict in childhood and BPD symptoms in late childhood using a prospective sample.


A community sample of 6050 mothers and their children (born between April 1991 and December 1992) were assessed. Mothers' family adversity was assessed during pregnancy and parenting behaviours such as hitting, shouting, hostility and parent conflict across childhood. Intelligence quotient (IQ) and DSM-IV Axis I diagnoses were assessed at 7–8 years. Trained psychologists interviewed children at 11 years (mean age 11.74 years) to ascertain BPD symptoms.


After adjustment for confounders, family adversity in pregnancy predicted BPD probable 1 to 2 adversities: odds ratio (OR)=1.34 [95% confidence interval (CI) 1.01–1.77]; >2 adversities: OR 1.99 (95% CI 1.34–2.94) and definite 1 to 2 adversities: OR 2.48 (95% CI 1.01–6.08) symptoms. Each point increase in the suboptimal parenting index predicted BPD probable: OR 1.13 (95% CI 1.05–1.23) and definite: OR 1.28 (95% CI 1.03–1.60) symptoms. Parent conflict predicted BPD probable: OR 1.19 (95% CI 1.06–1.34) and definite: OR 1.42 (95% CI 1.06–1.91) symptoms. Within the path analysis, the association between suboptimal parenting and BPD outcome was partially mediated by DSM-IV diagnoses and IQ at 7–8 years.


Children from adverse family backgrounds, who experience suboptimal parenting and more conflict between parents, have poor cognitive abilities and a DSM-IV diagnosis, are at increased risk of BPD symptoms at 11 years.

Original Articles
Copyright © Cambridge University Press 2012

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Bailey, JM, Shriver, A (1999). Does childhood sexual abuse cause borderline personality disorder? Journal of Sex and Marital Therapy 25, 4557.CrossRefGoogle ScholarPubMed
Batty, GD, Mortensen, EL, Osler, M (2005). Child IQ in relation to later psychiatric disorder: evidence from a Danish birth cohort study. British Journal of Psychiatry 187, 180181.CrossRefGoogle ScholarPubMed
Belsky, J, Beaver, KM (2011). Cumulative-genetic plasticity, parenting and adolescent self-regulation. Journal of Child Psychology and Psychiatry 52, 619626.CrossRefGoogle ScholarPubMed
Bernstein, DP, Cohen, P, Velez, CN, Schwab-Stone, M, Siever, LJ, Shinsato, L (1993). Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. American Journal of Psychiatry 150, 12371243.Google Scholar
Bowen, E, Heron, J, Waylen, A, Wolke, D; ALSPAC study team (2005). Domestic violence risk during and after pregnancy: findings from a British longitudinal study. BJOG: International Journal of Obstetrics and Gynaecology 112, 10831089.CrossRefGoogle ScholarPubMed
Brody, GH, Flor, DL (1998). Maternal resources, parenting practices, and child competence in rural, single-parent African American families. Child Development 69, 803816.CrossRefGoogle ScholarPubMed
Chanen, AM, Jovev, M, Jackson, HJ (2007). Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. Journal of Clinical Psychiatry 68, 297306.CrossRefGoogle ScholarPubMed
Chanen, AM, Jovev, M, McCutcheon, LK, Jackson, HJ, McGorry, PD (2008). Borderline personality disorder in young people and the prospects for prevention and early intervention. Current Psychiatry Reviews 4, 4857.CrossRefGoogle Scholar
Cohen, P, Crawford, TN, Johnson, JG, Kasen, S (2005). The Children in the Community Study of the Developmental Course of Personality Disorder. Journal of Personality Disorder 19, 466486.CrossRefGoogle ScholarPubMed
Copeland, KT, Checkoway, H, McMichael, AJ, Holbrook, RH (1977). Bias due to misclassification in the estimation of relative risk. American Journal of Epidemiology 105, 488495.CrossRefGoogle ScholarPubMed
Crawford, TN, Cohen, P, Brook, JS (2001). Dramatic erratic personality disorder symptoms: II. Developmental pathways from early adolescence to adulthood. Journal of Personality Disorders 15, 336350.CrossRefGoogle ScholarPubMed
Crick, NR, Murray-Close, D, Woods, K (2005). Borderline personality features in childhood: a short-term longitudinal study. Developmental Psychopathology 17, 10511070.CrossRefGoogle ScholarPubMed
Crowell, S, Beauchaine, T, Linehan, M (2009). A biosocial developmental model of borderline personality: elaborating and extending Linehan's theory. Psychological Bulletin 135, 495510.CrossRefGoogle ScholarPubMed
Entringer, S, Kumsta, R, Hellhammer, DH, Wadhwa, PD, Wust, S (2009). Prenatal exposure to maternal psychosocial stress and HPA axis regulation in young adults. Hormones and Behavior 55, 292298.CrossRefGoogle ScholarPubMed
Fergusson, DM, Boden, JM, Horwood, LJ (2006). Examining the intergenerational transmission of violence in a New Zealand birth cohort. Child Abuse and Neglect 30, 89–108.CrossRefGoogle Scholar
Geiger, T, Crick, NR (2001). A developmental psychopathology perspective on vulnerability to personality disorders. In Vulnerability to Psychopathology: Risk Across the Lifespan (ed. Ingram, R. and Price, J. M.), pp. 57–102. Guilford Press: New York.Google Scholar
Golding, J, Pembrey, M, Jones, R; ALSPAC Study Team (2001). ALSPAC: the Avon Longitudinal Study of Parents and Children, I: study methodology. Paediatric and Perinatal Epidemiology 15, 7487.CrossRefGoogle ScholarPubMed
Goodman, R, Ford, T, Richards, H, Gatward, R, Meltzer, H (2000). The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry 41, 645655.CrossRefGoogle ScholarPubMed
Gunnar, MR (1998). Quality of early care and buffering of neuroendocrine stress reactions: potential effects on the developing human brain. Preventive Medicine 27, 208211.CrossRefGoogle ScholarPubMed
Guzder, J, Paris, J, Zelkowitz, P, Feldman, R (1999). Psychological risk factors for borderline pathology in school-age children. Journal of the American Academy of Child and Adolescent Psychiatry 38, 206212.CrossRefGoogle ScholarPubMed
Herman, JL, Perry, JC, van der Kolk, BA (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry 146, 490495.Google ScholarPubMed
Hooley, JM, Hoffman, PD (1999). Expressed emotion and clinical outcome in borderline personality disorder. American Journal of Psychiatry 156, 15571562.CrossRefGoogle ScholarPubMed
Horwood, J, Salvi, G, Thomas, K, Hollis, C, Lewis, G, Menezes, PA, Thompson, A, Wolke, D, Zammit, S, Harrison, G (2008). IQ and non-clinical psychotic symptoms in 12-year-olds: results from the ALSPAC birth cohort. British Journal of Psychiatry 193, 185191.CrossRefGoogle ScholarPubMed
Hyman, IA (1997). The Case Against Spanking: How to Discipline Your Child Without Hitting. Jossey-Bass Inc.: San Francisco.Google Scholar
Johnson, JG, Cohen, P, Brown, J, Smailes, EM, Bernstein, DP (1999). Childhood maltreatment increases risk for personality disorders during early adulthood. Archives of General Psychiatry 56, 600606.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Chen, H, Kasen, S, Brook, JS (2006). Parenting behaviours associated with risk for offspring personality disorder during adulthood. Archives of General Psychiatry 63, 579587.CrossRefGoogle ScholarPubMed
Johnson, JG, Cohen, P, Smailes, EM, Skodol, AE, Brown, J, Oldham, JM (2001). Childhood verbal abuse and risk for personality disorders during adolescence and early adulthood. Comprehensive Psychiatry 42, 1623.CrossRefGoogle ScholarPubMed
Johnson, JG, Smailes, EM, Cohen, P, Brown, J, Bernstein, DP (2000). Associations between four types of neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study. Journal of Personality Disorders 14, 171187.CrossRefGoogle ScholarPubMed
Kitzmann, GN, Holt, A, Kenney, E (2003). Child witness to domestic violence a meta-analytic review. Journal of Consulting Clinical Psychology 1, 223353.Google Scholar
Kramer, HC (2007). DSM categories and dimensions in clinical and research contexts. International Journal of Methods in Psychiatric Research 16 (Suppl. 1), S8–S15.CrossRefGoogle Scholar
Lee, MY, Uken, A, Sebold, J (2007). Role of self-determined goals in predicting recidivism in domestic violence offenders. Research on Social Work Practice 17, 3041.CrossRefGoogle Scholar
LeGris, J, van Reekum, R (2006). The neuropsychological correlates of borderline personality disorder and suicidal behaviour. Canadian Journal of Psychiatry 51, 131142.CrossRefGoogle ScholarPubMed
Muthén, BO (1998–2004). Mplus Technical Appendices. Muthén & Muthén: Los Angeles.Google Scholar
Philipsen, A, Limberger, MF, Lieb, K, Feige, B, Kleindienst, N, Ebner-Priemer, U, Barth, J, Schmahl, C, Bohus, M (2008). Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder. British Journal Psychiatry 192, 118123.CrossRefGoogle ScholarPubMed
Posner, MI, Rothbart, MK, Vizueta, N, Thomas, KM, Levy, KN, Fossellla, J, Silbersweig, D, Stern, E, Clarkin, J, Kernberg, O (2003). An approach to the psychobiology of personality disorders. Developmental Psychopathology 15, 10931106.CrossRefGoogle Scholar
Rogosch, FA, Cicchetti, D (2005). Child maltreatment, attention networks, and potential precursors to borderline personality disorder. Developmental Psychopathology 17, 10711089.CrossRefGoogle ScholarPubMed
Salzman, JP, Salzman, C, Wolfson, AN, Albanese, M, Looper, J, Ostacher, M, Schwartz, J, Chinman, G, Land, W, Miyawaki, E (1993). Association between borderline personality structure and history of childhood abuse in adult volunteers. Comprehensive Psychiatry 34, 254257.CrossRefGoogle ScholarPubMed
Siever, L, Davies, K (1991). A psychobiologic perspective on the personality disorders. American Journal of Psychiatry 148, 16471658.Google ScholarPubMed
Stepp, SD, Pilkonis, PA, Hipwell, AE, Loebar, R, Stouthamer-Loeber, M (2010). Stability of borderline personality disorder features in girls. Journal of Personality Disorders 24, 460472.CrossRefGoogle ScholarPubMed
Stringaris, A, Maughan, B, Goodman, R (2010). What's in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: findings from the Avon Longitudinal Study. Journal of American Academy of Child and Adolescent Psychiatry 49, 474483.Google Scholar
Tyrer, P, Coombs, N, Ibrahimi, F, Mathilakath, A, Bajaj, P, Ranger, M, Din, R (2007). Critical developments in the assessment of personality disorder. British Journal of Psychiatry 190, 5159.CrossRefGoogle Scholar
Van IJzendoorn, MH, Juffer, F, Klein Poelhuis, CW (2005). Adoption and cognitive development: a meta-analytic comparison of adopted and nonadopted children's IQ and school performance. Psychological Bulletin 131, 301316.CrossRefGoogle ScholarPubMed
Waylen, A, Stallard, N, Stewart-Brown, S (2008). Parenting and health in mid-childhood: a longitudinal study. European Journal of Public Health 18, 300305.CrossRefGoogle ScholarPubMed
Weaver, TL, Clum, GA (1993). Early family environments and traumatic experiences associated with borderline personality disorder. Journal of Consulting Clinical Psychology 61, 10681075.CrossRefGoogle ScholarPubMed
Wechsler, D, Golombok, S, Rust, J (1992). WISC-III UK Wechsler Intelligence Scale for Children. Psychological Corp.: Sidcup.Google Scholar
Westen, D, Nakash, O, Thomas, C, Bradley, R (2006). Clinical assessment of attachment patterns and personality disorder in adolescents and adults. Journal of Consulting Clinical Psychology 74, 10651085.CrossRefGoogle ScholarPubMed
Wolke, D, Waylen, A, Samara, M, Steer, C, Goodman, R, Ford, T, Lamberts, K (2009). Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. British Journal of Psychiatry 195, 249256.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenberg, FR (2001). Attainment and maintenance of reliability of Axis I and II disorders over the course of a longitudinal study. Comprehensive Psychiatry 42, 369374.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR, Hennen, J, Reich, DB, Silk, KR (2006). Prediction of the 10-year course of borderline personality disorder. American Journal of Psychiatry 163, 827832.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR, Sickel, AE, Yong, L (1996). The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). McLean Hospital: Belmont, MA.Google Scholar
Zanarini, MC, Horwood, J, Waylen, A, Wolke, D (2004). The UK Version of the Childhood Interview for DSM-IV Borderline Personality Disorder (UK-CI-BPD). University of Bristol:: Bristol.Google Scholar
Zanarini, MC, Horwood, J, Wolke, D, Waylen, A, Fitzmaurice, G, Grant, BF (2011). Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year olds and 34,653 American adults. Journal of Personality Disorders 25, 607619.CrossRefGoogle Scholar
Zanarini, MC, Skodol, AE, Bender, D, Dolan, R, Sanislow, C, Schaefer, E, Morey, LC, Grilo, CM, Shea, MT, McGlashen, TH, Gunderson, JG (2000). The collaborative longitudinal personality disorders study II. Reliability of Axis I and II diagnosis. Journal of Personality Disorders 14, 291299.CrossRefGoogle Scholar
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