Stephanie D. Stepp

The Pittsburgh Girls Study: Overview and Initial Findings

The Pittsburgh Girls Study is a longitudinal, community–based study of 2,451 girls who were initially recruited when they were between the ages of 5 and 8 years. The primary aim of the study was testing developmental models of conduct disorder, major depressive disorder, and their co-occurrence in girls. In the current article, we summarize the published findings from the past 5 years of the PGS and place those results in the context of what it known to date about developmental psychopathology in girls. Key results suggest that DSM–IV mental disorders tend to have an insidious onset often beginning with subsyndromal symptom manifestation, and that there appear to be shared and unique developmental precursors to disorder in subgroups of girls based on race and poverty.

Children of mothers with borderline personality disorder: identifying parenting behaviors as potential targets for intervention.

Children of mothers with borderline personality disorder (BPD) should be considered a high-risk group given the wide array of poor psychosocial outcomes that have been found in these children. This article describes the parenting strategies that might explain the transmission of vulnerability from mothers with BPD to their offspring, from infancy through adolescence. We conclude that oscillations between extreme forms of hostile control and passive aloofness in their interactions with their children may be unique to mothers with BPD. We provide an overview of interventions that are currently recommended for mothers and family members with BPD, namely attachment therapy and psychoeducational approaches. On the basis of an integration of the empirical findings on parenting and child outcomes, as well as from the review of current approaches to intervention, we conclude with recommendations for treatment targets. We argue that mothers with BPD need psychoeducation regarding child development and recommended parenting practices and skills for providing consistent warmth and monitoring, including mindfulness-based parenting strategies.

The Clinical Utility of the Proposed DSM-5 Callous-Unemotional Subtype of Conduct Disorder in Young Girls

OBJECTIVE A callous-unemotional (CU) subtype of conduct disorder (CD) has been proposed as an addition to the fifth edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5). This study tested the hypothesis that young girls with the CU subtype of CD would exhibit more severe antisocial behavior and less severe internalizing problems over time relative to girls with CD alone. Second, the developmental outcomes of girls with CU traits in the absence of CD was examined because these girls would be overlooked by the proposed CU subtyping scheme. METHOD Theses issues were examined in a community sample of 1,862 girls 6 to 8 years of age at study onset. Outcomes included internalizing and externalizing problems, academic achievement, and global impairment assessed concurrently and at a 6-year follow-up. RESULTS Girls with the CU subtype of CD had higher levels of externalizing disorder symptoms, bullying, relational aggression, and global impairment than girls with CD alone. Girls with CD alone tended to have more anxiety problems than girls with the CU subtype of CD. Girls with high CU traits without CD exhibited higher ODD and attention-deficit/hyperactivity disorder (ADHD) symptoms and lower academic achievement at the 6-year follow-up relative to girls without CU traits and CD. Group differences at the 6-year follow-up were primarily accounted for by baseline differences on the outcomes. CONCLUSIONS The proposed DSM-5 CU subtype of CD identifies young girls who exhibit lower anxiety problems and more severe aggression, CD symptoms, academic problems and global impairment across time than girls with CD alone.

THE EFFECT OF DIALECTICAL BEHAVIOR THERAPY SKILLS USE ON BORDERLINE PERSONALITY DISORDER FEATURES

We assessed the effect of DBT skills utilization on features of borderline personality disorder as measured by the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). Participants were outpatients (N = 27) enrolled in a dialectical behavior therapy (DBT) program in a university-affiliated community mental health clinic. Diary cards were collected each week to track self-reported skills use. At the beginning of each new skills training module, patients completed another PAI-BOR. Univariate and multilevel analyses indicated significant improvement on the total PAI-BOR score and on several PAI-BOR subscale scores. Results also revealed that overall DBT skills use increased significantly over time, as did individual skills related to mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Multilevel modeling results indicated that overall skills use showed a significant effect on PAI-BOR total scores, Affective Instability scores, Identity Problems scores, and Negative Relationships scores, even after controlling for initial levels of distress and diary card compliance.

Adolescent Disruptive Behavior and Borderline Personality Disorder Symptoms in Young Adult Men

Very few studies have prospective information, especially regarding males, on the prediction of Borderline Personality Disorder (BPD) in adulthood from psychiatric disorders in childhood. Certain childhood disorders, however, have notably similar features in common with BPD. In particular, the affective dysfunction, hostility and interpersonal conflict of Oppositional Defiant Disorder (ODD) and the impulsivity of Attention Deficit Hyperactivity Disorder (ADHD) in particular may be indicative of an early developmental path towards BPD. The present study uses longitudinal data from a clinical sample of 177 boys, initially between the ages of 7 and 12, who were followed up annually to age 18, and who were reassessed at age 24 (n = 142). The study examines the prediction from repeated childhood measures of psychopathology measured annually through adolescence to BPD symptoms assessed at age 24, accounting for the effects of covariates including substance use, other personality disorders at age 24 and harsh physical punishment. The prevalence of BPD in this sample was consistent with other population estimates. Attention Deficit Hyperactivity Disorder (ADHD) and ODD were the only child psychiatric disorders to predict BPD symptoms, and the oppositional behavioral dimension of ODD was particularly predictive of BPD. These results indicate possible developmental links between early psychiatric disorders and BPD.

Prospective associations between features of borderline personality disorder, emotion dysregulation, and aggression

Difficulties with emotion regulation and behavioral instability, including impulsive aggression, are seen as core dimensions underlying borderline personality disorder (BPD). Although both BPD and antisocial personality disorder (ASPD) are associated with impulsivity and aggressive behavior, difficulties regulating emotions may be associated uniquely with BPD and may explain distinctive associations between BPD and aggression. This study was designed to examine the unique prospective associations between BPD symptoms at baseline, difficulties with emotion regulation and trait impulsivity, and psychological and physical aggression (both perpetration and victimization) over the course of a year after controlling for ASPD symptoms in a mixed clinical and community sample of adults (N = 150). Results of a multivariate path analysis demonstrated that associations between BPD symptoms at baseline and later psychological and physical aggression were fully mediated by difficulties with emotion regulation. Although BPD symptoms also predicted trait impulsivity, impulsivity did not predict aggression after controlling for emotion dysregulation. ASPD symptoms were directly associated with physical assault perpetration and victimization but were not associated with emotion dysregulation, impulsivity, or psychological aggression. These findings suggest that although both BPD and ASPD are associated with aggressive behaviors, associations between BPD symptoms and aggression are mediated uniquely by difficulties regulating emotions.

Criterion validity of the general factor of psychopathology in a prospective study of girls.

BACKGROUND The best-fitting model of the structure of common psychopathology often includes a general factor on which all dimensions of psychopathology load. Such a general factor would be important if it reflects etiologies and mechanisms shared by all dimensions of psychopathology. Nonetheless, a viable alternative explanation is that the general factor is partly or wholly a result of common method variance or other systematic measurement biases. METHODS To test this alternative explanation, we extracted general, externalizing, and internalizing factor scores using mother-reported symptoms across 5-11 years of age in confirmatory factor analyses of data from a representative longitudinal study of 2,450 girls. Independent associations between the three psychopathology factor scores and teacher-reported criterion variables were estimated in multiple regression, controlling intelligence, and demographic covariates. RESULTS The model including the general factor fit significantly better than a correlated two-factor (internalizing/externalizing) model. The general factor was robustly and independently associated with all measures of teacher-reported school functioning concurrently during childhood and prospectively during adolescence. CONCLUSIONS These findings weaken the hypothesis that the general factor of psychopathology in childhood is solely a measurement artifact and support further research on the substantive meaning of the general factor.

Interpersonal and emotional experiences of social interactions in borderline personality disorder.

General Aim: We examined interpersonal experiences of patients with borderline personality disorder (BPD) using a time-contingent diary procedure to collect information about social interactions for 7 days. Method: We examined the (1) quantity of social interactions and (2) interpersonal and emotional experiences during social interactions for patients with BPD (BPD; N = 42) compared with those with another personality disorder (OPD; N = 46) and those without significant personality pathology (NOPD; N = 23). Results: Results suggested that BPD patients have fewer social contacts compared with those in the NOPD group. Additionally, the BPD patients characterized their social interactions as more disagreeable, ambivalent, angry, empty, and sad compared with the OPD and NOPD groups. BPD patients reported experiencing more anxiety and less positive affect compared with the NOPD but not the OPD group. Conclusion: These findings highlight aspects of day-to-day interpersonal functioning that are specific to BPD.

Stability of Borderline Personality Disorder Features in Girls

Little empirical evidence exists regarding developmental antecedents of borderline personality disorder (BPD) features in children and adolescents. As a first step in addressing this gap in our knowledge, this study examined the factor structure and stability of putative underlying BPD features, specifically impulsivity, negative affectivity, and interpersonal aggression, in 6-12-year-old girls. We report on results from exploratory and confirmatory factor analyses of underlying BPD dimensions as rated by parents and teachers over six successive data waves in a large, community sample of girls (N = 2,451). Six factors were derived from parent ratings (i.e., Cognitive Dyscontrol, (Lack of) Self-Control, Hostility, Depression/Anxiety, Hyperactivity, and Relational Aggression) and five factors were derived from teacher reports (i.e., Cognitive Dyscontrol, Hyperactivity, (Lack of) Self-Control, Relational Aggression, and Depression). The item composition of similar parent and teacher factors was highly consistent. The year-to-year stability from ages 6 to 12 was high for parent factor scores (r ranging from .71-.85) and moderately high for teacher factor scores (r ranging from .49-.77). These findings suggest that underlying dimensions of BPD features can be reliably measured and are stable in 6-12-year-old girls.

Preoccupied Attachment and Emotional Dysregulation: Specific Aspects of Borderline Personality Disorder or General Dimensions of Personality Pathology?

Emotional dysregulation and impaired attachment are seen by many clinical researchers as central aspects of borderline personality disorder (BPD). Alternatively, these constructs may represent general impairments in personality that are nonspecific to BPD. Using multitraitmultimethod models, the authors examined the strength of associations among preoccupied attachment, difficulties with emotion regulation, BPD features, and features of two other personality disorders (i.e., antisocial and avoidant) in a combined psychiatric outpatient and community sample of adults. Results suggested that preoccupied attachment and difficulties with emotion regulation shared strong positive associations with each other and with each of the selected personality disorders. However, preoccupied attachment and emotional dysregulation were more strongly related to BPD features than to features of other personality disorders. Findings suggest that although impairments in relational and emotional domains may underlie personality pathology in general, preoccupied attachment and emotional dysregulation also have specificity for understanding core difficulties in those with BPD.