Dorothea Kluczniok1, Katja Boedeker2, Catherine Hindi Attar3, Charlotte Jaite2, Anna-Lena Bierbaum2, Daniel Fuehrer2, Luisa Paetz3, Katja Dittrich2, Sabine C Herpertz4, Romuald Brunner5, Sibylle Winter2, Andreas Heinz3, Stefan Roepke6, Christine Heim7, Felix Bermpohl3. 1. Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany. Electronic address: dorothea.kluczniok@charite.de. 2. Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany. 3. Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany. 4. Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany. 5. Section for Disorders of Personality Development, University of Heidelberg, Germany. 6. Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany. 7. Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Medical Psychology, Charité, Berlin, Germany.
Abstract
BACKGROUND: Both, maternal borderline personality disorder (BPD) and maternal major depressive disorder (MDD) are often associated with adverse consequences for children, including increased risk for child behavior problems. Reduced maternal emotional availability might play a critical role in transmitting maternal psychopathology on the child. Our aim was to investigate the association between emotional availability and maternal BPD and MDD in remission (rMDD), and if this interrelatedness mediates the association between maternal mental disorders and child behavior problems. METHODS: The interaction of 178 mother-child dyads was assessed during a play situation using the Emotional Availability Scales. Children were between 5 and 12 years old. Regression analyses were used to investigate the impact of maternal BPD and maternal rMDD on emotional availability. Ordinary least squares regression analyses using bootstrapping were conducted to investigate the mediating effect of emotional availability on the association between maternal mental disorders and child behavior problems. RESULTS: Mothers with BPD showed increased hostility during mother-child interaction, whereas history of MDD was associated with reduced sensitivity. Maternal hostility was a mediator between maternal BPD and number of child psychiatric disorders, as well as externalizing and internalizing behavior. Maternal sensitivity mediated the association between maternal rMDD and number of child psychiatric disorders, as well as internalizing child behavior. CONCLUSIONS: Our data suggest that mothers with BPD show a qualitatively different pattern of emotional availability compared to mothers with rMDD. These patterns might reflect two separate pathways of transgenerational transmission of aspects of maternal mental disorders, where intervention and training programs could start: maternal rMDD impacts on child behavior problems via reduced sensitivity, and maternal BPD via increased hostility, which could both be addressed with specific therapeutic interventions.
BACKGROUND: Both, maternal borderline personality disorder (BPD) and maternal major depressive disorder (MDD) are often associated with adverse consequences for children, including increased risk for child behavior problems. Reduced maternal emotional availability might play a critical role in transmitting maternal psychopathology on the child. Our aim was to investigate the association between emotional availability and maternal BPD and MDD in remission (rMDD), and if this interrelatedness mediates the association between maternal mental disorders and child behavior problems. METHODS: The interaction of 178 mother-child dyads was assessed during a play situation using the Emotional Availability Scales. Children were between 5 and 12 years old. Regression analyses were used to investigate the impact of maternal BPD and maternal rMDD on emotional availability. Ordinary least squares regression analyses using bootstrapping were conducted to investigate the mediating effect of emotional availability on the association between maternal mental disorders and child behavior problems. RESULTS: Mothers with BPD showed increased hostility during mother-child interaction, whereas history of MDD was associated with reduced sensitivity. Maternal hostility was a mediator between maternal BPD and number of childpsychiatric disorders, as well as externalizing and internalizing behavior. Maternal sensitivity mediated the association between maternal rMDD and number of childpsychiatric disorders, as well as internalizing child behavior. CONCLUSIONS: Our data suggest that mothers with BPD show a qualitatively different pattern of emotional availability compared to mothers with rMDD. These patterns might reflect two separate pathways of transgenerational transmission of aspects of maternal mental disorders, where intervention and training programs could start: maternal rMDD impacts on child behavior problems via reduced sensitivity, and maternal BPD via increased hostility, which could both be addressed with specific therapeutic interventions.