Fruzzetti 2005

Family interaction and the developmentof borderline personality disorder:A transactional model

ALAN E. FRUZZETTI,a CHAD SHENK,a and PERRY D. HOFFMANbaUniversity of Nevada, Reno; and bMt. Sinai College of Medicine, New York

AbstractAlthough no prospective epidemiological studies have evaluated the relationship between family interactions andthe development of borderline personality disorder ~BPD!, there is considerable evidence for the central role offamily interactions in the development of BPD. This paper describes the role of family interactions or processes,especially those that might be regarded as invalidating or conflictual, negative or critical, and the absence of morevalidating, positive, supportive, empathic interactions, in the development of BPD. Perhaps more importantly, theproposed model considers how these parental and family behaviors transact with the childs own behaviors andemotional vulnerabilities, resulting in a developmental model of BPD that is neither blaming of the family memberwith BPD nor of her or his parents and caregivers, and has important and specific implications for both preventionand intervention.

Borderline personality disorder ~BPD! is oneof the most complex and difficult disorders tounderstand and to treat. With high lifetimerates of suicide, hospitalization, and other treat-ment utilization, BPD presents an enormouspublic mental health problem in addition tothe considerable suffering that those with BPD,and their loved ones, endure. The develop-ment of empirically validated etiological mod-els would be invaluable in developing earlyprevention or intervention programs for BPD.However, like many psychological disorders,its relatively low prevalence in the generalpopulation ~as low as 0.30.7%; Lenzen-weger, Loranger, Korfine, & Neff, 1997!makeprospective epidemiological studies that eval-uate its etiology from multiple perspectivesprohibitive due to costs. Nevertheless, it isimportant to develop comprehensive modelsconsistent with available data. In this paper,

we will discuss a variety of issues pertainingto the development of BPD, including classi-fication problems, types of models, biologicaland genetic factors, the role of parental andcaregiver responses to a childs developingemotional experience, and several parent andfamily interaction factors, resulting in the de-scription of a comprehensive, transactionalmodel of the development of BPD.

Problems With CurrentConceptualizations of BPD

The Diagnostic and Statistical Manual of Men-tal Disorders4th Edition ~DSM-IV; Ameri-can Psychiatric Association, 1994, p. 650!defines BPD as a pervasive pattern of insta-bility of interpersonal relationships, self-image, and affects, and marked impulsivitythat begins by early adulthood and is presentin a variety of contexts. The DSM-IV delin-eates nine formal characteristics of BPD. Toreceive a diagnosis of BPD using the DSM-IV,an individual must meet a clinical threshold in

Address correspondence and reprint requests to: Alan E.Fruzzetti, Department of Psychology 298, University ofNevada, Reno, NV 89557; E-mail: [email protected].

Development and Psychopathology 17 ~2005!, 10071030Copyright 2005 Cambridge University PressPrinted in the United States of AmericaDOI: 10.10170S0954579405050479

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any of five or more of these nine criteria. Thus,the focus of the diagnosis of BPD is on thepresence of any five of these nine criteria andthat these problem criteria are associated withsignificant impairment in the persons dailyfunctioning.

Many difficulties with a formal classifica-tion system such as the DSM-IV have beenelaborated. For example, researchers and theo-rists have criticized the diagnostic system andpointed out the lack of empirical support forarbitrary diagnostic thresholds ~Morey, 1988!,the unreliability of many diagnoses due to clin-ical heterogeneity within diagnostic catego-ries ~Widiger & Sanderson, 1995!, and its lackof theoretical principles to guide its structure~Follette & Houts, 1996!. In addition, it hasbeen estimated that at least two-thirds of peo-ple diagnosed with BPD also meet criteria forone or more Axis I diagnoses ~Fabrega, Ul-rich, Pilkonis, & Mezzich, 1992!. Other notedproblems with diagnostic classification sys-tems in general, and with the DSM in particu-lar, include a lack of a clear distinction betweennormal and abnormal personality disorders~Livesley, Schroeder, Jackson, & Jang, 1994!,a high percentage of comorbidity between di-agnostic categories ~Oldham et al., 1992!, andits failure to consider context ~especially rela-tionships or ongoing transactions! in determin-ing diagnostic threshold ~Fruzzetti, 1996!.Diagnostic problems due to heterogeneity areabundant in BPD specifically: because thereare nine diagnostic criteria for this disorder,with only five criteria required for diagnosis,it is possible for there to be hundreds of dif-ferent iterations or variations of the BPD di-agnosis. Thus, the classification system allowsfor any two individuals diagnosed with BPDto have as few as one diagnostic criterion incommon. Useful research on subtypes of BPDis ongoing, but the many differing constella-tions of problems that all meet BPD criteriapose a problem for researchers and cliniciansalike. These kinds of problems raise questionsabout the validity of this diagnostic paradigmfor BPD and other disorders.

The issue of diagnostic validity is even moreproblematic when a diagnosis of BPD is as-sessed with children and adolescents. The DSMstates that personality disorders typically have

an onset in adolescence or early adulthoodand are stable over time, yet studies examin-ing the predictive validity of the diagnosis ofBPD in adolescence suggest that the diagnosisis not stable over time ~Garnet, Levy, Mat-tanah, Edell, & McGlashan, 1994; Levy et al.,1999!. These problems are likely the result ofa flawed classification system, poor under-standing of the etiology of BPD, or both. Forthese reasons, many researchers and theoristsare now looking to dimensional, rather thancategorical, conceptualizations of BPD.

Dimensional models of BPD based on sta-tistical techniques such as factor analysis andhierarchical modeling have begun to identifyaspects of BPD that are predictive of the com-ponent behaviors that are used to define anddiagnosis the disorder ~e.g., suicide attempts,parasuicide, impulsivity!. This approach avoidsthe nosological problems noted earlier, andincreases the predictive validity of the dimen-sions assessed, which in turn better informstreatment. In a review of the literature on BPD,Skodol et al. ~2002! characterized BPD in twobroad dimensions: impulsive aggression andemotion dysregulation ~e.g., affective instabil-ity!. Impulsiveaggression and emotion dys-regulation have recently received the mostattention from scientists representing a widevariety of theoretical positions ~Critchfield,Sanford, Levy, & Clarkin, 2004; Depue & Len-zenweger, 2001; deVegvar, Siever, & Trest-man, 1994; Keenan, 2000; Linehan, 1993;Links, Heslegrave, & van Reekum, 1999;Soloff et al., 2003!, although the validity ofthese dimensions to detect reliably and pre-dict a diagnosis of BPD has not been estab-lished. Current evidence supports impulsiveaggression and emotion dysregulation as keymediators and precursors of future suicidalbehavior; evaluating these variables furthermay be useful in understanding the develop-ment of BPD.

Factors Affecting the Development of BPD

Many distal factors have been identified in theetiology of BPD. Genetic and biological fac-tors, histories of sexual and physical traumain childhood, and familial characteristics such

1008 A. E. Fruzzetti, C. Shenk, and P. D. Hoffman

as problematic interactions between parentsand children have been shown to be relevant.Although an extensive review of this litera-ture is beyond the scope of this paper, we willbriefly consider the literature on several fac-tors that are relevant to building a model ofthe development of BPD.

Genetic and biological factorsResearchers have studied both the genetic in-fluence on meeting diagnostic threshold forBPD and the degree of inheritance for pheno-typic traits associated with BPD. In a study ofpersonality disorders using a sample of 221Norwegian twins, Torgersen et al. ~2000! founda 35% concordance rate between monozy-gotic twins and diagnostic threshold for BPD.This rate dropped to 7% for dizygotic twinsand the diagnosis of BPD, suggesting a ge-netic role in BPD development. With regardto phenotypic expressions of BPD, heritabil-ity rates for emotion dysregulation and impul-sivity have been reported to be 41 and 30%,respectively, for monozygotic twins,and with rates of 12 and 23%, respectively,for dizygotic twins ~Livesley, Jang, & Vernon,1998!. These studies suggest that for any oneperson diagnosed with BPD there is a small tomoderate chance that their children will ex-hibit these particular traits, whether the chil-dren meet full criteria for the disorder or not.Although these studies do appear to support agenetic association between BPD and the spe-cific behaviors associated with BPD, criticsmaintain that the familiality of BPD per se hasnot been definitively established ~e.g., Dahl,1993; White, Gunderson, & Zanarini, 2003!.Regardless of the transmission of BPD per se,these studies do seem to indicate that geneticsare a modest contributing factor to certain traits~e.g., impulsiveaggression and emotion dys-regulation! that are relevant to the develop-ment of BPD.

Impulsiveaggression and emotion dysreg-ulation have received a significant amount ofattention from biological researchers as well.Impulsive aggression has been implicated as asignificant predictor of future suicide at-tempts in both adults ~Brodsky, Malone, Ellis,Dulit, & Mann, 1997! and adolescents ~Stein,

Apter, Gidon, HarEven, & Avidan, 1998!.One biological explanation for the expressionof impulsiveaggressive behaviors maintainsthat reduced serotonergic activity, specificallyin the 5-hydroxytryptophan ~5-HT! system,inhibits a persons ability to modulate or con-trol destructive urges ~AtreVaidya & Hus-sain, 1999; Figueroa & Silk, 1997; Paris et al.,2004; Rinne, Westenberg, den Boer, & vanden Brink, 2000; Skodol et al., 2002!. Theseresults have been replicated with group differ-ences found among BPD populations and non-clinical controls. Blunting of serotonergicactivity in this same system may also contrib-ute to difficulties with emotion regulation~Depue & Lenzenweger, 2001; Krakowski,2003!. Thus, there appear to be differences inserotonergic functioning between those diag-nosed with BPD and control subjects.

A considerable amount of biological re-search on emotion regulation and dysregula-tion has focused on hormonal and physiologicalcorrelates following acute environmentalstressors. For instance, the hypothalamuspituitaryadrenal ~HPA! axis is one systemthat is often studied to note differences in emo-tion regulation as they pertain to varying lev-els of cortisol. It is generally understood thatexposure to environmental stress initially in-creases levels of cortisol in the HPA system,which contributes to the excitation of behav-ioral responses to stress ~e.g., fight or flight!that have a regulatory function on emotion~Diamond & Aspinwall, 2003; Figueroa & Silk,1997!. Frequent increases in cortisol over thecourse of time may affect the 5-HT system byblunting serotonergic activity, thereby linkingprolonged exposure to environmental stress tosymptoms of BPD through biological media-tors ~e.g., HPA, 5-HT systems!. Data of thiskind support models that integrate biologicalsystems and describe the elicitation of psycho-pathology as a result of dysfunction acrossthese systems ~Depue & Lenzenweger, 2001!.

Vagal tone is another physiological corre-late of an individuals response to stress that iscurrently a focus among BPD and emotionregulation researchers. Research on emotionregulation in children suggests that childrenwith a high vagal tone are more adept at reg-ulating their emotions and physiological re-

Family interaction and BPD 1009

sponses to an environmental stressor whencompared to children who have a low vagaltone ~Calkins, Smith, Gill, & Johnson, 1998;Gottman & Katz, 2002; Katz & Gottman, 1995;Porges, DoussardRoosevelt, & Maita, 1994!.

Although researchers have found consis-tent differences in serotonergic functioning forBPD patients, specific causal pathways for thephenotypic elicitation of problems associatedwith BPD are still not clear. Furthermore, thespecificity of reduced serotonin to impulsiveor aggressive behaviors is a major problemfor this model as well. For example, manypeople with major depressive disorder alsohave reduced serotonergic activity ~Golden &Gilmore, 1990! yet do not demonstrate impul-sive or aggressive behaviors comparable tothose with BPD ~e.g., parasuicide, and otherimpulsive behaviors!. In turn, pharmacologi-cal agents that target serotonergic functioningappear to have limited efficacy when treatingBPD ~Soloff, 2005!, especially when com-pared to the treatment of depression, althoughthe proposed mechanisms responsible for eachdisorder are similar. Research has also shownthat it is difficult to correlate biological mea-sures of serotonin with clinical measures ofimpulsivity and aggression ~Stein et al., 1996!,although this later point may be more meth-odological than ontological ~Critchfield et al.,2004!. Finally, it appears that significant andchronic environmental stressors, such as phys-ical abuse, sexual abuse, and neglect commonto BPD populations, at times plays a signifi-cant role in moderating ~eliciting or exacer-bating! the pathological functioning of thebiological correlates associated with BPD.

What seems clear from biological researchon the development of BPD is that it is essen-tial not to assume that an individuals biolog-ical make-up develops in isolation from socialand developmental factors. Indeed, biologicaldifferences in children, adolescents, or adultsmay represent considerably more than lineardifferential biological development. Biologi-cal differences may also result from socialand family responses to individuals over timethat shape individuals biology, or from morecomplicated transactions between individualtemperamental factors and social and familyprocesses ~see below!.

Trauma

Another factor receiving significant attentionin models of BPD is exposure to childhoodsexual abuse ~CSA!. CSA history in BPD pop-ulations has been reported to be as high as75% in both inpatient and outpatient samples~Battle et al., 2004; Silk, Lee, Hill, & Lohr,1995!, and there is evidence that CSA preva-lence is higher in BPD than in other disorders.For example, a history of CSA has been shownto discriminate between BPD populations anddepressed, non-BPD populations for both ad-olescents and adults ~Horesh, Sever, & Apter,2003; Ogata, Silk, & Goodrich, 1990!. Be-cause of high rates of CSA among those diag-nosed with BPD, many researchers havesuggested that CSA is etiologically linked tothe onset of BPD ~Guzder, Paris, Zelkowitz,& Feldman, 1999; Links & Munroe Blum,1990; Norden, Klein, Donaldson, Pepper, &Klein, 1995; Ogata, Silk, Goodrich, et al., 1990;Trull, 2001; Wagner & Linehan, 1997; Za-narini, 1997!. Closer examination, however,suggests a more complicated relationship be-tween CSA and the development of BPD.

CSA itself does not appear to be the mech-anism through which BPD develops. In a pro-spective study examining the factors thatpredict future suicidal behaviors, Yen et al.~2004! found that CSA was significantly asso-ciated with future suicidal behavior. However,the mediating variable of affective stability~similar to what we are calling emotion dys-regulation! was most predictive of futuresuicidal behaviors ~excluding previous para-suicidal behavior!. In addition, these research-ers found that major depression was notpredictive of suicidal behaviors. In a similarstudy, Brodsky et al. ~1997! found that CSAwas significantly related to lifetime numberof suicide attempts. However, they found im-pulsivity to be the mediator between CSA andprediction of future suicidality. Mediationaleffects of emotion dysregulation have beenfound with adolescent populations as well. Ina sample of adolescents exposed to physical,sexual, and0or emotional abuse, Shields andCicchetti ~1998! found that trauma was signif-icantly associated with behavioral problemsin adolescents. However, when emotional la-


bility or dysregulation was added to the regres-sion equation, maltreatment status per se nolonger predicted child behavior problems. Thatis, in sophisticated regression analyses, emo-tion dysregulation was more predictive of childproblems than maltreatment per se. Thus, al-though CSA may be a significant risk factorfor the development of BPD, the constellationof difficulties associated with BPD appears tobe mediated by the development of emotiondysregulation, and perhaps other difficulties.In addition, the simple fact remains that morethan 90% of victims of CSA do not developBPD, so CSA or other early traumas can per-haps best be understood as more distal riskfactors in the development of BPD.

Further complicating, and potentially con-founding, the relationship between CSA andBPD is the fact that physical abuse and emo-tional abuse and neglect co-occur at high rateswith CSA. Although researchers employ vary-ing definitions of sexual, physical, and emo-tional abuse ~and emotion neglect!, all of thesefactors are associated with the development ofBPD ~e.g., Trull, 2001!. Moreover, some evi-dence suggests that sexual and physical abuseper se are not the most important factors indetermining negative consequences of theseevents; rather, parental and caregiver re-sponse to the disclosure of the abuse ~validat-ing or invalidating of the report! may mediatethe effects of the abuse ~Horwitz, Widom,McLaughlin, & White, 2001!.

As mentioned above, research has also ex-amined the impact that various types of traumahave on biological functioning and on the de-velopment of psychopathology in both infantsand adolescents. For example, abnormalitiesin cortisol functioning frequently have beenobserved in samples with prior exposure totrauma. When an individual is exposed to stressor trauma, cortisol is secreted by the adrenalglands. For example, researchers found thatmaltreated adolescents had higher levels ofcortisol than nonmaltreated children through-out daily functioning, which in turn, were as-sociated with more internalizing behaviorproblems ~Cicchetti & Rogosch, 2001!. Simi-larly, Ramsay and Lewis ~1994! found thatinfants from low-trauma environments natu-rally habituated to stressors by learning regu-

lation skills, which then reduced the productionof cortisol in their bloodstreams. Infants fromhigh-trauma environments do not seem to learnthese self-regulatory skills, which likely con-tributes to the higher average levels of corti-sol in the bloodstream. This suggests that earlyand frequent exposure to traumatic events inchildhood may have a significant influence onbiological processes that affect the ability toregulate emotional arousal and distress~Keenan, 2000!. Thus, although a person mayor may not have a genetic predisposition tothe development of BPD ~or to traits associ-ated with BPD!, the biological functioning ofa person at risk for BPD can be shaped anddeveloped through traumatic events ~Figueroa& Silk, 1997!, and likely also through thesuccessful development of self-regulationskills. Thus, for example, the occurrence ofchronic abuse may lead to higher baseline emo-tional arousal, which could make the develop-ment of problematic means of coping ~e.g.,parasuicide, substance use! more likely. Thatis, the combination of chronically high emo-tional arousal, poor impulse control, and prob-lems regulating emotion ~i.e., not learningordinary self-regulatory emotion skills; cf.Fruzzetti, Shenk, Mosco, & Lowry, 2003!, mayprovide a situation in which dysfunctional cop-ing patterns and other problematic behaviorsare easily and frequently reinforced.

A prospective study by Johnson, Cohen,Brown, Smailes, and Bernstein ~1999! re-ported that children who experienced child-hood abuse or neglect were four times morelikely to be diagnosed with a personality dis-order during young adulthood than childrenwho were not abused. Data such as this sug-gests a strong relationship between trauma andpersonality dysfunction, although the causalpathways remain unclear. Most children whohave been abused will not develop any person-ality disorder ~Binder, McNiel, & Goldstone,1996! or even experience long-term psycho-logical difficulties of any kind when the sam-ple is examined prospectively ~Horwitz et al.,2001!. In fact, less than 10% of children witha CSA history go on to meet criteria for BPDas adolescents or adults. KendallTackett, Wil-liams, and Finkelhor ~1993!, in a review ofthe literature on abuse during childhood, noted


a number of variables that minimized the lon-ger term effects of trauma on these children.These factors included absence of force, shorterduration of abuse, having a nonrelative abuser,absence of pretrauma family problems, thechild being able to externalize blame to appro-priate others, and maternal support.

This raises the important question of whatsocial and family processes, associated withabuse or not, may influence development to-ward BPD and problems with impulse controland emotion dysregulation versus toward morenormative functioning.

Family interactions

Physical, sexual, and emotional abuse and theirsequellae, of course, occur in a family contexteven when not perpetrated by a family mem-ber. As noted, children who receive parentalsupport ~e.g., believing the childs report ofabuse, protecting the child without becomingoverprotective, not expressing high levels ofanger! recover more quickly from abuse thanchildren who do not receive these types ofparental support after an abuse incident ~Ever-son, Hunter, Runyon, Edelsohn, & Coulter,1989, 1991!. Thus, parental and other care-giver responses ~family interactions! play animportant role in mitigating against the ef-fects of abuse. In contrast, the lack of emo-tional involvement, support, and validationmay actually potentiate the effects of abuseand be related more generally to the develop-ment of BPD or related problems.

Specifically, neglect, emotional underin-volvement, and invalidation by caretakers ap-pear to contribute to the development of BPD.Prospective studies ~Johnson, Cohen, Gould,Kasen, Brown, et al., 2002! have shown thatparental emotional underinvolvement towardchildren impairs their ability to socialize ef-fectively, which then increases their chancesof engaging in suicidal behaviors. In this samestudy, this type of parenting was associatedwith risk for suicide attempts after parentalpsychopathology was statistically controlled,thereby illustrating the importance of the par-enting relationship in the etiology of BPD.Other studies also suggest that low parentalinvolvement is a significant risk factor for var-

ious dimensions of personality dysfunction~ZweigFrank & Paris, 1991!, whereas thesesame parenting styles may not be predictiveof depression ~Carter, Joyce, Mulder, & Luty,2001!.

In addition to high rates of childhood abuse,Zanarini et al. ~1997! reported that 92% of theborderline patients surveyed reported ~retro-spectively! having experienced biparental ne-glect and emotional denial before the age of18, with emotional denial being a significantpredictor of the diagnosis of BPD. Conversely,other studies have shown that the diagnosis ofBPD actually statistically predicts the pres-ence of parental neglect in this sample ~Battleet al., 2004!. Researchers in this area con-clude that abuse alone ~like other factors! isneither necessary nor sufficient for the devel-opment of BPD, and that contextual featuressuch as specific parentchild relationships andinteractions ~along with other factors such asthe parents relationship! are also key compo-nents in the development of BPD. In otherwords, the specific etiology of BPD appearsto be complex and not linear: abuse or trauma,biological predispositions, environmentalevents, and ongoing parentchild and othersocial interactions are not regarded as inde-pendent causal factors in the development ofBPD, but rather are a set of factors of stronginfluence ~e.g., Meehl, 1977! that interplay incomplex ways.

The effects of neglectful or uninvolved par-enting on their children are familiar to devel-opmental and clinical psychologists. Stemmingfrom Baumrinds ~1967, 1991! conceptualiza-tion of parenting styles, data have suggestedconsistently that children and adolescents ex-posed to this type of parenting more likelydevelop significant behavioral and psycholog-ical difficulties ~Lamborn, Mounts, Steinberg,& Dornbusch, 1991; Steinberg, Lamborn,Darling, Mounts, & Dornbusch, 1994!. Re-searchers have also begun to recognize thedetrimental effects of parental uninvolvementspecific to BPD populations. For example,Hooley and Hoffman ~1999! found that rela-tively high levels of emotional involvementby family members were significantly associ-ated with better clinical outcomes at a 1-yearfollow-up for patients diagnosed with BPD.


Thus, although it is important to considertemperament and biological, trauma, and fa-milial variables in the development of BPD,viewing any one of these variables in isolationdoes not provide an adequate account of thedevelopment of BPD. We must consider theinterplay among all of these factors to under-stand the development of BPD, and to identifyrelevant mechanisms of change that are im-portant for successful intervention. Next, wewill discuss a transactional approach to con-ceptualizing BPD that incorporates all of thesefactors into a model of the development ofBPD.

Transactional and Other Types of Models

Transactional models have long been apart ofdevelopmental psychology. For example, Bron-fenbrenners ~1979! ecological model has beenuseful in identifying the contextual influencesexerted on a developing child or adolescentbeyond traditional models that only look atthe immediate family context. Ecological mod-els such as this have influenced the way de-velopmental theorists approach the issue ofthe development of psychopathology. Forexample, leading theorists and researchersin adolescence are embracing contextual0transactional models of pathology ~Steinberg& Avenevoli, 2000! that incorporate the recip-rocal interplay between environmental and bio-logical development. Transactional analysesof individuals and their environment have beeninfluential in the field of developmental psy-chopathology as well, where a trend towardecologicaltransactional models of pathologyis also apparent ~Cicchetti & Rogosch, 2002;Lynch & Cicchetti, 1998!.

When discussing the development of psy-chopathology, it is important to make a dis-tinction between a biological or behavioralpredisposition and a present disposition, to asubsequent event or process. A predispositionis an early causal factor that is independent ofother factors and not essentially changed overtime. Present disposition describes a currentstate biologically, or current tendency to act ina particular way. A disposition may be a prox-imal cause that was influenced by other fac-tors and is in an ongoing transaction with other

factors. To make the distinction further, it maybe useful to compare several different types ofmodels of behavior, and distinguish them fromthe transactional model that we propose.

Individual difference modelsIndividual difference models in developmen-tal psychopathology generally focus on bio-logical or genetic explanations of problembehaviors. In such models, conditions suffi-cient for the manifestation of the disorderreside within the individual, regardless of learn-ing history or developmental processes. In sucha model, the behaviors of BPD would be man-ifested irrespective of family or social envi-ronment, according to factors solely withinthe person. As noted earlier, to date there islittle evidence that the problems of BPD aresolely ~or even largely! the result of genetic orindividual biological factors irrespective of so-cial environmental factors.

Temperament is often a key component ofindividual difference models. It has beenwidely studied for many years, especially as afactor in the development of psychopathologyin children and adolescents ~Frick, 2004!. De-scriptors of problematic temperament in theclinical literature include moody, diffi-cult, and ill-mannered, which has made themeasurement of temperament challenging ~La-hey, 2004!. Despite widely varying conceptu-alizations of temperament, a clear link betweenindividual components of temperament andpsychopathology has been established. How-ever, the specificity with which temperamentcontributes to psychopathology has yet to beelucidated.

Temperament is often regarded as a biolog-ical or genetic component that can predisposesomeone to experience psychopathology, whichis contingent upon environmental factorsthroughout the life span. This concept has beendescribed as goodness of fit ~Seifer, 2000!,whereby the relation of temperament to psy-chopathology is mediated through the familialexperiences of the child. For example, Calkins,Dedmon, Gill, Lomax, and Johnson ~2002!demonstrated that children who were moreeasily frustrated ~a common measurement oftemperament! during a particular task had more


intense physiological reactions and less abil-ity to regulate their emotions compared tochildren who were not as easily frustrated.Data such as this suggest that temperamentis a key component of emotional reactivityand physiological arousal related to emotion.These data also suggest that children livingin an environment in which parents sootheand instruct their children how to manage theiremotional responses are more likely to be ef-fective at managing emotion without resort-ing to aggressive or other dysfunctionalbehaviors.

As mentioned above, models focusing onbiological or genetic factors as sufficient causesof individual psychopathology in general, andBPD in particular, appear limited. Althoughindividual temperament and biology appear toplay important roles in to the development ofvarious psychological problems, their roleslikely are in more complex interaction or trans-action with multiple other variables in the de-velopment of BPD.

Environmental models

These models typically maintain that somekinds of stressful or traumatic events or pro-cesses are sufficient to explain a particulardisorder. For example, a sufficient amount ofanoxia will result in brain damage, the natureof the damage depending on age and develop-ment. No matter how healthy an individualinfant, child, or adult may be, neurologicalimpairment will result from oxygen depriva-tion of a particular duration. Childhood phys-ical and sexual abuse may also be consideredexamples of trauma, of course. But, as notedabove, although high rates of childhood phys-ical and sexual abuse have consistently beenreported ~e.g., Zanarini, Gunderson, & Marino,1989!, only a small minority of people whohave been victims of childhood abuse havethe pervasive difficulties found in BPD. More-over, a significant percent of those with BPDdid not have childhood physical or sexual abuseexperiences. Thus, the available evidence doesnot support these factors ~or other environmen-tal factors in this type of model! as sufficientto explain the development of BPD.

Interactional models

With interactional models, a necessary levelon one factor, in combination with a particu-lar event ~or other factor! interact to result in aparticular condition. The factors are static andessentially unrelated. Such models are oftenreferred to as diathesis stress models, and arecommon models for diseases. An importantdimension here is that the presence of the firstfactor ~also called a risk factor, condition, ordiathesis! is not typically considered norma-tive. Consider, for example, being geneticallypredisposed to certain allergic reactions ~e.g.,ragweed!. If a person never comes in contactwith ragweed, he or she will never becomecongested, sneeze, and so forth from ragweed,regardless of this predisposition. If the predis-position is present and the person is exposed~it may take several exposures! the individualbecomes symptomatic. In this case, neitherthe genetic0biological predisposition ~exist-ing even prior to exposure to ragweed! nor theenvironmental event itself ~presence of rag-weed! are sufficient to cause the allergic reac-tion. Rather, both factors, in combination, causethe sneezing. Moreover, the predisposition andthe stressor are static: avoiding ragweed wouldnot diminish the predisposition, and the levelof predisposition has no impact on the amountof ragweed present. As such, the predisposingfactor and the stress factor are orthogonal.Currently, interactional models are a popularmeans of understanding, at least retrospec-tively, available data that show high rates offamily distress and emotion vulnerability inadults with BPD, but these models may bequite limited theoretically.

Transactional models

An alternative to an interactional model, ofcourse, is a transactional model, wherein two~or more! factors transact, or influence eachother reciprocally, resulting in a particular con-dition ~for an individual! or relationship style~for a parentchild or spouse dyad!. Transac-tional models are common ways of understand-ing the development of all kinds of behavioralrepertoires in social interactional situations~Fruzzetti, 1996, 2002; Fruzzetti & Iverson, in


press!, including severe problems such as BPD.Unlike interactional models, in transactionalmodels a person exhibits a particular behavior~normative or not! that has some impact on theperson social or family environment ~which mayitself be normative or not!. The person may bepredisposed to this behavior, or it may simplyreflect his or her current disposition. People inthe social and family environment respond,shaping the individual, who responds, again af-fecting others in the social and family environ-ment, and so forth. Thus, a transactional processensues, with each part influencing the other ~re-ciprocal influence between the individual andher or his social environment!. Of course, rel-evant aspects of genetics, biological strengthsand limitations, and previous learning and so-cialization, are all instantiated during thetransaction.

For example, in a transaction between aparent and a child in a grocery store, the childmight be ~normatively! tired and hungry oneday, and ask for a candy bar in the candy aislein a whiny kind of way. The parent, also nor-matively tired, might respond brusquely, andthe child might get upset and noisier. The par-ent, perhaps feeling embarrassed, might givethe child the candy bar even though she or hehas never done this before; the child becomesquiet, even content, having received the candy;and subsequently the parent feels some relief~an example of Pattersons coercive familyprocess; e.g., Patterson, 2002!. The next timethey are in the grocery store, the child may getwhiny and ask for a candy bar even if she orhe is not as tired or hungry. In addition, theparent may give the child a candy bar in thosecircumstances even if he or she is not tiredeither. It is likely that each person has influ-enced ~in this case, reinforced! the others be-havior in similar situations in the future. Noticethat if this kind of transaction were to con-tinue it could result in the child being dis-posed to tantrums ~i.e., having an abnormallylow threshold for tantrums!, at least in certainsituations. The child may also develop height-ened sensitivity to others and may not developskills to tolerate distress in general. Of course,this pattern also could result in the parent be-ing disposed to high reactivity regarding thechild ~i.e., having a low threshold for trying to

placate the child, getting very upset when thechild does tend toward a tantrum, putting a lotof effort into trying to keep the child frombecoming unhappy or throwing a tantrum!.

Thus, it is important to distinguish be-tween predispositions ~current action tenden-cies that are the direct result of genetic ortemperament factors in the individual! and cur-rent dispositions ~current propensities to actin a particular way, the reasons or causes notimplied nor known definitively!. Unless wehave clear evidence of predispositions ~ab-normal factors present entirely in the person,essentially irrespective of learning or life ex-periences!, it may be more accurate to refer tocurrent dispositions.

The distinction between dispositions andpredispositions is important in understandingthe development of BPD, and may account inpart for the variety of etiological pathwaysthat have been proposed. As adults, peoplewith BPD show dispositions to affective dys-regulation, interpersonal chaos, cognitivedysregulation, impulsivity, and so forth. Im-portantly, evidence suggests that many of thesebehaviors can be moderated in both adoles-cents and adults ~e.g., Miller, Wyman, &Huppert, 2000; Robins & Chapman, 2004!.Currently, there is insufficient evidence to sup-port BPD as a function solely of either indi-vidual differences or environmental factors,and interactional models may similarly beproblematic. Alternatively, a transactionalmodel may hold some promise.

Emotion Regulation and BPD

Linehan and colleagues have developed a trans-actional model of the development of BPD,also called a biosocial theory, which providesthe theoretical basis for dialectical behaviortherapy ~Linehan, 1993!. This biosocial theoryis, in essence, a modern contextual behavioraltheory, or transactional model, that is com-pletely compatible with a developmentalpsychopathology perspective. The model em-phasizes ~a! the role of temperament in thechild, including the possible roles of geneticsand early biological development; ~b! the roleof parenting and other family or caregiver re-sponses to the child, as well as the overall


quality of the family environment; ~c! thepersonenvironment transaction over time; ~d!the resulting continuum of individual disposi-tions and range of behaviors from health todisorder; and ~e! a modern contextual behav-ioral analysis, including operant and classicalconditioning, of key behaviors ~including cog-nition, biology, emotion, temperament, and at-tachment styles, along with overt behavior! toexplain the development and maintenance ofBPD. What follows is an elaboration and ex-tension of this model.

In this model ~Fruzzetti & Iverson, in press;Linehan, 1993!, chronic and pervasive emo-tion dysregulation is considered the core fea-ture and core difficulty in BPD ~and relateddisorders; Fruzzetti, 2002! rather than a symp-tom of the disorder. Emotion dysregulationis a state of negative or aversive emotionalarousal that is sufficiently high to disrupt cog-nitive and behavioral self-management: the in-dividual may lose track of important long-term goals, experience diminished abilities tosolve problems or engage in complex cogni-tive tasks, and engage in behaviors increas-ingly designed only to reduce negative arousal,irrespective of long-term consequences. Thus,emotion dysregulation is hypothesized toprovide a framework from which the otherbehaviors of BPD may be understood. Thecharacteristic behaviors and patterns of BPDare understood either to be problematic at-tempts to regulate dysregulated emotion,problematic attempts to prevent or truncatedysregulated emotions, or natural consequencesof dysregulated emotion.

For example, impulsive behaviors such asparasuicide ~self-injury! or substance abuse inBPD most often function to facilitate an es-cape from high levels of aversive arousal ~orto prevent escalating arousal from becominghighly aversive!. Chaotic relationships andfears of abandonment, in contrast, result nat-urally when an individual is chronically dys-regulated: such a person would naturally, whendysregulated, put significant demands on oth-ers, often making relationships difficult. Fre-quently this results in others minimizing,avoiding, or ending a relationship, causing sub-sequent fears of ~real! abandonment. Of course,abandonment may further contribute to the

individuals low threshold for reacting ~emo-tionally and socially! and therefore increasesubsequent dysregulation tendencies in rela-tionships. Thus, if we are able to understandthe factors that contribute to the developmentof chronic and pervasive emotion dysregula-tion, we will understand the development ofBPD.

The development of emotion regulation, ofcourse, is a normative developmental process,and includes many component behaviors. Forexample, Gross ~1998, p. 275! suggests thatnormative emotion regulation includes pro-cesses by which individuals influence whichemotions they have, when they have them,and how they experience and express theseemotions. Thompson ~1994! notes that emo-tion regulation processes are in the service ofthe individuals long-term goals and not nec-essarily in the service of short-term goals ~suchas relief from negative arousal!. Emotion dys-regulation often includes such a high level ofexperienced aversive emotional arousal thatthe individual may engage in problematic be-haviors simply to escape from these short-term unpleasant private experiences ~e.g.,substance use, angry outbursts, verbal aggres-sion, extreme social withdrawal or isolation!.

Thus, emotion dysregulation in general ispredicated on the following factors ~Fruzzetti& Iverson, in press!: ~a! vulnerability to neg-ative emotion, specifically high sensitivity, highreactivity, and slow return to baseline, whichinfluence emotional arousal at any givenmoment ~cf. Linehan, 1993!; ~b! deficientemotion-relevant skills or competencies thatallow a person to choose situations in whichhe or she can act effectively; manage socialinteractions effectively; be aware of relevantstimuli; discriminate more relevant from lessrelevant stimuli; identify, label, tolerate, andexpress private experiences accurately; andmanage arousal in ways that are consistentwith long-term goals and values; and ~c! prob-lematic responses of others ~especially part-ners and parents! to expressions of emotion,wants, thoughts, and goals; these responses ofothers are an integral part of emotion dysreg-ulation because demands of others can initiatearousal and responses of others can reduce orexacerbate arousal, and social situations are


the most common in which demands are placedon individuals with BPD to which they re-spond with dysregulated emotion.

According to Linehan ~1993!, people withBPD have extreme difficulties with emotionregulation, as evidenced by ~a! extreme diffi-culties compared to norms in changing or mod-ulating the physiological arousal associated withemotion ~emotional lability!, ~b! extreme dif-ficulties orienting or reorienting attention or cog-nitive processing ~cognitive dysregulation!, ~c!extreme difficulties compared to the norm in-hibiting mood-dependent actions ~impulsiv-ity!, ~d! abnormally high likelihood of escalatingor blunting emotions ~escape or avoidance!, and~e! dispositions to organize behavior in the ser-vice of internal or mood-dependent goals ~es-cape behaviors, interpersonal insensitivity!rather than longer term goals.

Emotion dysregulation ~for which BPD maybe considered the prototype! is hypothesizedto develop as a result of transactions betweena person with emotion vulnerabilities andparents, partners, or others that respond in in-validating ways. Figure 1 displays the core

features of this model. We will discuss themodel in some detail, considering both emo-tion vulnerabilities and invalidating family re-sponses, and finally describe the transactionbetween these two reciprocal factors in thedevelopment of BPD.

Emotion vulnerability

What we refer to as emotion vulnerability isdefined and determined by three factors: emo-tion sensitivity, emotion reactivity, and slowreturn to baseline arousal ~cf. Linehan, 1993!.

Emotion sensitivity. Emotionally vulnerableindividuals are more likely to have high sen-sitivity to ~low threshold for discriminating!the emotionally relevant things in their world.Because they discriminate or notice ~with orwithout cognitive awareness! emotionally rel-evant stimuli in their world more readily, theyhave a lower threshold for reacting in a vari-ety of situations, compared to norms. In con-trast, people with lower sensitivity may beviewed as even tempered, or possibly disinter-

Figure 1. The transactional model: emotion dysregulation a invalidating response cycle; *includes out of controlbehavior.


ested or disengaged; if a person does not no-tice emotionally relevant stimuli, he or shecannot react to them.

Emotion reactivity. People high in emotionreactivity demonstrate more intense emo-tional responses to emotionally relevant stim-uli when these stimuli are noticed. Emotionallyvulnerable individuals will respond morequickly and0or with greater intensity across avariety of situations, again compared to norms.Of course, high reactivity can include reactingwith a wide variety of emotional responses~e.g., sadness, shame, anger, fear!.

Return to arousal baseline. For some peopleit takes a longer period of time to return tobaseline after becoming emotionally aroused.People who return to baseline quickly are lessvulnerable to the next emotionally relevantevent in their life ~that they discriminate, atleast!; in contrast, those who return very slowlyare likely to remain at least partially emotion-ally aroused when the next emotionally rele-vant event occurs, which may make subsequentreactions more likely to be problematic.

In this model, only the combination of allthree of these factors ~high sensitivity, highreactivity, and slow return to baseline! makesa person vulnerable to chronic emotion dys-regulation or BPD. Only the combination offactors is likely to keep a persons arousalhigh regularly and interfere with the develop-ment of normative regulatory behaviors. How-ever, the development of BPD requires thatthe emotionally vulnerable person also lacksufficient skills to manage these vulnerabili-ties successfully, and transact with and in aninvalidating environment: emotion vulnerabil-ities are not the disorder per se.

What is uncertain is when individuals whohave problems with emotion regulation andmeet criteria for BPD as adolescents or adultsfirst begin to demonstrate emotion vulnerabil-ity that is not normative. For example, someadolescents and adults with BPD may havehad normative emotion functioning, or tem-perament, as infants or young children. Forthese individuals, chronic, pervasive, aver-sive, and0or invalidating responses ~includingneglect! when they were infants and children

may have transacted with their emotional sys-tem ~incipient vulnerabilities! to result in in-creased emotion vulnerability ~sensitivity,reactivity, slow return to baseline! and affectdysregulation over time. Alternatively, someadolescents and adults with BPD may havebeen, as infants and children, extremely sen-sitive and reactive, with a slow return to base-line arousal ~highly vulnerable!, such that evennormatively healthy parenting could havemaintained or even exacerbated their emo-tional vulnerability and increased their dispo-sition to dysregulation. Notice that in eithercase the individual was vulnerable to the ac-tual family environment in which she or helived: we may not be able to identify ~posthoc!whether there was initial temperamental0biological vulnerability, normatively problem-atic parenting, or both, during the devel-opmental transactional process. Thus, manycombinations of emotional vulnerability in in-fancy and childhood and invalidating parent-ing environments could lead to BPD, or otherdisorders. In principle, even very high emo-tion vulnerability in a child living in a validat-ing family environment could lead to normativeemotional functioning, or even high resil-ience, as adults. This hypothesis is consistentwith some models within behavior genetics aswell ~cf. Scarr & McCartney, 1983! that ad-dress the transactions between what an indi-vidual brings to her or his environment, whatthe environment brings, and what behaviorsare selected in those contexts. Much longitu-dinal research is needed to understand and testthese processes to create a more comprehen-sive, and empirically validated, model.

Invalidating family environmentsAlthough the word invalidating is often em-ployed in psychology, in this model it is usedto describe a particular set of responses, incontext, by parents or others in the social andfamily environment, to an individuals behav-ior ~including verbal or other expressions ofemotion, want, pain, etc.!. Thus, invalidatingis not consonant with bad but more a de-scription of the inaccuracy and0or judgmentalquality ~rejection of something valid! demon-strated in response to the person. Describing a


response as invalidating depends less on thetopography of the response in isolation thanits relevance and function regarding thepersons experience or behavior to which itresponds. For example, if a child sees a sweetdessert and says Im hungry and the parentreplies, No, youre not hungry or you dontwant that, we would consider the parent to beinvalidating the childs hunger and experienceof wanting the sweets. A whole range of to-pographies would be invalidating: Youre al-ways wanting something, you ungrateful littlesnot ~in a nasty tone! might be more obvi-ously negative, whereas oh, my love, youdont want that big dessert now, do you? ~ina loving voice! may be nicer, but is still inval-idating. Similarly, misperceiving the childsemotional experience ~whether due to paren-tal preoccupation with other stimuli or inaccu-rate expression by the child! may lead tomislabeling of the childs emotion, and mis-matched responding that invalidates her orhis actual emotional experience. This type ofinvalidating response is similar to what someclinicians may call empathic failure.

Whereas validating responses legitimize thechilds ~or adults! valid experiences, includ-ing emotions, desires, sensations, thoughts, andso forth, invalidating responses delegitimizevalid experiences ~directly maintain the expe-rience is wrong or invalid, or that the childshould not have that experience or behavior!or simply fail to acknowledge their existenceand0or legitimacy ~indirectly maintaining theexperience is wrong or invalid!. Validatingresponses are not necessarily warm or posi-tive, and do not necessarily convey agree-ment, compliance, or approval; they do conveylegitimacy and acceptance of the others ex-perience or behavior, at least minimally. Thus,validating responses acknowledge or legiti-mize only valid behaviors; criticizing or point-ing out problems with faulty behaviors is quitedifferent ~e.g., no, you cant wear your san-dals to school today because it is cold andsnowing outside is invalidating a problem-atic or essentially invalid request; telling thechild she is stupid for wanting to wear sandalswould be, of course, invalidating!.

Thus, invalidation and criticality or nega-tive expression overlap, but are not necessarily

the same. For example, in a recent study of cou-ple interactions ~Fruzzetti, 2005!, traditionallydefined negativity ~rated by blind observers!was entered first in a regression model to pre-dict relationship satisfaction. Then validatingand invalidating behaviors were entered as aset, which significantly improved the model.Similarly, the relationship between behaviorsrated ~by observers! as invalidating and re-ported by subjects as negative or conflictual ismodest ~r .29; Fruzzetti, Shenk, Lowry, &Mosco, 2005!. Moreover, validating responsesare not necessarily present just because inval-idating responses are absent, and vice versa:the correlation between validating and invali-dating behaviors ~observer ratings! in one re-cent study was about .34 ~Fruzzetti et al.,2005!. Yet, invalidation may be a core part ofthe transaction in the development of emo-tional and behavioral difficulties. For exam-ple, in a recent study of adolescents and theirparents, Shenk and Fruzzetti ~2005! found thatobserved parental invalidation was highly re-lated to adolescent reports of family distress,adolescent distress and psychopathology, andadolescentsinability to identify and label emo-tions, and related to parent reports of child be-havior problems. Similarly, Schneider andShipman ~2005! found that lower levels of ob-served maternal validation and higher levels ofobserved maternal invalidation for theirchildrens expression of sadness were associ-ated with depression in those children. Thus,validating and invalidating behaviors, althoughthey may at times overlap with more commonconstructs ~e.g., support or positivity for vali-dating and conflict, criticism, or negativity forinvalidating behavior!, seem to represent a moredistinct conceptualization of this part of familyinteractions ~Fruzzetti, 2005; Fruzzetti &Fruzzetti, 2003; Fruzzetti & Iverson, 2004, inpress!, one that may be important in under-standing the development of chronic emotiondysregulation and BPD.

Understanding Invalidating Responses

Let us consider more specifically some inval-idating processes and the effects of chronicand pervasive invalidation developmentally.


Types of invalidating responses and likelydevelopmental consequences for children

Invalidation of emotions, thoughts, wants, andother internal or private behaviors. In an in-validating family environment the childs com-munication of her or his valid ~actual! internalor private experiences ~thoughts, feelings,wants, etc.! are met often by erratic, inappro-priate, or extreme responses. This can include~but is not limited to! ~a! not accepting orrefuting the accuracy or veracity of the personsself-description; ~b! treating the persons validresponses ~emotions, thoughts, wants, etc.! toevents or situations as invalid, inappropriate,flawed, and so forth; ~c! dismissing or trivial-izing opinions, thoughts, feelings, wants, andso forth; ~d! criticizing and0or punishing thesedescriptions; ~e! pathologizing normative re-sponses; ~f ! normalizing problematic or patho-logical or abnormal responses; and0or ~g!attributing the persons normative and legit-imate feelings, thoughts, wants, and so forth,to socially unacceptable characteristics ~e.g.,a disorder such as BPD, paranoia, intent tomanipulate, lack of motivation, immaturity!.

An interesting phenomenon relevant to theeffects of invalidation on emotional develop-ment is described in experimental research in-vestigating thought and emotion suppressionthat can result from being told not to think orfeel certain things ~cf. Cioffi & Holloway,1993; Wegner & Gold, 1995!. A reboundeffect has been described in which trying notto think about a particular thing or trying notto feel a particular emotion leads, paradoxi-cally, to focusing more attention on the un-wanted thought or feeling and increasing theintensity of the experience rather than decreas-ing it. For example, telling a small child not tospill her or his full glass of milk may lead thechild to focus more on not spilling ~ratherthan simply drinking successfully!, perhapsincreasing the likelihood of spilling. Thus, insome invalidating environments being told,Dont be angry or you should not be sad~or other invalidating responses! may lead thechild to pay more attention to the undesiredprivate experience, which increases its inten-sity and increases the probability of the childengaging in associated problematic behavior.

If a parent or caregiver responds in an invali-dating way to behavior X, saying somethinglike, dont do X and the child does more ofX, it is likely that the parent would respondwith increasingly aversive behaviors ~includ-ing increased invalidation!, contributing to fur-ther emotion vulnerability and, ultimately, toemotion dysregulation.

Invalidation of overt or public behavior. Inaddition to invalidating private experiencessuch as emotional experiences, wants, andthoughts, parents or others can also respondwith invalidation to many public behaviors ina manner that likely disrupts normative devel-opment. Invalidating behavior in its essencepunishes behavior that has some validity orlegitimacy, so not all forms of criticism, neg-ative feedback, and so forth, are consideredinvalidating. For example, telling a child thathe was wrong to hit a friend or sibling, per-haps even scolding the child for it, is criticaland may be negative and unpleasant, but wouldnot be invalidating if the focus remained onthe specifics of hitting, its consequences, andso forth. However, extremely critical or aver-sive family environments are likely also to behighly invalidating, and have a number of del-eterious consequences ~Biglan, Lewin, & Hops,1990! on both internal experiences and publicbehavior. Avoiding aversives can become amain motivation for a childs behavior, andshe or he may not be able to do so via effec-tive means. The child may instead developdysfunctional escape or avoidance behaviors~numbing out, self-injury, depression, sub-stance use, aggression, bingeing or purging,dangerous, sensation-seeking, or other prob-lem behaviors!. High levels of aversive re-sponding thus may have the generalized effectof producing erratic behavior, a common prob-lem in BPD.

Moreover, complex developmental reper-toires, such as intense and sustained engage-ment in problem solving, which involve bothcognitive attention and behavioral control, maynot be learned in invalidating environmentsbecause such complex behaviors often requireconsistent feedback that validates small im-provements over time ~shaping! rather thanconsistently calling attention to shortcomings


~invalidating progress, effort, desire, frustra-tion, etc.!. Without the ability to solve com-plex problems, children ~and later, teens andadults!must rely on others to solve them, lead-ing to what is socially often considered pas-sivity, neediness ~e.g., fears of abandonment,enmeshment!, and social manipulation. Fi-nally, high levels of invalidation, aversive crit-icism, and punishment for engaging in ordinary,developmentally appropriate, activities pro-vide the opportunity for a wide range of with-drawal, escape, and avoidance behaviors to benegatively reinforced. That is, by creating reg-ular situations of high negative emotionalarousal, especially in the absence of good prob-lem solving and coping skills, these kinds ofdysfunctional escape responses ~e.g., sub-stance use, self-injury, eating disordered be-haviors, dissociation!may be the only skillsa child or adolescent may have in response tochronic high negative emotion.

Minimizing difficulties. Expectations for ma-ture ~appropriate to age! behavior, when cou-pled with support ~both instrumental andemotional! is a common recipe for effectiveparenting. However, when a parent minimizesthe difficulties that a developmentally appro-priate task or situation present to a child, theparent is unlikely to provide either the instru-mental help or the emotional support to helpthe child master the task. This may occur morefrequently if a child is quite different in tem-perament and natural abilities from the par-ent: the parent may not easily comprehendhow something so simple ~perhaps the par-ent easily mastered this type of task as a child!could be difficult for the child, and may sub-sequently invalidate the child on many levels~e.g., youre not trying hard, or you arejust doing this to be contrary to me, or look,its very easy; whats the matter with you?!.This poses a particularly vexing problem forsome parents because there may be a thin linebetween validating the childs potential ~e.g.,you can do it, said in an encouraging way,without suggesting that failure in task willresult in judgment of the child! and invalidat-ing the childs experience ~e.g., you can doit, said in an insistent way, suggesting thatacceptance and support is contingent on suc-

cess!. Again, the pervasiveness of invalidat-ing responses is what defines the parents asinvalidating, not normative miscues and occa-sional invalidating responses.

Invalidation of a sense of self and self-initiatedbehavior. The concept of self is utilizedacross a wide range of theoretical perspec-tives. For our purposes here, a persons selfincludes the private context of her or his emo-tions, thoughts, wants, and overt public behav-iors. This includes the individuals perspective,knowing what one feels, thinks, wants, and soforth ~e.g., Koerner, Kohlenberg, & Parker,1996!, unfettered by environmental constraints.

This view of the development of the selfhas important implications for invalidating en-vironments. If a whole class of private expe-riences are systematically invalidated ~wants,feelings, etc.! in childhood, the developingperson might have enormous difficulty identi-fying or trusting ~knowing! what he or shewants. For example, the very experience ofI may be largely related to normal valida-tion during language development. Kohlen-berg and Tsai ~1991! suggest that validation ofa whole class of private behaviors ~e.g., Iwant ice cream, I see the dog, I am hot!help the child to know both what she or hefeels in language that is consistent with theverbal community, and to know the differencebetween I want0feel0am and he0she wants0feels0is that is a separate person. This is con-sistent with considerable research on emotionsocialization, but more clearly highlights therole of invalidation per se, when the develop-mental process is problematic. Thus, in ex-tremely invalidating environments, parents orcaregivers do not teach children to discrimi-nate effectively between what they feel andwhat the caregivers feel, what the child wantsand what the caregiver wants ~or wants thechild to want!, what the child thinks and whatthe caregiver thinks. The probability of an in-validating response may depend on whetherthe parent is paying attention to the child andhis or her developmental needs versus theparents own emotion, or other distracting stim-uli, and children show greater abilities in emo-tion regulation and the development of selfwhen the parent attends to the child and


responds in a validating way ~Fruzzetti &Fruzzetti, 2005!.

The lack of consistent validating responses,along with at least intermittent invalidatingresponses, does not provide appropriate ~nor-mative! discrimination training or socializa-tion of emotion and other private experiences.Such a maladaptive process naturally leads toseveral of the problems described by individ-uals with BPD, such as a sense of emptiness~not knowing ones private experiences atall!, boredom ~not knowing what one wants orfeels, or what to do to experience nonaversivestimulation!, or fears of abandonment ~a validfear if one must rely on others to interpret theworld!.

It is important to note again that such in-validation may not be malevolent, and the formof the parents behavior per se may vary con-siderably: the form may be harsh and aversiveor may be pleasant and0or normative. For ex-ample, a child sensitive to warm temperaturesmay say the bath water is too hot or have anextreme pain response even if the water isonly just above room temperature. Invalida-tion occurs when the parent or caregiver re-sponds to the child by forcing the child intothe tub, saying, no, the temperature is fine,honey or when the caregiver spanks and yellsat the child for being difficult. What makesthe response invalidating is that it does notacknowledge the childs experience as ~possi-bly! valid, the caregiver does not respond asthough it is valid ~e.g., the caregiver couldsay, OK, lets add some more cold watereven if the temperature seems fine to her orhim!, nor does the caregiver support or helpthe child to tolerate or adjust to the water. Ofcourse, if the bath water initially is hot enoughto burn the child and damage the childs skin,in the future the child, ironically, may be morepainfully sensitive even to lukewarm water.Thus, invalidation may increase the childssensitivity, which makes invalidation morelikely in the future ~see Figure 1!.

In another sense, however, an importantdevelopmental process regarding intrinsicallymotivated behavior also may be disrupted bychronic invalidation. Intrinsic or self-initiatedbehavior comes out of the context of theindividual ~including her or his learning his-

tory! and is not under aversive control in thepresent or historically ~the person does notengage in the behavior because of its rewardsfrom others, nor to avoid aversive responsesfrom others!. Thus, in a sense, these intrinsicor self behaviors come out of a context thatis largely the person ~healthy self ! at that mo-ment ~observing ones own thoughts, feelings,desires, etc.!. A successful individual engagesin a considerable amount of intrinsic or self-initiated behavior, which allows one to trans-act with the social environment well ~fosteringhigh rates of activity and involvement in theworld in general, allowing others to shape ap-propriate responses, encouraging adaptive be-haviors specifically that provide a sense ofautonomy and mastery, etc.!. Invalidating en-vironments, by reinforcing escape and with-drawal behaviors, and meting out aversiveresponses at high rates, no doubt punish manyintrinsic or self-initiated behaviors as well.This may lead to tendencies toward depres-sion and anxiety, social isolation, emotionlability, self-invalidation, ostensibly self-sabotaging behaviors, or pervasive hopelessthinking, and so forth, all common behaviorsamong individuals with BPD.

Consequences of pervasive invalidatingresponses

The consequences for an emotionally vulner-able child living in invalidating environmentsare many, including wide-ranging negative ef-fects on emotional and social development andfunctioning. Below we will highlight some ofthe major effects of chronic, pervasive inval-idation for vulnerable individuals.

Heightened emotional arousal. One immedi-ate effect of invalidation is heightened emo-tional arousal ~Swann & Schroeder, 1995!. Insituations of chronic invalidation, over timethe individuals baseline level of arousal mayincrease ~thereby increasing emotion sensitiv-ity!, and the person may become activated toavoid situations that commonly result in fur-ther negative arousal. However, if importantattachment figures are also the source of in-validation, this may result in more ambiva-


lent, approachavoid relationships common inBPD.

Cognitive and attentional dysregulation. Highlevels of emotional and psychophysiologicalarousal interfere with cognitive processing ingeneral. An invalidating environment may besufficiently chaotic to affect normative atten-tional control development in general. In par-ticular, a persons ability to self-focus, becomeaware of private ~thoughts and feelings! andpublic events may not be reinforced by aninvalidating, chaotic, family environment.

Emotion skill deficits. Because of a lack ofvalidation or a surfeit of invalidation a personsverbal labels for her or his emotions may notdevelop in a way that is consistent with othersin the verbal community. Moreover, consis-tent and accurate verbal labeling and goodemotion socialization is essential in ourlanguage-based culture for others to respondto our experience and situation effectively.From a developmental perspective, a personrequires outside focus and labeling fromothers that is consistent and accurate ~corre-sponding with norms within the culture! todiscriminate and label new phenomena. No-where is this more evident than in discriminat-ing and labeling private phenomena that arenot directly observable to others.

For example, a child learns to label her orhis experiences as hot or cold when othersconsistently notice the environmental condi-tions corresponding to the childs behavior~shivering, sweating! and apply an accuratelabel ~e.g., accurate empathy!. If the child isshivering and the ambient temperature is 808F,an attentive caregiver will assess the childshealth ~perhaps she or he also has a fever,aches, etc.! and likely will label this phenom-enon as sick instead of simply cold. Thisway, the child learns to scan the environmentfor certain cues ~outside temperature! that,together with her or his private experience~feeling cold, etc.!, inform the label and theexplanation for the phenomenon. Analogousprocesses occur with emotions. If a child werehit by an older sibling and cried, looked downquietly with eyes closed, a normative label

would likely be sad. Alternatively, in thesame circumstances, the child might insteadglare at the offending sibling and clench heror his fists. In this situation, a normative labelwould probably be angry, not sad. In aninvalidating environment, the more accuratelabel would less likely be applied, and theperson teaching the labeling would base thelabel on cues outside the child ~perhaps onlyon environmental cues, or only on how thecaregiver feels!. Consequently, the childtransacting with others in an invalidating en-vironment will less likely integrate both envi-ronmental events and private experiences intothe label ~and explanation! for the emotion.Of course, this problematic labeling could besomewhat circumscribed ~e.g., only certainfeelings might be invalidated! or highly gen-eralized ~many negative feelings, along withwants and desires, and other self-initiated be-haviors, could be ignored and0or invalidatedin a more pervasive manner!. The inaccuracyof the labels for private experiences automat-ically reduces the likelihood that good copingresponses will be learned to manage or reg-ulate emotions because emotions must bediscriminated and labeled accurately for ap-propriate coping strategies to be learned.

Secondary emotions. In addition to problemswith mislabeling emotions, maladaptive emo-tional responding to cues may also be learned.Regular invalidation of primary emotions ~thosethat are normative, justified, and healthy; Green-berg & Safran, 1989! can lead children to learnto respond with secondary emotions ~problem-atic emotions that are not justified or norma-tive in the situation!. For example, routineinvalidation of primary emotions such as sad-ness or disappointment may lead children tofeel angry or ashamed ~common secondary emo-tions! in situations in which sadness or disap-pointment might be more primary. This furthercontributes to emotion skill deficits ~above! andmay elicit further invalidation, resulting inhigher rates of emotion dysregulation.

Emotion dysregulation. Emotion regulation is,of course, at the heart of this model of BPD,as noted earlier. Not only are basic skills indiscriminating and labeling emotion not learned


or are compromised ~above! in the presenceof pervasive invalidation, but also an indi-viduals ability to regulate or manage strongemotions may never be learned. This may beunderstood in part as it relates to poor identi-fication or labeling of emotion: if a particularfeeling or desire is not discerned at all, ordiscerned but mislabeled, the most effectivecoping skills to manage that feeling will notbe trained or learned. Even if the feeling ~orother private experience! is accurately identi-fied and labeled, the caregiver~s! may still notprovide effective strategies or skills for cop-ing ~e.g., the parent may still minimize thedifficulties associated with coping and hencenot provide instruction and support!.

Thus, in an invalidating family environ-ment, emotion management skills are simplynot taught, shaped, encouraged, modeled, andso forth, to the extent necessary for success-ful emotional development. Instead, the childlearns ineffective repertoires to manage dis-tress by necessity. Unfortunately, some of themost destructive behaviors that borderline cli-ents demonstrate likely were learned becausemore skillful ways of managing emotion werenot available. That is, rather than learning ef-fective coping skills for tolerating distress, bor-derline individuals more likely learnedproblematic means of managing strong emo-tions, either by escalating and demanding thatothers manage the situation ~and hence, exter-nally regulate the individuals emotions!, byescaping these experiences through impulsiveacts ~e.g., high sensory behaviors like cutting,sexual activity! that could override high neg-ative emotional arousal, or by numbing orreducing high arousal with alcohol or othersubstance use.

In addition, not having the skills to iden-tify, label, and manage strong emotions mayresult in oscillation between emotional inhibi-tion and extreme emotional experiencing andexpression. Borderline clients may not havehad experience successfully managing or reg-ulating their emotions, so naturally would beintermittently reinforced for ignoring risingnegative emotion ~or not discriminating it ini-tially! because sometimes they would reregu-late, either by chance, or someone wouldfacilitate it externally. This would reinforce

emotional inhibition. Alternatively, on thoseoccasions in which inhibition did not result indiminished arousal, they might become awareof it, or express these strong feelings, but doso only past the point at which they could nolonger inhibit, a point too high for the personto regulate them independently. This wouldlead to what might seem to others to be wildlychangeable, unpredictable displays: the expres-sion of moderate emotion would be unlikely~it would be inhibited, looking much like sat-isfaction or a lack of arousal!, and would meanthat untended moderate arousal could oftenescalate into higher, more unpleasant, arousalthat could no longer be inhibited. These kindsof unpredictable behaviors could easily be-come a context for further invalidation, withothers viewing the borderline individuals be-havior as crazy, manipulative, out of control,unpredictable, lazy, and so forth.

Passivity in problem solving. Invalidation mayalso include minimizing the difficulty of solv-ing problems ~just do it! by failing to appre-ciate and validate either the inherent difficultyin a task or its difficulty under a heightenedstate of emotional arousal ~anxious apprehen-sion, shame, etc.!. If a child does not learnhow to solve small ~developmentally appro-priate! problems, and does not develop self-efficacy in approaching problems to be solved,the child will increasingly turn to others tosolve those problems. Over time, the childmay not develop entire repertoires and insteadrely on others in many instrumental situa-tions. If the child or adolescent ~or adult! alsoinhibits emotion associated with these situa-tions ~i.e., suppresses rather than expressesthe emotion accurately!, he or she may seem,and indeed be called, manipulative, lazy, andso forth, which of course, would further inval-idate the persons actual ~valid! emotion andmotivation.

Self-invalidation. Of course, another conse-quence of invalidation is that individuals mightnot learn to trust their emotional responses asvalid when parents and caregivers regularlyinvalidate them. That is, if ones private expe-riences are pervasively invalidated, ones own


experience does not predict or seem to corre-spond with the responses of others, and thuswe may learn not trust our own experience~we refer to this phenomenon as gaslight-ing in reference to the 1940 and 1944 films;Fruzzetti, 1995!. Furthermore, self-invalidationmay also be reinforced because it may leadto diminished criticism, aggression, and in-validation by others ~Hops, Biglan, & Sher-man, 1987!. A vicious cycle often ensues: aperson is pervasively invalidated, he or shedoes not learn emotion skills very well, andmislabels, inaccurately expresses, and0or self-invalidates frequently; others ~even poten-tially validating ones! see the person as chaoticand unpredictable, perhaps emotionally ex-treme, and further invalidate the person;this leads to more self-invalidation. Self-invalidation, of course, is highly associatedwith various forms of individual psychopa-thology ~e.g., depression! in addition toBPD, although in various models other labelsmay be employed. For example, Swann andcolleagues ~e.g., Giesler, Josephs, & Swann,1996; Swann, 1997! have demonstrated thatwhen a persons negative self-construct isinvalidated with a positive evaluation fromanother, the individual may try to demon-strate or prove that his or her constructis correct ~i.e., paradoxically exhibit more ofthe behavior being invalidated!. Thus, a per-son who sees herself as unreliable may pro-ceed to do something in fact unreliable, ifanother person comments on her consistency.This may not be to sabotage the relationship,but rather ~according to Swann! to bring eval-uations from others in line with her self-construct. It is clear how pervasive invalidationfrom others can result in chronic self-invalidation and the creation of enduring neg-ative self-constructs, and how the self-verification process in turn can maintainnegative self-views and self-invalidation evenin reasonably compensatory relationships. Thisis one factor that may make interventions withindividuals with BPD particularly difficult,and make validation a particularly importantfeature of treatment.

Social and interpersonal dysregulation. Fi-nally, as suggested above, it may be difficult

to validate a person who is self-invalidating.Emotionally dysregulated individuals may useescape behaviors such as anger and aggres-sion or shame and withdrawal to titrate theirarousal ~intentionally or not!, making stable,reciprocal relationships difficult. Further-more, individuals who have difficulties ~a!identifying their desires and preferences, ~b!self-validating what they want, ~c! assertingwhat they want, and ~d! managing negativefeelings such as disappointment, fears of aban-donment, and so forth, may appear unpredict-able in relationships. Consequently, they maydevelop extreme interpersonal styles, oscillat-ing between nurturing and giving to othersand feeling that they are being exploited. BPDindividuals may indeed have problems trust-ing others. Similarly, an acquaintance beingnice to someone with much self-loathing~negative self-construct! may result in a veryquixotic, negative, response, at which pointthe person likely withdraws or becomes crit-ical, reinforcing the negative self-view andkeeping relationship patterns chaotic. Thus,following immersion in an invalidating envi-ronment, borderline individuals may later con-tribute toward selecting further invalidatingenvironments as a result of a combination ofmultiple skill deficits and familiarity, reinforc-ing the cycle of invalidation from others, self-invalidation, and dysfunctional coping.

Factors that make invalidation more likely

Experience or behavior is unexpected. Evenamong biological relatives there are signifi-cant differences in temperament. When achilds private experiences are very differentfrom those of a parent or caregiver, the parentmay not even imagine that the childs emo-tion, sensations, or wants are what they are.This may be exacerbated if one or more sib-lings are similar in temperament to the parent;this might make it even more likely that ordi-nary ~albeit significant! differences would bemissed and misunderstood ~invalidated!. Fur-thermore, invalidation would be even morelikely if one child displays extreme emotionvulnerability and siblings are both normativeand similar to parent~s!.


Behavior puts unwanted demands on another.Invalidation may be considerably more likelywhen recognition of a childs vulnerability orvalid needs would put significant demandson parents or on the care giving system. Onemodel of this systemically is the increasedprescription of stimulants as active ~but notpathological! children enter the school sys-tem. Alternatively, many parents have strongimplicit rules, for example, that all childrenshould receive the same amount of attention.However, if one child genuinely needs morethan the others do to foster healthy develop-ment, parents may opt to minimize the need~invalidate the child! rather than break therule. In addition, parents may struggle withtheir own psychological difficulties such asdepression, anxiety, substance abuse, or otherproblems, highly prevalent in the families ofthose with BPD ~e.g., Trull, 2001!. These par-ents may have few emotional resources leftto give to needy children, having enormousneeds themselves. This sets up a situation inwhich the childrens needs can easily be in-validated, which of course ~paradoxically!, in-creases their needs for nurturance, support,and validation.

Other person has insufficient ability to helpor understand. This situation is similar tothe one above, except that perhaps no parentor caregiver may have the ability to give acertain child what is needed. Colic inchildren provides an example: for many chil-dren with colic, no amount or type of parentalsoothing really makes a difference. Fortu-nately, colic is typically time-limited, and isreadily diagnosed, so it is less likely that par-ents blame children for it. However, emo-tional colic may be a useful metaphor forsome extremely vulnerable children, for whomno available remedies for their suffering arefound, even among caring, stable parentswho may even seek help and guidance fromexperts. Over time, such caregivers can burnout, have fewer resources to give, andeven they may begin to invalidate the childfor her or his own suffering by minimizing thechilds distress or blaming her or him for thedistress.

Transactions and Reciprocity BetweenEmotion Vulnerability andInvalidating Responses

The problems of BPD are chronic and severe.Although it may be possible for someone tobe born with clear precursors to BPD, there isvery limited evidence to support this. Simi-larly, although very harsh and problematic fam-ily environments clearly result in myriadproblems for the children who grow up inthem ~both as children and later as adoles-cents and adults!, evidence suggests that suchfamily environments do not specifically leadto BPD. Therefore, in this model, the combi-nation of emotion vulnerability and an invali-dating family environment provide the requisiteprecursors, and as these factors transact overtime, each leads to a worsening in the other.Much research is needed to clarify and sup-port this model.

For example, a child born with an extreme~e.g., very sensitive, reactive! temperament islikely to be different ~statistically! in impor-tant ways from her or his parents or caregiv-ers. Moreover, such a child is likely to bemore emotionally vulnerable and needier thanan average child, and therefore puts very highdemands on caregivers. If the childs environ-ment is less than optimal, and the caregiversstruggle with their own difficulties ~depres-sion, substance abuse, problems in living!, theymay already engage in high rates of invalidat-ing behavior ~perhaps neglectful, inattentive,harsh, demanding, critical, etc., as well as poorattention to and frequent misunderstanding ofthe childs experiences!, along with low ratesof validating behavior. The increased burdensand demands of a needy child may stress par-ents or caregivers a great deal more, exacer-bating their own distress and their invalidatingtendencies, which in turn further destabilizethe child and facilitate the child going down aproblematic developmental pathway: the vul-nerable child becomes more vulnerable overtime, and the invalidating family environmentbecomes more invalidating over time. With-out some significant change in this system,chronic and serious problems are likely.

However, the form of invalidation may besubtle, which makes research difficult, requir-


ing intensive observation and longitudinalfollow-up. Similarly, a childs vulnerabilitiestoward negative emotion may not start out asextreme, and even if they are they may not bepublic in many situations, further complicat-ing measurement and research. The possibil-ity that extreme differences in both childrensand parents behaviors can still lead to prob-lems with emotion dysregulation and BPD isconsistent with available ~typically retrospec-tive! data, and is therefore a strength of thismodel. However, considerably more study isneeded to validate both the essential transac-tional nature of the model and the specificcomponent parts of the model.

This model does have significant heuristicvalue in developing early interventions withtroubled families and0or children with ex-treme emotional vulnerabilities. For exam-ple, parents in troubled parentchild dyadscan learn the importance of trying to under-stand and validate problematic child behav-iors ~especially private ones!, in addition tohelping children change them and learn toregulate their emotion. For example, parenttraining programs could be expanded to in-cluded greater emphasis on emotion social-

ization and validation. Parents with deficitsin identifying and describing their childrensemotions and wants could be targeted for helpin these domains, and their children couldreceive additional coaching and support fromother caregivers to try to compensate for pa-rental deficits or overall problematic transac-tions. Similarly, interventions with distressedparents could focus on reducing their dis-tress, especially in situations in which theyare likely to invalidate, or fail to validate,their child.

Finally, another advantage of this model isthat there is no inherent blame placed eitheron the child ~or later adolescent or adult! or onthe parents or caregivers. There are many path-ways that may lead to the problems associatedwith BPD, and it may be impossible ~and ir-relevant! to determine which part came first,the childs emotional vulnerability or theparents invalidation. At the point of discov-ery of the emotion regulation problems or bor-derline personality traits it may be sufficientto implement relevant interventions to alterthe transaction, which would likely result inimproved well being for those on both sidesof the transaction.

References

American Psychiatric Association. ~1994!. Diagnostic andstatistical manual of mental disorders ~4th ed.!. Wash-ington, DC: Author.

AtreVaidya, N., & Hussain, S. M. ~1999!. Borderlinepersonality disorder and bipolar mood disorder: Twodistinct disorders or a continuum? Journal of Nervousand Mental Disease, 187, 313315.

Battle, C. L., Shea, M. T., Johnson, D. M., Yen, S., Zlot-nick, C., Zanarini, M. C., et al. ~2004!. Childhoodmaltreatment associated with adult personality dis-orders: Findings from the collaborative longitudinalpersonality disorders study. Journal of PersonalityDisorders, 18, 193211.

Baumrind, D. ~1967!. Child care practices anteceding threepatterns of preschool behavior. Genetic PsychologyMonograph, 75, 4388.

Baumrind, D. ~1991!. Effective parenting during the earlyadolescent transition. In P. A. Cowan & E. M. Heth-erington ~Eds.!, Family transitions ~pp. 111163!.Hillsdale, NJ: Erlbaum.

Biglan, A., Lewin, L., & Hops, H. ~1990!. A contextualapproach to the problem of aversive practices in fam-ilies. In G. R. Patterson ~Ed.!, Depression and aggres-sion in family interaction ~pp. 103129!. Hillsdale,NJ: Erlbaum.

Binder, R. L., McNiel, D. E., & Goldstone, R. L. ~1996!.Is adaptive coping possible for adult survivors of child-hood sexual abuse? Psychiatric Services, 47, 186188.

Brodsky, B. S., Malone, K. M., Ellis, S. P., Dulit, R. A., &Mann, J. J. ~1997!. Characteristics of borderline per-sonality disorder associated with suicidal behavior.American Journal of Psychiatry, 154, 17151719.

Bronfenbrenner, U. ~1979!. The ecology of human devel-opment: Experiments by nature and design. Cam-bridge, MA: Harvard University Press.

Calkins, S. D., Dedmon, S. E., Gill, K. L., Lomax, L. E.,& Johnson, L. M. ~2002!. Frustration in infancy: Im-plications for emotion regulation, physiological pro-cesses, and temperament. Infancy, 3, 175197.

Calkins, S. D., Smith, C. L., Gill, K. L., & Johnson, M. C.~1998!. Maternal interactive style across contexts: Re-lations to emotional, behavioral, and physiologicalregula

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