This project is a NIMH-funded randomized control trial of mothers with elevated borderline personality disorder (BPD) symptoms who have preschool aged children. BPD is a serious mental illness characterized by extreme emotions, chaotic interpersonal relationships, suicidal behaviors, and a poor sense of self. Offspring of mothers with BPD are at an elevated risk for developing mental illness across the lifespan. Difficulty managing emotions are a hallmark feature of BPD, and yet the ability to do so is necessary for responding effectively to children’s’ emotions. This response process is called maternal emotion socialization, which has a major impact on how children develop their own emotion regulation (ER) skills. ER develops rapidly during preschool and deficits in preschool ER are recognized as underlying future mental disorders.

Executive Functioning (EF) and Theory of Mind (ToM) are also key developmental processes which develop rapidly during the preschool period and are understood to be compromised in individuals with BPD. Given these known deficits, it is likely that mothers with BPD struggle to provide requisite support for their children’s development in these domains. Further, poor EF and ToM represent key transdiagnostic risk factors for many forms of psychopathology and deficits in social competence. As children whose mothers have BPD are at elevated risk for psychopathology across development, it is possible that deficits in EF and ToM which emerge during the preschool period may be mechanistic in conveying this risk.

Given that DBT has proven to be effective in reducing impairment from BPD symptoms, our study focuses on examining whether offspring development can improve as a result of mother’s involvement in DBT. A total of 270 mother-preschooler dyads will be recruited over the course of 5 years at the University of Oregon and University of Pittsburgh (135 dyads at each site). Mothers will complete a phone screener and full clinical intake to determine eligibility in the study. Mothers with elevated BPD symptoms will be randomized to receive either DBT Skills treatment or family services as usual. There will also be a third group of mothers without any mental health symptoms that will serve as an additional control group. All eligible dyads then come into the lab to be assessed 4 times across 1 year.

Overall, the project will therefore assess the relationship between mother and child emotion regulation and the extent to which child outcomes improve when mothers receive DBT Skills, a treatment that directly targets emotion regulation.