Family Dysfunction and Gene Expression: Effects on Personality and Behavior

Jenny Macfie, Ph.D., Department of Psychology, University of Tennessee Knoxville

It’s amazing what you can discover if you actually look

When it comes to the “scientific” literature about what causes borderline personality disorder (BPD) and other forms of self-destructive and self-defeating behavior, readers of my blogs know that I think genetic influences are way overemphasized and the effects of dysfunctional family dynamics and child abuse ignored as much as possible.

In my clinical practice, I see dramatic evidence that the effects of the family dysfunction on behavior are often passed down from one generation to the next.  A few studies have also looked at this, and in every case supported this viewpoint.

Two more recent studies support my views in general about what creates the disorder.

Jenny Macfie and others, following the work of Karlen Lyons-Ruth described in a previous post, actually watched the interactions between children aged 4-7 and their mothers with BPD (“A Mother’s Borderline Personality Disorder and Her Sensitivity, Autonomy Support, Hostility, Fearful/disoriented Behavior, and Role Reversal with her Young Child,” Journal of Personality Disorders 31(6):  pp. 721-737, 2017).  

The pairs were given a task with the following instructions: “This puzzle is for your child to complete, but feel free to give any help your child might need.” A researcher presented one puzzle at a time in order of increasing difficulty.  Mothers who did not have the disorder and their child were also given the task. All interactions were observed and scored.

Mothers who had BPD “demonstrated significantly less sensitivity and autonomy support [supporting the child’s efforts to solve the puzzles without the assistance of the parent], more hostility, more role reversal, and more fearful/disoriented behavior in interactions with their children than did comparison mothers.

“Role reversal” is the child taking care of the mother instead of the other way around. In this study they specifically looked at mothers deferring to their child’s demands, the pair acting like playmates (for example, child abandons task and the two run around the room rather than the mother setting limits), and mothers taking the child’s attention away from the task by demanding signs of affection from the child.

There was no group of mothers with other personality disorders so we do not know if the researchers results are specific to mothers with BPD.

In a second, unrelated study, Pierre Eric-Lutz and his colleagues looked at the effects of child abuse on the expression of genes that control the development of the brain (“Association of a History of Child Abuse with Impaired Myelination in the Anterior Cingulate Cortex: Convergent Epigenetic, Transcriptional, and Morphological Evidence,” American Journal of Psychiatry 174 (12), pp.1185-1194, 2017).

Epigenetics refers to the process by which environmental influences turn genes on and off. Most genes in a cell are not operating at all at any given time. Epigenetics ties environmental and genetic influences together in ways that a lot of people in the various mental health field either seem to be unaware of, or consciously ignore. The anterior cingulate cortex is a part of the brain heavily involved in making decisions regarding what to do in various social situations.

Without going into the authors’ methodology, which was quite sophisticated, the study found that individuals abused during childhood showed significantly decreased expression of a large collection of genes involved in myelination of cells in that part of the brain. Myelination is process which markedly changes the level of functioning of brain cells that are part of so-called white matter.

Once again, we find that one of the main purposes of the genes that create the brain in human beings is to make humans exquisitely sensitive to the social environment.

Who's in Charge in Families, Parents or Children? A Paradox

In a recent column, my favorite parenting columnist John Rosemond asked a mother and father, “Who are the most important people in your family?” They replied, as many of today's parents are wont to do, “Our kids!”

Rosemond essentially read them the riot act:  “There is no reasonable thing that gives your children that status... many if not most of the problems they’re having with their kids—typical stuff, these days—are the result of treating their children as if they, their marriage, and their family exist because of the kids when it is, in fact, the other way around... without the parents, their kids wouldn’t eat well, have the nice clothing they wear, live in the nice home in which they live, enjoy the great vacations they enjoy, and so on.

He added: "This issue is really the heart of the matter. People my age know it’s the heart of the matter because when we were kids it was clear to us that our parents were the most important people in our families. And that, right there, is why we respected our parents and that, right there, is why we looked up to adults in general."

I absolutely agree with Rosemond that the parents' marriage should be the most important relationship in the house—not the relationship between the parents and the kids—and that the parents should be the authority figures in charge. The idea that this is the proper hierarchy within the house is in fact the basis of one of the more effective forms of family therapy, Salvador Minuchin's structural family therapy. 

On the other hand, I do have a slightly skewed take about the phenomenon of parents thinking their kids should be the most important people in the house that differs slightly from Rosemond.

The part I disagree with him about is when he say that, because of the parents' behavior, it is no longer clear to children these days that the parents are in charge. In fact, our brains are biogenetically programmed to put our primary adult attachment figures in charge. Our very survival depends on it.

When the children seem to be in charge, I believe they are just acting like it is not clear to them who is in charge, and are acting as if it is they, and not the parents. So how to explain the paradox? It may seem confusing, but it is actually quite simple. 

If children do in fact know that parents make the important decisions in the home, and the parents in their wisdom have decided that the children are more important and that the children's choices should be paramount, then who are they to question the parents' judgment? They will go along with it: They will act like they should make all the decisions, because doing so is in line with precisely the important decision the parents seem to them to have made.

Finally a Study on Borderline Personality Disorder That Looks at Family Dynamics

Karlen Lyons-Ruth, Ph.D.

When it comes to the study of personality disorders as described in medical journals, it seems like most of what's been published lately in the field looks at which superficial aspects of personality disorders and personality variables correlate with one another and to what extent, or how often some construct like "impulsive aggression" is found in various populations. Such correlations usually turn out to moderate at best and never ever close to being 100% predictive of anything. 

While group data like this may help therapists prioritize - to a minimal degree - which other issues in a patient's life on which to focus clinical attention whenever they happen to note one of these characteristics, it really tells us nothing about the individual patient. Not to mention that it neglects literally thousands of other important details that may apply only to the patient at hand.

IMO, such studies are just different ways of slicing up the same old bread, when it is the bakery that needs the attention. The bakery is the interpersonal environment in which personality disorder traits develop and flurish.

Of course, as readers of my blog know, it's very difficult to study the bakery "empirically," because a lot of what goes on involves subtexts or unspoken communication in family relationships. These subtexts not only change over time but, especially in the world of personality disorders, the subtexts of family interactions can contradict one another. To make matters even worse, some of these contradictory messages may show up only rarely, but become significant when seen in light of the history of the family over the lifetime of the participants as well as the family's history over several generations. All of this is almost impossible to quantify.

I was pleased to see in a recent issue of the Journal of Personality Disorders that, for the first time in a long time, some researchers tried to address these issues in at least a partially comprehensive way (Karlen Lyons-Ruth, PhD, Laura E. Brumariu, PhD, Jean-Francois Bureau, PhD, Katherine Hennighausen, PhD, and Bjarne Holmes, PhD: "Role Confusion And Disorientation In Young Adult-Parent Interaction Among Individuals With Borderline Symptomatology." Journal of Personality Disorders, 29(5), 641–662, 2015). 

Dr. Lyons-Ruth and her colleagues did their best to look at what they so nicely referred to as the "minute to minute fabric of interaction..."  Their data lent much support to my idea that, as a manifestation of what evolutionary biologists call kin selection, children sacrifice their own needs in order to stabilize unstable parents.

In fact, while I previously thought of so-called parent-child role reversal as applying only in cases in which children act more like parents to their childlike parents than the other way around, I realized one could conceptualize the spoiling behavior seen in borderline personality disorder (See the post The Family Dynamics of Patients with Borderline Personality Disorders) as just another form of children taking care of unstable parents - although a much more subtle and covert form.

In so called "empirical studies" to date, the quality of parent-child interaction has rarely been observed directly. In this study, 120 young adults were assessed for features of borderline personality disorder, for severity of childhood maltreatment through interviews and self-report measures, and for disturbances in parent-child interaction during a videotaped conflict discussion task. The last part addressess a huge criticism of the literature I have been making: no one actually looks directly at what is going on at home.  

Of course, the way the family behaves in a laboratory setting is only an approximation of what goes on when no one is watching, and much important behavior undoubtedly gets omitted under this type of observation (as oppposed to when Supernanny spends a couple of nights in the home) - but at least it is something that can be observed directly. To paraphrase a line from the movie The Big Short that showed how certain people were able to see through the fraud perpetrated by mortgage bankers prior to the burst of the housing bubble in 2008, "If you want to understand a process, actually looking at it is a very good place to start."

The conclusions of the study: Borderline traits, as well as suicidality and self-injury specifically, were associated with more role confusion and more disoriented behavior in interactions with the parent.

The definitions of these terms, quoting more from the article: In infancy, the term disorganized refers to the apparent lack of a consistent way of organizing attachment responses to the parent when under stress. The types of disorganized behaviors observed in infancy include apprehensive, helpless, or depressed behaviors, unexpected alternations of approach and avoidance toward the attachment figure, and other marked conflict behaviors such as prolonged freezing or stilling or slowed “underwater” movements.

Controlling children, on the other hand, “Actively attempt to control or direct the parent’s attention and behavior, and assume a role which is usually considered more appropriate for a parent with reference to a child. Controlling behaviors are thought to represent a compensatory attempt by the child to maintain the involvement and attention of the attachment figure by taking over direction of the parent-child relationship.

Two forms of this controlling behavior were observed. Controlling-caregiving behavior is characterized by organizing and guiding the parent or providing support and encouragement to the parent (e.g. child praises the parent or asks if a parent is all right). Controlling-punitive behavior is characterized by episodes of hostility toward the parent that are marked by a challenging, humiliating, cruel, or defying quality (e.g., child tells parent that the parent is terrible at doing a task). The study found that, among young adults with recurrent suicidality/self-injury, 40% displayed high levels of role confusion compared to 16% of those who were not suicidal. 

Neither form of disturbed interaction mediated the independent effect of childhood abuse on borderline symptoms. In other words, these patterns contributed to the development of the disorder in an additive fashion to the usual culprit of child abuse. As the authors say, "even when present, abuse events are often only the tip of the iceberg and index pervasive difficulties within the family in establishing caregiving routines, managing anger, and maintaining discipline"  (p.643) (Italics mine).

One interesting sidelight was noted on p. 656: with depression controlled (that is, subtracted as a factor in the mix), young adult-parent interaction associated with borderline traits included a particularly contradictory combination of role confused/caregiving behavior and punitive behavior. This contradictory mix is "similar to the mixed forms of childhood controlling behavior toward the parent that predict elevated BPD features in adulthood...", as had been noted by the first author in a previous work from 2013. This odd mixture of punitive and caregiving behavior "converges with the often-described shifts from idealizing to devaluing behavior experienced in therapeutic interactions with borderline patients."

This means that the so-called "splitting" seen in patients with BPD may be triggered by the demand characteristics of interactions with parents as they change over a period of time. This finding is highly consistent with what I have written about extensively.

Borderline Personality Family Dynamics: The Parents, Part II

In my post of 2/6/11, Dysfunctional Family Roles, Part I: The Spoiler, I opined that the basic problem in the "borderline" family (one that produces offspring with borderline personality disorder [BPD]) is that the parents in such families see the role of being parents as the end all and be all of human existence, but all the while, deep down, they either frequently hate being a parent or see their parental role as being an impediment to their personal fulfillment.

In Part I of this post, I described the one most common major issue - gender role conficts - and the resultant behavior patterns, that I have discovered leads individuals within a family to develop a severe conflict over the parenting role. In Part II, I will describe the other ones.

To repeat a caveat from the previous post: All of these issues may seem very common everywhere, and indeed they are. Most families that face them do not produce emotional conflicts significant enough to create BPD pathology. Rather, the issues in families that do have been magnified significantly by an interacting tableau of historical events impacting the family and the individual proclivities of each and every family member and descendent.

Common issue #2 causing parental ambivalence over being parents: Untimely deaths. The loss of children, in particular, may make someone fearful over losing the others while, at the same time, may lead to parental resentment over the fears and insecurities created by the presence of the remaining ones.

For example, one grandparent of a patient in our clinic had lost 10 out of 11 children to disease; the 11th was the parent of the therapist's BPD patient. The grandmother was overprotective of the mother but at the same time avoided closeness for fear of the pain of losing yet another child. When the mother grew up and left home, the grandmother became depressed. The patient was then given up as a child to the care of the grandmother to help feel the void, and became the new focus of the grandmother's hyperconcern and insecurity. This is also an example of a parent giving up a child as a gift to a grandparent - the subject of my 10/15/2010 post.

Issues #3 and #4: Financial reverses and chronic illnesses - including severe mental illnesses. Because of the financial strains and general chaos caused by these considerations, the joy of raising children may be suddenly turned into a frightful burden, both emotionally and financially, and thereby generate parental ambivalence.

Interestingly, the presence of bipolar disorder - with which BPD is often confused these day by both incompetent psychiatrists and the public despite the fact that they do not look anything alike - in a parent may lead to the very chaos in families that generates BPD behavior in children. Children in such a family are at risk both biologically and genetically for bipolar disorder and environmentally for BPD.

Issue #5: Ambivalence over religious or cultural values concerning childbearing, child rearing and filial responsibilities may lead to parental ambivalence. Examples include:

• 1.  The Roman Catholic emphasis on large families in a day and age when children cost a small fortune to raise. This may lead parents to follow the church rules but be extremely unhappy about the results.
• 2. Children, often the eldest female in a traditional family, may be called upon to take care of younger siblings in large families. In doing so they are often forced to give up exciting adolescent activities in which their peers at school freely indulge. The result may be that they become identified with the caretaker role yet resentful of it. When they leave home and have families of their own, this history may lead them to resent their own children. 

I     I used to practice in Los Angeles where I saw many Chicano (Mexican American) patients.  I saw several females who had functioned as "mother's assistants" when they were growing up. They were the eldest sister in large families. They had to stay home and take care of their younger siblings, and frequently had to miss important social events in school such as their senior Proms. Their younger sisters, however, got to go to and do everything the olders sisters had missed. When these older sisters grew up and had their own children, this recreated the family of origin issues for them and induced ambivalence in them about their brood.



•  The eldest male in a traditional family, such as seen in some Asian cultures, may be called upon to take over the family business in a career that he may just happen to hate. The costs incurred in raising children may lead to continuing family pressure to keep the business going when he wants out. The anger of Son #1 in such a situation may be displaced onto his children.

Issue #6: Parent-child role reversals. If adults in the family become incapacitated for whatever reason, and the children are therefore called upon to take over heavy adult responsibilities prematurely, the children may become resentful in a manner analogous to the situation of the eldest female in a traditional family described above.

Such individuals often describe this state of affairs with statements such as “I never got to be a kid.” [This is not the reason, however, that Michael Jackson said that]. A similar situation occurs when parents who were infantalized by their own families of origin appear to be unable to take care of themselves. Their children then try to fill the power vacuum and take care of them before they are really equipped to do so.

Issue #7: A couple has a child to “save the marriage.” The child then becomes the reason that the parents must continue in their miserable relationship. The resentment within the marital dyad becomes symbolized by the child whose presence was supposed to make the relationship better, but instead has led to the continuation of the same old marital misery.

The child then begins to believe that the family problems are all his or her fault, and the parents do not seem to try very hard to counter this belief. Children in such a bind usually come to the conclusion that their very existence is the reason their parents seem to hate each other. They may also feel that it is their reponsibility to provide a distraction to the parents' anger at one another by drawing anger on to themselves. This is one of the functions of the spoiler role.

Two or even several of these issues can present themselves simultaneously to a family, thus increasing parental ambivalence over the presence of children almost exponentially. The whole family becomes embroiled in quite a stew, and the abuse and neglect of children that sometimes results from these conflicts becomes more understandable, although still not excusable.

Expressing empathic understanding of the family's behavior, without condoning it, is far more productive in helping a family to stop troublesome behavior patterns than raking them over the coals for their misbehavior.