The Invalidating Childhood Environment Scale (ICES): psychometric properties and relationship to borderline personality symptomatology

The impact of childhood trauma on borderline personality organization in a community sample of Greek emerging adults

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The five-factor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

The relationship between childhood emotional abuse and borderline personality disorder: the mediating role of difficulties in emotion regulation among Lebanese adults

OBJECTIVE

The present study investigates the mediating effect of difficulties in emotion regulation in the association between childhood emotional abuse and Borderline Personality Disorder (BPD) among Lebanese adults.

METHOD

This cross-sectional study, involving 411 participants, was conducted between March and August 2022. Lebanese individuals from all governorates of the country were recruited using the Snowball Sampling technique. Three self-report scales were utilized to complete this research; the 'Difficulties in Emotion Regulation Scale-Brief Version (DERS-16)' which evaluates the difficulties in emotion regulation of individuals, the 'Childhood Trauma Questionnaire-Short Form (CTQ-SF)' which grants a subjective evaluation of the general childhood environment of the participants, as well as the 'Borderline Personality Questionnaire (BPQ)' which measures Borderline Personality Disorder traits, that demonstrate significant convergence with the disorder.

RESULTS

The results indicate that DERS-16 played an indirect effect role between childhood emotional abuse scores and Borderline Personality Disorder. Higher emotional abuse scores were significantly associated with higher DERS-16 scores, which in turn was significantly associated with higher BPQ scores. Moreover, childhood emotional abuse was directly associated with higher BPQ scores.

CONCLUSION

This work suggests that, among the different forms of childhood abuse, emotional abuse may have a role in the development of Borderline Personality Disorder. Training on emotion regulation strategies would potentially benefit individuals in preventing BPD development and facilitating therapeutic processes.

Development and psychometric properties of the Chinese Invalidating Family Scale

The present study aims to develop the Chinese Invalidating Family Scale (CIFS) and examine its psychometric properties. The CIFS comprises two parts that measure the degree (Part 1) and types (Part 2) of family invalidation. Study 1 explored the structure and reliability of the CIFS using data from Sample 1 (N = 1323; Mage  = 26.3) and Sample 2 (N = 152; Mage  = 25.1). Part 1 of the CIFS is separated into father (20 items) and mother (27 items) subscales. Exploratory factor analysis identified four factors for the father subscale and five factors for the mother subscale. The shared factors are neglect, denial, emotional dysregulation, and overemphasis on achievements, while psychological control is the unique dimension for Mother subscale. Part 2 includes five items assessing the types of family environment. Results indicated acceptable to good reliability of the CIFS, with Cronbach's α higher than 0.60, split-half reliability higher than 0.70, ICCs higher than 0.70, and high criterion-related validity. Study 2 examined the structure and the validity of Part 1 with Sample 3 (N = 2282; Mage  = 19.90) through confirmatory factor analysis. Part 1 showed good construct validity (RMSEAs = 0.05, GFI, NFI, CFI, and AGFI >0.90) and acceptable convergent validity (AVE >0.36, CR >0.76). Overall, the CIFS is a promisingly stable and valid tool to evaluate the invalidating family environment in Chinese culture.

Examining the intergenerational transmission of parental invalidation: Extension of the biosocial model

This study examined the intergenerational transmission of parental invalidation and whether parental difficulties in emotion regulation mediated the association between past experiences of invalidation and current invalidating parenting practices. We also aimed to investigate whether gender might influence the transmission of parental invalidation. We recruited a community sample of 293 dual-parent families (adolescent and their parents) based in Singapore. Parents and adolescents each completed measures of childhood invalidation, whereas parents additionally reported on their difficulties in emotion regulation. Results based on path analyses demonstrated that past parental invalidation experienced by fathers positively predicted current perceived invalidation by their children. The association between mothers' childhood invalidation and current invalidating practices was fully mediated by mothers' difficulties with emotion regulation. Further analyses revealed that parents' current invalidating behaviors were not predicted by their past experiences of paternal or maternal invalidation. These findings point to the importance of considering the family invalidating environment as a whole when examining the influence of past experienced parental invalidation on emotion regulation and invalidating behaviors of second-generation parents. Our study provides empirical support for the intergenerational transmission of parental invalidation and highlights the need to address childhood experiences of parental invalidation in parenting programs.

Direct and indirect associations among mothers' invalidating childhood environment, emotion regulation difficulties, and parental apology

BACKGROUND

Effective emotion regulation abilities are essential for engaging in positive, validating parenting practices. Yet, many parents report difficulties with both emotion regulation and positive parenting, and these difficulties may in part be the result of parents' own childhood experiences of invalidation. Building upon prior literature documenting the intergenerational transmission of invalidation and emotion dysregulation, the present study examined the associations between these constructs and a specific parenting practice - parental apology - that can be conceptualized as a type of validating parenting practice.

METHODS

Using a sample of 186 community mothers, we tested direct and indirect relationships via correlational and path analysis between participants' retrospective reports of parental invalidation during childhood, difficulties with emotion regulation, and two aspects of parental apology - proclivity (i.e., participants' self-reported propensity to apologize to their child) and effectiveness (i.e., participants' inclusion of specific apology content when prompted to write a child-directed apology). Parental invalidation, difficulties with emotion regulation, and parental apology proclivity were measured via self-report questionnaires. Apology effectiveness was measured by coding written responses to a hypothetical vignette.

RESULTS

There was a significant negative bivariate relationship between difficulties with emotion regulation and parental apology proclivity and effectiveness. Parents' own childhood experiences of invalidation were linked to parental apology indirectly via emotion regulation difficulties.

CONCLUSIONS

Results suggest that mothers with greater difficulties regulating emotions may be less able to or have a lower proclivity to apologize to their child when appropriate. Thus, parent apology may be an important addition to current calls for parent validation training.

Invalidating childhood environments and nonsuicidal self-injury in university students: Depression and mental pain as potential mediators

OBJECTIVES

The aim of this study was to evaluate the potential mediating effects of depression and psychache (i.e., extreme mental pain) on the relationship between parental invalidation and nonsuicidal self-injury (NSSI) in young adults.

METHOD

A sample of 2474 university students responded to previously validated measures of current NSSI, childhood parental invalidation, depression, and psychache.

RESULTS

Using a parallel mediation model, path analysis using structural equation modeling demonstrated full mediation by depression and psychache of the link between parental invalidation and NSSI.

CONCLUSIONS

Findings suggest that the association between invalidating childhood environments and NSSI has the potential to be mitigated by addressing issues of depression and psychache.

Emotion regulation mediates relationships between perceived childhood invalidation, emotional reactivity, and emotional eating

Dialectical Behavior Therapy (DBT) is informed by the biosocial model which suggests that emotional sensitivity and childhood invalidation interact to influence emotion dysregulation, leading to behavioral disorders. Although adapted DBT interventions have resulted in improved emotional eating, little research has been conducted to examine whether key aspects of the biosocial model apply to emotional eating. Adults ( N = 258) were enrolled via Amazon’s Mechanical Turk. Three separate mediation analyses were performed using Hayes’ SPSS macro. Results showed that emotion regulation difficulties mediated the relationships between biosocial variables (i.e. perceived maternal and paternal invalidation and emotional reactivity) and emotional eating.

Confirmatory Factor Analysis of the Invalidating Childhood Environment Scale in Spanish (ICES)

Background/Objective: The Invalidating Childhood Environment Scale (ICES) is an instrument designed to assess retrospectively parental invalidation experience, according to Marsha Linehan’s definition of invalidation. The main aim of this paper is to determine the factorial structure of the ICES. Three factor structures: Standard Model, Reduced Model, and 2 Factor Model are examined. Also, the association between invalidating experience and borderline symptoms is studied. Method: Data from a non-clinical, volunteer sample of 274 adults was collected. Participants completed 4 surveys: Demographic surveys, Invalidating Childhood Environment Scale (ICES), Borderline Symptoms List (BSL 23), and Parental Bonding Instrument (PBI). Statistical analyses included confirmatory factor analysis and multiple linear regression. Results: The results of the analysis presented indicate that the ICES is a reliable instrument, and that the 2 Factor Model is good fit and allows for a broader understanding of invalidation and it’s qualities. The results of the linear regression analysis indicated a mild but significant association between invalidation and BPD symptoms. Internal consistency was acceptable for all levels. Conclusion: The outcome of this study shows that the ICES is a useful instrument that can be used to make progress in uncovering the role of childhood invalidation in BPD.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale

PURPOSE

The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology.

METHODS

A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested.

RESULTS

Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology.

CONCLUSIONS

The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Childhood adversity and borderline personality disorder: a meta-analysis

OBJECTIVE

The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies.

METHOD

Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects.

RESULTS

A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups.

CONCLUSIONS

This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.

Vulnerable narcissism as a mediator of the relationship between perceived parental invalidation and eating disorder pathology

PURPOSE

Parental invalidation and narcissism have been proposed to play an important role in understanding the etiology of eating disorders. The current research aimed to address two main gaps in the literature. The first aim was to determine the differential associations of grandiose and vulnerable narcissism with eating disorder pathology. The second aim was to find a common mediator between both maternal and paternal invalidation and eating disorder pathology. It was hypothesized that when controlling for vulnerable narcissism, grandiose narcissism would not predict eating disorder pathology. In addition, it was hypothesized that vulnerable narcissism would be a mediator of the relationship between parental invalidation and eating disorder pathology.

METHODS

Participants were 352 women aged 18-30 years who were recruited from the general and tertiary student population, and as such constituted a community sample. Participants completed the Invalidating Childhood Environment Scale, Brief-Pathological Narcissism Inventory, Eating Disorder Examination Questionnaire, the Avoidance of Affect Subscale of the Distress Tolerance Scale, and the Emotional Expression as a Sign of Weakness Subscale of the Attitudes Towards Emotional Expression Scale in an online survey.

RESULTS

Results showed that, when controlling for vulnerable narcissism, grandiose narcissism was no longer associated with eating disorder pathology. It was also found that parental invalidation had a positive indirect effect upon eating disorder pathology, via vulnerable narcissism.

CONCLUSIONS

The findings indicate that vulnerable narcissism is more strongly associated with eating disorder pathology as opposed to grandiose narcissism and help to further elucidate the mechanisms via which parental invalidation might exert its negative effect on eating disorder pathology.

LEVEL OF EVIDENCE

A cross-sectional survey (Level V).

The Perceived Invalidation of Emotion Scale (PIES): Development and psychometric properties of a novel measure of current emotion invalidation

Emotion invalidation is theoretically and empirically associated with mental and physical health problems. However, existing measures of invalidation focus on past (e.g., childhood) invalidation and/or do not specifically emphasize invalidation of emotion. In this article, the authors articulate a clarified operational definition of emotion invalidation and use that definition as the foundation for development of a new measure of current perceived emotion invalidation across a series of five studies. Study 1 was a qualitative investigation of people's experiences with emotional invalidation from which we generated items. An initial item pool was vetted by expert reviewers in Study 2 and examined via exploratory factor analysis in Study 3 within both college student and online samples. The scale was reduced to 10 items via confirmatory factor analysis in Study 4, resulting in a brief but psychometrically promising measure, the Perceived Invalidation of Emotion Scale (PIES). A short-term longitudinal investigation (Study 5) revealed that PIES scores had strong test-retest reliability, and that greater perceived emotion invalidation was associated with greater emotion dysregulation, borderline features and symptoms of emotional distress. In addition, the PIES predicted changes in relational health and psychological health over a 1-month period. The current set of studies thus presents a psychometrically promising and practical measure of perceived emotion invalidation that can provide a foundation for future research in this burgeoning area. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Shame and Non-suicidal Self-injury: Conceptualization and Preliminary Test of a Novel Developmental Model among Emerging Adults

Non-suicidal self-injury (NSSI) is particularly prevalent during adolescence and emerging adulthood. The salience of shame during these developmental periods suggests that shame may be inherently linked to NSSI, and at least partially explain the high rates of NSSI observed among youth. In this article, a theoretical developmental model relating shame and NSSI is proposed, and results from a preliminary test of a sub-set of cross-sectional relationships in this model is presented. In the model tested, it was hypothesized that adverse caregiving experiences in prior development (i.e., childhood to late adolescence) like parental invalidation and child maltreatment, established predictors of NSSI, would be linked to proximal episodes of NSSI (i.e., past year) through current shame-proneness (i.e., experiencing shame in a trait-like manner) and internalizing shame-coping (i.e., responding to shame through attacking one's self and withdrawing). It was also hypothesized that some key proximal predictors of NSSI during youth development, such as low body esteem, increased loneliness and heightened psychological distress, would be linked to proximal NSSI via shame-proneness and internalizing shame-coping. Using structural equation modelling, it was observed that data, obtained via self-reports completed by 573 emerging adults (age in years: M = 20.7, SD= 2.20, 69.1% female, NSSI history: n = 220, where most recent NSSI episode was within a year of study participation) recruited throughout Australia between June 2013 and June 2014, fit the hypothesized model well. Tests of indirect effects indicated that current shame-proneness and internalizing shame-coping significantly linked perceived parental invalidation and prior experiences of child maltreatment to proximal NSSI, though this relationship was, unexpectedly, an inverse one in relation to child maltreatment. Current shame-proneness was also linked to proximal NSSI via internalizing shame-coping, current loneliness, and current psychological distress, but not through current body esteem. Finally, proximal self-evaluations of body esteem, loneliness and increased psychological distress were linked to recent NSSI through internalizing shame-coping. The theory and findings presented in this article contribute to a deeper developmental understanding of NSSI among youth, highlight crucial pathways between adverse caregiving experiences and NSSI, and illuminate important shame-based mechanisms that potentially warrant clinical attention for at-risk individuals. Future research directions and clinical recommendations are discussed.

Childhood emotional invalidation and right hemispheric mu suppression during a pain empathy task: An EEG study

Empathy is a critical aspect of social behavior, and impairment in empathic processing is linked to hindered social interactions and several disorders. Despite much interest in this topic, our understanding of the developmental and neural involvement for empathic processing is limited. Recent evidence suggests the Mirror Neuron System (MNS) may play a role in this behavior, and that mu rhythm suppression found over the sensorimotor cortices may be a proxy for the MNS. Therefore, we aimed to measure mu rhythm oscillations in response to empathic processing during observation of painful action-based situations using electroencephalogram (EEG). Our second goal was to examine how perceived parental emotional invalidation (EI) during childhood may relate to empathy and influence mu suppression. Our results showed that mu rhythm suppression was strongest over the right hemisphere. EI had a significant influence on this suppression between painful and non-painful images, and was negatively correlated with behavioral measures of empathy. Our findings suggest that perceived childhood EI may decrease empathizing abilities and influence neural responses to the painful experiences of others. Implications from this study could entail clinical intervention targeted at emotional invalidation to foster the healthy development of empathy.

Association among self-compassion, childhood invalidation, and borderline personality disorder symptomatology in a Singaporean sample

BACKGROUND

Linehan's biosocial theory posits that parental invalidation during childhood plays a role in the development of borderline personality disorder symptoms later in life. However, little research has examined components of the biosocial model in an Asian context, and variables that may influence the relationship between childhood invalidation and borderline symptoms. Self-compassion is increasingly regarded as an adaptive way to regulate one's emotions and to relate to oneself, and may serve to moderate the association between invalidation and borderline symptoms. The present study investigated the association among childhood invalidation, self-compassion, and borderline personality disorder symptoms in a sample of Singaporean undergraduate students.

METHODS

Two hundred and ninety undergraduate students from a large Singaporean university were recruited and completed measures assessing childhood invalidation, self-compassion, and borderline personality disorder symptoms.

RESULTS

Analyses using multiple regression indicated that both childhood invalidation and self-compassion significantly predicted borderline personality disorder symptomatology. Results from moderation analyses indicated that relationship between childhood invalidation and borderline personality disorder symptomatology did not vary as a function of self-compassion.

CONCLUSION

This study provides evidence in support of aspects of the biosocial model in an Asian context, and demonstrates a strong association between self-compassion and borderline personality disorder symptoms, independent of one's history of parental invalidation during childhood.

Parent-child relationship associated with the development of borderline personality disorder: A systematic review

The parent-child relationship (PCR) is considered as a central factor in most contemporary theories on the aetiology of borderline personality disorder (BPD). This systematic review aimed to answer the three following questions: (1) How is the PCR described by BPD participants and their parents in comparison to other normative and clinical groups? (2) Which aspects of the PCR are specifically associated with a BPD diagnosis in adulthood? (3) How can the facets of the PCR identified in the reviewed studies shed light on the general aetiological models of BPD? Forty studies were retained and divided into three categories: perspective of BPD probands, perspective of their parents and perspective of family. Borderline personality disorder participants consistently reported a much more dysfunctional PCR compared to normal controls. Comparisons with participants presenting DSM-IV Axis-I and Axis-II disorders were a lot less consistent. BPD probands rated more negatively the PCR compared to their parents. Low parental care and high parental overprotection may represent a general risk factor for psychopathology, different from normal controls but common to BPD and other mental disorders. An interesting candidate for a specific PCR risk factor for BPD appears to be parental inconsistency, but further studies are necessary to confirm its specificity. Copyright © 2017 John Wiley & Sons, Ltd.

Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents

Borderline personality disorder (BPD) is a pervasive personality disorder that poses a burden for affected individuals, their family members and society as a whole. Current research suggests that early childhood abuse, including emotional abuse, may be an important predictor of later BPD symptomology. Further, an emerging body of literature suggests that anxiety sensitivity (AS) may serve as a form of emotional vulnerability and be a key variable in the relation between abuse and the development of BPD symptomatology. This literature has relied on retrospective recall of abuse and AS in adult samples. As a result, there is a dearth of literature examining these variables in adolescence, which is a developmental period in which personality traits begin to emerge. This study explored the impact of AS in the development of BPD symptoms in a group of 277 adolescents. Results suggest a significant indirect effect of emotional abuse on BPD symptoms via AS, after controlling for sex, grade and prior levels of AS (indirect effect = 0.04, standard error (SE) = 0.02 (95% confidence interval (CI) = 0.001-0.070)). These findings suggest that, among adolescents, AS may serve as an important contributor to the development of BPD symptoms. Implications for interventions and future research are further discussed.

Perceived emotional invalidation and borderline personality disorder features: a test of theory

Contemporary theories of borderline personality disorder (BPD) have detailed the functional importance of emotional invalidation in meaningful relationships as an aetiological and perpetuating factor of its core disturbances. The purpose of our study was to test aspects of Linehan's (1993) biosocial and Fruzzetti (1996) and Fruzzetti, Shenk, and Hoffman's (2005) validation/invalidation family interactions transactional theories in a community sample of 186 participants. Results indicated that a multi-mediational path model of invalidation in meaningful relationships, emotion dysregulation, poor distress tolerance and BPD symptoms provided a perfect fit to the data and accounted for a substantial amount of variance in BPD (38%). The results provided support for these complimentary theories of BPD, which hold promise for clinical applications and future research.

Complex PTSD, affect dysregulation, and borderline personality disorder

Complex PTSD (cPTSD) was formulated to include, in addition to the core PTSD symptoms, dysregulation in three psychobiological areas: (1) emotion processing, (2) self-organization (including bodily integrity), and (3) relational security. The overlap of diagnostic criteria for cPTSD and borderline personality disorder (BPD) raises questions about the scientific integrity and clinical utility of the cPTSD construct/diagnosis, as well as opportunities to achieve an increasingly nuanced understanding of the role of psychological trauma in BPD. We review clinical and scientific findings regarding comorbidity, clinical phenomenology and neurobiology of BPD, PTSD, and cPTSD, and the role of traumatic victimization (in general and specific to primary caregivers), dissociation, and affect dysregulation. Findings suggest that BPD may involve heterogeneity related to psychological trauma that includes, but extends beyond, comorbidity with PTSD and potentially involves childhood victimization-related dissociation and affect dysregulation consistent with cPTSD. Although BPD and cPTSD overlap substantially, it is unwarranted to conceptualize cPTSD either as a replacement for BPD, or simply as a sub-type of BPD. We conclude with implications for clinical practice and scientific research based on a better differentiated view of cPTSD, BPD and PTSD.