Maneta, E., Cohen, S., Schulz, M. S., & Waldinger, R. J. (2013). Two to tango: A dyadic analysis of links between borderline personality traits and intimate partner violence. Journal of Personality Disorders 27, 233-43.
Maneta, E., Cohen, S., Schulz, M. S., & Waldinger, R. J. (2013). Two to tango: A dyadic analysis of links between borderline personality traits and intimate partner violence. Journal of Personality Disorders, 27, 233-43.
E.K. Maneta1, S. Cohen2, M.S. Schulz3, R.J. Waldinger2
1Children’s Hospital Boston, Harvard Medical School
2Massachusetts General Hospital, Harvard Medical School
3Bryn Mawr College
Acknowledgments: Funded by a grant from the National Institute of Mental Health (K08 MH01555)
Mailing Address: 151 Merrimac Street, 2nd Floor, Boston MA 02114 Telephone Number: 201-321-1905
Although research has shown links between borderline personality and intimate partner violence (IPV), few studies have examined how each partner’s personality traits may influence the other’s behavior(Hines, 2008). This study incorporated dimensional assessments of borderline personality organization (BPO) in both partners into a dyadic model that examined associations with IPV. In a community sample of 109 couples, Actor-Partner Interdependence Modeling was used to examine links between BPO traits in each partner and victimization and perpetration of IPV. Men’s level of BPO traits was associated with more IPV towards and more victimization by their partners. Women’s level of BPO traits was associated with their victimization only. This study is unique in examining links between BPO and IPV in couples using analyses that account for the interdependence of these variables in dyads.
Two to tango: A dyadic analysis of links between borderline personality traits and intimate partner violence
Intimate partner violence (IPV) is highly prevalent among US couples (Bell & Naugle, 2008; Flynn & Graham, 2010; Krahé, Bieneck, & Möller, 2005). Tjaden and Thoennes (2000)looked at data from the National Violence against Women Survey and found that 7% of men and 20.4% of women reported being physically abused by their partners in the past. The bi- directionality of IPV has also been gaining more attention in the past decade and Archer’s meta- analysis (2000) showed that men and women were physically aggressive in relationships with approximately equal frequency. Stith et al. (2004) noted that male-to-female partner violence was a strong predictor of the use of physical aggression by the receiving partner as well. Among the many factors believed to contribute to IPV are a history of childhood abuse (Hosser, Raddatz, & Windzio, 2007; Whitfield, Anda, Dube, & Felitti, 2003), jealousy, the need for power, and relationship dissatisfaction (Schumacher, Feldbau-Kohn, Slep, & Heyman, 2001). Personality traits and disorders – particularly Borderline and Antisocial Personality disorders – have also been associated with IPV in numerous studies(Costa & Babcock, 2008; Hines, 2008; Ross & Babcock, 2009). However, these studies have generally used categorical approaches as embodied in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-RT, 2000) to compare individuals with and without personality disorders, rather than focusing on the psychological features that underlie such diagnoses and may be present in varying degrees in any community- based sample.
The purpose of this study is to look at psychological traits that may contribute to IPV by examining links among violent couples’ behavior, victimization and borderline personality organization. To date, the vast majority of studies of IPV have focused on men and women individually rather than investigating violence in a fully dyadic context that explicitly acknowledges reciprocal violence and examines how psychological features in one individual may contribute to that individual’s own violent behavior and the likelihood of being victimized by a partner. To our knowledge, this is the first study that examines links between each partner’s borderline personality characteristics and IPV by incorporating data from both partners into an Actor Partner Interdependence Model (Kashy, Kenny, Reis, & Judd, 2000), which is being used with increasing frequency to examine complex dyadic effects in couple relationships(Bodenmann, Ledermann, & Bradbury, 2007; Ledermann, Bodenmann, Rudaz, & Bradbury, 2010).
Borderline personality and intimate partner violence
Borderline Personality Disorder (BPD) is a highly prevalent disorder characterized by pervasive instability in interpersonal relationships, self-image and emotion regulation (DSM-IV- RT, 2000). Grant et al. (2008)report in their study that the lifetime prevalence of BPD is 5.9% with similar rates among men (5.6%) and women (6.2%). BPD traits are frequently associated with significant functional impairment (Ansell, Sanislow, McGlashan, & Grilo, 2007; Leichsenring, Leibing, Kruse, New, & Leweke, 2011) and one of the most commonly seen impairments is the uncontrolled use of aggression (Látalová & Praško, 2010). The link between BPD and IPV has been well established in the literature. For example, Costa and Babcock (2008) looked at 184 couples with violent and non-violent men and found that men who engaged in IPV were more likely to have borderline features. Hines (2008) looked at the relationship between borderline personality traits and intimate partner aggression in a non-clinical sample of 14,154 men and women and confirmed that borderline personality was linked with IPV. She also reported that borderline personality traits were strongly associated with IPV in men and women equally.
Researchers have argued that maladaptive psychological characteristics (e.g., ineffective defenses) are often not specific to individual DSM-IV disorders but instead are arrayed on a spectrum of severity and cut across multiple diagnostic categories (R. J. Waldinger & Schulz, in press). A dimensional approach to characterizing maladaptive personality functioning allows for the appreciation of the considerable variation among individuals with the same DSM diagnosis (Widiger & Mullins-Sweatt, 2010; Widiger & Sanderson, 1995).Westen et al. (2006) argue that personality disorder syndromes are too complex and multifaceted to be accurately described by seven to nine criteria per disorder used in the DSM. In keeping with this line of thought, Dutton (1994)was among the first to use Kernberg’s (1966; O. F. Kernberg, 2004)broader concept of borderline personality organization (BPO) in studying links between IPV and borderline personality. Borderline personality organization describes individuals with low anxiety tolerance, primitive coping mechanisms (e.g., projection, denial, splitting), and proneness to significantly distorted thinking under stress. This “umbrella” includes individuals with a variety of Axis II personality disorders – most notably Narcissistic and Histrionic Personality Disorders – and Borderline Personality Disorder is conceptualized as being a more severe representation on the BPO spectrum(John F. Clarkin, Lenzenweger, Yeomans, Levy, & Kernberg, 2007). Reports of the prevalence of borderline personality organization have estimated rates of 11-15% among the general population (Dutton, 1994). Dutton (1994) also found that more severe BPO features and behaviors were associated with use of physical violence in intimate relationships.
Most studies of the link between IPV and personality traits have focused on men and women separately to avoid problems created by the dependency of two partners in a relationship
– that is, that individuals in couples are not independent of each other and therefore cannot be considered together in data analysis using standard parametric statistics. This study uses the APIM, which accounts for dependencies and allows consideration of the attributes of both partners in the dyad, to understand not only individual influences but also how these attributes might influence partners’ behavior. In this way, an APIM model that simultaneously examines both partners’ personality organizations and IPV can help distinguish between actor effects (links between one’s own personality traits and one’s own violent behavior) and partner effects (links between one’s own personality traits and a partner’s violent behavior). Such a model can, for example, shed light on the question, “Do my personality characteristics not only make it more likely that I perpetrate IPV (actor effect) but also make it more likely that my partner perpetrates IPV (partner effect)?” This study examines the degree to which both partners’ BPO characteristics are linked with perpetration of violence toward and/or victimization by an intimate partner.
One hundred nine couples were recruited through advertisements in the Boston metropolitan area to participate in a study about intimate relationships (for details see (R.J. Waldinger & Schulz, 2006). Couples with recent histories of IPV were oversampled. To be eligible, couples had to be fluent in English and living together for at least 12 months or married. Men and women were categorized as violent if either they or their partner reported on the Conflict Tactics Scales (CTS2, Straus, Hamby, Boney-McCoy, & Sugarman, 1996) that they had been physically violent in their relationship at least twice in the prior year. Individuals were characterized as non-violent if they had never touched their partner in anger, and individuals who had been violent toward their partner but not in the past year were excluded from the study.
Couples were screened for eligibility by telephone and came to our laboratory for two sessions, during which each partner completed questionnaires. Mean ages for men and women respectively were 33.2 (SD = 8.8) and 31.7 years (SD = 8.5). The median length of couples’ relationships was 1.9 years (range = 0.4 – 30.0), 33.3% were married, and 78.2% did not have children. The ethnic makeup of the sample was 58.4% Caucasian, 29.0% African American, 7.8% Hispanic, 3.0% Asian or Pacific Islander, and 2.0% Native American. The median family income per year was between $30,000 and $45,000, with 19.3% of families earning less than
$15,000, and 26.0% indicating that they earned more than $60,000. Participants varied widely in their educational experience: 45.0% had a bachelor’s or more advanced degree, 17.0% had some post-high school education (vocational, some college, or an associate’s degree), and 38.0% had a high school education or less. During the previous year, 56% of men and 57% of women reported physical violence towards their partners. Violence was present in 68 of 109 couples (62.4%). In 55 out of 68 couples, violence was bilateral (that is, each partner was violent toward the other), in 6 couples only the man was violent towards his partner, and in 7 couples only the woman was violent towards her partner. IRB-approved written informed consent was obtained and couples were paid $250 ($125 per person) for their participation.
Borderline Personality Traits. Personality traits were assessed using an abridged version of the three primary clinical subscales (primitive defenses, identity diffusion and reality testing) of the Inventory of Personality Organization (IPO; (Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001). This version consisted of a 44-item self-report questionnaire with items selected by Clarkin, Foelsch and Kernberg (1997) after excluding items from the original version that reduced the internal consistency of the scale and were judged to be clinically and theoretically non-essential (Foelsch et al., 1999). Total BPO scores, which represent the sum of the three primary clinical subscales, were used in analyses in this study. The abridged version of the IPO has demonstrated good internal consistency and reliability as measured by Foelsch et al.(1999) with Cronbach’s alphas ranging from 0.84 to 0.89 for the three primary clinical subscales.
Cronbach’s alpha in the present study was .95 for both men and women for the total BPO scale. Individual BPO subscales were not considered separately in analyses due to their high correlations with each other and with the total BPO scale (rs ranged from 0.6 to 0.8).
Intimate partner violence. Intimate partner violence was assessed using the CTS-2 (Straus, et al., 1996). The CTS-2 is a 78-item questionnaire asking about the frequency and severity of participants’ own aggressive behaviors and those of their partners during the past year. The physical aggression subscale (12 items for both self- and partner-report) was used in all analyses. Participants were categorized as violent if at a minimum they endorsed acts such as slapping or shoving the partner, or twisting the partner’s arm or hair at least twice in the previous year. The CTS-2 has demonstrated good reliability and good discriminant and construct validity (Straus, et al., 1996). In the present study Cronbach’s alpha for the physical aggression subscale was 0.85 for women’s self report, 0.87 for her partner’s report of her aggression, 0.82 for men’s self report and 0.88 for his partner’s report of his aggression. To minimize under-reporting of aggression, we used the highest score reported by either partner for each individual’s physical aggression score (Archer, 1999; Schafer, Caetano, & Clark, 2002).
We examined the association between IPV and each partner’s level of BPO using the APIM (Kashy, et al., 2000). Use of this technique, which simultaneously estimates the link between each individual’s personality traits and both self and partner IPV, is particularly important when looking at violence between partners, as IPV is often bi-directional (Archer, 2000; Stith, et al., 2004). Even when it is not, an individual’s personality features may influence his or her partner’s marital behaviors, including physical aggression. By simultaneously examining both actor and partner effects, we can narrow the range of possible mechanisms that might contribute to IPV. For example, weak actor effects and strong partner effects would suggest that a person’s violent behavior is more strongly related to the psychological defenses and personality traits of the partner than to that of the perpetrator.
Figure 1 illustrates the analytical model. Individual, or actor, effects capture the influence of each individual’s borderline personality traits on his/her own perpetration of partner violence. Paths a and b represent, respectively, the influence of man’s personality traits on his aggression within the relationship (actor effects) as well as on his partner’s use of IPV (partner effects).
Similarly, paths c and d represent the influence of a woman’s personality traits on both her use of IPV as well as her partner’s use of aggression. In order for actor effects or partner effects to be estimated accurately, they have to be estimated while controlling for the other effects; that is, to understand, for example, the influence of his borderline personality traits on his own IPV (an actor effect) the model must simultaneously account for the influence of his partner’s personality traits on his use of aggression. The double-headed arrow between both partners’ personality traits (path e) acknowledges explicitly the potential influence of assortative mating (the possibility that individuals with similar personality characteristics choose one another) and other unmeasured variables that may affect the personality of both partners. Similarly, the double- headed arrow between both partners’ use of IPV (path f) takes into account mutual influences that are not included in the APIM. Because this is a fully saturated model, traditional fit indices based on chi-square goodness of fit are not available (Cook & Kenny, 2005). AMOS SEM software version 17.0 was used to run the analysis.
Mean scores on the physical aggression subscale of the CTS-2 for men were 10.5 (SD = 16.9) with a range from 0 to 89. Mean scores for women were 15.0 (SD = 27.7) with a range from 0 to 140. Given the fact that the CTS-2 measures both frequency and severity of aggressive acts these scores may represent either more frequent minor acts such as twisting a partner’s arm or hair five times in the previous year, or less frequent more severe acts such as using a knife or gun on a partner in the previous year. Mean scores on the total BPO scale for men were 6.1 (SD
= 1.9) with scores ranging from 1.4 to 11.3. Mean scores for women were 6.2 (SD = 1.8) with scores ranging from 3.5 to 10.4. These scores are a composite of the three primary clinical subscales (primitive defenses, reality testing, identity diffusion) and therefore may represent individuals who either had a high score in one of the subscales (i.e. high primitive defenses which reflects splitting, externalization etc.) or who had a fairly even score in all three subscales.
Preliminary analyses of the links between borderline personality traits and intimate partner violence (aggression and victimization) were conducted using Pearson correlations. Man’s level of borderline personality organization was significantly correlated with both his own use of violence against his partner (r = 0.29, p < 0.01) as well as with his victimization (r = 0.24, p< 0.05). Woman’s level of borderline personality organization was only correlated with her partner’s use of violence towards her (r = 0.26, p< 0.05).
The results of the APIM analysis examining links between borderline personality traits and IPV are presented in figure 2. The model examined the relationship between total BPO score and IPV. This model accounted for 6.4% of the total variance in women’s IPV and also 13.1% of the total variance in men’s IPV. Men’s BPO was positively linked with their physically aggressive behavior towards their partner (β = 0.26, p< 0.01) and was also positively linked with being the object of more aggression from their partner (β = 0.23, p< 0.05). A woman’s BPO was positively linked (β = 0.22, p < 0.05) with her being the object of physical aggression from her partner but was not linked with her own violent behavior towards her partner.
The purpose of this study was to examine links between borderline personality traits and IPV in couples using a model that simultaneously accounts for both individual and dyadic influences. Use of the APIM allowed us to examine how each individual’s level of borderline personality organization is associated with both his and her own aggressiveness in the relationship and with the partner’s aggressiveness.
Borderline personality organization and intimate partner violence
Consistent with findings of prior studies (Costa & Babcock, 2008; Dutton, 1993), APIM analyses indicate that a man’s level of BPO is linked with his use of IPV. Moreover, men with higher levels of BPO were subject to more aggression from their partners. While the link between victimization and borderline personality has been examined in prior research (Zanarini, Frankenburg, Reich, Hennen, & Silk, 2005), prior studies have not focused specifically on victimization within an intimate partnership. This study examined the relationship between men’s BPO traits and their risk of victimization within intimate relationships while accounting for their partner’s level of BPO traits, which allows for more accurate estimation of these links.
Although previous studies have found an association between women’s borderline personality and their use of IPV(Hines, 2008; Stuart, Moore, Gordon, Ramsey, & Kahler, 2006) we did not find this link to be significant. The links for women found in other studies may be due to their focus on DSM-IV criteria, which may reflect a more behaviorally impaired subset of BPO. It may be that for women, the association between borderline personality traits and IPV is largely restricted to those on the more pathological end of the spectrum as defined by DSM-IV criteria for BPD. Moreover, by considering men’s and women’s personality traits and behaviors in the same model, we may have corrected for overestimation of the significance of this link when women’s data are examined in isolation in traditional regression models. Results of the APIM analyses suggest that the influence of women’s borderline personality traits on their aggressive behavior toward their partners is small compared to the influence of their partner’s level of borderline personality organization.
Our results indicate that a woman’s level of borderline personality organization was, however, linked with her partner’s use of violence in the relationship. Zanarini et al., (2005) report that women with borderline personality are at higher risk of experiencing emotional, physical, verbal and sexual abuse. Drapeau and Perry (2009) also report that individuals with BPD are not only more prone to being hurt but also to hurting others. To our knowledge, however, this is the first study to look at the link between BPO and IPV specifically in a dyadic model that accounts for each partner’s influence on the other. The fact that more borderline pathology in both men and women is linked with increased victimization may indicate that those higher in borderline traits are more likely to choose partners who are prone to violence – a question that warrants further research. In addition, individuals with borderline traits may have deficits in self-regulation that make them more likely to behave aggressively, and their violence may in turn spark more aggressive responses by their partner. Furthermore, difficulties with self- regulatory problems in one partner could lead to anger provocation in the other and an inability to then help diffuse that anger.
Implications, Limitations and Directions for Future Research
The association between borderline personality traits and risk of intimate partner victimization for both men and women warrants further exploration. Future research must incorporate statistical modeling that allows for analysis of interdependent dyadic data so that each partner’s contributions and possible dyadic influences can be more clearly distinguished.
If replicated, these findings have important clinical implications for the treatment of violent couples. They may pinpoint for therapists specific psychological mechanisms used by individuals in violence-prone couples. The BPO measure addresses three such mechanisms through the primitive defenses, reality testing and identity diffusion subscales. The primitive defenses subscale assesses the use of defenses such as splitting, idealization, devaluation and projective identification, all of which distort one’s images of other people. Distorted images of others’ motives and behaviors may play a role in intimate partners resorting to violence. The reality testing subscale reflects one’s ability to assess situations and behaviors based on “social criteria of reality” (Dutton, 1994). Poor reality testing could interfere with one’s ability to accurately assess an escalating interpersonal situation and thereby impair judgment about when to take steps to de-fuse an altercation. The identity diffusion subscale assesses difficulties in distinguishing between one’s own thoughts and feelings and those of others, which could also potentially impair one’s judgment about the possible causes of and remedies for interpersonal conflict. The treatment of individuals with Borderline Personality disorder remains challenging. However, over the last decade there is increasing evidence that treatments designed specifically to target the core traits can have a major impact (Bedics, Atkins, Comtois, & Linehan, 2011).
Using treatment modalities such as Dialectical Behavior Therapy, clinicians can focus on the specific behavioral manifestations of these psychological features as potential remediable targets that aim to decrease IPV.
This study has several important strengths. Use of the highest level of aggression reported by self or partner as an index of each person’s violent behavior helps minimize under-reporting of IPV (Archer, 1999; Schafer, et al., 2002). As noted previously, the use of the APIM helps distinguish between actor and partner effects in examining relations between borderline personality traits and IPV. Moreover, the sample used in this study was ethnically diverse and community-based and therefore more representative of the general population than the court- mandated or clinic based samples used in most prior studies of IPV.
Several limitations are also important to keep in mind. The study is cross-sectional; findings are correlational and cannot inform us directly about causation. This is especially important when considering the possibility that an abused partner’s personality traits may cause an abuser to act violently. Such conclusions cannot be drawn from our results. There is a need for further research that more closely examines actual patterns of interaction between individuals with high levels of borderline personality organization and partners who behave aggressively in the dyad. At its best the model in this study explains 13.6% of the variance in the reported intimate partner violence and it is therefore clear from this study and others that additional work is needed to identify other potential precipitants and causes of violence in couples. In addition, further research is needed with larger samples to replicate these results.
Nevertheless, this study represents an advance in the examination of links between borderline personality traits and IPV, and our findings illustrate the importance of using couples’ data when addressing these links.
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Figure 1. Actor and partner effects of level of borderline personality organization on intimate partner violence
Figure 2. Estimated actor and partner standardized effects of level of borderline personality organization on intimate partner violence
Note: figure presents standardized coefficients.
+ p< .10; * p< .05; ** p< .01