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Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology

  • Katja Dittrich (a1), Felix Bermpohl (a2), Dorothea Kluczniok (a2), Catherine Hindi Attar (a2), Charlotte Jaite (a1), Anna Fuchs (a3), Corinne Neukel (a4), Sabine C. Herpertz (a4), Romuald Brunner (a5), Sibylle Maria Winter (a1), Ulrike Lehmkuhl (a1), Stefan Roepke (a6), Michael Kaess (a7), Christine Heim (a8) (a9) and Katja Boedeker (a1)...



Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology.


We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5–12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology.


Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress.


The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.


Corresponding author

Author for correspondence: Katja Dittrich, E-mail:


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Achenbach, TM (1991) Manual for the child behavior checklist/4–18 and 1991 profile. Burlington VT. Department of Psychiatry, University of Vermont.
Arbeitsgruppe Deutsche Child Behavior Checklist (1998) Elternfragebogen über das Verhalten von Kindern und Jugendlichen; deutsche Bearbeitung der Child Behavior Checklist (CBCL/4–18). Einführung und Anleitung zur Handauswertung mit deutschen Normen, bearbeitet von M. Döpfner, J. Plück, S. Bölte, K. Lenz, P. M. Arbeitsgruppe Kinder-, Cologne, Germany: Jugend- und Familiendiagnostik (KJFD).
Baer, RA, Peters, JR, Eisenlohr-Moul, TA, Geiger, PJ and Sauer, SE (2012) Emotion-related cognitive processes in borderline personality disorder: a review of the empirical literature. Clinical Psychology Review 32, 359369.
Banzhaf, C, Hoffmann, F, Kanske, P, Fan, Y, Walter, H, Spengler, S, Schreiter, S, Singer, T and Bermpohl, F (2018) Interacting and dissociable effects of alexithymia and depression on empathy. Psychiatry Research 270, 631638.
Berecz, H, Tényi, T and Herold, R (2016) Theory of mind in depressive disorders: a review of the literature. Psychopathology 49, 125134.
Bifulco, A, Brown, GW and Harris, TO (1994) Childhood experience of care and abuse (CECA): a retrospective interview measure. Journal of Child Psychology and Psychiatry and Allied Disciplines 35, 14191435.
Bödeker, K, Fuchs, A, Führer, D, Kluczniok, D, Dittrich, K, Reichl, C, Reck, C, Kaess, M, Hindi Attar, C, Möhler, E, Neukel, C, Bierbaum, A-L, Zietlow, A-L, Jaite, C, Lehmkuhl, U, Winter, SM, Herpertz, S, Brunner, R, Bermpohl, F and Resch, F (2019) Impact of maternal early life maltreatment and maternal history of depression on child psychopathology: mediating role of maternal sensitivity? Child Psychiatry and Human Development 50, 278290.
Burt, KB, Van Dulmen, MHM, Carlivati, J, Egeland, B, Sroufe, LA, Forman, DR, Appleyard, K and Carlson, EA (2005) Mediating links between maternal depression and offspring psychopathology: the importance of independent data. Journal of Child Psychology and Psychiatry and Allied Disciplines 46, 490499.
Cole, PM, Michel, MK and Teti, LO (2018) The development of emotion regulation and dysregulation: a clinical perspective. Monographs of the Society for Research in Child Development 59, 73102.
Cusi, AM, MacQueen, GM, Spreng, RN and McKinnon, MC (2011) Altered empathic responding in major depressive disorder: relation to symptom severity, illness burden, and psychosocial outcome. Psychiatry Research 188, 231236.
Davis, MH (1980) A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology 10, 85.
Davis, MH (1983) A mulitdimensional approach to individual differences in empathy. Journal of Personality and Social Psychology 44, 113126.
de Vignemont, F and Singer, T (2006) The empathic brain: how, when and why? Trends in Cognitive Sciences 10, 435441.
Derntl, B, Seidel, EM, Schneider, F and Habel, U (2012) How specific are emotional deficits? A comparison of empathic abilities in schizophrenia, bipolar and depressed patients. Schizophrenia Research 142, 5864.
Dittrich, K, Bödeker, K, Kluczniok, D, Jaite, C, Hindi Attar, C, Führer, D, Herpertz, SC, Brunner, R, Winter, SM, Heinz, A, Roepke, S, Heim, C and Bermpohl, F (2018 a) Child abuse potential in mothers with early life maltreatment, borderline personality disorder, and depression. British Journal of Psychiatry 213, 412418.
Dittrich, K, Fuchs, A, Bermpohl, F, Meyer, J, Führer, D, Reichl, C, Reck, C, Kluczniok, D, Kaess, M, Hindi Attar, C, Möhler, E, Bierbaum, AL, Zietlow, AL, Jaite, C, Winter, SM, Herpertz, SC, Brunner, R, Bödeker, K and Resch, F (2018 b) Effects of maternal history of depression and early life maltreatment on children's health-related quality of life. Journal of Affective Disorders 225, 280288.
Döpfner, M, Schmeck, K, Berner, W, Lehmkuhl, G and Poustka, F (1994) Reliability and factorial validity of the child behavior checklist: an analysis of a clinical sample and a field sample. Zeitschrift für Kinder- und Jugendpsychiatrie 22, 189205.
Dziobek, I, Preißler, S, Grozdanovic, Z, Heuser, I, Heekeren, HR and Roepke, S (2011) Neuronal correlates of altered empathy and social cognition in borderline personality disorder. NeuroImage 57, 539548.
Eyden, J, Winsper, C, Wolke, D, Broome, MR and MacCallum, F (2016) A systematic review of the parenting and outcomes experienced by offspring of mothers with borderline personality pathology: potential mechanisms and clinical implications. Clinical Psychology Review 47, 85105.
Fonagy, P and Bateman, A (2008) The development of borderline personality disorder – a mentalizing model. Journal of Personality Disorders 22, 421.
Gartstein, MA, Bridgett, DJ, Dishion, TJ and Kaufman, NK (2009) Depressed mood and maternal report of child behavior problems: another look at the depression–distortion hypothesis. Journal of Applied Developmental Psychology 30, 149160.
Goodman, S and Rouse, M (2011) Maternal depression and child psychopathology: a meta-analytic review. Psychology Review 14, 127.
Grienenberger, J, Kelly, K and Slade, A (2005) Maternal reflective functioning, mother-infant affective communication, and infant attachment: exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment and Human Development 7, 299311.
Guttman, HA and Laporte, L (2000) Empathy in families of women with borderline personality disorder, anorexia nervosa, and a control group. Family Process 39, 345358.
Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
Harari, H, Shamay-Tsoory, S, Ravid, M and Levkovitz, Y (2010) Double dissociation between cognitive and affective empathy in borderline personality disorder. Psychiatry Research 175, 277279.
Hayes, AF (2009) Beyond Baron and Kenny: statistical mediation analysis in the new millennium. Communication Monographs 76, 408420.
Hayes, AF (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, N.Y.: The Guilford Press.
Jensen, PS and Watanabe, H (1999) Sherlock Holmes and child psychopathology assessment approaches: the case of the false-positive. Journal of the American Academy of Child and Adolescent Psychiatry 38, 138146.
Kaess, M, Parzer, P, Mattern, M, Resch, F, Bifulco, A and Brunner, R (2011) [Childhood Experiences of Care and Abuse (CECA) – validation of the German version of the questionnaire and interview, and results of an investigation of correlations between adverse childhood experiences and suicidal behaviour]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 39, 243252.
Kasius, MC, Ferdinand, RF, Van den Berg, H and Verhulst, FC (1997) Associations between different diagnostic approaches for child and adolescent psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines 38, 625632.
Kluczniok, D, Boedeker, K, Hindi Attar, C, Jaite, C, Bierbaum, AL, Fuehrer, D, Paetz, L, Dittrich, K, Herpertz, SC, Brunner, R, Winter, S, Heinz, A, Roepke, S, Heim, C and Bermpohl, F (2018) Emotional availability in mothers with borderline personality disorder and mothers with remitted major depression is differently associated with psychopathology among school-aged children. Journal of Affective Disorders 231, 6373.
Ladegaard, N, Videbech, P, Lysaker, PH and Larsen, ER (2015) The course of social cognitive and metacognitive ability in depression: deficit are only partially normalized after full remission of first episode major depression. British Journal of Clinical Psychology 55, 269286.
Lecrubier, Y, Sheehan, DV, Weiller, E, Amorim, P, Bonora, I, Sheehan, KH, Janavs, J and Dunbar, GC (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry 12, 224231.
Li, M, D'Arcy, C and Meng, X (2016). Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychological Medicine 46, 717730.
Liotti, G, Pasquini, P and Cirrincione, R (2001) Predictive factors for borderline personality disorder: patients’ early traumatic experiences and losses suffered by the attachment figure. Acta Psychiatrica Scandinavica 102, 282289.
Locher, SC, Barenblatt, L, Fourie, MM, Stein, DJ and Gobodo-Madikizela, P (2014) Empathy and childhood maltreatment: a mixed-methods investigation. Annals of Clinical Psychiatry 26, 97110.
Loranger, AW, Janca, A and Sartorius, N (1997). Assessment and Diagnosis of Personality Disorders: The ICD-10 International Personality Disorder Examination (IPDE). Cambridge, U.K.: Cambridge University Press.
Mombour, W, Zaudig, M, Berger, P, Gutierrez, K, Berner, W, Berger, K, von Cranach, M, Giglhuber, O and von Bose, M (1996) IPDE: International Personality Disorder Examination. Huber: Bern, Switzerland.
Mor, N, Doane, LD, Adam, EK, Mineka, S, Zinbarg, RE, Griffith, JW, Craske, MG, Waters, A and Nazarian, M (2010) Within-person variations in self-focused attention and negative affect in depression and anxiety: a diary study. Cognition and Emotion 24, 4862.
Nazarov, A, Frewen, P, Parlar, M, Oremus, C, Macqueen, G, Mckinnon, M and Lanius, R (2014) Theory of mind performance in women with posttraumatic stress disorder related to childhood abuse. Acta Psychiatrica Scandinavica 129, 193201.
New, AS, aan het Rot, M, Ripoll, LH, Perez-Rodriguez, MM, Lazarus, S, Zipursky, E, Weinstein, SR, Koenigsberg, HW, Hazlett, EA, Goodman, M and Siever, LJ (2012) Empathy and alexithymia in borderline personality disorder: clinical and laboratory measures. Journal of Personality Disorder 26, 660675.
O'Connor, LE, Berry, JW, Weiss, J and Gilbert, P (2002) Guilt, fear, submission, and empathy in depression. Journal of Affective Disorders 71, 1927.
Parlar, M, Frewen, P, Nazarov, A, Oremus, C, MacQueen, G, Lanius, R and McKinnon, MC (2014) Alterations in empathic responding among women with posttraumatic stress disorder associated with childhood trauma. Brain and Behavior 4, 381389.
Paulus, C (2009) The Saarbrueck Personality Questionnaire on Empathy: Psychometric Evaluation of the German Version of the Interpersonal Reactivity Index. Saarbrücken, Germany: Universität des Saarlandes, Available at
Plant, DT, Barker, ED, Waters, CS, Pawlby, S and Pariante, CM (2013) Intergenerational transmission of maltreatment and psychopathology: the role of antenatal depression. Psychological Medicine 43, 519528.
Plant, DT, Pawlby, S, Pariante, CM and Jones, FW (2017) When one childhood meets another – maternal childhood trauma and offspring child psychopathology: a systematic review. Clinical Child Psychology and Psychiatry 23, 483500.
Preckel, K, Kanske, P and Singer, T (2018) On the interaction of social affect and cognition: empathy, compassion and theory of mind. Current Opinion in Behavioral Sciences 19, 16.
Psychogiou, L, Daley, D, Thompson, MJ and Sonuga-Barke, EJS (2008) Parenting empathy: associations with dimensions of parent and child psychopathology. British Journal of Developmental Psychology 26, 221232.
Roepke, S, Vater, A, Preißler, S, Heekeren, HR and Dziobek, I (2012) Social cognition in borderline personality disorder. Frontiers in Neuroscience 6, 195.
Sauer, C, Arens, EA, Stopsack, M, Spitzer, C and Barnow, S (2014) Emotional hyper-reactivity in borderline personality disorder is related to trauma and interpersonal themes. Psychiatry Research 220, 468476.
Schneider, D, Regenbogen, C, Kellermann, T, Finkelmeyer, A, Kohn, N, Derntl, B, Schneider, F and Habel, U (2012) Empathic behavioral and physiological responses to dynamic stimuli in depression. Psychiatry Research 200, 294305.
Schreiter, S, Pijnenborg, GHM and Aan Het Rot, M (2013) Empathy in adults with clinical or subclinical depressive symptoms. Journal of Affective Disorders 150, 116.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Janavs, J, Weiller, E, Keskiner, A, Schinka, J, Knapp, E, Sheehan, MF and Dunbar, GC (1997) The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry 12, 232241.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 2233.
Singer, T and Klimecki, OM (2014) Empathy and compassion. Current Biology 24, R875R878.
Thoma, P, Zalewski, I, von Reventlow, HG, Norra, C, Juckel, G and Daum, I (2011) Cognitive and affective empathy in depression linked to executive control. Psychiatry Research 189, 373378.
Wilbertz, G, Brakemeier, E-L, Zobel, I, Haerter, M and Schramm, E (2010) Exploring preoperational features in chronic depression. Journal of Affective Disorders 124, 262269.
Wingenfeld, K, Duesenberg, M, Fleischer, J, Roepke, S, Dziobek, I, Otte, C and Wolf, OT (2018) Psychosocial stress differentially affects emotional empathy in women with borderline personality disorder and healthy controls. Acta Psychiatrica Scandinavica 137, 206215.
Zanarini, MC, Frankenburg, FR, Dubo, ED, Sickel, AE, Trikha, A, Levin, A and Reynolds, V (1998) Axis I comorbidity of borderline personality disorder. American Journal of Psychiatry 155, 17331739.


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Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology

  • Katja Dittrich (a1), Felix Bermpohl (a2), Dorothea Kluczniok (a2), Catherine Hindi Attar (a2), Charlotte Jaite (a1), Anna Fuchs (a3), Corinne Neukel (a4), Sabine C. Herpertz (a4), Romuald Brunner (a5), Sibylle Maria Winter (a1), Ulrike Lehmkuhl (a1), Stefan Roepke (a6), Michael Kaess (a7), Christine Heim (a8) (a9) and Katja Boedeker (a1)...


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