Exploring Experiences of Teen and Young Adult Siblings of Clients with BPD

Kelly Klein, BS

McLean Hospital
Exploring Experiences of Teen and Young Adult Siblings of Clients with BPD

Scientific Abstract

Background: Having a sibling with a mental illness can significantly disrupt the family system and negatively impact the functioning and well-being of other family members (Bowman et al., 2014; Bowman et al., 2017). This is likely particularly salient for teen and emerging adult siblings living in the home. Available literature on the impact of experiencing a sibling’s mental illness is limited, especially within the realm of borderline personality disorder (BPD). Existing explorations predominantly focus on the sibling diagnosed with BPD (Distel et al., 2012; Laporte et al., 2012) and fail to examine the experiences and needs of other siblings in the family. Preliminary data and clinical observations with this population suggest siblings need unique support, given their likely exposure to a sibling’s ineffective emotional reactivity and/or high- risk behaviors that impact family relationships and functioning. Additionally, siblings play an important, though less frequently explored, role in family transactions by engaging in behaviors that influence other family members, including siblings with BPD.

Method: To better understand sibling experiences and guide the development of a DBT-informed intervention to support siblings, researchers will collect data from adolescent (i.e., 13-21yo) siblings of teen and emerging adult patients with emotion dysregulation, BPD, and/or high-risk behaviors via two independent methods. To explore sibling experiences more broadly, researchers will conduct a series of virtual focus groups. A total of approximately 30 siblings will participate in semi-structured conversations guided by two DBT clinicians; participants will discuss family functioning, social support and coping, and clinical needs and interests. To directly assess targeted elements of psychosocial functioning, approximately 100 siblings will complete an anonymous online survey of standardized questionnaires assessing psychological distress, family functioning and relationships, and various coping and emotion regulation strategies. Participants will be invited to share additional insights about their experiences via open-ended questions.

Results: These responses and focus group content will be transcribed and coded for relevant themes using grounded theory techniques. Data collection is currently ongoing. By March 2021, researchers will have collected and analyzed preliminary findings from both arms of the study including 1) emergent themes from open-ended responses and discussions and 2) descriptive data on participant functioning, sibling and family relationships, and targets for intervention.

Conclusion: Data will be applied to inform preliminary discussions of a targeted, DBT-informed, group-based intervention for adolescent and young adult siblings of clients with BPD.

 

SoundCloud Transcript

Hi everyone! My name is Kelly Klein. I am a student-researcher at the McLean Hospital. My poster looks to explore experiences of teen and young adult siblings of clients with BPD (Borderline Personality Disorder). This is a prospective study, and we are beginning data collection this month (March, 2021).

 

This study really began with Clinical Observations – Clinical observations with this population suggest they may need unique support, given their likely exposure to a sibling’s ineffective emotional reactivity and/or high-risk behaviors that may have disrupted the family system or required targeted intervention. These experiences may result in their own emotional and behavioral reactions, confusion regarding a sibling’s behavior and their role in navigating it, and concerns for caregivers and family members. Siblings may experience conflict about burdening parents while still wanting and needing parental attention and support. Ultimately, these experiences likely impact a sibling’s development as well as sibling and family relationships.

 

Dialectical Behavior Therapy (DBT) is already increasingly including parents/caregivers via interventions such as family connections. However – DBT comes from the assumption of the transactional model. Not only the patient is struggling, but the patient’s environment is also struggling. And the patient’s environment, often includes more than just the caregivers.

 

Transactions between family members – between caregivers, between caregivers and children, and between siblings – play an important role in maintaining and disrupting problematic patterns associated with dysfunction and emotion dysregulation. Siblings, therefore, play an important, though less frequently explored, role in these transactions by engaging in behaviors that influence other family members, including siblings with BPD. 

 

Existing literature demonstrates that having a sibling with a mental illness can significantly disrupt the family system and negatively impact the functioning and well-being of other family members.

 

Preliminary sibling-oriented psychoeducational interventions for siblings of patients with schizophrenia or cancer have been well-explored with goals of increasing knowledge, coping capacity, and overall mental well-being.  Unfortunately, the sibling literature associated with (BPD) has been brief, assessing only genetic factors between siblings and predominantly focusing on the sibling with a BPD diagnosis.

 

An understanding of the sibling’s role, whether it be as a ‘caregiver’ for their sibling, or of ‘not increasing burden’ for their parents, has been examined. Research suggests that siblings have overlapping as well as specific needs, in-comparison to the parent-carers.

 

Given the lack of existing data on the sibling experience, we are conducting a needs assessment study of adolescent (i.e., 13-21yo) siblings of teen and emerging adult patients with emotion dysregulation, BPD, and high-risk behaviors.

 

We plan to conduct this assessment in two phases. The first includes a brief, online survey collecting both objective and qualitative self-report of sibling experiences. Participants will be invited to share additional insights about their experiences via open-ended questions.

 

To explore sibling experiences more broadly, we will conduct a series of virtual focus groups. A total of approximately 30 siblings will participate in semi-structured conversations guided by two DBT clinicians; participants will discuss family functioning, social support and coping, and clinical needs and interests.

 

 

Data collection is slated to begin this month (March, 2021). Researchers will collect and analyze preliminary findings from both arms of the study including 1) emergent themes from open-ended responses and discussions and 2) descriptive data on participant functioning, sibling and family relationships, and targets for intervention. Data will be applied to inform preliminary discussions of a targeted, DBT-informed, group-based intervention for adolescent and young adult siblings of clients with BPD.

 

 

 

 

research Areas

Authors

Kelly Klein, B.S., Luciana Payne, Ph.D., Lauren Yadlosky, Ph.D., Carey Sevier, M.S., Joanna Watson, Ph.D.

Principal Investigator

Luciana Payne, PhD

Affiliated Website