Emerging Borderline Personality Features, Attachment Representations and Behavioral Dysregulation in School-Age Children.

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Learn more: PMC Disclaimer | PMC Copyright Notice J Child Adolesc Trauma . 2025 Jan 7;18(2):349–363. doi: 10.1007/s40653-024-00678-7 Emerging Borderline Personality Features, Attachment Representations and Behavioral Dysregulation in School-Age Children Olivier Didier 1, ✉ , Miguel M Terradas 1, 2, 3, 4 Author information Article notes Copyright and License information 1 Département de psychologie, Université de Sherbrooke – Campus de Longueuil, 150, Place Charles Lemoyne, bureau 200, Longueuil, J4K 0A8 Canada 2 Institut universitaire Jeunes en difficulté, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada 3 Équipe AJIR: Difficultés d’Adaptation des Jeunes et Interventions de Réadaptation, Université de Sherbrooke, Sherbrooke, Canada 4 Centre Interdisciplinaire de développement International en santé, Université de Sherbrooke, Sherbrooke, Canada ✉ Corresponding author. Accepted 2024 Dec 18; Collection date 2025 Jun. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. PMC Copyright notice PMCID: PMC12129881  PMID: 40469784 Abstract This study aims to shed light on the influence of insecure attachment representations on the presence of emerging borderline personality features (EBPF) in school-age children, and the role of these features in manifestations of behavioral dysregulation. The sample is composed of 116 children aged 7 to 12 ( M age = 9.11; SD = 1.68; 47 girls) drawn from three groups: children under youth protective care ( n = 35), consulting psychologists or child psychiatrists ( n = 42), and the general population ( n = 39). The EBPF were evaluated using the Borderline Personality Features Scale for Children. Attachment representations were assessed using the Child Attachment Interview. The Child Behavior Checklist for youth was used to verify the presence of behavioral dysregulation. Analyses of variance indicate that the three groups differ in the insecurity of attachment representations and the extent of behavioral dysregulation, with children under youth protective care showing the highest levels and children in the general population showing the lowest. Children under youth protective care have a higher EBPF score than the general population. Regression analyses confirmed that more insecure attachment representations predict an increase in EBPF, while the latter influence the increase in behavioral dysregulation. A partial mediating effect of EBPF was found in the relationship between attachment representations and behavioral dysregulation. To our knowledge, this is the first study to identify a mediation trajectory between attachment representations, EBPF, and behavioral dysregulation in a sample of school-age children. These results are discussed with regard to their implications for borderline-to-be functioning. Keywords: Emerging borderline personality features, Attachment, Behavioural dysregulation, Maltreatment, Childhood Introduction In terms of symptoms, borderline personality disorder (BPD) manifests as instability in interpersonal relationships, identity, and affective regulation (American Psychiatric Association [APA], 2013 ). Adults suffering from this disorder may exhibit frantic efforts to avoid real or imagined abandonment, impulsivity, suicidal or self-harming behaviors, gestures or threats, a chronic sense of emptiness, intense and contextually inappropriate anger, as well as dissociative symptoms or persecutory ideations in stressful situations (APA, 2013 ). The diagnosis of BPD in childhood is controversial. Three positions have been taken regarding the possibility of making a formal diagnosis in childhood (Dubé et al., 2013 ). A first position is defended by the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013 ), according to which diagnosis before the age of 18 should only be made in rare cases where maladaptive personality features are pervasive, persist over time and are not linked to normative developmental stages. This posture aims to limit the risk of stigmatization when the child’s functioning has not yet crystallized (Bellino et al., 2022 ; Dubé et al., 2013 ). A second position supported by P. Kernberg and colleagues (Kernberg, 1990 ; Kernberg et al., 2000 ) is in favor of diagnosing BPD during childhood in order to intervene early and in a targeted manner to prevent the onset of the disorder in adulthood. A third, intermediate position supports the possibility of identifying emerging borderline personality features (EBPF) during childhood, without making a diagnosis. From a developmental perspective, this approach offers a compromise between avoiding stigmatization and early intervention. Rather than relying solely on symptom observation to identify a disorder, adherents of this position suggest considering various aspects of the child’s individual functioning and environment to identify those children on an at-risk developmental trajectory for BPD in adulthood. Thus, in addition to the presence of EBPF, professionals working with these children should pay attention to early traumatic experiences, dysfunctional parenting, innate vulnerability factors related to the child’s temperament, the presence of developmental deficits in several spheres of functioning, the early presence of internalizing or externalizing psychopathology, and an insecure attachment style (Bozzatello et al., 2019 ; Crick et al., 2005 ; Lingiardi & McWilliams, 2017 ; Pine, 1986 ). In this respect, Zanarini and colleagues (Zanarini & Frankenburg, 1997 ; Zanarini et al., 2000 ) have noted that BPD in adulthood is associated with a combination of the individual’s tendency to emotionally amplify distress and the occurrence of traumatic experiences during childhood, particularly prolonged separation situations (e.g., death of a parent, severe and chronic disorder in a parent), disturbed parental involvement (e.g., overinvestment and overprotection from one parent, conflictual relationship between parents, disinvestment from one parent, inconsistency of care, parentification of the child) and sexual assault or physical abuse. The increased presence of noise (Pine, 1986 ) triggered by this combination is thought to be at the root of developmental deficits underlying the presence of EBPF, insecure attachment and behavioral dysregulation. Primary Attachment Relationships and EBPF The early relational context between a child and their main caregivers plays an important role in the development of BPD. Various authors have described deficiencies in the child-parent relationship that can lead to the symptomatic picture of the disorder. Drawing on his clinical experience, Pine ( 1986 ) proposed that borderline pathology stems from a failure to establish a secure, trusting relationship with the caregiving figure during childhood. The insecurity felt due to the uncertainty of the parent’s responses to internal states, or even to maltreating parental practices that accentuate discomfort and distress, would notably alter the development of the child’s capacities to cope with discomfort, to regulate emotions and to internalize coherent patterns regarding how to relate to others so that their needs are met. Fonagy and colleagues ( 2003 ) have emphasized that the process of children’s internalization of secure representations of their primary relationships is inseparable from the development of their ability to conceive behaviors, both their own and those of others, as being driven by mental states (e.g., intentions, desires, emotions, beliefs). They maintain that failures in the representation of mental states, as well as insecure attachment representations, underlies the functioning of individuals with BPD, particularly with regard to the tendency to regulate oneself through acting out, impulsivity and emotional instability (Fonagy, 2000 ; Fongay et al., 2003). Attachment representations are mental models that form expectations regarding the caregiver’s responses to the child’s needs (Bretherton & Munholland, 2008 ) and develop from the parent’s ability to meet their child’s needs (De Wolff & van Ijzendoorn, 1997 ). When the parent’s ability to respond to the child’s specific needs is satisfactory, and the child develops a sense of confidence in the possibility of finding comfort and security with their caregiver, the attachment is said to be secure (Ainsworth et al., 1978 ). The child can then effectively use the parent to explore and regulate their internal experiences. Moreover, a child who has developed an insecure attachment must turn to alternative strategies to cope with their needs. Thus, the child who experiences an attachment figure adopting rejecting or intrusive behaviors towards needs could use deactivation strategies, for example by inhibiting their attachment needs and attempting to manage their internal states by themselves (Ainsworth et al., 1978 ). When parental practices are unstable, inconsistent and provoke a sense of frustration, the child may use hyperactivation strategies, notably by amplifying the expression of distress in order to challenge the caregiver (Ainsworth et al., 1978 ). Attachment deactivation strategies are associated with the development of insecure avoidant attachment representations, whereas hyperactivation strategies are linked to insecure preoccupied representations (Shmueli-Goetz et al., 2004 ). In contrast, children with disorganized attachment have not been able to internalize a coherent strategy regarding their behaviors and apprehensions when a need arises in a relational context (Main & Solomon, 1990 ). As a result of chaotic parenting practices that may have engendered a sense of dread, these children may express contradictory behaviors and attitudes towards the caregiving figure (Main & Hesse, 1990 ). At school age, disorganized attachment may be reflected in controlling behaviors towards the parent (Main & Cassidy, 1988 ). In the scientific literature, the impact of children’s early experiences with their parents on the nature of their attachment representations is well established. Two studies presenting the results of meta-analyses carried out on a total sample of several thousand children show that maltreatment is associated with the development of insecure attachment, particularly of the disorganized type (Cyr et al., 2010 ; van Ijzendoorn et al., 1999 ). Also, in a study of 59 Italian children aged 9 to 13, including 24 children in protective care ( M age = 11.26; SD = 1.69; 12 girls) and 35 children from the general population ( M age = 10.69; SD = 0.79; 17 girls), it was observed that children from the general population had more secure and less insecure attachments to both mother and father than children in protective care (Zaccagnino et al., 2015 ). These results are similar to those obtained by Bifulco and colleagues ( 2017 ) from a sample of 118 English youth in protective care aged 10 to 18 ( M age = 14.20; SD = 1.86; 43 girls). This study revealed that all but one of the young participants had an insecure attachment, either disorganized, avoidant or preoccupied. Thus, in children presenting EBPF, attachment representations are expected to reflect the internalization of experiences of failures occurring within the bond with the main caregivers, in particular experiences associated with maltreatment and failures in the co-regulation process between the child and their parent. Abuse and EBPF Longitudinal studies have shown that adverse childhood experiences are associated with increased BPD symptoms in adolescence (Boone et al., 2022 ; Geselowitz et al., 2021 ) and adulthood (Carlson et al., 2009 ; Johnson et al., 1999 ; Widom et al., 2009 ). The relationship between childhood maltreatment and school-age EBPF has also been documented. Thus, by studying a sample of 225 American children from the general population aged 11 to 14 ( M age = 12.15; SD = 0.82; 101 girls), Gratz and colleagues ( 2011 ) were interested in the predictors of borderline personality features, measured using a 9-item scale adapted from DSM criteria to the developmental context of childhood. They identified that these features were independently predicted by having experienced emotional abuse during childhood. A study of 599 American children aged 10 to 12 ( M age = 11.30; SD = 0.94; 304 girls) and from a disadvantaged socioeconomic background showed that children who had suffered maltreatment, particularly physical abuse or neglect, reported more EBPF than non-maltreated children (Hecht et al., 2014 ). The results of this research indicate that the longer the maltreatment continues, the more important the features are. Finally, a longitudinal study of 2,232 British children from the general population selected from a twin registry showed that the increase in EBPF at age 12 was linked to maltreatment before age 10 (Belsky et al., 2012 ). Attachment and EBPF The influence of attachment representations on the presence of borderline personality features has mainly been evaluated in studies of adolescent and adult populations, as well as in longitudinal studies. To this end, adult research in the U.K., the U.S. and Canada has identified the mediating and moderating role of insecure attachment representations between experiences of adversity in childhood and the presence of symptoms or BPD in adulthood (see, Cirasola et al., 2017 ; Cohen et al., 2017 ; Crow & Levy, 2019 ; Godbout et al., 2019 ). Research following a longitudinal approach has also verified the influence of attachment on the development of BPD. Carlson and colleagues ( 2009 ) followed a sample of 162 children (80 girls) into adulthood. It was found that maltreatment in the first year and a half of life, disorganized attachment behaviors in infancy and various environmental risk factors (e.g., family instability, stressful family life events) are all associated with increased BPD symptoms in adulthood. However, EBPF was not assessed during childhood in the study. Lyons-Ruth et al. ( 2013 ) studied 56 young people from socioeconomically at-risk families from childhood to early adulthood. It was found that the presence of maternal disinvestment in the child’s attachment behaviors predicted an increase in BPD symptoms in adulthood. In addition, disorganized and controlling attachment behaviors in children at age 8 were associated with an increased presence of BPD symptoms in adulthood. To our knowledge, the only studies that have examined the relationship between attachment and EBPF in school-age children have focused on the behaviors of the parent or child in the relationship, and not on attachment representations. For example, in a general population sample, Fleck and colleagues ( 2023 ) observed that less-structuring maternal behaviors and withdrawal behaviors from the child during a task where the dyad had to discuss a conflictual subject were associated with an increase in EBPF in youth. Thus, several research findings seem to point to the role played by attachment representations in the relationship between childhood maltreatment and the presence of EBPF. In line with the developmental perspective, it is expected that the relationships between these variables, previously tested with adolescents and adults, can be observed in samples of school-age children. To our knowledge, this has not yet been evaluated empirically. EBPF and Manifestations of Behavioral Dysregulation In addition to damage to attachment representations, it is expected that the early relationship experiences of children with EBPF will also affect their ability to regulate their behaviors (Fonagy, 2000 ; Pine, 1986 ). In fact, when attachment is secure, and the caregiver looks at the child’s inner world with a sensitive and differentiated gaze, the child internalizes the image of this caring and thinking adult. The child internalizes the containing functions that enable them to cope with states of tension and to regulate their psychic life (Fonagy et al., 2000 ). Repeated failures to regain a sense of security within the dyad can lead to excessive reliance on the external world and acting out to regulate internal experiences (Fonagy, 2000 ). Various studies have verified the effects of maltreatment on behavioral dysregulation in school-age children. Research conducted on 346 American children aged 2 to 16 ( M age = 7.90; SD = 3.75; 180 girls) who had been removed from their original family environment due to maltreatment found that 42% of boys and 28% of girls in the sample presented a clinical level of externalizing behavior (Dubowitz et al., 1993 ). Externalizing behaviors, which are manifestations of behavioral dysregulation, include both aggressive and delinquent behaviors (Achenbach & Rescorla, 2001 ). By way of comparison, Hunt and colleagues ( 2017 ) found, in a sample of 3,108 American 9-year-olds from socioeconomically at-risk families, that 8.2% of children exhibited a clinical level of externalizing behaviors. The authors also observed a strong positive association between the number of adverse events experienced during childhood and the extent of externalizing behaviors. In addition, the relationship between maltreatment and behavioral dysregulation has been observed in several other studies, for example concerning children in protective care (Kayser et al., 2011 ), who had been sexually assaulted (Ensink et al., 2016 , 2017 ), or who had been abused (Kim et al., 2009 ). Notably, Ensink and colleagues ( 2016 , 2017 ) demonstrated that the child’s reduced ability to represent their own mental states and those of others played a mediating role between the experience of sexual aggression and behavioral dysregulation. With regard to the relationship between borderline features and behavioral dysregulation, studies of adolescents have shown that the increased presence of BPD symptoms is associated with increased difficulties in regulating behavior and aggression (Burnette & Reppucci, 2009 ; Nelson et al., 2014 ; Sharp et al., 2011 ). In particular, the results obtained by Burnette and Reppucci ( 2009 ) with adolescent girls held in a juvenile correctional service indicate that BPD symptoms mediate the relationship between childhood abuse and aggressive behavior in adolescence. In samples of school-age children, studies show a similar link between EBPF and behavioral dysregulation. In a study carried out in Quebec among 94 children aged 7 to 12 ( M age = 9.8; 13 girls) followed in psychiatry, it was determined that children with a clinical level of EBPF displayed more externalizing behaviors than other children in the sample (Guzder et al., 1999 ). Rogosch and Cicchetti ( 2005 ) studied a group of 360 American children aged between 6 and 12 who were at socioeconomic risk (185 of whom had experienced abuse). They found that children who had experienced maltreatment showed more precursors of BPD than non-maltreated children, in particular emotional lability, relational conflicts, relational aggression, and self-mutilation behaviors. The overall score associated with these precursors of BPD was positively correlated with the presence of externalizing problems and aggressive behavior. In a sample of 1,050 children aged between 5 and 12 ( M age = 8.42; SD = 2.31; 509 girls), Babinski and colleagues ( 2021 ) found that EBPF in young people was associated with a greater presence of emotional dysregulation symptoms associated with attention deficit disorder with or without hyperactivity and oppositional defiant disorder. Regarding the relationship between attachment and behavioral dysregulation, Fearon and colleagues ( 2010 ) carried out a series of meta-analyses based on results obtained from children aged 12 and under. They found that children with insecure attachments (avoidant, preoccupied or disorganized) reported more externalizing behaviors than securely attached children. This relationship seemed more pronounced for boys than for girls, as well as for clinical samples compared to non-clinical samples. Finally, the results of the meta-analyses indicated that children with a disorganized attachment had more externalizing behaviors than children with another type of attachment. However, moderation analyses found that this relationship was only present in samples composed of boys or mixed samples. These findings regarding the relationship between insecure attachment, particularly when it is disorganized, and behavioral dysregulation are similar to those obtained in longitudinal studies. For example, Lyons-Ruth and colleagues ( 1993 ) demonstrated that insecure attachment behaviors at 18 months predict an increased presence of hostile behaviors at age 5. Similarly, the Minnesota study (Sroufe, 2005 ) revealed that insecure attachment in infancy is associated with an increase in behavioral problems at school age. Current Study The aim of the present study is to verify the relationships between attachment representations, EBPF and behavioral dysregulation in a diverse sample of school-aged children with regard to early traumatic experiences in the relationship with the care figure and emotional or behavioral difficulties requiring psychological services. Firstly, it is expected that children who have experienced maltreatment in their attachment relationships and those receiving psychological services because of emotional or behavioral difficulties will show higher levels of insecure attachment representations, EBPF and behavioral dysregulation than those from the general population. Secondly, we hypothesize that insecure attachment representations and behavioral dysregulation are both associated with an increase in the EBPF score. Thirdly, EBPF is expected to play a mediating role in the relationship between insecure attachment representations and behavioral dysregulation. Thus, the internalization of early failures in attachment relationships would influence the manifestation of personality features and the resources enabling the child to cope with internal states. Deficits in this area would encourage regulation through action. Method Participants and Procedure Three groups of children aged 7 to 12 were recruited in the province of Quebec, Canada. The total sample consisted of 116 participants. The first group included 35 children ( M age = 9.71; SD = 1.71; 7 girls) removed from their original family environment due to maltreatment and placed in specialized child protection resources. These children were removed from their family environment under the Youth Protection Act (Loi sur la protection de la jeunesse, 2021 ). These are young people who may have been physically abused (34.4% of the group), sexually assaulted (25.7%), abandoned by a parent (37.1%) or have witnessed physical violence (37.1%). A second group of 42 children ( M age = 9.43; SD = 1.55; 20 girls) was recruited from a university psychology clinic and child psychiatry hospital departments. These children received psychological care as a result of emotional or behavioral difficulties, but were not the subject of a referral to child protection. In this group, 4.8% of the children experienced physical abuse, 9.5% experienced parental abandonment, and 7.1% witnessed physical violence. None of them had been sexually assaulted. A third group comprising 39 children ( M age = 8.23; SD = 1.44; 20 girls) from the general population were recruited by contacting various schools and through publications on social networks. These participants were not receiving psychological services because of emotional or behavioral difficulties and had not suffered any recognized abuse within their family. In this group, 2.6% experienced parental abandonment, and 5.1% witnessed physical violence. None of them had been physically abused or sexually assaulted. Because of the developmental consequences of intellectual disability and autism spectrum disorder, children with these conditions were excluded from the study. The study was approved by the research ethics committees of the institutions involved (Research Ethic Committee Letters and Human Sciences of Université de Sherbrooke [2012-59] and Youth in difficulty of the Integrated University Health and Social Services Center of Centre-Sud-de-l’Île-de-Montréal [MP-CJM-IU-13-09-14]). After obtaining written consent from their parents, each child was interviewed individually. The instruments were administered over two or three sessions as part of a wider study aimed at understanding the intrapsychic and relational factors that may explain behavioral dysregulation in children in protective care. For groups consulting a psychologist or child psychiatrist and from the general population, parents were asked to fill in questionnaires. A researcher was available to answer parents’ inquiries regarding the questionnaires. The questionnaires were filled in by the referral educator for the children in care, as these children had no day-to-day contact with their parents. The children in care were interviewed by a research assistant in a neutral room in their residential unit, while the children in the other two groups were interviewed in a university clinic. Measuring Instruments Sociodemographic Questionnaire Brief questionnaire completed by the childcare worker responsible for the child in the case of youth in foster care, and by the mother in the case of children from the general population or consulting a psychologist or a child psychiatrist. It collects information regarding the child’s age, gender, and significant life events. The estimated time to complete this questionnaire is five minutes. Child Attachment Interview Attachment representations were assessed using the French version of the Child Attachment Interview (CAI; Ensink & the sexual abuse research group of Université Laval, 2002 ; based on the original English version; Target et al., 1998 ). It consists of a semi-structured interview lasting about 30 min and comprising 15 items. The child is invited to describe his relationship with each parent and to provide examples to illustrate the nature of these relationships. He is also invited to answer questions such as “Give me an example of a time when you were really upset and wanted help”. The CAI is analyzed based on the video recording and the verbatim transcript of the interview, in order to consider both verbal and non-verbal elements. A single score for the entire interview is assigned for each scale (emotional openness, balance of positive and negative references to attachment figures, use of examples, idealization of mother or father, involving anger with mother or father, detachment/denigration/minimization (dismissal) of mother or father, conflict resolution, disorganization, coherence). The coherence scale reflects the integration of all other scales and considers the characteristics of the child’s speech. Discourse coherence is conceptualized based on the four principles (quantity, quality, relevance, manner) described by Grice ( 1975 ) in relation to cooperative conversation. It is a strong indicator of the child’s attachment security (Shmueli-Goetz et al., 2008 ). The interviews were conducted by doctoral students in psychology who had completed their clinical training. The protocols were rated by two people accredited by the Anna Freud Center. A study of children from the general and clinical populations (Shmueli-Goetz et al., 2008 ) demonstrated satisfactory temporal stability after three months (Kappa between 0.52 and 1.00) and after one year (between 0.42 and 0.74). The instrument has good interjudge reliability (between 0.67 and 0.78). Borderline Personality Features Scale for Children (BPFS-C) The EBPF were evaluated using the French translation of the Borderline Personality Features Scale for Children (BPFS-C; Crick et al., 2005 ), using the translation/retranslation method (Behling & Law, 2000 ) by Terradas and Achim ( 2010 ). It is a self-report questionnaire composed of 24 statements divided into four domains: emotional instability (six items; for example, “My feelings are very strong. For instance, when I get mad, I get really mad. When I get happy, I get really, really happy”), identity problems (six items; for example, “I feel that there is something important missing about me, but I don’t know what it is”), negative relationships (six items; for example, “I’ve picked friends who have treated me badly”), and self-destruction (six items; for example, “I get into trouble because I do things without thinking”). The estimated time to complete the questionnaire is 15 min. Each item is answered on a five-point Likert scale ranging from not at all true to always true . The total score corresponds to the sum of the statements (Minimum = 24; Maximum = 120). The English version of the instrument has excellent internal consistency and construct validity (Crick et al., 2005 ). Validation of the French version was carried out on 262 French-speaking children and 43 bilingual children from the province of Quebec. The four components that form the structure of this version are quite similar to those of the original version (impulse control, negative interpersonal relationships, emotion regulation, feelings of emptiness). The internal consistency of the French version (α = 0.87) and the correlation between the total scores of the English and French versions ( r =.84) are satisfactory (Arsenault et al., 2012 ; Dubé et al., 2015 ). Internal consistency is good in the current study, as measured by McDonald’s omega ( ω = 0.84). Child Behavior Checklist for Youth Aged 6 to 18 Years The 113-item questionnaire developed by Achenbach and Rescorla ( 2001 ) is designed to verify the presence of behavioral dysregulation, or externalizing behaviors, in children. The tool is completed by the childcare worker responsible for the child in the case of youth living in care, and by the mother in the case of children from the general population consulting a psychologist or child psychiatrist. The estimated time for administration is 15 min. The tool measures emotional (internalized behaviors: anxiety/depression and withdrawal/depression scales) and behavioral difficulties present in children. The score on the externalizing behaviors scale (Minimum = 0; Maximum = 70) is the sum of the scores on the aggressive behaviors (18 items; for example, the adult must indicate if the child “Destroys his/her own things”) and behaviors that break social rules (17 items; for example, the adult must indicate if the child “Breaks rules at home, school, or elsewhere”) subscales. The tool has excellent internal consistency; Cronbach’s alpha for symptom scales is 0.95. Interjudge reliability is 0.96 for items measuring specific problems, while test-retest reliability based on a one-week interval between tests is 0.95 (Achenbach & Rescorla, 2001 ). The internal consistency of the externalizing behaviors scale in the present study is excellent ( ω = 0.94). Results Descriptive and Preliminary Analyses To verify whether the proportion of boys and girls differed between groups, chi-square tests were performed. Analyses show that the group of children in residential care contains a higher proportion of boys than the groups of children consulting a psychologist or child psychiatrist ( χ 2 = 6.40; p =.01) and from the general population ( χ 2 = 7.79; p =.01). An analysis of variance revealed that the average age of participants varied between the three groups ( F (2, 113) = 9.65; p <.001). Bonferroni-corrected post-hoc analyses show that the group from the general population is significantly younger than the groups of residential children ( p <.001) and consulting a psychologist or child psychiatrist ( p =.002). Table 1 presents the central tendency and dispersion statistics for each variable under study by group. Table 1. Descriptive statistics (means, standard deviations) for variables Groups Variables In Care M ( SD ) a Consulting child psychiatrists or psychologists M ( SD ) General population M ( SD ) Child Attachment Interview b Scales Emotional openness 2.94 (1.54) 4.20 (1.94) 4.86 (2.15) Balance of positive and negative references to attachment figures 2.95 (0.90) 4.25 (1.43) 4.61 (1.82) Use of examples 3.53 (1.47) 4.88 (1.74) 5.11 (1.79) Involving anger with mother 2.17 (1.62) 3.03 (2.14) 2.14 (1.70) Involving anger with father 2.08 (1.86) 2.60 (1.94) 2.14 (1.60) Idealization of mother 4.39 (1.97) 3.87 (1.77) 3.79 (1.81) Idealization of father 4.14 (2.46) 3.87 (1.89) 4.21 (1.95) Dismissal of mother 5.18 (1.47) 3.86 (1.95) 3.67 (2.27) Dismissal of father 5.93 (1.44) 3.75 (2.02) 4.17 (2.51) Conflict resolution 3.06 (1.25) 4.08 (1.65) 4.51 (1.86) Disorganization 0.47 (0.51) 0.18 (0.38) 0.05 (0.23) Coherence 2.68 (1.24) 4.04 (1.99) 4.82 (1.96) BPFS-C 65.43 (12.95) 61.14 (13.31) 57.60 (13.44) CBCL – Externalizing problems subscale 26.27 (9.35) 18.05 (11.18) 7.85 (7.20) Open in a new tab a Mean (Standard deviation); b For each scale, the score varies between 1 and 9, except for the Disorganization scale, which is scored according to absence (0) or presence (1) Pearson correlation analyses conducted within the total sample (Table 2 ) show that a higher score on the EBPF instrument is significantly associated with a lower level ( r = −.41 to − 0.21) on the CAI attachment security scales (emotional openness, balance of positive and negative references to attachment figures, use of examples, conflict resolution, coherence) and increased scores ( r =.21 to 0.30) on attachment insecurity scales (anger with mother, dismissal of mother, dismissal of father). A higher level of behavioral dysregulation is significantly associated with a decrease ( r = −.44 to − 0.30) in the CAI security scales. A positive and significant correlation ( r =.22 to 0.44) was also observed between behavioral dysregulation and dismissal of attachment figures, as well as the presence of disorganization. Higher levels of EBPF are significantly associated with more behavioral dysregulation ( r =.35). Table 2. Correlations between variables Variables 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 1. Gender a - 2. Age − 0.09 - 3. Emotional openness − 0.33 ** 0.09 - 4. Balance of references − 0.31 ** 0.06 0.65 ** - 5. Use of examples − 0.29 ** 0.20 * 0.84 ** 0.71 ** - 6. Anger with mother − 0.09 0.00 − 0.18 − 0.11 − 0.05 - 7. Anger with father − 0.01 0.06 − 0.12 0.06 0.04 0.73 ** - 8. Idealization of mother 0.17 0.06 − 0.29 ** − 0.20 * − 0.34 ** − 0.21 * − 0.13 - 9. Idealization of father 0.12 − 0.11 − 0.26 * − 0.32 ** − 0.39 ** − 0.04 − 0.39 ** 0.48 ** - 10. Dismissal of mother 0.38 ** 0.13 − 0.57 ** − 0.63 ** − 0.63 ** 0.04 − 0.18 0.30 ** 0.45 ** - 11. Dismissal of father 0.37 ** 0.07 − 0.67 ** − 0.64 ** − 0.69 ** − 0.04 − 0.04 0.36 ** 0.32 ** 0.81 ** - 12. Conflict resolution − 0.24 * 0.01 0.75 ** 0.57 ** 0.68 ** − 0.45 ** − 0.34 ** − 0.30 ** − 0.34 ** − 0.57 ** − 0.63 ** - 13. Disorganization b 0.25 ** − 0.07 − 0.41 ** − 0.38 ** − 0.37 ** 0.25 * 0.27 ** 0.14 − 0.04 0.25 * 0.38 ** − 0.44 ** - 14. Coherence − 0.31 ** 0.07 0.90 ** 0.75 ** 0.85 ** − 0.33 ** − 0.22 * − 0.34 ** − 0.33 ** − 0.67 ** − 0.71 ** 0.85 ** − 0.52 ** - 15. BPFS-C 0.06 0.07 − 0.21 * − 0.26 ** − 0.22 * 0.30 ** 0.17 0.15 0.12 0.20 * 0.21 * − 0.41 ** 0.19 − 0.31 ** - 16. Externalizing problems 0.19 * 0.09 − 0.38 ** − 0.31 ** − 0.30 ** 0.16 0.07 0.11 0.03 0.27 ** 0.22 * − 0.39 ** 0.44 ** − 0.44 ** 0.35 ** Open in a new tab Notes. * p <.05; ** p <.01; a girl = 0, boy = 1; b absence = 0, presence = 1; N = 88–116 Comparisons of Attachment Representations, EBPF and Behavioral Dysregulation Between the Three Groups To verify whether the level of the variables under study differed between groups, analyses of variance were performed. Analyses were carried out controlling for the effect of participants’ gender and age. The postulate of homogeneity of group variances has been verified. When the Levene test was significant, comparison analyses robust to heteroscedasticity (HC3 method) were used. Where variances were homogeneous, Bonferroni-adjusted post-hoc analyses were performed. Table 3. Group effect on variable levels, controlling for age and gender Variables F η p ² Significant inter-group comparisons a Emotional openness 9.69 ** 0.15 1 < 2 and 3 b Balance of positive and negative references 12.67 ** 0.20 1 < 2 and 3 b Use of examples 12.51 ** 0.19 1 < 2 and 3 Involving anger with mother 2.63 0.05 Involving anger with father 0.80 0.02 Idealization of mother 0.29 0.01 Idealization of father 0.20 0.01 Dismissal of mother 2.21 0.04 Dismissal of father 6.44 ** 0.12 1 > 2 and 3 b Conflict resolution 12.29 ** 0.19 1 < 2 < 3 b Disorganization 6.14 ** 0.11 1 > 2 and 3 b Coherence 13.80 ** 0.21 1 < 2 < 3 b BPFS-C 2.71 0.05 Externalizing problems 34.03 ** 0.38 1 > 2 > 3 b Open in a new tab Notes. η p ² = partial eta squared; * p <.05; ** p <.01; a 1 = In care, 2 = Consulting psychologists or child psychiatrists, 3 = General population; b HC3 method Regarding the CAI scales associated with secure attachment representations, children in residential care have a significantly lower average score for emotional openness than children in groups consulting a psychologist or child psychiatrist ( p <.01) and from the general population ( p <.001). Similarly, children in residential care showed significantly less balance in positive and negative references to parents, and used significantly fewer examples than the other two groups ( p <.001). The interpersonal conflict resolution skills of children in residential care are significantly lower than those of children consulting a psychologist or child psychiatrist ( p =.01) and the general population ( p <.001). On the coherence scale, the residential group scored significantly lower than the other two groups ( p <.001) and the group consulting a psychologist or child psychiatrist exhibited a significantly less coherent discourse than the general population group ( p =.03). Regarding CAI scales related to insecure attachment, children in residential care expressed significantly more dismissal of their fathers than children receiving psychological or child psychiatric care ( p <.001) and the general population ( p =.03). Children in residential care have a significantly higher level of disorganization than children consulting a psychologist or child psychiatrist ( p =.01), while the latter show more disorganization than children in the general population ( p =.02). Regarding the BPFS-C score, there was no difference between groups, controlling for age and gender. Age ( p =.84) and gender ( p =.95) have no significant effect as control variables in the ANOVA model testing the group effect on BPFS-C. By removing these variables from the model, a significant group effect explaining 5.4% of the variance is found for EBPF ( F (2, 113) = 3.23; p =.04). Thus, children in the residential group have a higher incidence of EBPF than children in the general population ( p =.04). The level of externalizing behavior is significantly higher among children in residential care than among those consulting a psychologist or child psychiatrist ( p =.001). Furthermore, the latter display more externalizing problems than children in the general population ( p <.001). Relationship between CAI Scales, EBPF and Behavioral Dysregulation To verify the relationships between the variables under study, regression analyses were carried out, controlling for the effect of age and gender (see Tables 4 and 5 ). First, analyses were conducted to evaluate the influence of each CAI scale, one scale at a time, on EBPF. Similarly, the influence of each individual CAI scale on behavioral dysregulation was verified. The postulates of normality, homoscedasticity, linearity of the relationship and absence of strong multicollinearity were respected for all analyses according to the residual analysis and the variance inflation factor (VIF). Table 4. Predictive effect of CAI scales on EBPF in total sample, controlling for age and gender CAI Scale β ∆F p ∆ r 2 Emotional openness − 0.23 5.35 0.02 0.05 Balance of positive and negative references − 0.28 8.00 0.01 0.07 Use of examples − 0.24 6.07 0.02 0.05 Involving anger with mother 0.31 10.55 0.002 0.09 Involving anger with father 0.17 2.78 0.10 0.03 Idealization of mother 0.14 1.98 0.16 0.02 Idealization of father 0.13 1.41 0.24 0.02 Dismissal of mother 0.20 3.59 0.06 0.03 Dismissal of father 0.20 3.43 0.07 0.03 Conflict resolution 0.20 3.99 0.04 0.04 Disorganization − 0.43 21.61 < 0.001 0.17 Coherence − 0.33 12.02 < 0.001 0.10 Open in a new tab Notes. β = standardized coefficient; ∆ F = F variation; ∆ r 2 = r 2 variation Table 5. Predictive effect of variables on behavioural dysregulation in the total sample, controlling for age and gender Variables β ∆F p ∆ r 2 Emotional openness − 0.36 15.16 < 0.001 0.12 Balance of positive and negative references − 0.29 9.04 0.003 0.08 Use of examples − 0.29 9.40 0.003 0.08 Involving anger with mother 0.18 3.47 0.07 0.03 Involving anger with father 0.06 0.34 0.56 0.003 Idealization of mother 0.07 0.53 0.47 0.01 Idealization of father 0.03 0.05 0.82 0.001 Dismissal of mother 0.21 4.33 0.04 0.04 Dismissal of father 0.15 2.10 0.15 0.02 Conflict resolution 0.44 24.51 < 0.001 0.18 Disorganization − 0.37 15.90 < 0.001 0.13 Coherence − 0.43 22.00 < 0.001 0.16 EBPF 0.33 14.65 < 0.001 0.11 Open in a new tab Notes. β = standardized coefficient; ∆ F = F variation; ∆ r 2 = r 2 variation Analyses designed to test the predictive effect of each of the CAI scales on EBPF reveal that increases in EBPF scores are significantly predicted by decreases in CAI scales associated with secure attachment representations, controlling for the effects of participants’ age and gender. Thus, a lower score on the emotional openness (4.7% of variance explained), balance of positive and negative references (7.2%), use of examples (5.3%), conflict resolution (17.1%) and coherence (10.1%) scales significantly predicted an increase in EBPF in the overall sample. In addition, a higher level on the scales associated with insecure attachment representations significantly predicts an increase in the score on the instrument measuring EBPF. This result is observed for the disorganization (3.6% of variance explained) and involving anger with mother (9.3%) scales. The influence of the dismissal of the mother and father scales on the EBPF is marginally significant. Complementary analyses were carried out using the PROCESS module and bootstrapping (1,000 samples) to verify whether the relationships found between the CAI scales and EBPF were moderated by the effect of the participants’ affiliation group, controlling for age and gender. A moderating effect of the group affiliation was found for the emotional openness ( F (2, 104) = 3.31; p =.04; ∆ r 2 = 0.06) and disorganization scales ( F (2, 102) = 4.11; p =.02; ∆ r 2 = 0.07). Thus, a lower level on the emotional openness scale predicts an increase in the EBPF score within the general population group (Effect = -2.59; t = -2.52; p =.01), whereas the relationship is not significant for children in residential care ( p =.18) and consulting a psychologist or child psychiatrist ( p =.34). A similar interactive effect is observed for the disorganization scale. The presence of disorganization is significantly associated with an increase in the EBPF score in the general population (Effect = 29.68; t = 3.10; p =.002), compared with the group in care ( p =.94) and consulting a psychologist or child psychiatrist ( p =.52). This last result must be put into perspective, however, since the presence of disorganization was noted in only two children in the general population group. This is an interesting result from an exploratory point of view, but has an obvious limitation in terms of its generalizability. Regression analyses were conducted to test the predictive effect of each CAI scale and BPFS-C on the level of behavioral dysregulation, controlling for age and gender. The results indicate that lower scores on scales associated with secure attachment representations, namely emotional openness (11.8% of variance explained), balance of positive and negative references (7.8%), use of examples (7.7%), conflict resolution (12.8%) and coherence (16.3%), predicts a significant increase in behavioral dysregulation in the total sample. A higher level of dismissal of mother (3.8% of variance explained) and the presence of disorganization (17.9%) also significantly predict greater behavioral dysregulation. Also, an increase in the EBPF score was significantly associated with an increase in behavioral dysregulation (11.0%). Complementary analyses using the PROCESS module reveal a moderating effect of group affiliation in the relationship between mother idealization and behavioral dysregulation ( F (2, 93) = 5.63; p =.004; ∆ r 2 = 0.07). Thus, increased idealization of the mother predicts greater behavioral dysregulation in the general population. (Effect = 2.55; t = 2.95; p =.004), while the relationship was not significant in the residential group ( p =.61) and the psychology or child psychiatry consulting group ( p =.11). Mediating Effect of EBPF in the Relationship Between Attachment Representations and Behavioral Dysregulation The CAI coherence scale was considered in order to verify the mediating effect of EBPF in the relationship between attachment representations and behavioral dysregulation, controlling for age and gender. The PROCESS module was used, and the absence of strong multicollinearity was verified beforehand (see Fig. 1 ). Fig. 1. Open in a new tab Mediating effect of EBPF in the relationship between coherence and behavioural dysregulation, controlling for age and gender Notes. Only statistically significant relationships are shown in the figure. The coefficients qualifying the relationships are the non-standardized coefficients Direct effect analysis indicates that the predictive effect of the coherence scale on manifestations of behavioral dysregulation, controlling for age and gender, remains significant and negative after the addition of EBPF as a control variable ( t = -3.79; p <.001). As measured by bootstrapping (1,000 samples), the indirect effect of EBPF in the relationship between attachment representations and behavioral dysregulation, controlling for age and gender, is statistically significant (Effect = -0.43; I.C. 95%: -0.93, -0.04). Decreased coherence predicts an increase in the EBPF score, which in turn is associated with an increased presence of behavioral dysregulation. Thus, EBPF have a significant partial mediating effect in the relationship between insecure attachment representations and behavioral dysregulation. Indeed, the influence of coherence on behavioral dysregulation diminishes, but remains significant when the mediator variable is included in the model. Discussion The present study focused on attachment representations, EBPF and behavioral dysregulation in a sample of school-age children in protective care, consulting a psychologist or child psychiatrist, and from the general population. The objectives were to compare attachment representations, EBPF and behavioral dysregulation between groups. The research also aimed to clarify the relationships between these variables, in particular the mediating effect of EBPF in the relationship between attachment representations and behavioral dysregulation. The first hypothesis suggested that groups of children who were in care and consulting a psychologist or child psychiatrist had less secure attachment representations, as well as higher scores of EBPF and behavioral dysregulation than the group drawn from the general population. With regard to the security of attachment representations, as measured by the CAI coherence scale, the results indicate that children in protective care have more insecure attachment representations than children in the other two groups. Moreover, children consulting a psychologist or child psychiatrist have a lower level of coherence than those in the general population. A similar gradation is observed between groups regarding the presence of disorganization. These results suggest that the security of attachment representations varies according to the nature of the failures in the child-parent relationship. Thus, even in the absence of legally recognized abuse, children who present emotional or behavioural difficulties requiring psychological care may have had to deal with failures in the co-regulation processes with the care figure. These may be relational experiences that have altered the development of the child’s sense of trust and comfort in the parent’s ability to deal with difficult states and find comfort (Ainsworth et al., 1978 ). In line with previous studies (see, for example, Cyr et al., 2010 ; Zaccagnino et al., 2015 ), the level of insecurity is highest among children in the sample whose relationships with their parents have been marked by traumatic experiences of abuse. This can be seen in the CAI scales which reflect the ability to approach relational contexts of care in an emotionally nuanced way, to link internal experiences to external situations and to resolve conflicts that may emerge in connection with the care figure. Differences in the level of behavioral dysregulation indicate a strong effect of group affiliation. These results reflect the disorganizing role of traumatic relational experiences on the ability to cope with difficult internal states and highlight that the use of acting out to regulate the psychic world can be noted in the absence of a history of abuse requiring specific legal intervention. This is similar to observations already made, for example by Kayser et al. ( 2011 ). Furthermore, children who have experienced maltreatment report a higher EBPF score than those in the general population, which is consistent with results of previous research (see, for example, Hecht et al., 2014 ). However, the size of the observed effect of the group on EBPF is relatively small. This might suggest that borderline traits, as measured by the BPFS-C, can be identified beyond a context where early parenting practices were decidedly deficient, or even traumatic. Various authors emphasize the respective contributions of traumatic experiences and individual characteristics in the clinical picture of children with EBPF (see, for example, Gratz et al., 2011 ; Zanarini & Frankenburg, 1997 ). The second hypothesis proposed that insecure attachment representations and behavioral dysregulation are associated with an increase in the EBPF score. The results confirm the predictive effect of attachment representations on EBPF. In particular, all the scales associated with a more secure attachment are negatively related to the EBPF score. Scales reflecting heightened insecurity, such as involving anger with the mother, predict an increase in the EBPF score. These results offer support for proposals concerning the influence of vestiges of early relational experiences on personality development, and in particular the presence of deficits placing the individual at risk of developing BPD in adulthood (see, for example, Bozzatello et al., 2019 ; Pine, 1986 ; Zanarini et al., 2000 ). The fact that the conflict resolution scale is the CAI component that explains the largest share of variance in EBPF is a reminder of the intense emotional activation that can occur in individuals with BPD in conflict situations, and against which reflective capacity cannot be applied to the resolution process (Fonagy et al., 2000 ). The empirical observations made in the present sample of school-age children are thus similar to those of previous studies that have linked attachment and borderline traits in adolescent and adult samples, as well as in the context of longitudinal specifications (see, for example, Carlson et al., 2009 ; Godbout et al., 2019 ; Milijkovitch et al., 2018 ). Additional analyses revealed a moderating effect of group affiliation on the emotional openness and disorganization scales, both of which predict the EBPF score in youth from the general population only. The observed association between a low ability to appeal to emotions in speech and increased EBPF only among children from the general population may be explained by the greater variance of these two variables within this group compared to the other two. The identification of this predictive relationship, whose effect size is also relatively small, would therefore be more likely to be carried out within a group that is less homogeneous. With regard to the disorganization scale, the moderating effect of the group affiliation must be qualified and approached from an exploratory point of view, since it is based on the fact that disorganization was noted in only two participants from the general population. Even so, this result suggests that EBPF may emerge from an early relational context that is not recognized as traumatic, but in which the development of personality aspects associated with borderline functioning would be compromised. Regarding the predictive effect of the CAI scales on behavioral dysregulation, the results confirm the influence of insecure attachment representations on the tendency to regulate the internal world through behaviors. All scales associated with greater attachment security are negatively related to the level of externalizing behavior. This is in line with theoretical proposals describing the role of early relationships in the development of the capacities necessary for emotional and behavioral regulation (Fonagy et al., 2000 ) and with the results of meta-analyses conducted by Fearon and colleagues ( 2010 ). Among the CAI scales associated with attachment insecurity, the presence of disorganization explains the largest share of variance in behavioral dysregulation. Disorganization indicates the presence of traumatic traces in the child’s psyche, affecting the continuity and coherence of internal experiences (Main & Hesse, 1990 ). These are unbound affective states that cannot be used to organize experiences, or even fragments that attack the child’s psychic integrity. When faced with these traces that cannot be represented, acting out is favored as a means of regulating tensions. A moderating effect of group affiliation was found for a CAI scale. Thus, greater idealization of the mother predicts an increase in behavioral dysregulation in the general population group only. This suggests that the use of the idealization process influences the level of externalizing behavior only in a context of low behavioral dysregulation and in the absence of clinical difficulties. The third hypothesis proposed that EBPF mediate the relationship between attachment representations and behavioral dysregulation. This mediation model was proposed considering longitudinal studies that demonstrated the predictive influence of insecure attachment in infancy on the presence of borderline personality traits later in life (for example, Carlson et al., 2009 ) and behavioral problems at school age (for example, Lyons-Ruth et al., 1993 ; Sroufe, 2005 ). The results confirm a partial mediating effect of EBPF in the relationship between attachment insecurity, as measured with the coherence scale, and behavioral dysregulation. Previous research has established the role of relational experiences of failure of the co-regulatory process between the care figure and the child on the insecurity of the latter’s attachment representations (see, for example, Cyr et al., 2010 ). The present study suggests that these relational experiences, beyond their mental representations, influence personality development, in particular the presence of deficits in domains related to borderline-to-be functioning. These deficits, manifested in the form of EBPF (Crick et al., 2005 ; Pine, 1986 ), impair the child’s ability to cope with tensions from both internal and external worlds, promoting regulation through acting out. To our knowledge, this mediating effect was observed empirically for the first time. Conclusion, Strenghts and Limitations of the Study The aim of the study was to verify the relationships between attachment representations, EBPF and behavioral dysregulation in a sample of school-age children composed of three groups (children in protective care, consulting a psychologist or child psychiatrist, from the general population). The results confirm that children in care who have suffered early traumatic experiences have more insecure attachment representations and show more behavioral dysregulation than those in the other two groups. This difference is also present between children consulting a psychologist or child psychiatrist and those in the general population. The EBPF score is higher in the residential group than in the general population. As expected, a partial mediating effect of EBPF was found between the nature of attachment representations and behavioral dysregulation. Thus, more insecure attachment representations predict an increase in the EBPF score, which in turn influences the increased presence of behavioral dysregulation. To our knowledge, this is the first study to identify a mediation trajectory between these three variables in a sample of school-age children. One of the study’s strengths is the use of a sample composed of three groups distinguished on the basis of early traumatic experiences and clinical manifestations. This made it possible to increase the variance within the total sample and to verify the moderating effect of the group in the relationships between the variables. Certain limitations of the study must be emphasized. Firstly, the CAI rating was based on video recordings of interviews conducted by the researchers with young people. Children under protective care were interviewed in a neutral space within their residential environment, while the other two groups were interviewed in a university clinic. Despite efforts to score the CAI fairly, the scorers’ ability to distinguish between groups may have led to bias. In addition, the assessment of EBPF using a self-report questionnaire has validity limitations, which argues for the use of a variety of instruments to measure this variable (e.g., questionnaires completed by both parent and child). The effect of social desirability could thus have altered the child’s responses, particularly when the items were read by the research assistant. The child’s ability to take an accurate look at their own functioning may also be limited, particularly in the context of clinical difficulties and traumatic antecedents. Moreover, by highlighting the role of insecure attachment representation, the study supports the importance of considering the developmental condition of children with EBPF for intervention. Professional intervention should then enable these young people to develop a trusting relationship with a caregiver. Within this new relationship, the child can gradually acquire the capacities they were unable to develop in their primary relationships, such as understanding behaviors as being motivated by mental states. From a prevention perspective, the results also highlight the importance of paying attention to early relational failures that occur at a young age, in order to identify children whose developmental trajectory seems at risk of leading to borderline pathology in adulthood. Funding This work was supported by the Institut universitaire Jeunes en difficulté (IUJD). Data Availability No data are available. Declarations Ethical Approval All procedures performed in this study were in accordance with the ethical standards of the Comité d’éthique de la recherche Lettres et sciences humaines de l’Université de Sherbrooke. Informed Consent Informed consent was obtained from all individual participants included in the study. For children, consent from a parent was obtained. 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