Stephanie D. Stepp

University of Pittsburgh | Pitt · Department of Psychiatry

Suicide is currently the 5th leading cause of death among children aged 5–11, a rate that has more than tripled in the last decade, and one that has increased significantly more among Black compared to White children. Specifying early childhood phenotypes of suicidality is critical for prevention of suicidal behavior. Such phenotypes need to be cul...

Examining the impact of maternal borderline personality disorder (BPD) on parent-child interactions could elucidate pathways of intergenerational risk and inform intervention. The current study used an expanded version of the Observing Mediational Interactions to investigate (a) associations between maternal BPD symptom severity and mediational par...

BMI is commonly used to measure risk to prenatal health but may not be sensitive to adiposity-associated health problems for Black women. The aim of the present study was to test associations between indices of prenatal health and BMI in Black women. Data were from 652 women enrolled in two studies. Height and weight were used to calculate BMI. Dep...

Background Observational assessments of parent-adolescent conflict can guide interventions to prevent and reduce conflict and mental health problems. The authors identified the Observing Mediational Interactions (OMI) as a particularly useful coding system for examining parent-adolescent conflict. The OMI is the observational measure used in the Me...

Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system respon...

Introduction Despite the clinical relevance, little is known about variability in positive adult outcomes (i.e., flourishing, life satisfaction) of female adolescent conduct problems (CP), or interpersonal factors that promote these types of well‐being. We hypothesized differential associations between adolescent CP trajectories and indicators of a...

Borderline personality disorder (BPD) is a serious mental illness characterized by instability in affective, cognitive, and interpersonal domains. BPD co-occurs with several mental disorders and has robust, positive associations with the general factors of psychopathology (p-factor) and personality disorders (g-PD). Consequently, some researchers h...

Research in youth psychopathy has focused heavily on the affective features (i.e., callous-unemotional [CU] traits) given robust links to severe and chronic forms of externalizing behaviors. Recently, there have been calls to expand the scope of work in this area to examine the importance of other interpersonal (i.e., antagonism) and behavioral (i....

Background Aggression is a transdiagnostic indicator of risk and represents one of the most common reasons children are referred for mental health treatment. Theory and research highlight the impact of maternal invalidation on child aggression and suggest that its influence may vary based on differences in child physiological reactivity. Moreover,...

Research in youth psychopathy has focused heavily on the affective features (i.e., callous-unemotional [CU] traits) given robust links to severe and chronic forms of externalizing behaviors. Recently, there have been calls to expand the scope of work in this area to examine the importance of other interpersonal (i.e., antagonism) and behavioral (i....

Children of parents with emotion regulation (ER) difficulties may be at heightened risk for internalizing and externalizing problems, and maternal invalidation may explain this association. The current study used a cross-informant design to test the indirect effect of clinician-rated maternal ER difficulties on teacher-reported internalizing and ex...

Integrative data analysis (IDA) was used to derive developmental models of depression, externalizing problems, and self-regulatory processes in three prevention trials of the Family Check-Up and one longitudinal, community-based study of girls over a 10-year span covering early to late adolescence (N = 4,773; 74.9% female, 41.7% white). We used mod...

Considerable attention has been directed towards studying co-occurring psychopathology through the lens of a general factor ( p -factor). However, the developmental trajectory and stability of the p -factor have yet to be fully understood. The present study examined the explanatory power of dynamic mutualism theory – an alternative framework that s...

In the 10 years following the publishing of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), studies have accumulated testing the validity and utility of the alternative model for personality disorders (AMPD) in the context of borderline personality disorder (BPD). In this article, we review the studies that have te...

Borderline personality disorder (BPD) is characterized by dichotomous thinking, biases in processing emotion-related information, impulsive responding, and identity disturbance — each of which may affect how individuals respond to assessment items. This study used item-response theory tree models to examine the association between number of self-re...

Multiple informant assessment is the norm when evaluating borderline personality pathology (BPP) in adolescence, especially by including reports from both parents and adolescents. However, these reports tend to be discrepant, and it is unclear how to integrate. The current study used a trifactor model to isolate sources of variance in parents' and...

While the Research Domain Criteria (RDoC) acknowledges that environmental and developmental influences represent important elements of the RDoC framework, there is little specificity regarding how and when to systematically examine the impact of these dimensions on domains of function. The primary aims of this paper are to demonstrate the ways in w...

Background The science of stress exposure and health in humans has been hampered by differences in operational definitions of exposures and approaches to defining timing, leading to results that lack consistency and specificity. In the present study we aim to empirically derive variability in type, timing and chronicity of stress exposure for Black...

Youth with callous-unemotional (CU) traits are at high risk for aggression and antisocial behavior. Extant literature suggests that CU traits are related to abnormal autonomic responses to negatively-valenced emotional stimuli, although few studies have tested autonomic responding specifically during social interactions. To address this knowledge g...

Background: The transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among females, little is known about changes in emotional distress across the early postpa...

Background: Social ecological models designed to understand disparities in sexually transmitted infection (STI) prevalence highlight understudied structural and community risk factors. Guided by a social ecological model, this study identified profiles based on substance use-related STI risk, and examined associations of the profiles with selected...

Background Parental invalidation is central to etiological models of borderline personality disorder (BPD). Previous studies relied on retrospective accounts or laboratory observations to examine these associations. There is a dearth of research assessing these constructs in daily life, and limited studies have tested the effect of parental invalid...

Parental responses to negative emotion, one key component of emotion socialization, may function to increase (or decrease) reactive aggression over time via indirect effects on emotion dysregulation. However, despite its transdiagnostic relevance, very little research has examined this developmental risk pathway, and no studies have done so during...

Purpose: Adolescent suicidal ideation (SI) and nonsuicidal self-injury (NSSI) are associated with depression, but few studies adequately represent sexual minorities. This study investigated whether the association between SI/NSSI and depression varies by sexual orientation. Method: SI, NSSI, sexual orientation, and depressive symptoms were measured...

Sexual minority women (SMW) report higher rates of substance use and disorder across the lifespan, and greater levels of minority stress in adolescence and young adulthood. Minority stress mediation models propose that higher levels of social stressors may increase emotion dysregulation, which in turn increases the propensity toward substance misus...

Sexual minority women (SMW) report higher rates of substance use and disorder across the lifespan, and greater levels of minority stress in adolescence and young adulthood. Minority stress mediation models propose that higher levels of social stressors may increase emotion dysregulation, which in turn increases the propensity toward substance misus...

Emotional functioning can be assessed across multiple levels of analysis (e.g., subjective, physiological). The degree of concordance/discordance across such indices may mark psychopathology risk. The current study assessed associations between physiological and subjective indices of emotional responding among drinkers, with (n = 39) and without (n...

Objective: In adults, pain is prospectively associated with overweight/obesity and concurrently associated with dysregulated eating, with evidence for stronger associations in women than men. This study aimed to evaluate whether similar associations among pain response, BMI, and loss of control (LOC) eating are also evident in adolescent girls. M...

Adolescence is a developmental period during which youth tend to initiate sexual behavior, which may include sexual risk behavior. Symptoms of borderline personality disorder (BPD) are associated with increased rates of risky behaviors. However, little is known about longitudinal associations between BPD symptoms and sexual risk behaviors during ad...

Insecure attachment and borderline personality disorder (BPD) are defined by similar affective and interpersonal processes. Individuals diagnosed with BPD, however, represent only a subset of those described as insecurely attached, suggesting that attachment may hold broader relevance for socio-affective functioning. Based on a 21-day ecological mo...

Background Individual variability in tonic (resting) and phasic (reactivity) respiratory sinus arrhythmia (RSA) may underlie risk for dysregulated emotion and behavior, two transdiagnostic indicators that permeate most psychological disorders in youth. The interaction between tonic and phasic RSA may specify unique physiological profiles during the...

This investigation answers and amplifies calls to model the transdiagnostic structure of psychopathology in clinical samples of early adolescents and using stringent psychometric criteria. In 162 clinically referred, clinically evaluated 11–13-year-olds, we compared a correlated two-factor model, containing latent internalizing and externalizing fa...

Early threat exposure is a transdiagnostic risk factor for psychopathology, and evidence suggests that genetic variation in the oxytocin receptor ( OXTR ) moderates this association. However, it is unclear if this gene-by-environment (G×E) interaction is tied to unique risk for disorder-specific outcomes or instead increases shared risk for general...

Leading etiological theories implicate the family environment in shaping borderline personality disorder (BPD). Although a substantive literature explores familial aggregation of this condition, most studies focus on parent influence(s) on offspring symptoms without examining youth symptom influence on the parent. The current study investigated rec...

Objective Research has yielded factors considered critical to risk for borderline personality disorder (BPD). Yet, these factors overlap and are relevant to other disorders, like depression and conduct disorder (CD). Regularized regression, a machine learning approach, was developed to allow identification of the most important variables in large d...

Interpersonal dysfunction is a core feature of personality disorders, often affecting close relationships. Nevertheless, little is known about the moment-to-moment dynamic processes by which personality pathology contributes to dysfunctional relationships. Here, we investigated the role of physiological attunement during a conflict discussion in ro...

Little is known about pathogenic affective processes that cut across diverse mental disorders. We examine how dynamic features of positive and negative affect differ or converge across internalizing and externalizing disorders in a diagnostically diverse urban sample using bivariate dynamic structural equation modeling. One-hundred fifty-six young...

Purpose: To test the validity of a modified Trier Social Stress Test (TSST) for studying stress reactivity in sexual minority women. Method: 274 female participants (66.4% Black American), half of whom identified as lesbian/gay or bisexual and half as heterosexual, completed the TSST with instructions to describe an experience of discrimination....

Objective: Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case fo...

Dissociation is associated with risk for suicide in adults, but this link is not well studied in adolescents, in spite of their marked suicide risk. This study assessed adolescents’ dissociative experiences in daily life and evaluated the association between dissociative experiences and suicide risk, including the independence of this relationship...

Insecure attachment and borderline personality disorder (BPD) are defined by similar affective and interpersonal processes. Individuals diagnosed with BPD, however, represent only a subset of those described as insecurely attached, suggesting that attachment may hold broader relevance for socio-affective functioning. Based on a 21-day ecological mo...

Borderline personality disorder (BPD) and alcohol use disorder frequently co-occur, yet we know relatively little about risk processes underlying this association. Previous research with nonclinical samples has highlighted how drinking motives may link personality characteristics with heavy alcohol use and problems. The present study substantively...

Despite the centrality of adult romantic relationships to the conceptualization of borderline personality disorder (BPD), little is known about the earlier development of this interdependency during adolescence. Thus, we examined the co-development of romantic relationships and BPD symptoms from ages 15 to 19 in a large urban sample of girls (N = 2...

Emotional distress during pregnancy is likely influenced by both maternal history of adversity and concurrent prenatal stressors, but prospective longitudinal studies are lacking. Guided by a life span model of pregnancy health and stress sensitization theories, this study investigated the influence of intimate partner violence (IPV) during pregnan...

Parental verbal aggression and corporal punishment are associated with children’s conduct problems and oppositional defiant disorder (ODD). The strength of bidirectional relationships among specific disruptive behaviors has been inconsistent across gender, and the direction of influence between parental aggression and girls’ ODD symptoms is particu...

Early sexual behavior plays a vital role in female reproductive health. Victimization experiences such as sexual harassment may have a unique impact on girls’ sexual health. We examined the prospective associations between sexual harassment during adolescence and high-risk sexual activity in early adulthood. Using mixed-effects logistic regression...

Few studies have examined behaviors in romantic relationships associated with borderline personality disorder (BPD). We assessed critical variables from marital research: the emotional bank account (positive-to-negative behaviors) and the four horsemen of the apocalypse (criticism, defensiveness, contempt, and stonewalling). Couples (N = 130, or 26...

Objective Eating pathology is more prevalent among women compared to men, but prevalence and correlates associated with eating pathology likely vary among subgroups of women. This study examines prevalence and correlates of restrictive and weight control‐related eating pathology in sexual minority women. Method Data were collected from the Pittsbu...

Interpersonal dysfunction is a core feature of personality disorders, often affecting close relationships. Nevertheless, relatively little is known about the moment-to-moment interactional processes that contribute to discord. Here, we investigated the role of physiological attunement during a conflict discussion in romantic couples oversampled for...

Personality disorders (PDs) are commonly associated with romantic relationship disturbance. However, research has seldom evaluated who people with high PD severity partner with, and what explains the link between PD severity and romantic relationship disturbance. First, we examined the degree to which people match with partners with similar levels...

Background Adolescence is characterized by developmental changes in social relationships, which may contribute to, or protect against, psychopathology and risky behaviors. Non-suicidal self-injury (NSSI) is one type of risky behavior that typically begins during adolescence and is associated with problems in relationships with family members and pe...

Objective: Psychopathology research is transitioning from relying on discrete diagnoses to domains of transdiagnostic processes. Although this resolves many problems, this research is largely based on nomothetic principles and reflects between-person differences assessed at one point in time. However, transdiagnostic domains of individual differenc...

Borderline personality disorder (BPD) and alcohol use disorder often co-occur, yet we know little about risk processes underlying this association. We tested two mechanistic pathways linking BPD symptoms and alcohol-related problems. In the "affective pathway," we hypothesized that BPD symptoms would be associated with alcohol-related problems thro...

Objective To investigate near‐term risk for self‐injurious urges, we evaluated how within‐person changes in internalizing and externalizing negative affect, as well as interpersonal rejection and criticism, impact subsequent nonsuicidal self‐injury (NSSI) and suicide urges in daily life. Method Young adult women (N = 62) from an ongoing community...

Purpose: To examine the longitudinal cohesion and stability of sexual minority status indicators. Methods: The sample comprised 2,450 girls recruited from the city of Pittsburgh at ages 5-8 years. Sexual attraction, sexual partnering, romantic partnering, and sexual orientation identity were assessed between 14 and 22 years. Results: Repeated...

Objective To determine whether childhood body mass index (BMI), assessed in childhood, differs between lesbian/gay and bisexual (LGB) and heterosexual late adolescents, and whether childhood social stressors impact the association between sexual orientation and childhood BMI. Methods Participants included 2,070 late adolescents from the Pittsburgh...

We examined event-contingent recording of daily interpersonal interactions in a diagnostically diverse sample of 101 psychiatric outpatients who were involved in a romantic relationship. We tested whether the unique effect of borderline personality disorder (BPD) symptoms on affective responses (i.e., hostility, sadness, guilt, fear, and positive a...

Background Female involvement in the juvenile justice system (JJS) has increased rapidly in recent years. Although deficits in self‐control and responsibility are associated with delinquency and higher rates of police contacts and arrests, much of this research has focused on males and/or selected samples of youth who already have a history of JJS...

The interaction between monoamine oxidase A (MAOA) and childhood maltreatment as a predictor of personality pathology in females: Emotional reactivity as a potential mediating mechanism – ERRATUM - Amy L. Byrd, Stephen B. Manuck, Samuel W. Hawes, Tayler J. Vebares, Vishwajit Nimgaonkar, Kodavali V. Chowdari, Alison E. Hipwell, Kate Keenan, Stephani...

Calls have increased to place interpersonal and self-disturbance as defining features of personality disorders (PDs). Findings from a methodologically diverse set of studies suggest that a common factor undergirds all PDs. The nature of this core of PDs, however, is not clear. In the current study, interviews were completed for DSM-IV PD diagnosis...

Research consistently demonstrates that common polymorphic variation in monoamine oxidase A ( MAOA ) moderates the influence of childhood maltreatment on later antisocial behavior, with growing evidence that the “risk” allele (high vs. low activity) differs for females. However, little is known about how this Gene × Environment interaction function...

We examined event-contingent recording (ECR) of daily interpersonal interactions in a diagnostically diverse sample of 101 psychiatric outpatients who were involved in a romantic relationship. We tested whether the unique effect of borderline personality disorder (BPD) symptoms on affective responses (i.e., hostility, sadness, guilt, fear, positive...

PurposeTo assess whether the higher prevalence of childhood trauma exposure but lower prevalence of alcohol use in Black vs. White adolescent girls reflects a lower magnitude of association between trauma and alcohol use initiation in Black girls; and additionally, whether low socioeconomic status (SES) and neighborhood factors account in part for...

In the original article, in Table 3, the sentence "Primary caregiver education ≤ 12 years" should be "Primary caregiver education < 12 years". The original article was corrected.

Objective: Cognitive-behavioral and interpersonal models of loss of control (LOC) eating have been underexplored in adolescents. Methods: By using data from community-based adolescent girls assessed annually over 4 years, the cognitive-behavioral (n = 416) and interpersonal (n = 418) models were examined by using a regression-based bootstrapping...

Purpose: Neuroimaging studies suggest that altered brain responses to food-related cues in reward-sensitive regions characterize individuals who experience binge-eating episodes. However, the absence of longitudinal data limits the understanding of whether reward-system alterations increase vulnerability to binge eating, as theorized in models of...

Narcissism has significant interpersonal costs, yet little research has examined behavioral and affective patterns characteristic of narcissism in naturalistic settings. Here we studied the effect of narcissistic features on the dynamic processes of interpersonal behavior and affect in daily life. We used interpersonal theory to generate transactio...

Callous-unemotional (CU) traits have proven important for designating children and adolescents showing a pattern of particularly severe, stable, and aggressive antisocial behaviors (Frick, Ray, Thornton, & Kahn, 2014). Individuals with secondary CU traits represent a subpopulation that are distinguished from those with primary CU traits by their hi...

Elucidating early signs and symptoms of borderline personality disorder (BPD) has important implications for screening and identifying youth appropriate for early intervention. The purpose of this study was to identify dimensions of child temperament and psychopathology symptom severity that predict conversion to a positive screen for BPD over a 14...

We examined the relationship between psychopathology and interpersonal problems in a sample of 825 clinical and community participants. Sixteen psychiatric diagnoses and five transdiagnostic dimensions were examined in relation to self-reported interpersonal problems. The structural summary method was used with the Inventory of Interpersonal Proble...

Postpartum depression may disrupt socio-affective neural circuitry and compromise provision of positive parenting. Although work has evaluated how parental response to negative stimuli is related to caregiving, research is needed to examine how depressive symptoms during the postpartum period may be related to neural response to positive stimuli, e...

Epidemiological research suggests racial differences in the presentation of eating disorder symptoms. However, no studies have examined associations between race and eating disorder symptom trajectories across youth and adolescence, which is necessary to inform culturally sensitive prevention programs. The purpose of the current study was to examin...

Purpose While research has consistently shown a correlation between gang involvement and peer victimization, less is known about the direction of this relationship, especially among girls. The current study tests competing hypotheses to determine whether girls become gang involved following victimization, whether they experience peer victimization...