Maternal borderline personality disorder symptoms and convergence between observed and reported infant negative emotional expressions

Study protocol for a multi-center RCT testing a group-based parenting intervention tailored to mothers with borderline personality disorder against a waiting control group (ProChild*-SP1)

Background/aims

Borderline personality disorder (BPD) is a severe mental disorder characterized by an unstable sense of self, intense and rapidly changing affect, as well as impulsive and self-destructive behaviors. Interpersonal relationships of individuals with BPD are characterized by marked instability, a lack of dependability, and quick changes between love and hate. For children of individuals with BPD, this can lead to permanent stress and attachment insecurity and an increased risk of adverse physical and mental health development. To reduce dysfunctional parenting and improve positive parenting, and in turn, to promote healthy child development, a group intervention for mothers with BPD was developed. This study aims to evaluate this first disorder-specific parenting intervention for BPD in a randomized controlled trial.

Method

In a parallel-group, two-arm, randomized controlled trial, an initial N = 178 mothers diagnosed with BPD and their children aged 6 months to 6 years are assigned to either the parenting intervention or a waiting control group. If taking place, participants of both groups continue their regular treatment for BPD diagnosis (e.g., individual therapy, medication). The primary outcomes are changes in parenting from baseline (day 0) to post intervention (week 12) and follow-up (6 months after group intervention; month 9). The waiting control group can attend the group intervention at the end of all assessments. Participants allocated to the intervention group are expected to show improvement in their parenting and a reduction in child abuse potential. Maternal emotion regulation and mental distress are analyzed as secondary outcomes.

Discussion

Mothers with BPD may need tailored help when reporting difficulties raising their children. The first disorder-specific parenting intervention has been developed to close this gap. ProChild is part of a large government-supported consortium, which aims to investigate different aspects of abuse and maltreatment in childhood and adolescence.

Trial registration

ClinicalTrials.gov NCT04169048. Registered on Nov 19, 2019.

Brief report: The impact of the broad autism phenotype on parent perception of autism symptoms in their children with and without autism spectrum disorder compared to teachers

BACKGROUND

Evaluation of children with autism spectrum disorder (ASD) includes caregiver-reported rating scales of symptom presentation. The extent to which a broad autism phenotype (BAP) in parents of children with ASD might impact their endorsement of autism symptoms in their children with and without ASD has not been well evaluated.

AIMS

This study analyzed whether varying degrees of parental BAP were associated with reported autism symptoms in offspring with and without ASD.

METHODS AND PROCEDURES

We used the Broad Autism Phenotype Questionnaire as a measure of BAP in parents and parent- and teacher-report on the Social Responsiveness Scale (SRS) to assess autism symptoms in children with ASD and their typically developing (TD) siblings (N = 5714). We assessed the relationship between parental BAP and parent-teacher discordance. We compared teacher reports of autism symptoms in children with varying degrees of BAP exposure.

OUTCOMES AND RESULTS

Mothers with higher levels of BAP over-reported autism symptoms in their children (compared to teachers) than mothers with lower BAP. TD children from parents with greater BAP displayed more autism symptoms than children from households with less BAP.

CONCLUSIONS AND IMPLICATIONS

BAP is associated with parent report of autism symptoms when compared to teacher report. For children with ASD, it is possible that differences in ratings reflect parent perception and not autism symptomatology; whereas, TD children from households with higher levels of BAP exposure showed more phenotypic autism symptom presentation on teacher-completed measures. Researchers and clinicians should consider BAP when interpreting caregiver and teacher reports.

Familiäre Transmission der Borderline-Persönlichkeitsstörung

Hintergrund

Forschungsergebnisse weisen übereinstimmend darauf hin, dass Kinder von Müttern mit einer Borderline-Persönlichkeitsstörung (BPS) ein erhöhtes Risiko aufweisen, emotionale und verhaltensbezogene Auffälligkeiten zu entwickeln und/oder im Jugendalter selbst BPS-spezifische Symptomausprägungen zu zeigen.

Fragestellung

Welche Faktoren sind bei der familiären Transmission der BPS involviert, und welche Implikationen für die Praxis können darauf aufbauend abgeleitet werden?

Material und Methode

Auf der Basis einer umfassenden Literaturrecherche wurden aktuelle Forschungsbefunde zur familiären Transmission der BPS von Müttern zu ihren Kindern zusammengetragen und Kernbefunde in einem Transmissionsmodell integriert.

Ergebnisse

Das hier postulierte Transmissionsmodell bildet ein komplexes Zusammenspiel verschiedener Einflussfaktoren und Übertragungsmechanismen ab. Neben Faktoren aufseiten der Mutter und des Kindes werden externe Faktoren in das Modell integriert. Darüber hinaus werden (epi-)genetische und pränatale Einflüsse, die Bedeutung der Mutter-Kind-Interaktion und familiäre sowie soziale bzw. gesellschaftliche Einflüsse als Übertragungsmechanismen betont. Zudem wird eine potenziell präventive Wirkung der Hilfesysteme angenommen.

Schlussfolgerung

Aus dem Modell werden Ansatzpunkte abgeleitet, die dazu beitragen könnten, die Vulnerabilität sowie Belastungsfaktoren zu reduzieren und somit eine gesunde kindliche Entwicklung in dieser Risikogruppe zu fördern.

Parenting in Patients with Borderline Personality Disorder, Sequelae for the Offspring and Approaches to Treatment and Prevention

PURPOSE OF REVIEW

We review recent findings concerning the implications of borderline personality disorder (BPD) on parenting behaviors, the parent-child relationships, and parental and child outcomes. We focus on self-report and interview data characterizing parents with BPD and their children as well as on observational paradigms investigating parent-child relationships and the quality of dyadic interactions. Novel treatment approaches are discussed.

RECENT FINDINGS

Parents with BPD suffer from increased parenting stress and display characteristic behavioral patterns towards their children, impeding the formation of a healthy parent-child relationship and disrupting offspring emotional development. Offspring are at greater risk of maltreatment and developing BPD themselves, with parental affective instability playing a substantial mediating role. Mothers with BPD face a meaningful burden in their parenting role. Mechanisms of the transmission of BPD pathology onto the following generation are beginning to be understood. Targeted interventions have been devised recently, with preliminary testing producing encouraging results.

Emotion Socialization Strategies of Mothers With Borderline Personality Disorder Symptoms: The Role of Maternal Emotion Regulation and Interactions With Infant Temperament

Although the interpersonal difficulties associated with borderline personality disorder (BPD) are well established, their manifestations within the context of parent-child relationships remain understudied. The current study investigated the relation of maternal BPD symptoms to nonsupportive emotion socialization (i.e., the extent to which mothers punish or minimize their young children's displays of negative emotions), as well as the mediating role of maternal emotion regulation difficulties in this relation. The authors also investigated the moderating role of maternal BPD symptoms in the relation between infant temperamental anger and fear and punitive/minimizing emotion socialization. Using a sample of 99 mother-infant dyads, the authors found that maternal BPD symptoms were significantly related to punitive/minimizing emotion socialization and that maternal emotion regulation difficulties mediated this relation. Moreover, maternal BPD symptoms strengthened the association between mother-reported infant anger and punitive/minimizing emotion socialization. These results extend the growing literature on the impact of maternal BPD on child development.

"There is not much help for mothers like me": Parenting Skills for Mothers with Borderline Personality Disorder - a newly developed group training program

BACKGROUND

Dysfunctional relationships and emotion dysregulation are hallmark features of borderline personality disorder (BPD). Women with BPD are, therefore, particularly challenged when raising a child. A group training program was developed for mothers with BPD to enhance their parenting skills and help them raise their children. The program is based on cognitive-behavioral principles and skills derived from Dialectical Behavior Therapy (DBT).

METHODS

N = 15 mothers with BPD who had young children (aged 0-6 years) participated in a 12-week training program. To estimate the participants' impairment, parental stress and psychological distress were assessed before the training. After the training, participants and trainers were asked to provide feedback regarding the evaluation of and the changes due to the training.

RESULTS

Participants' self-reported stress related to parenting, as well as psychological distress and depressive symptoms, was high. Participants' acceptance of the program was very good. Especially role plays were rated as useful. Trainers evaluated the program as helpful and reported visible changes in participants' behavior and attitudes towards parenting.

CONCLUSIONS

The results on the acceptance of the training program are promising.

TRIAL REGISTRATION

NCT02935218, Unique Protocol ID: RenRos01 Initial release 80 August 2016, last release 13 October 2016; 'retrospectively registered'.