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Fleck L, Fuchs A, Williams K, Moehler E, Resch F, Koenig J, Kaess M. Child temperament as a longitudinal predictor of mother-adolescent interaction quality: are effects independent of child and maternal mental health? Eur Child Adolesc Psychiatry 2024; 33:2791-2801. [PMID: 38240837 PMCID: PMC11272696 DOI: 10.1007/s00787-023-02359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/14/2023] [Indexed: 07/26/2024]
Abstract
Adaptive parent-child interaction plays a major role in healthy child development. Caregiver mental health problems can negatively impact parent-child interaction. In turn, interactional quality is often studied as a predictor of child outcome. However, child characteristics supposedly shape parent-child interactions as well. Given associations between child and caregiver mental health and child temperament, this study aimed at differentiating their effects on dyadic interaction quality in adolescence. Child temperament and character at age 5 were investigated as longitudinal predictors of observed mother-adolescent interactional quality at age 14 in a community sample (N = 76). It was examined whether these effects were independent of maternal and child mental health and earlier dysfunctional interaction. Lower novelty seeking, higher reward dependence, and higher cooperativeness separately predicted higher dyadic interactional quality at age 14. Controlling regressions for dysfunctional interaction at age 5, which was a significant negative predictor of later interactional quality, cancelled out the effects of novelty seeking and cooperativeness. Past or concurrent maternal or child psychopathology did not explain variance in mother-adolescent interaction. Applying backward selection, a model including reward dependence and dysfunctional interaction at age 5 and concurrent maternal stress showed the best fit for explaining dyadic interaction quality. Results suggest that enduring rather than transient child features predict interactional quality in a community sample. Effects of temperament are not better explained by those of psychopathology, but a combination of child, maternal, and dyadic features predicted dyadic behaviour best. Selective prevention should target parenting in the context of challenging child characteristics specifically.
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Affiliation(s)
- Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Eva Moehler
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Pourdehghan P, Mohammadi MR, Mostafavi SA, Khaleghi A, Ahmadi N. The Relationship of Parental Personality Disorders with Offspring Eating Disorders at Childhood and Adolescence Age. Child Psychiatry Hum Dev 2024; 55:361-371. [PMID: 35964272 DOI: 10.1007/s10578-022-01407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 11/03/2022]
Abstract
This study aimed to investigate parents' PDs that could be associated with children and adolescents' EDs. We studied association of parental PDs with offspring EDs in age group 6-18 years in a nationally representative sample of Iranians with 27,111 children and adolescents and their parents. We used a multistage random cluster sampling method. We used Millon Clinical Multiaxial Inventory-Third Edition and Persian present and lifetime version of Kiddie Schedule for Affective Disorders and Schizophrenia to measure parental PDs and children and adolescents' EDs, respectively. We used descriptive statistics and binary logistic regression analysis methods to analyze the data. Maternal but not paternal PDs were significantly associated with EDs in offspring. Maternal antisocial, borderline, schizoid, histrionic, and compulsive PDs were significantly associated with EDs in offspring by 32.06, 4.66, 4.32, 3.15, and 1.71 odd ratios, respectively. Of EDs in offspring, anorexia nervosa and binge ED were significantly associated with maternal PDs.
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Affiliation(s)
- Parandis Pourdehghan
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Ali Mostafavi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Sved Williams A, Hill R. The Management of Perinatal Borderline Personality Disorder. J Clin Med 2023; 12:6850. [PMID: 37959315 PMCID: PMC10650510 DOI: 10.3390/jcm12216850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways.
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Affiliation(s)
- Anne Sved Williams
- Women’s and Children’s Health Network, North Adelaide 5006, Australia;
- Faculty of Psychiatry, University of Adelaide, Adelaide 5005, Australia
- School of Medicine and Psychology, Australian National University, Canberra 2601, Australia
| | - Rebecca Hill
- Women’s and Children’s Health Network, North Adelaide 5006, Australia;
- Faculty of Psychiatry, University of Adelaide, Adelaide 5005, Australia
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Cimino S, Tambelli R, Cerniglia L. The Role of Maternal Personality Organization and of the p Factor in Predicting Parental Distress, the Quality of Parental Care, and Offspring's Dysregulation Symptoms. Psychol Res Behav Manag 2023; 16:3963-3971. [PMID: 37780227 PMCID: PMC10540785 DOI: 10.2147/prbm.s423698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/05/2023] [Indexed: 10/03/2023] Open
Abstract
Background It has been posited that parental distress, the quality of maternal care and offspring's dysregulation can be predicted by maternal maladaptive characteristics. However, only a few studies have considered mothers' personality organizations and features of the p factor in mothers as possible predictors of symptoms in their children. Methods In a sample of N=524 subjects, this study evaluated the effect of mothers' personality organization and of the p factor on parental distress, parental care and offspring's dysregulation symptoms. Mothers filled out the IPO, the ASR, and the PSI-SF; children's teachers filled out the TRF; children were administered the PBI. Results We found that different mother groups (neurotic, borderline, psychotic organization) have distinct impact on parental distress, quality of care, and children's dysregulation, mediated by the p factor. Conclusion This study can contribute to the understanding of the key factors underpinning mothers and children's psychopathology.
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Affiliation(s)
- Silvia Cimino
- Sapienza. University of Rome. Department of Dynamic, Clinical and Health, Rome, Italy
| | - Renata Tambelli
- Sapienza. University of Rome. Department of Dynamic, Clinical and Health, Rome, Italy
| | - Luca Cerniglia
- International Telematic university Uninettuno, Faculty of Psychology, Rome, Italy
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Senberg A, Schmucker M, Oster A, Zumbach J. Parental personality disorder and child maltreatment: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2023; 140:106148. [PMID: 37060689 DOI: 10.1016/j.chiabu.2023.106148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children. OBJECTIVE This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment. PARTICIPANTS AND SETTING Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023. METHODS First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size). RESULTS After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment. CONCLUSIONS Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity. OTHER This work was not supported by any funding.
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Affiliation(s)
- Asne Senberg
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
| | - Martin Schmucker
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstraße 49b, 91052 Erlangen, Germany.
| | - Anna Oster
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
| | - Jelena Zumbach
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
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Mitrogiannis I, Evangelou E, Efthymiou A, Kanavos T, Birbas E, Makrydimas G, Papatheodorou S. Risk factors for preterm labor: An Umbrella Review of meta-analyses of observational studies. RESEARCH SQUARE 2023:rs.3.rs-2639005. [PMID: 36993288 PMCID: PMC10055511 DOI: 10.21203/rs.3.rs-2639005/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Preterm birth defined as delivery before 37 gestational weeks, is a leading cause of neonatal and infant morbidity and mortality. Understanding its multifactorial nature may improve prediction, prevention and the clinical management. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risks factors associated with PTB, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by robust evidence. We included 1511 primary studies providing data on 170 associations, covering a wide range of comorbid diseases, obstetric and medical history, drugs, exposure to environmental agents, infections and vaccines. Only seven risk factors provided robust evidence. The results from synthesis of observational studies suggests that sleep quality and mental health, risk factors with robust evidence should be routinely screened in clinical practice, should be tested in large randomized trial. Identification of risk factors with robust evidence will promote the development and training of prediction models that could improve public health, in a way that offers new perspectives in health professionals.
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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). Trials 2022; 23:589. [PMID: 35870944 PMCID: PMC9308114 DOI: 10.1186/s13063-022-06531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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The Role of Childhood Trauma on Prenatal Attachment: A Cross-Sectional Study. J Nerv Ment Dis 2022; 211:281-288. [PMID: 36450276 DOI: 10.1097/nmd.0000000000001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although the quality of prenatal attachment is a strong predictor of the quality of postnatal mother-infant attachment and mother-child interaction, little is known about the specific impacts of maternal exposure to childhood traumas, and it deserves more attention. This study was conducted to determine whether there is a relationship between childhood traumas and prenatal attachment levels. Prenatal attachment and childhood trauma were evaluated in 104 pregnant women using the Prenatal Attachment Scale and Childhood Trauma Questionnaire. Our results showed that all kinds of childhood traumatic experiences were associated with lower prenatal attachment scores. Also, more severe childhood traumas were strongly associated with weaker prenatal attachment. This study contributes to the very limited literature on the prenatal attachment of expectant mothers with childhood traumas by emphasizing the importance of pregnant women's exposure to childhood traumas as a risk factor for low prenatal attachment.
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Suess H, Wiegand-Grefe S, Adema B, Daubmann A, Kilian R, Zapf A, Winter SM, Lambert M, Wegscheider K, Busmann M. Clinical Trial Data: Both Parents Having Psychiatric Symptoms as Risk Factor for Children's Mental Illness. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1697. [PMID: 36360425 PMCID: PMC9688718 DOI: 10.3390/children9111697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 01/07/2024]
Abstract
Children of mentally ill parents represent a particularly vulnerable risk group for the development of mental illness. This study examines whether there is a predictive association between children's psychiatric symptomatology and (1) the clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10) of their mentally ill parent as well as (2) to families both parents showing psychiatric symptoms. The study is part of the multicenter controlled trial project "Children of Mentally Ill Parents" (CHIMPS). For this purpose, the psychiatric symptomatology of the mentally ill parent (N = 196) and his or her partner (N = 134) as well as the psychiatric symptomatology of their children aged 4 to 18 years (N = 290) was measured using clinical rated ICD-10-diagnosis, self-rated Brief Symptom Inventory (BSI), and Child Behavior Checklist (CBCL). Using multilevel analyses, the severity of the parental psychiatric symptomatology (BSI) was identified as a significant predictor of children's psychiatric symptomatology (CBCL). Children of parents with a personality disorder (ICD-10) were not more affected than children of parents with another ICD-10-diagnosis. However, children with two parents showing psychiatric symptoms (CBCL) were significantly more affected than children with one mentally ill parent. The results of this study support the well-known view that parental mental illness is a risk factor for children's psychiatric symptoms. Therefore, increased support, especially in high-risk families, both parents having psychiatric symptoms, is highly necessary and should be implemented in the future psychotherapeutic family care.
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Affiliation(s)
- Hannah Suess
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bonnie Adema
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University at Bezirkskrankenhaus Guenzburg, 89312 Guenzburg, Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Sibylle M. Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Martin Lambert
- Department of Adult Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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García-Anaya M, Caballero-Romo A, González-Macías L. Maintaining Factors of Anorexia Nervosa Addressed from a Psychotherapeutic Group for Parents: Supplementary Report of a Patient's Therapeutic Success. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11396. [PMID: 36141668 PMCID: PMC9517022 DOI: 10.3390/ijerph191811396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Anorexia nervosa is an eating disorder (ED) where up to 30% of individuals remain unresponsive to treatments, whether they partially respond, or do respond and later relapse. It has been broadly reported how presenting maladaptive family functioning and communication style contributes to treatment drop-out, poor treatment compliance, and poor long-term outcomes. We studied the mother and father of a patient with AN, binge-purge subtype (according to DSM-IV TR) who achieved remission after her parents but not her attended an intervention through a psychotherapy group for parents (PGP). (2) Methods: We previously reported this patient's case report, and now, through an Interpretative Phenomenological Analysis (IPA) approach, we aimed to explore the understanding and meanings ascribed by the mother and father to their experience at the PGP and to their daughter's clinical and functional improvement. (3) Results: We identified two main stages along the process: one related to the presence of maintaining factors of their daughter's disorder, and the other related to the emergence of a reflective function and to the implementation of behavioral, emotional and cognitive changes. (4) Conclusions: The interview revealed both parents' experience at the PGP promoted a change process, where they were able to modify their previous style of communication and functioning, and to identify them as a contributors to maintain their daughter's disorder. Reflective function (RF) emerged in the mother and father throughout the psychotherapeutic process. Both parents also revealed some elements that were intergenerationally transmitted, that affected three generations and contributed to maintaining the ED. We observed the multilevel open-group structure of the PGP, enhancing the mother's and father's change process.
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Affiliation(s)
- María García-Anaya
- Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Alejandro Caballero-Romo
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Laura González-Macías
- Eating Disorders Clinic, Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
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Bartsch DR, Roberts R, Proeve M. Relationships between parental borderline symptom severity, empathy, parenting styles and child psychopathology. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2031947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dianna R. Bartsch
- School of Psychology, University of Adelaide, Adelaide, Australia
- SALHN Mental Health Service, SA Health, Adelaide, Australia
| | - Rachel Roberts
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Michael Proeve
- School of Psychology, University of Adelaide, Adelaide, Australia
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12
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Herpertz SC, Schneider I, Renneberg B, Schneider A. Patients With Personality Disorders in Everyday Clinical Practice–Implications of the ICD-11. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022:arztebl.m2022.0001. [PMID: 34809749 DOI: 10.3238/arztebl.m2022.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with difficult personalities or personality disorders are a special challenge for primary care physicians. Their style of interpersonal interaction is often difficult. As the ICD-11 classification comes into use, a new systematic approach to diagnosis is being introduced that focuses on the patient's functional impairments in everyday life. We describe the implications for the diagnosis and treatment of patients of this type. METHODS This review is based on pertinent publications retrieved by a selective search, with particular attention to primary care and to somatic morbidity and mortality. RESULTS 10-12% of the population suffers from personality disorders. A high degree of psychiatric comorbidity is typical; somatic diseases are also more than twice as common as in the general population. In emergency medicine, persons with personality disorders are more likely than others to present with a suicide attempt. Their lifetime risk of suicide is between 1.4% and 4.5% (the latter for persons with borderline personality disorder). CONCLUSION Primary care physicians have an important role in the initial diagnosis of patients with personality disorders and in the planning of their treatment. Such patients require special care and attention from their physicians in view of their elevated somatic morbidity and mortality. In everyday clinical practice, physicians who encounter patients with complex and persistent mental problems, or just with a difficult style of interpersonal interaction, should consider the possibility of a personality disorder and motivate such patients to undergo psychotherapy, if indicated.
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Seeger FR, Neukel C, Williams K, Wenigmann M, Fleck L, Georg AK, Bermpohl F, Taubner S, Kaess M, Herpertz SC. Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support. Curr Psychiatry Rep 2022; 24:591-601. [PMID: 36282473 PMCID: PMC9592879 DOI: 10.1007/s11920-022-01367-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior. RECENT FINDINGS Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.
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Affiliation(s)
- Fabian R Seeger
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Marc Wenigmann
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna K Georg
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Svenja Taubner
- Department of Psychosocial Prevention, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Voßstraße 4, D - 69115, Heidelberg, Germany.
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Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel) 2021; 11:diagnostics11112142. [PMID: 34829488 PMCID: PMC8620075 DOI: 10.3390/diagnostics11112142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.
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Dubreucq M, Plasse J, Gabayet F, Blanc O, Chereau I, Cervello S, Couhet G, Demily C, Guillard-Bouhet N, Gouache B, Jaafari N, Legrand G, Legros-Lafarge E, Mora G, Pommier R, Quilès C, Verdoux H, Massoubre C, Franck N, Dubreucq J. Being parent is associated with suicidal history in people with serious mental illness enrolled in psychiatric rehabilitation. J Psychiatr Res 2021; 140:395-408. [PMID: 34144443 DOI: 10.1016/j.jpsychires.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Parenting is a central life experience that could promote recovery in people with Serious Mental Illness (SMI). It could also be challenging for parents with SMI and result in poor recovery-related outcomes. Parenting is often overlooked in psychiatric rehabilitation. The objectives of the present study were to identify the characteristics and needs for care of mothers and fathers with SMI enrolled in a multicentric non-selected psychiatric rehabilitation SMI sample. We consecutively recruited 1436 outpatients from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). The evaluation included standardized scales for clinical severity, psychosocial function, quality of life and satisfaction with life, wellbeing, personal recovery and a broad cognitive battery. We found that parenting was associated to suicidal history in mothers and fathers with SMI. In the multivariate analysis, being mother was best explained by insight (p < 0.015, adjusted OR = 0.76 [0.59-0.90]), current age (p < 0.001, aOR = 1.13 [1.07-1.21]), education level (p = 0.008; aOR = 0.12 [0.02-0.53]) and family accommodation (p = 0.046, aOR = 0.19 [0.03-0.84]). Being father was best explained by suicidal history (p = 0.005, aOR = 3.85 [1.51-10.10]), marital status (in relationship, p < 0.001; aOR = 7.81 [2.73-23.84]), satisfaction with family relationships (p = 0.032, aOR = 1.22 [1.02-1.47]) and current age (p < 0.001, aOR = 1.16 [1.10-1.23]). In short, parenting was associated to increased history of suicide attempt in mothers and fathers with SMI. Mothers and fathers with SMI may have unique treatment needs relating to parenting and recovery-related outcomes. The implementation of interventions supporting the needs of parents with SMI in psychiatric rehabilitation services could improve parent and children outcomes.
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Affiliation(s)
- M Dubreucq
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France.
| | - J Plasse
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - F Gabayet
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France
| | - O Blanc
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - S Cervello
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - G Couhet
- Centre référent de réhabilitation psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de réhabilitation psychosociale, Centre de la Tour de Gassies, Bruges, France
| | - C Demily
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre de référence maladies rares Génopsy, pôle ADIS, centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
| | | | - B Gouache
- Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - N Jaafari
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - G Legrand
- Association Hospitalière Sainte Marie, Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037, Clermont-Ferrand Cedex 1, France
| | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - G Mora
- Association Hospitalière Sainte Marie, Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037, Clermont-Ferrand Cedex 1, France
| | - R Pommier
- REHALise, CHU de Saint-Etienne, France
| | - C Quilès
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | - H Verdoux
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux, Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | | | | | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France; Pôle Centre, centre hospitalier Le Vinatier, Lyon, France
| | - J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon, France; Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France; Fondation FondaMental, Créteil, France; Réseau Handicap Psychique, Grenoble, France
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16
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Zacharia A, Taylor BL, Sweeney A, Morant N, Howard LM, Johnson S. Mental Health Support in the Perinatal Period for Women With a Personality Disorder Diagnosis: A Qualitative Study of Women's Experiences. J Pers Disord 2021; 35:589-604. [PMID: 32539620 DOI: 10.1521/pedi_2020_34_482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Women who receive a diagnosis of personality disorder may face particular challenges in the context of having a baby. However, this area has received little attention. This study aimed to qualitatively explore experiences of mental health support during the perinatal period in a group of mothers who self-reported having a personality disorder diagnosis. Semistructured interviews were conducted with 12 women who received mental health support during the perinatal period. These data were analyzed thematically. Key themes related to women feeling judged to be unfit mothers; not feeling heard or understood by services; feeling that services struggled with the complexity of their needs; valuing specialist support to cope with their struggles in motherhood; and valuing professional relationships that resembled real-life friendships. Our findings raise questions about how best to provide support to this group of women and about the use and consequences of the diagnosis of personality disorder among new mothers.
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Affiliation(s)
- Alice Zacharia
- Division of Psychiatry, University College London, London, UK
| | | | - Angela Sweeney
- Population Health Research Institute, St. George's University of London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
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Weingarten S, Diop S, Specht C, Turmes L, Juckel G, Mavrogiorgou P. Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder. Compr Psychiatry 2021; 108:152248. [PMID: 34044326 DOI: 10.1016/j.comppsych.2021.152248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD. AIM The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder. METHODS Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the "Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter" (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined. RESULTS Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment. CONCLUSIONS Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.
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Affiliation(s)
- Sina Weingarten
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Shirin Diop
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Christina Specht
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Luc Turmes
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany.
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
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Kerr S, Penner F, Sharp C. Interpersonal Problems in Parents and Adolescent Borderline Personality Disorder Features. J Pers Disord 2021; 35:74-93. [PMID: 33764823 DOI: 10.1521/pedi_2021_35_518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research shows that parental personality pathology is associated with borderline personality disorder features and internalizing/externalizing symptoms in offspring. However, studies have been limited by DSM-IV-based assessments of parental personality pathology. The authors leveraged evidence that interpersonal problems described by the Interpersonal Circumplex align with Criterion A of the DSM-5 Alternative Model for Personality Disorders and therefore used a measure of interpersonal problems to capture parental personality pathology. The authors hypothesized that parental interpersonal problems would be associated with a latent variable of borderline features in adolescent offspring. They also examined whether this relation with offspring borderline features existed above and beyond relations with offspring internalizing/externalizing symptoms, age, and gender. The sample included 524 inpatient adolescents (Mage = 15.31, 62.4% female) and their parents (80.5% female). Parental interpersonal problems demonstrated unique relationships with adolescent borderline features and externalizing symptoms, but not internalizing symptoms. Implications of the results, limitations, and future directions are discussed.
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Affiliation(s)
- Sophie Kerr
- University of Houston, Department of Psychology, Houston, Texas
| | | | - Carla Sharp
- University of Houston, Department of Psychology, Houston, Texas
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19
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The impact of maternal personality traits on behavioral problems in preschool-aged children: a population-based panel study in South Korea. Arch Womens Ment Health 2021; 24:321-328. [PMID: 32995949 DOI: 10.1007/s00737-020-01069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
The impact of maternal personality traits on offspring behavioral problems has not been well established. In our study, the association between maternal personality traits and behavioral problems in preschool-aged children was investigated. A total of 192 preschoolers with their mothers, who were part of a population-based panel study in South Korea, were included in the present study. Maternal personality traits were assessed by the Personality Assessment Inventory (PAI) when the children were 1 year old. The Child Behavior Checklist (CBCL) 1.5-5 was used to identify behavioral problems in the children at 4 and 5 years of age. Maternal personality (borderline, somatization) positively correlated with behavioral problems (externalizing, internalizing, and dysregulation) in children. Maternal paranoid personality trait correlated with children's internalizing and dysregulation behavioral problems. Multiple linear regressions showed that maternal borderline trait significantly predicted children's externalizing (B = 0.302, P = 0.001), internalizing (B = 0.211, P = 0.020), and dysregulation problems (B = 0.327, P < 0.001). Similarly, maternal somatization trait predicted children's internalizing problems (B = 0.291, P < 0.001). Maternal borderline and somatization traits showed association with children's behavioral problems. Psychological intervention and support for mothers with these personality traits may be helpful in raising children with behavioral problems.
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20
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[Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:463-480. [PMID: 32886047 DOI: 10.13109/prkk.2020.69.5.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services Parenting can be a key element in the psychiatric rehabilitation process, but it may come with many challenges for parents with mental health problems. Illness symptoms, together with social and sociocultural factors, can have adverse effects on family life or parenting behaviors and entail severe consequences for a child's psychosocial development. Bidirectional interactions can increase parental burden and thus worsen a parent's course of illness. This vicious circle can be broken by the provision of early and adequate support of mothers and fathers with mental health problems. Adult mental health services can make an important yet often underestimated contribution here. This article refers to parents' resources and needs and introduces both opportunities and challenges for adult mental health services when it comes to dealing with parenting needs. Mental health professionals are in a pivotal position for extending adequate support to clients on their parental needs. These professionals' skills and knowledge regarding parenting are essential for the successful implementation of family-focused practices in adult mental health services. Beyond the individual level, there is a need for policies and guidelines stipulating the integration of family and child perspectives in adult mental health services. In a broader view, a program from Finland shows how mental health professionals as well as peers can support parents and their families during the treatment process.
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21
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Dunn A, Cartwright-Hatton S, Startup H, Papamichail A. The Parenting Experience of Those With Borderline Personality Disorder Traits: Practitioner and Parent Perspectives. Front Psychol 2020; 11:1913. [PMID: 32849122 PMCID: PMC7426472 DOI: 10.3389/fpsyg.2020.01913] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful. Aim To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them. Methods Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison. Results Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents. Conclusion This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given.
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Affiliation(s)
- Abigail Dunn
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Helen Startup
- Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, United Kingdom
| | - Alexandra Papamichail
- Department of Health Service and Population Research, Kings College London, London, United Kingdom
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22
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Kouppis E, Björkenstam C, Gerdin B, Ekselius L, Björkenstam E. Childbearing and mortality among women with personality disorders: nationwide registered-based cohort study. BJPsych Open 2020; 6:e95. [PMID: 32838831 PMCID: PMC7488311 DOI: 10.1192/bjo.2020.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People with a personality disorder have a higher mortality and reduced life expectancy than the general population. Childbearing is thought to have a protective effect on morbidity and mortality. Yet, there are no studies on whether childbearing is related to a lower mortality among women with personality disorder. AIMS This study examined associations between childbearing and mortality among women with personality disorder. Our hypothesis was that parity would be associated with lower mortality. METHOD This register-based cohort study included 27 412 women treated for personality disorder in in-patient or specialised out-patient care between 1990 and 2015. We used nationwide population-based registers to obtain information on sociodemographics, child delivery, healthcare use and mortality. Mortality risk estimates were calculated as hazard ratios (HRs) with 95% CIs using Cox regression. Adjustments were made for year of birth, educational level, age at diagnosis, comorbidity and severity of personality disorder. RESULTS Nulliparous women had a nearly twofold increased mortality risk (adjusted HR = 1.78, 95% CI 1.50-2.12) compared with parous women and over twofold mortality risk (adjusted HR = 2.29, 95% CI 1.72-3.04) compared with those giving birth after their first personality disorder diagnosis. Those giving birth before their first personality disorder diagnosis had a 1.5-fold higher risk of mortality than those giving birth after their first personality disorder diagnosis (adjusted HR = 1.48, 95% CI 1.06-2.07). There was a threefold risk of suicide in nulliparous women compared with those giving birth after their first personality disorder diagnosis (adjusted HR = 2.90, 95% CI 1.97-4.26). CONCLUSIONS Childbearing history should be an integral part of the clinical evaluation of women with personality disorder.
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Affiliation(s)
| | | | - Bengt Gerdin
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Lisa Ekselius
- Department of Neuroscience, Uppsala University, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Uppsala University, Sweden; and Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Abstract
Zusammenfassung
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.
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Marshall CA, Jomeen J, Huang C, Martin CR. The Relationship between Maternal Personality Disorder and Early Birth Outcomes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165778. [PMID: 32785040 PMCID: PMC7460127 DOI: 10.3390/ijerph17165778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24–3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12–3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR’s indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17–4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.
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Affiliation(s)
- Claire A. Marshall
- Perinatal Mental Health Liaison Team, Humber Teaching NHS Foundation Trust, Hull HU2 8TD, UK;
| | - Julie Jomeen
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull HU6 7RX, UK;
| | - Colin R. Martin
- Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull HU6 7RX, UK
- Correspondence:
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Argent SE, Kalebic N, Rice F, Taylor P. Offspring outcomes when a parent experiences one or more major psychiatric disorder(s): a clinical review. EVIDENCE-BASED MENTAL HEALTH 2020; 23:113-121. [PMID: 32303570 PMCID: PMC10231511 DOI: 10.1136/ebmental-2019-300123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/02/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022]
Abstract
We sought evidence on quantifiable offspring outcomes, including problems, needs and strengths, associated with their experience of major parental psychiatric disorder(s), focusing on schizophrenia, affective illnesses and personality disorder(s). We were motivated by the absence of any systematic exploration of the needs of offspring of parents in secure hospitals. Seven electronic databases were searched to identify systematic reviews of studies quantifying offspring outcomes when a parent, or parent surrogate, has major psychiatric disorder(s). Our search (updated in February 2018) identified seven high-quality reviews, which incorporated 291 unique papers, published in 1974-2017. The weight of evidence is of increased risk of poor offspring outcomes, including psychiatric disorder and/or behavioural, emotional, cognitive or social difficulties. No review explored child strengths. Potential moderators and mediators examined included aspects of parental disorder (eg, severity), parent and child gender and age, parenting behaviours, and family functioning. This clinical review is the first review of systematic reviews to focus on quantifiable offspring problems, needs or strengths when a parent has major psychiatric disorder(s). It narratively synthesises findings, emphasising the increased risk of offspring problems, while highlighting limits to what is known, especially the extent to which any increased risk of childhood problems endures and the extent to which aspects of parental disorder moderate offspring outcomes. The absence of the reviews' consideration of child strengths and protective factors limits opportunity to enhance offspring resilience.
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Affiliation(s)
- Sarah Elizabeth Argent
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Natasha Kalebic
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Frances Rice
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Pamela Taylor
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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Nath S, Pearson RM, Moran P, Pawlby S, Molyneaux E, Howard LM. Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:621-634. [PMID: 31642966 DOI: 10.1007/s00127-019-01790-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions. METHODS Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index). RESULTS Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217]. CONCLUSIONS Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions.
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Affiliation(s)
- Selina Nath
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Day C, Briskman J, Crawford MJ, Foote L, Harris L, Boadu J, McCrone P, McMurran M, Michelson D, Moran P, Mosse L, Scott S, Stahl D, Ramchandani P, Weaver T. An intervention for parents with severe personality difficulties whose children have mental health problems: a feasibility RCT. Health Technol Assess 2020; 24:1-188. [PMID: 32174297 PMCID: PMC7103915 DOI: 10.3310/hta24140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The children of parents with severe personality difficulties have greater risk of significant mental health problems. Existing care is poorly co-ordinated, with limited effectiveness. A specialised parenting intervention may improve child and parenting outcomes, reduce family morbidity and lower the service costs. OBJECTIVES To develop a specialised parenting intervention for parents affected by severe personality difficulties who have children with mental health problems and to conduct a feasibility trial. DESIGN A pragmatic, mixed-methods design to develop and pilot a specialised parenting intervention, Helping Families Programme-Modified, and to conduct a randomised feasibility trial with process evaluation. Initial cost-effectiveness was assessed using UK NHS/Personal Social Services and societal perspectives, generating quality-adjusted life-years. Researchers collecting quantitative data were masked to participant allocation. SETTING Two NHS mental health trusts and concomitant children's social care services. PARTICIPANTS Parents who met the following criteria: (1) the primary caregiver of the index child, (2) aged 18-65 years, (3) have severe personality difficulties, (4) proficient in English and (5) capable of providing informed consent. Index children who met the following criteria: (1) aged 3-11 years, (2) living with index parent and (3) have significant emotional/behavioural difficulties. Exclusion criteria were (1) having coexisting psychosis, (2) participating in another parenting intervention, (3) receiving inpatient care, (4) having insufficient language/cognitive abilities, (5) having child developmental disorder, (6) care proceedings and (7) index child not residing with index parent. INTERVENTION The Helping Families Programme-Modified - a 16-session intervention using structured, goal-orientated strategies and collaborative therapeutic methods to improve parenting, and child and parent functioning. Usual care - standard care augmented by a single psychoeducational session. MAIN OUTCOME MEASURES Trial feasibility - rates of recruitment, eligibility, allocation, retention, data completion and experience. Intervention acceptability - rates of acceptance, completion, alliance (Working Alliance Inventory-Short Revised) and experience. Outcomes - child (assessed via Concerns About My Child, Eyberg Child Behaviour Inventory, Child Behaviour Checklist-Internalising Scale), parenting (assessed via the Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale), parent (assessed via the Symptom Checklist-27), and health economics (assessed via the Client Service Receipt Inventory, EuroQol-5 Dimensions). RESULTS The findings broadly supported trial feasibility using non-diagnostic screening criteria. Parents were mainly referred from one site (75.0%). Site and participant factors delayed recruitment. An estimate of eligible parents was not obtained. Of the 86 parents referred, 60 (69.7%) completed screening and 48 of these (80.0%) were recruited. Participants experienced significant disadvantage and multiple morbidity. The Helping Families Programme-Modified uptake (87.5%) was higher than usual-care uptake (62.5%). Trial retention (66.7%, 95% confidence interval 51.6% to 79.6%) exceeded the a priori rate. Process findings highlighted the impact of random allocation and the negative effects on retention. The Helping Families Programme-Modified was acceptable, with duration of delivery longer than planned, whereas the usual-care condition was less acceptable. At initial follow-up, effects on child and parenting outcomes were detected across both arms, with a potential outcome advantage for the Helping Families Programme-Modified (effect size range 0.0-1.3). For parental quality-adjusted life-years, the Helping Families Programme-Modified dominated usual care, and child quality-adjusted life-years resulted in higher costs and more quality-adjusted life-years. At second follow-up, the Helping Families Programme-Modified was associated with higher costs and more quality-adjusted life-years than usual care. For child quality-adjusted life-years, when controlled for baseline EuroQol-5 Dimensions, three-level version, usual care dominated the Helping Families Programme-Modified. No serious adverse events were reported. CONCLUSION The Helping Families Programme-Modified is an acceptable specialised parenting intervention. Trial methods using non-diagnostic criteria were largely supported. For future work, a definitive efficacy trial should consider site selection, recruitment methods, intervention efficiency and revised comparator condition. TRIAL REGISTRATION Current Controlled Trials ISRCTN14573230. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Crispin Day
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Jackie Briskman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mike J Crawford
- The Centre for Psychiatry, Department of Medicine, Imperial College London, London, UK
| | | | - Lucy Harris
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Janet Boadu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul McCrone
- Institute of Lifecourse Development, University of Greenwich, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Liberty Mosse
- CAMHS Research Unit, Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Ramchandani
- PEDAL Research Centre, The Faculty of Education, University of Cambridge, Cambridge, UK
| | - Timothy Weaver
- Department of Mental Health, Social Work and Integrative Medicine, School of Health and Education, Middlesex University, London, UK
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Day C, Briskman J, Crawford MJ, Foote L, Harris L, Boadu J, McCrone P, McMurran M, Michelson D, Moran P, Mosse L, Scott S, Stahl D, Ramchandani P, Weaver T. Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties. BMJ Open 2020; 10:e033637. [PMID: 32034024 PMCID: PMC7045220 DOI: 10.1136/bmjopen-2019-033637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Specialist parenting intervention could improve coexistent parenting and child mental health difficulties of parents affected by severe personality difficulties. OBJECTIVE Conduct a feasibility trial of Helping Families Programme-Modified (HFP-M), a specialist parenting intervention. DESIGN Pragmatic, mixed-methods trial, 1:1 random allocation, assessing feasibility, intervention acceptability and outcome estimates. SETTINGS Two National Health Service health trusts and local authority children's social care. PARTICIPANTS Parents: (i) primary caregiver, (ii) 18 to 65 years, (iii) severe personality difficulties, (iv) proficient English and (v) capacity for consent. Child: (i) 3 to 11 years, (ii) living with index parent and (iii) significant emotional/behavioural difficulties. INTERVENTION HFP-M: 16-session home-based intervention using parenting and therapeutic engagement strategies. Usual care: standard care augmented by single psychoeducational parenting session. OUTCOMES Primary feasibility outcome: participant retention rate. SECONDARY OUTCOMES (i) rates of recruitment, eligibility and data completion, and (ii) rates of intervention acceptance, completion and alliance (Working Alliance Inventory-Short Revised). Primary clinical outcome: child behaviour (Eyberg Child Behaviour Inventory). SECONDARY OUTCOMES child mental health (Concerns About My Child, Child Behaviour Checklist-Internalising Scale), parenting (Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale) and parent mental health (Symptom-Checklist-27). Quantitative data were collected blind to allocation. RESULTS Findings broadly supported non-diagnostic selection criterion. Of 48 participants recruited, 32 completed post-intervention measures at mean 42 weeks later. Participant retention exceeded a priori rate (HFP-M=18; Usual care=14; 66.7%, 95% CI 51.6% to 79.6%). HFP-M was acceptable, with delivery longer than planned. Usual care had lower alliance rating. Child and parenting outcome effects detected across trial arms with potential HFP-M advantage (effect size range: 0.0 to 1.3). CONCLUSION HFP-M is an acceptable and potentially effective specialist parenting intervention. A definitive trial is feasible, subject to consideration of recruitment and retention methods, intervention efficiency and comparator condition. Caution is required in interpretation of results due to reduced sample size. No serious adverse events reported. TRIAL REGISTRATION NUMBER ISRCTN14573230.
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Affiliation(s)
- Crispin Day
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jackie Briskman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | | | | | - Lucy Harris
- Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Boadu
- King's Health Economics, P024 David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paul McCrone
- King's Health Economics, P024 David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Mental Health, Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Mary McMurran
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | | | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | - Liberty Mosse
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Ramchandani
- Faculty of Education, PEDAL Research Centre, University of Cambridge, Cambridge, UK
| | - Tim Weaver
- Department of Mental Health, Middlesex University, London, UK
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29
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Garland J, Miller S. Borderline personality disorder: part 1 – assessment and diagnosis. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SUMMARYGeneral adult psychiatrists are largely responsible for the care of patients with personality disorders in community and in-patient settings, and this can be associated with diagnostic and management challenges. In the first of two articles focusing specifically on borderline personality disorder (BPD), we summarise the core clinical features of the disorder and discuss appropriate diagnostic practice.
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30
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Iqbal SZ, French-Rosas LN, Banu S, Han JY, Shah AA. Borderline Personality Disorder: Impact, Overlap, and Comorbidities. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20191206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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31
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Mielke EL, Neukel C, Fuchs A, Hillmann K, Zietlow AL, Bertsch K, Reck C, Möhler E, Herpertz SC. The Cycle of Abuse: Emotional Availability in Resilient and Non-Resilient Mothers with Early Life Maltreatment. Psychopathology 2020; 53:298-305. [PMID: 32937629 DOI: 10.1159/000509904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early life maltreatment (ELM) has a high risk of transmission across generations, known as "the cycle of abuse." ELM is also an important risk factor for developing mental disorders, and having a mental disorder increases the risk of child abuse. Both the abuse potential in mothers with ELM and in mothers with a history of mental disorders might be associated with a disturbed mother-child interaction. OBJECTIVE The current study examined differences in emotional availability between mothers with a history of ELM and previous or current mental disorders (non-resilient), mothers with ELM without mental disorders (resilient), and control mothers without ELM and without mental disorders. METHODS Thirty-three non-resilient mothers, 18 resilient mothers, and 37 control mothers and their 5- to 12-year-old children participated in a standardized mother-child interaction task. Videotaped interactions were rated by three independent, trained raters based on the Emotional Availability Scales (EA Scales) and compared between the groups. RESULTS The non-resilient mothers and their children showed reduced maternal sensitivity, structuring, non-intrusiveness, non-hostility, responsiveness, and involvement compared to the resilient mothers and their children and the control mothers and their children (p = 0.006, ηp2 = 0.12). No differences on any of the EA Scales were found between resilient mothers and control mothers. CONCLUSIONS These deficits in mother-child interaction in non-resilient mothers might contribute to mechanisms that could explain the cycle of abuse. Interestingly, resilient mothers, who did not develop a mental disorder despite having experienced ELM, did not show these deficits. Thus, prevention programs promoting resilience might be a key to break the cycle of abuse.
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Affiliation(s)
- Emilia Louisa Mielke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany,
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karen Hillmann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anna-Lena Zietlow
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Institute of Medical Psychology, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Corinna Reck
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,Clinic for Child and Adolescent Psychiatry, SHG Hospital, Kleinbittersdorf, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Steele KR, Townsend ML, Grenyer BFS. Parenting and personality disorder: An overview and meta-synthesis of systematic reviews. PLoS One 2019; 14:e0223038. [PMID: 31574104 PMCID: PMC6772038 DOI: 10.1371/journal.pone.0223038] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/13/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVES Maladaptive parenting (including childhood maltreatment, abuse and neglect) has been implicated in the scientific literature exploring the aetiology of personality disorder, particularly borderline personality disorder (BPD). Our primary objective was to summarise the evidence on the relationship between parenting and personality disorder, assisting clinical decision-makers to translate this research into clinical policy and practice. METHODS We conducted an overview of systematic reviews that assessed individuals with personality disorder pathology for experiences of maladaptive parenting, compared to psychiatric or healthy comparisons/controls, and the impact on psychopathological and relational outcomes. Systematic literature searches were conducted in Scopus, Web of Science, MEDLINE, PsycINFO, and by hand in August 2018. Methodological quality was assessed using the CASP systematic review checklist, and results were qualitatively synthesised. A pre-determined protocol was registered in Prospective Register of Systematic Reviews (PROSPERO 2019:CRD42018096177). RESULTS Of the 312 identified records, 293 abstracts were screened, 36 full-text articles were retrieved and eight systematic reviews met pre-determined criteria for qualitative synthesises. The majority of studies reported outcomes related to BPD (n = 7), and study design, methodology and quality varied. Within the eight systematic reviews there were 211 primary studies, of which 140 (66.35%) met eligibility criteria for inclusion in this overview. Eligible primary studies reported on 121,895 adult, child/adolescent and parent-offspring participants, with most studies focused on borderline personality pathology (n = 100, 71.43%). Study design and methodology also varied for these studies. Overall, five systematic reviews overwhelming found that maladaptive parenting was a psychosocial risk factor for the development of borderline personality pathology, and three studies found that borderline personality pathology was associated with maladaptive parenting, and negative offspring and parenting-offspring outcomes. CONCLUSIONS In light of these findings, we recommend greater emphasis on parenting in clinical practice and the development of parenting interventions for individuals with personality disorder. However, our understanding is limited by the heterogeneity and varying quality of the evidence, and as such, future research utilising more rigorous research methodology is needed.
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Affiliation(s)
- Kayla R. Steele
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Berthelot N, Lemieux R, Garon-Bissonnette J, Muzik M. Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma. J Midwifery Womens Health 2019; 65:85-95. [PMID: 31566890 DOI: 10.1111/jmwh.13034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents. METHODS Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment. RESULTS There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment. DISCUSSION Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Ransley R, Sleed M, Baradon T, Fonagy P. “What support would you find helpful?” The relationship between treatment expectations, therapeutic engagement, and clinical outcomes in parent–infant psychotherapy. Infant Ment Health J 2019; 40:557-572. [DOI: 10.1002/imhj.21787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rachel Ransley
- Research Department of ClinicalEducational and Health PsychologyUniversity College London London United Kingdom
- The Anna Freud National Centre for Children and Families London United Kingdom
| | - Michelle Sleed
- Research Department of ClinicalEducational and Health PsychologyUniversity College London London United Kingdom
- The Anna Freud National Centre for Children and Families London United Kingdom
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe)The Anna Freud National Centre for Children and Families London United Kingdom
| | - Tessa Baradon
- The Anna Freud National Centre for Children and Families London United Kingdom
- School of Human and Community DevelopmentUniversity of Witwatersrand Johannesburg South Africa
| | - Peter Fonagy
- Research Department of ClinicalEducational and Health PsychologyUniversity College London London United Kingdom
- The Anna Freud National Centre for Children and Families London United Kingdom
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35
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Yokoyama Y, Hakulinen T, Sugimoto M, Silventoinen K, Kalland M. Maternal subjective well-being and preventive health care system in Japan and Finland. Eur J Public Health 2019; 28:652-657. [PMID: 29272457 DOI: 10.1093/eurpub/ckx211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers. Methods In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother. Results Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age. Conclusion Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does.
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Affiliation(s)
- Yoshie Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Tuovi Hakulinen
- Children, Adolescence and Families Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Masako Sugimoto
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Karri Silventoinen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mirjam Kalland
- Swedish School of Social Science, University of Helsinki, Helsinki, Finland
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36
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Geerling I, Roberts RM, Sved Williams A. Impact of infant crying on mothers with a diagnosis of borderline personality disorder: A qualitative study. Infant Ment Health J 2019; 40:405-421. [PMID: 30964954 DOI: 10.1002/imhj.21776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mothers with borderline personality disorder (BPD) and their infants often have compromised relationships. To further understand the complexities, this study explored (a) the experiences of mothers with BPD in response to infant crying and (b) how these parenting responses impact on mothers' interpersonal functioning with significant others. Six mothers with clinical BPD were recruited from a mother-baby psychiatric unit and interviewed using an interpretative phenomenological analysis (IPA) approach. Transcripts of the semistructured interviews were coded for themes and subthemes. Dominant themes revealed that mothers with BPD entered motherhood in a psychologically fragile state, hypersensitive to experiencing intense physiological-emotional pain and cognitive chaos in response to infant crying. Automatic maladaptive flight-fright responses including suicide attempts were common. A novel theme revealed some mothers' split identity, and only the "mother" part could attend to infant crying. Finally, the data provided an understanding of the detrimental domino effect on close family. Mothers also highlighted gaps in accessibility of current mental health services and parenting programs, and their desire to prevent the intergenerational transmission of attachment problems and BPD symptoms to offspring. Clinical implications include antenatal BPD screening, psychoeducation about infant crying, and greater access for programs supporting the whole family to improve outcomes.
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Affiliation(s)
- Ingrid Geerling
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Anne Sved Williams
- Women's & Children's Health Network, Adelaide, Australia.,Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
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Krumm S, Checchia C, Kilian R, Becker T. Mental health nurses' and psychiatrists' views on addressing parenthood issues among service users. Int J Ment Health Nurs 2019; 28:425-435. [PMID: 30066391 DOI: 10.1111/inm.12525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 12/28/2022]
Abstract
Mental health professionals (MHPs) are in a central position to provide support for mental health service users (MHSUs) in regard to parental needs, from preconception to caring for children. This study aims to examine whether mental health nurses and psychiatrists regard the issue of having children and being a parent as relevant to be considered in a clinical setting, how they describe the MHPs' roles and responsibilities in this regard, and to what extent they feel willing and able to fulfil these demands. A qualitative approach was undertaken by conducting four focus groups with 30 MHPs (15 nurses and 15 psychiatrists) within an inpatient mental health service in south Germany. We found that MHPs generally acknowledged the importance of parenting issues for psychiatric treatment. However, they assessed the talks between MHPs and MHSUs about parenting as less relevant in routine practice; the issue of the desire for children in particular was seen as generally not important. Addressing parenthood issues was restricted to mainly two areas: clarifying children's situations during inpatient treatment and considering medication issues among (potentially) pregnant service users. MHPs' focus on the adult service user, privacy, and historical issues were the main arguments against addressing parenthood issues.
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II at Bezirkskrankenhaus Guenzburg, Ulm University, Guenzburg, Germany
| | - Carmen Checchia
- Department of Psychiatry and Psychotherapy II at Bezirkskrankenhaus Guenzburg, Ulm University, Guenzburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II at Bezirkskrankenhaus Guenzburg, Ulm University, Guenzburg, Germany
| | - Thomas Becker
- Department of Psychiatry and Psychotherapy II at Bezirkskrankenhaus Guenzburg, Ulm University, Guenzburg, Germany
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Parenting in Patients with Borderline Personality Disorder, Sequelae for the Offspring and Approaches to Treatment and Prevention. Curr Psychiatry Rep 2019; 21:9. [PMID: 30729325 DOI: 10.1007/s11920-019-0996-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Barlow J, Sembi S, Parsons H, Kim S, Petrou S, Harnett P, Dawe S. A randomized controlled trial and economic evaluation of the Parents Under Pressure program for parents in substance abuse treatment. Drug Alcohol Depend 2019; 194:184-194. [PMID: 30447510 DOI: 10.1016/j.drugalcdep.2018.08.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is growing interest in the provision of parenting support to substance misusing parents. METHODS This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted. RESULTS Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p < 0.03) and per-protocol analyses (p < 0.01). There was also significant reliable change (recovery/improvement) in 30.6% of the PuP group compared with 10.3% of the TAU group (p < 0.02), and deterioration in 3% compared with 18% (p < 0.02). The probability that the program is cost-effective was approximately 51.8% if decision-makers are willing to pay £1000 for a unit improvement in the primary outcome, increasing to 98.0% at a £20,000 cost-effectiveness threshold for this measure. CONCLUSIONS Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed.
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Affiliation(s)
- Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sukhdev Sembi
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Sungwook Kim
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Stavros Petrou
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Paul Harnett
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Australia.
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Sved Williams AE, Yelland C, Hollamby S, Wigley M, Aylward P. A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants. J Psychiatr Pract 2018; 24:331-340. [PMID: 30427820 DOI: 10.1097/pra.0000000000000330] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group. METHODS A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week. RESULTS A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships. CONCLUSIONS This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.
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Affiliation(s)
- Anne E Sved Williams
- SVED WILLIAMS: Helen Mayo House, Womens and Childrens Health Network, North Adelaide, South Australia, Australia; and University of Adelaide, South Australia, Australia YELLAND, HOLLAMBY, and WIGLEY: Helen Mayo House, Womens and Childrens Health Network, North Adelaide, South Australia, Australia AYLWARD: Flinders University, Adelaide, South Australia, Australia
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Hubert S, Aujoulat I. Parental Burnout: When Exhausted Mothers Open Up. Front Psychol 2018; 9:1021. [PMID: 29997543 PMCID: PMC6028779 DOI: 10.3389/fpsyg.2018.01021] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Until recently, research conducted on parental exhaustion was exclusively concerned with parents of sick children. However, situations where exhaustion occurs as a result of being physically and emotionally overwhelmed by one's parental role in the absence of a child's condition is gaining increasing interest. The aim of our study was to give voice to exhausted mothers, in order to get a better understanding of what it means to be exhausted in relation with one's parental role, from the perspective of those who have experienced it. We referred to phenomenological interpretative analysis for methods of data collection and data analysis, and included five mothers who were each interviewed twice. Our analysis revealed a superordinate theme of fear, which was central in every aspect of the mothers' accounts of their experiences, from the fear to not be a good enough mother to the fear related to unlearning control and experiencing discontinuity of one's sense of self. Our results call for the development of specific interventions to prevent, anticipate, or treat the phenomenon of exhaustion in parents, so as to help them and their children cope better with these situations of extreme vulnerability, which are often reinforced by senses of guilt, shame, and loneliness.
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Affiliation(s)
- Sarah Hubert
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Isabelle Aujoulat
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
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Ruisch IH, Buitelaar JK, Glennon JC, Hoekstra PJ, Dietrich A. Pregnancy risk factors in relation to oppositional-defiant and conduct disorder symptoms in the Avon Longitudinal Study of Parents and Children. J Psychiatr Res 2018; 101:63-71. [PMID: 29550610 DOI: 10.1016/j.jpsychires.2018.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pregnancy factors have been implicated in offspring oppositional-defiant disorder (ODD) and conduct disorder (CD) symptoms. Literature still holds notable limitations, such as studying only a restricted set of pregnancy factors, use of screening questionnaires which assess broadly defined outcome measures, and lack of control for disruptive behavior comorbidity and genetic confounds. We aimed to address these gaps by prospectively studying a broad range of pregnancy factors in relation to both offspring ODD and CD symptomatology in the Avon Longitudinal Study of Parent and Children. METHODS Outcomes were ODD and CD symptom scores at age 7;9 years using the Development and Well-Being Assessment interview. We analyzed maternal (N ≈ 6300) and teacher ratings (N ≈ 4400) of ODD and CD scores separately using negative binomial regression in multivariable models. Control variables included comorbid attention-deficit/hyperactivity disorder symptoms, ODD or CD symptoms as appropriate, and genetic risk scores based on an independent CD genome-wide association study. RESULTS Higher ODD symptom scores were linked to paracetamol use (IRR = 1.24 [98.3% confidence interval 1.05-1.47], P = 0.002, teacher ratings) and life events stress (IRR = 1.22 [1.07-1.39], P = 0.002, maternal ratings) during pregnancy. Higher CD symptom scores were linked to maternal smoking (IRR = 1.33 [1.18-1.51], P < 0.001, maternal ratings), life events stress (IRR = 1.24 [1.11-1.38], P < 0.001, maternal ratings) and depressive symptoms (IRR = 1.14 [1.01-1.30], P = 0.006, maternal ratings) during pregnancy. CONCLUSIONS Common and potentially preventable pregnancy risk factors were independently related to both offspring ODD and CD symptomatology in children from the general population. Future studies should further address genetic confounds and confounding by environmental factors later in life.
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Affiliation(s)
- I Hyun Ruisch
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands.
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525GA Nijmegen, The Netherlands.
| | - Pieter J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
| | - Andrea Dietrich
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry, Hanzeplein 1, 9713GZ Groningen, The Netherlands.
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Kluczniok D, Boedeker K, Hindi Attar C, Jaite C, Bierbaum AL, Fuehrer D, Paetz L, Dittrich K, Herpertz SC, Brunner R, Winter S, Heinz A, Roepke S, Heim C, Bermpohl F. Emotional availability in mothers with borderline personality disorder and mothers with remitted major depression is differently associated with psychopathology among school-aged children. J Affect Disord 2018; 231:63-73. [PMID: 29453011 DOI: 10.1016/j.jad.2018.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/15/2018] [Accepted: 02/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both, maternal borderline personality disorder (BPD) and maternal major depressive disorder (MDD) are often associated with adverse consequences for children, including increased risk for child behavior problems. Reduced maternal emotional availability might play a critical role in transmitting maternal psychopathology on the child. Our aim was to investigate the association between emotional availability and maternal BPD and MDD in remission (rMDD), and if this interrelatedness mediates the association between maternal mental disorders and child behavior problems. METHODS The interaction of 178 mother-child dyads was assessed during a play situation using the Emotional Availability Scales. Children were between 5 and 12 years old. Regression analyses were used to investigate the impact of maternal BPD and maternal rMDD on emotional availability. Ordinary least squares regression analyses using bootstrapping were conducted to investigate the mediating effect of emotional availability on the association between maternal mental disorders and child behavior problems. RESULTS Mothers with BPD showed increased hostility during mother-child interaction, whereas history of MDD was associated with reduced sensitivity. Maternal hostility was a mediator between maternal BPD and number of child psychiatric disorders, as well as externalizing and internalizing behavior. Maternal sensitivity mediated the association between maternal rMDD and number of child psychiatric disorders, as well as internalizing child behavior. CONCLUSIONS Our data suggest that mothers with BPD show a qualitatively different pattern of emotional availability compared to mothers with rMDD. These patterns might reflect two separate pathways of transgenerational transmission of aspects of maternal mental disorders, where intervention and training programs could start: maternal rMDD impacts on child behavior problems via reduced sensitivity, and maternal BPD via increased hostility, which could both be addressed with specific therapeutic interventions.
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Affiliation(s)
- Dorothea Kluczniok
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany.
| | - Katja Boedeker
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Catherine Hindi Attar
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Charlotte Jaite
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Anna-Lena Bierbaum
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Daniel Fuehrer
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Luisa Paetz
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Katja Dittrich
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, University of Heidelberg, Germany
| | - Sibylle Winter
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Andreas Heinz
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Stefan Roepke
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Christine Heim
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Medical Psychology, Charité, Berlin, Germany
| | - Felix Bermpohl
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
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Laporte L, Paris J, Zelkowitz P. Estimating the prevalence of borderline personality disorder in mothers involved in youth protection services. Personal Ment Health 2018; 12:49-58. [PMID: 28944592 DOI: 10.1002/pmh.1398] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/28/2017] [Accepted: 08/18/2017] [Indexed: 11/05/2022]
Abstract
Characteristics of borderline personality disorder (BPD) can undermine maternal capacity and in some cases lead to involvement with youth protection services (YPS). Yet, few studies exist on the prevalence of maternal BPD in this context and on the comparison of these families with families with other maternal psychiatric disorders or families with no mental illness within YPS. The current study surveyed 291 caseworkers working with mothers whose children and adolescents are followed by YPS. After reported prevalence was adjusted with validation procedures, the prevalence of maternal BPD in a sample of 1875 mothers was 34.3%. Comparison of three groups of families suggest that some risk factors, including substance abuse and severe conjugal conflicts, were more frequent in mothers with BPD than in mothers with other psychiatric illness or none. Furthermore, results revealed that 48.9% of mothers with BPD had a history of being followed by YPS in their childhood. Finally, children of mothers with BPD were placed at a younger age than the other children and were less often reported for conduct disorder. These results call for more attention to these highly vulnerable parents and children in both research and in adult and child mental health services. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lise Laporte
- Department of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada.,Centre de recherche Jeunes en difficulté CIUSS Centre sud de l'île de Montréal, Quebec, Canada
| | - Joel Paris
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
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Huntley F, Wright N, Pickles A, Sharp H, Hill J. Maternal mental health and child problem behaviours: disentangling the role of depression and borderline personality dysfunction. BJPsych Open 2017; 3:300-305. [PMID: 29234522 PMCID: PMC5707443 DOI: 10.1192/bjpo.bp.117.005843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is not known whether associations between child problem behaviours and maternal depression can be accounted for by comorbid borderline personality disorder (BPD) dysfunction. AIM To examine the contributions of maternal depression and BPD symptoms to child problem behaviours. METHOD Depression trajectories over the first-year postpartum were generated using repeated measurement from a general population sample of 997 mothers recruited in pregnancy. In a stratified subsample of 251, maternal depression and BPD symptoms were examined as predictors of child problem behaviours at 2.5 years. RESULTS Child problem behaviours were predicted by a high maternal depression trajectory prior to the inclusion of BPD symptoms. This association was no longer significant after the introduction of BPD symptoms. CONCLUSIONS Risks for child problem behaviours currently attributed to maternal depression may arise from more persistent and pervasive difficulties found in borderline personality dysfunction. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017, this is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.
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Affiliation(s)
- Fay Huntley
- , ClinPsyD, PhD, Department of Psychological Sciences, Institute of Psychology, Health and Society, , University of Liverpool, UK
| | - Nicola Wright
- , BSc, MSc, Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Andrew Pickles
- , FMedSci, Professor, Biostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen Sharp
- , DClinPsy, PhD, Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jonathan Hill
- , FRCPsych, Professor, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Prevalence of psychopathology in children of parents with mental illness and/or addiction: an up to date narrative review. Curr Opin Psychiatry 2017; 30:312-317. [PMID: 28441171 DOI: 10.1097/yco.0000000000000341] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Children of parents with a mental illness and/or addiction are at high risk for developing a mental illness themselves. Parental mental illness is highly prevalent leading to a serious number of children at high risk. The aim of this review is to give an up-to-date overview of psychopathology in children of parents with various mental illnesses and/or addiction, based on recent literature. RECENT FINDINGS Worldwide, 15-23% of children live with a parent with a mental illness. These children have up to 50% chance of developing a mental illness. Parental anxiety disorder sets children at a more specific risk for developing anxiety disorder themselves, where children of parents with other mental illnesses are at high risk of a large variety of mental illnesses. Although preventive interventions in children of mentally ill parents may decrease the risk of problem development by 40%; currently, these children are not automatically identified and offered help. SUMMARY This knowledge should encourage mental health services to address the needs of these children which requires strong collaboration between Child and Adolescent Mental Health Services and Adult Mental Health Services. Directions for further research would be to include both parents, allow for comorbidity and to look deeper into a broader variety of mental illnesses such as autism and personality disorder other than borderline.
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Marcoux AA, Bernier A, Séguin JR, Boike Armerding J, Lyons-Ruth K. How do mothers with borderline personality disorder mentalize when interacting with their infants? Personal Ment Health 2017; 11:14-22. [PMID: 27860436 DOI: 10.1002/pmh.1362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/07/2022]
Abstract
Mothers with borderline personality disorder (BPD) have been theorized to have decreased mentalization ability, which is the capacity to perceive and interpret mental states. This could increase the risk for troubled relationships with their infants and therefore have adverse consequences for child social and emotional development. Mind-mindedness (MM), which codes the mother's references to her infant's mental states during an interaction, is one method of indexing mothers' mentalizing ability. However, research has yet to examine MM in mothers with BPD. Our objective was to assess the MM ability of 38 mothers during interactions with their 12-month-old infants, including 10 mothers with BPD and 28 mothers without a psychiatric diagnosis. Trained observers assessed maternal MM from 2 min of videotaped mother-infant free play. BPD was assessed with the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Mothers with and without BPD did not differ in the proportion of total comments referring to infant mental states. However, mothers in the BPD group proportionately made 3.6 times more misattuned mind-related comments than control mothers. Thus, mothers with and without BPD appear equally likely to envision mental states in their infants. However, mothers with BPD also appear more likely to misread their infants' mental states. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Jean R Séguin
- University of Montreal, Montreal, Quebec, Canada.,Ste-Justine University Hospital Research Center, Montreal, Canada
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Gullbrå F, Smith-Sivertsen T, Rortveit G, Anderssen N, Hafting M. Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study. BMC FAMILY PRACTICE 2016; 17:154. [PMID: 27821069 PMCID: PMC5100102 DOI: 10.1186/s12875-016-0553-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/29/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Severe illness among parents may interfere with their parenting. Children having ill or substance-abusing parents are at risk of own health problems and psychosocial difficulties. The health care system should identify families in need of help and provide the help needed. For ill parents, it can be difficult to seek help and advices for their parenting. The aim of this study was to identify important factors for the general practitioner (GP) to bear in mind during encounters with ill and substance-abusing parents, to enable the GP to provide appropriate support for the children. METHOD A qualitative approach was chosen and the data material was semi-structured individual interviews with 12 parents with mental illness, substance abuse or severe somatic illness. The participants were recruited through GPs in Norway, and the interviews were performed in 2014. We used systematic text condensation for analysis. RESULTS It was important for the participants that the GP was oriented about their family and children's situation. They wanted to be regarded as competent parents in ordinary families; however, they were aware that their illness affected their parenting. They expressed a need for advice about how to inform the children of their illness and talk to them about their challenges, and, if necessary, utilize helpers who could inform the children and talk to them directly. There were often many agencies involved, and it was important that the helpers cooperated and shared information. In addition, the parents were in need of information about support services. CONCLUSION Ill parents in this study conveyed a double message to their helpers. They wanted to be considered as responsible and well-intended parents who wished the best for their children. At the same time they needed support in parenting. The GP should take the time to listen to the parents' first spontaneous description about an ordinary daily life (while realising that it may not necessarily be an accurate report), then explore their worries and needs of support.
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Affiliation(s)
- Frøydis Gullbrå
- Research Unit for General Practice, Uni Research Health, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | - Guri Rortveit
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Norman Anderssen
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Marit Hafting
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
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Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedláčková Z, Hruby R. Quality of life in borderline patients comorbid with anxiety spectrum disorders - a cross-sectional study. Patient Prefer Adherence 2016; 10:1421-33. [PMID: 27536074 PMCID: PMC4975144 DOI: 10.2147/ppa.s108777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls. METHODS Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale. RESULTS BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains. CONCLUSION Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable.
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Affiliation(s)
- Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, IP Pavlova 6, 77520 Olomouc, Czech Republic, Tel +420 603 414 930, Email
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc
- Department of Psychiatry, Hospital Liberec, Liberec
| | - Zuzana Sedláčková
- Department of Psychology, Faculty of Arts, Palacky University Olomouc, Olomouc, Czech Republic
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Renneberg B, Rosenbach C. "There is not much help for mothers like me": Parenting Skills for Mothers with Borderline Personality Disorder - a newly developed group training program. Borderline Personal Disord Emot Dysregul 2016; 3:16. [PMID: 27980787 PMCID: PMC5131544 DOI: 10.1186/s40479-016-0050-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
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'.
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Affiliation(s)
- Babette Renneberg
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, D - 14195 Berlin, Germany
| | - Charlotte Rosenbach
- Department of Education and Psychology, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, D - 14195 Berlin, Germany
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