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Eyden J, MacCallum F, Bornstein MH, Broome M, Wolke D. Parenting knowledge and parenting self-efficacy of mothers with borderline personality disorder and depression: "I know what to do but think I am not doing it". Dev Psychopathol 2024; 36:648-659. [PMID: 36744536 DOI: 10.1017/s095457942200147x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Borderline personality disorder (BPD) is a complex mental health condition often associated with previous childhood adversity including maladaptive parenting. When becoming a parent themselves, mothers with BPD have difficulties with various parenting cognitions and practices, but unknown is whether they have appropriate knowledge of sensitive parenting. This study explored whether differences in parenting knowledge or self-efficacy are specific to BPD or also found in mothers with depression, and whether symptom severity or specific diagnosis better explain parenting perceptions. Mothers with BPD (n = 26), depression (n = 25) or HCs (n = 25) completed a Q-sort parenting knowledge task and a parenting self-efficacy questionnaire. Results showed mothers with BPD had the same knowledge of sensitive parenting behaviors as mothers with depression and healthy mothers. Self-reported parenting self-efficacy was lower in mothers with BPD and depression compared with healthy mothers, with symptom severity most strongly associated. A significant but low correlation was found between parenting self-efficacy and knowledge. Findings suggest that mothers with BPD and depression know what good parenting is but think they are not parenting well. Mental health difficulties are not associated with parenting knowledge, but symptom severity appears to be a common pathway to lower parenting self-efficacy. Future interventions should test whether reduction of symptom severity or positive parenting feedback could improve parenting self-efficacy.
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Affiliation(s)
- Julie Eyden
- Department of Psychology, University of Warwick, Coventry, UK
| | - Fiona MacCallum
- Department of Psychology, University of Warwick, Coventry, UK
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child & Human Development, Bethesda, MD, USA
- Institute for Fiscal Studies, London, UK
- UNICEF, New York, NY, USA
| | - Matthew Broome
- Institute for Mental Health, Department of Psychology, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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2
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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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Schneider I, Fuchs A, Herpertz SC, Lobo FM. Microsocial analysis of dyadic interactions with toddlers and mothers with borderline personality disorder. Arch Womens Ment Health 2023; 26:589-597. [PMID: 37438620 PMCID: PMC10491556 DOI: 10.1007/s00737-023-01346-9] [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: 03/14/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
Borderline personality disorder (BPD) is known for disruptions in mother-child interaction, but possible underlying patterns of micro-behavior are barely understood. This is the first study examining behavioral dyadic synchrony-the coordinated and reciprocal adaptation of behavior-and regulation on a micro-level and relating it to macro-behavior in mothers with BPD and their toddlers. Twenty-five mothers with BPD and 29 healthy mothers participated with their 18- to 36-month-old toddlers in a frustration-inducing paradigm. Mother and toddler behavior was continuously micro-coded for gaze, affect, and vocalization. Synchrony, operationalized as the simultaneous engagement in social gaze and positive affect, and (co-)regulative behaviors and their contingencies were analyzed and associated with borderline symptom severity, the overall quality of interaction, and child internalizing and externalizing behavioral problems. Dyads with mothers with BPD showed significantly less synchrony compared to dyads with healthy mothers. Low synchrony was associated with high BPD symptom severity and low overall interaction quality. Dyads with BPD used the same amount of regulative behaviors as dyads with healthy mothers. Though both groups equally responded to children's negative emotionality, mothers with BPD were less effective in drawing the dyad back into synchrony. For dyads with BPD, regulative behaviors were negatively associated with child externalizing behaviors. BPD symptomology may reduce the effectiveness of mothers' attempts to attune to their child's needs. An emphasis on synchrony and regulative behaviors may be an important therapeutic target for parenting programs in mothers with BPD.
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Affiliation(s)
- Isabella Schneider
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany.
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Blumenstr. 8, 69115, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - Frances M Lobo
- Department of Psychology, The University of North Carolina at Greensboro, 294 Eberhart Building, Greensboro, NC, 27402, USA
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Schittek A, Roskam I, Mikolajczak M. Parental burnout and borderline personality stand out to predict child maltreatment. Sci Rep 2023; 13:12153. [PMID: 37500720 PMCID: PMC10374633 DOI: 10.1038/s41598-023-39310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023] Open
Abstract
Parental burnout is a severe disorder resulting from the exposure to chronic stress in the parental role, that can translate into neglectful and violent parental behaviors towards the offspring. This study (N = 1003 parents) aims to examine the relative weight of parental burnout, job burnout, depression, generalized anxiety disorder, borderline personality, sadism, psychopathy, Machiavellianism, narcissism, and child abuse potential, in predicting violence and neglect towards the offspring. Social desirability was controlled. When all predictors are entered together in the model, violence and neglect towards the offspring are best predicted by borderline personality and parental burnout. Our results also indicate that sadism is a robust predictor of violence, however weaker than parental burnout and borderline personality. These results emphasize the importance of preventing parental burnout and supporting parents with borderline personality.
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Affiliation(s)
- Alice Schittek
- UCLouvain, Place Cardinal Mercier 10, 1348, Louvain-la-Neuve, Belgium.
| | - Isabelle Roskam
- UCLouvain, Place Cardinal Mercier 10, 1348, Louvain-la-Neuve, Belgium
| | - Moïra Mikolajczak
- UCLouvain, Place Cardinal Mercier 10, 1348, Louvain-la-Neuve, Belgium
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Francis JL, Sawyer A, Roberts R, Yelland C, Drioli-Phillips P, Sved Williams AE. Mothers with borderline personality disorders' experiences of mother-infant dialectical behavior therapy. J Clin Psychol 2022; 79:1245-1260. [PMID: 36515397 DOI: 10.1002/jclp.23465] [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: 04/10/2022] [Revised: 08/09/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information. AIMS This study aimed to explore the subjective experiences of women who had completed MI-DBT. MATERIAL AND METHODS Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes. RESULTS Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability. DISCUSSION AND CONCLUSIONS This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.
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Affiliation(s)
- Jaimee L Francis
- Department of psychology, University of Adelaide, Adelaide, Australia.,Novita Children' Service, St Marys, Australia
| | - Alyssa Sawyer
- Department of psychology, University of Adelaide, Adelaide, Australia
| | - Rachel Roberts
- Department of psychology, University of Adelaide, Adelaide, Australia
| | - Chris Yelland
- Perinatal and Infant Mental Health, Womens and Childrens Health Network, North Adelaide, Australia
| | | | - Anne E Sved Williams
- Perinatal and Infant Mental Health, Womens and Childrens Health Network, North Adelaide, Australia.,Department of Psychiatry, University of Adelaide, Adelaide, Australia
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Barnicot K, Welsh M, Kalwarowsky S, Stevens E, Iles J, Parker J, Miele M, Lawn T, O'Hanlon L, Sundaresh S, Ajala O, Bassett P, Jones C, Ramchandani P, Crawford M. Video feedback parent-infant intervention for mothers experiencing enduring difficulties in managing emotions and relationships: A randomised controlled feasibility trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1188-1210. [PMID: 36018275 DOI: 10.1111/bjc.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Parents experiencing mental health difficulties consistent with "personality disorder", often related to a history of complex trauma, may face increased challenges in parent-child relationships and child socioemotional development. There are no published randomised controlled trials (RCTs) evaluating perinatal parent-child interventions for this population. We evaluated the feasibility and acceptability of undertaking an RCT of the video feedback intervention for positive parenting adapted for perinatal mental health (VIPP-PMH). DESIGN Feasibility study incorporating a pilot RCT. METHODS Mothers with enduring difficulties in managing emotions and relationships, consistent with a "personality disorder", and their 6- to 36-month old infants were randomly allocated to receive six sessions of VIPP-PMH (n = 20) or usual care alone (n = 14). RESULTS 76% of eligible mothers consented to participate. Intervention uptake and completion rates were 95% (≥1 VIPP-PMH session) and 70% (6 sessions), respectively. Follow-up rates were 85% at month 5 and 65% at month 8 post-baseline. Blinded observer-ratings of maternal sensitivity in parent-child interaction favoured the intervention group at month 5 (RR = 1.94, 95% CI 0.67-5.63) and month 8 (RR = 1.91, 95% CI 0.68-5.33). Small changes over time in self-rated parenting confidence and stress favoured the intervention group. There were no clear intervention effects on maternal non-intrusiveness or mental health, or on child behaviour problems, emotional functioning, or self-regulation. CONCLUSIONS An RCT of VIPP-PMH is feasible and acceptable to implement with mothers experiencing difficulties consistent with perinatal "personality disorder". A fully powered definitive RCT should be undertaken.
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Affiliation(s)
- Kirsten Barnicot
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College London, London, UK
- Centre for Mental Health Research, City University of London, London, UK
| | - Morgan Welsh
- Department of Psychology, University of Surrey, Guildford, UK
| | - Sarah Kalwarowsky
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Eloise Stevens
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College London, London, UK
| | - Jane Iles
- Department of Psychology, University of Surrey, Guildford, UK
| | - Jennie Parker
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Maddalena Miele
- Research and Development/Perinatal Mental Health Service, Central & North West London NHS Foundation Trust, London, UK
| | - Tara Lawn
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Laura O'Hanlon
- Perinatal Mental Health Service, East London NHS Foundation Trust, London, UK
| | - Sushma Sundaresh
- Perinatal Mental Health Service, Oxleas NHS Foundation Trust, London, UK
| | - Ola Ajala
- Perinatal Mental Health Service, Camden & Islington NHS Foundation Trust, London, UK
| | | | - Christina Jones
- Department of Psychology, University of Surrey, Guildford, UK
| | | | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
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Kramer U, Eubanks CF, Bertsch K, Herpertz SC, McMain S, Mehlum L, Renneberg B, Zimmermann J. Future Challenges in Psychotherapy Research for Personality Disorders. Curr Psychiatry Rep 2022; 24:613-622. [PMID: 36227450 PMCID: PMC9633470 DOI: 10.1007/s11920-022-01379-4] [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] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. RECENT FINDINGS Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy.
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Affiliation(s)
- Ueli Kramer
- University of Lausanne, Lausanne, Switzerland.
- University of Windsor, Windsor, Canada.
| | | | - Katja Bertsch
- Ludwig-Maximilians-Universität Munich, Munich, Germany
| | | | - Shelley McMain
- Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, Canada
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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8
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Seehausen A, Renneberg B, Hübenthal M, Katzenstein H, Rosenbach C. Kinder von Eltern mit einer Borderline-Persönlichkeitsstörung. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Sved Williams A, Osborn A, Yelland C, Hollamby S. Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder. Arch Womens Ment Health 2021; 24:641-648. [PMID: 33742283 DOI: 10.1007/s00737-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.
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Affiliation(s)
- Anne Sved Williams
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia. .,The University of Adelaide, Adelaide, South Australia.
| | - Amanda Osborn
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia.,The University of Adelaide, Adelaide, South Australia
| | - Chris Yelland
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
| | - Sharron Hollamby
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
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10
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Rodríguez Otero F, Medina Dorta TDP, Cabrera-Abreu C. Behavioural disorder or borderline personality disorder? The importance of early intervention. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:293-296. [PMID: 33328023 DOI: 10.1016/j.rcp.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/27/2019] [Accepted: 03/08/2019] [Indexed: 06/12/2023]
Abstract
Diagnosing borderline personality disorder during adolescence is usually controversial. In this paper we present a clinical case in which an outline of the main characteristics of borderline personality disorder during adolescence is summarised. The need of taking into consideration the precursor characteristics of borderline personality disorder in young people is also highlighted. At the same time, other significant behavioural disorders found in young people are emphasized as possible forerunners of a borderline personality disorder diagnosis. Finally, we insist upon the need to implement early intervention programmes for these patients based on current models.
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Affiliation(s)
- Fernando Rodríguez Otero
- Unidad de Media Estancia, Hospital Universitario de Gran Canaria Doctor Negrín, Las Pamas de Gran Canaria, España.
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[Assisting the Forgotten Ones - Interventions for Children of Parents with Psychological Disorders]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:426-442. [PMID: 32886049 DOI: 10.13109/prkk.2020.69.5.426] [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: 11/27/2022]
Abstract
Assisting the Forgotten Ones - Interventions for Children of Parents with Psychological Disorders Mental diseases are associated with high levels of distress in various areas of life for those, who are affected. Taking a closer look at the social circumstances, not exclusively the people themselves but also their family members are affected, especially children. In adult treatment these children are often neglected, even if they have a higher risk of suffering a mental illness themselves. A huge amount of this risk is related to the special family environment children are often exposed to right after birth. We already find prevention programs helping these children and their parents to protect their mental health. These programs largely differ regarding parental psychopathology, setting or intensity. This article gives an overview of the special circumstances these children may be confronted with and hence derivates possible starting points to support affected families. A few existing programs will be described in detail. Empirical findings presented in the article give hope for the effectiveness of already existing programs and besides highlight the need for further research and changes in the care system.
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12
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Zalewski M, Maliken AC, Lengua LJ, Martin CG, Roos LE, Everett Y. Integrating dialectical behavior therapy with child and parent training interventions: A narrative and theoretical review. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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14
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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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15
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Fossati A, Somma A. Improving Family Functioning to (Hopefully) Improve Treatment Efficacy of Borderline Personality Disorder: An Opportunity Not to Dismiss. Psychopathology 2018; 51:149-159. [PMID: 29486480 DOI: 10.1159/000486603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/26/2017] [Indexed: 11/19/2022]
Abstract
People having intimate relationships with persons suffering from borderline personality disorder (BPD) - for instance, members of their family - are likely to be involved in stormy, roller coaster relationships. Thus, they may feel overwhelmed by extreme, unpredictable feelings and situations, even when they do not suffer from any mental disorder or have no problems with mentalization. As a consequence of living with a BPD relative, family members often experience an emotional and financial burden, and may blame themselves for their relative's illness or for not being able to do more to help. This can lead to emotional pain including anxiety, guilt, anger, frustration, despair, and hopelessness. Available evidence suggests a possible usefulness of family interventions for relatives of BPD persons. Starting from these background considerations, a qualitative review of the published literature on family interventions for relatives of BPD persons was carried out. The main findings concerning specific contents and available effectiveness data of psychoeducational family interventions, family skills training, and mentalization-based family programs are reported, in the perspective of 3 family intervention scenarios: (a) taking care of the family of origin of the BPD person; (b) taking care of the new family that the BPD person has started; (c) helping the BPD person to be an effective parent.
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Affiliation(s)
- Andrea Fossati
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Turro Hospital, Milan, Italy
| | - Antonella Somma
- Vita-Salute San Raffaele University, Milan, Italy.,San Raffaele Turro Hospital, Milan, Italy
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