Evaluation of early relational disturbance in high‐risk populations: Borderline personality disorder features, maternal mental state, and observed interaction

Abstract

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother-infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother-infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and selfas-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother-Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother-infant interaction. Implications for research and clinical practice are discussed.

Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study

“…The greatest deficits in interaction quality are characterised by disorganisation, including confusion, inconsistency, or frightening behaviours and affect (Van Ijzendoorn et al, 1999). Researchers have shown maternal disorders and certain personality traits (Hazell Raine et al, 2020; Lorenzini and Fonagy, 2013) particularly those characterised by greater emotional dysregulation, such as borderline personality disorder, to have adverse associations with mother–infant relationship quality, including EA (Kim et al, 2012; Kluczniok et al, 2018; Newman-Morris et al, 2020). Accordingly, the inconsistency in mood that is characteristic of BD could be a potential mechanism underlying the lower EA associated with BD compared to MDD.…”

Parental Reflective Functioning and Its Association With Parenting Behaviors in Infancy and Early Childhood: A Systematic Review

“…The overall PRF was not significantly correlated with maternal structuring and non-intrusiveness in two studies with psychosocial high-risk mothers and mothers without risk status ( Perry et al, 2015 ; Newman-Morris et al, 2020 ). In one of the two studies, the overall PRF was significantly correlated with maternal non-hostility , showing a medium-sized effect ( Newman-Morris et al, 2020 ).…”

“…For both positive and negative parenting constructs, the effect sizes of the association with PRF and its sub-dimensions are mainly small to nearly medium. Only one study found a large-sized effect ( Hasselbeck, 2015 ), while four studies found medium- to nearly large-sized effects, all using bivariate statistical methods ( Grienenberger et al, 2005 ; Ensink et al, 2019 ; Newman-Morris et al, 2020 ; Suardi et al, 2020 ). Six studies reported associations based on both bivariate and multivariate statistical methods, of which over half of them revealed a considerable alteration of the bivariate effect ( Huth-Bocks et al, 2014 ; Hasselbeck, 2015 ; Buttitta et al, 2019 ; Newman-Morris et al, 2020 ).…”

“…Depending on the type and severity of psychopathology, it is likely to be associated with PRF differently. While one of the studies linked pre-mentalizing modes with maternal postpartum depression ( r = 0.44, p = 0.001), another study demonstrated a paradoxical positive link ( r = 0.47, p < 0.01) between higher levels of BPD features and PRF ( Krink et al, 2018 ; Newman-Morris et al, 2020 ). The latter study also revealed a buffering and protective effect of PRF, moderating the negative impact of distorted maternal representations on maternal non-hostile behavior.…”

Impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the coronavirus disease 2019 pandemic.

“…An under-researched possibility is that above and beyond those manifest features of expecting mothers and pregnancies, level of personality functioning might be a key factor in identifying vulnerable pregnant women. Indeed, pregnant women with borderline features have already been identified as a high-risk group likely to experience emotional regulation and mentalization difficulties with aspects of parenting, resulting in a myriad of neurodevelopmental, psychological, relational, and behavioral consequences in the offspring (e.g., Blankley et al, 2015;Newman-Morris et al, 2020). Studying the level of personality functioning may also provide indications for gradated levels of monitoring and care, based on the level of personality dysfunction.…”