Mothers with borderline personality disorders' experiences of mother–infant dialectical behavior therapy

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.

The Management of Perinatal Borderline Personality Disorder

“…It is also apparent that mothers with BPD are frequently aware that their models for parenting could be flawed and that without new skills and knowledge, intergenerational problems in their infants are possible [25]. Zalewski et al [26] also explored similar themes and invited participants to identify what therapeutic interventions may be helpful.…”

“…A recent article [61] reveals the extent of dropouts from group therapy in non-perinatal situations at 48%, although Iliakis et al [62] found a 70% completion rate with individuals, comparable to MI-DBT groups. A recent qualitative study highlights the women's positive views of MI-DBT [25] and their motivation to be good mothers, which is likely to enhance attendance/retention rates, as is the on-site provision of childcare. Documented long-term outcomes for BPD also provide some hope that interventions work.…”

Dissociation in mothers with borderline personality disorder: a possible mechanism for transmission of intergenerational trauma? A scoping review

“…Eyden et al [ 23 ] note “precisely how parenting strategies unravel between mother-infant dyads requires further explication” (p. 102). Efforts to explicate underlying interactional mechanisms that contribute to disrupted caregiving in this group are particularly important when considering that there is no difference in reported caregiver concern for children in this group [ 24 – 26 ] as compared to other populations. BPD caregivers wish to care for their children, but due to these mechanisms this caregiving ability may be undermined.…”