Mothers with borderline personality disorders&apos; experiences of mother–infant dialectical behavior therapy

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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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A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder.

Peter Fonagy, Patrick Luyten (2008)

The precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct neural circuits underlying these facets. Hence, we provide a comprehensive account of BPD by showing how its core features are related to each other in theoretically meaningful ways. More specifically, we argue that BPD is primarily associated with a low threshold for the activation of the attachment system and deactivation of controlled mentalization, linked to impairments in the ability to differentiate mental states of self and other, which lead to hypersensitivity and increased susceptibility to contagion by other people's mental states, and poor integration of cognitive and affective aspects of mentalization. The combination of these impairments may explain BPD patients' propensity for vicious interpersonal cycles, and their high levels of affect dysregulation and impulsivity. Finally, the implications of this expanded mentalization-based approach to BPD for mentalization-based treatment and treatment of BPD more generally are discussed.