Table 4 Summary of studies investigating the impact of maternal BPD on parenting, and on children N of mothers N of children Study (children’s ages) With BPD Healthy Controls With other disorders Of mothers with BPD Of healthy control mothers Of mothers with other disorders How BPD in the mother was diagnosed Measures Quality rating out of 5 Summary of findings Abela et al., (2005) (6-14 years) - - - 20 - 120 from mothers with MDD SCID-II Verbal interviews, K-SADS, CASQ, CRSQ, SEQ, CDAS-R, CDEQ, IPPA and RSSC 3.6 Parental BPD was significantly related to children having more depressive symptoms, negative attributional style, dysfunctional attitudes, insecure attachment style, and excessive reassurance seeking. 45% of these children had experienced a major depressive episode Barnow et al., (2006) 16 116 36 mothers with depression 23 156 47 from mothers with depression, 31 from mothers with SCID-II Diagnostic Expert System for Psychiatric Disorders, SSAGA, and the 4 More comorbidity in the mothers with BPD. Described by their children as being overprotective. Children whose mothers had
(11-18 years) 28 mothers with other personality disorders Cluster C PDs Children Diagnostic Interview for Psychiatric Disorder. All given the CBCL, TCI, EMBU, YSR, and the Rosenberg Scale. Mothers interviewed using the Diagnostic Expert System for Psychiatric Disorders, and SSAGA BPD had higher harm avoidance, more attention problems, more delinquency and aggression, social problems, and more of depression, anxiety, emotional problems, suicidal tendencies, and lower self-esteem Crandell et al., (2003) (2 months) 8 12 - 8 12 - Completion of the questionnaire and full interview section of the SCID-II Interactions between mother and baby rated using the global ratings for interactions (Murray et al., 1996) 4 Mothers with BPD relate to their infants in an intrusively insensitive manner, and their mother-infant interactions were scored as less satisfying by an objective rater. During the mother's non-response stage, infants of mothers with BPD had
more dazed looks. After this stage, they showed less positive affect Crittenden & Newman (2010) (3-36 months) 15 17 - - - - DIB-R AAI, Working Model of the Child Interview 3.8 Mothers with BPD reported higher levels of depression and parenting stress Delavenne et al., (2008) (3 months) 17 17 - 17 17 - SIDP4 Used vocal recordings of interactions and used software to define interactional phrases 3.8 Mothers with BPD had more fragmented interactions with their infants, characterised by longer pauses, fewer interactional phrases, and more non-vocal sounds to fill gaps. Infants of mothers with BPD vocalised less than control infants. Their vocalisations were also shorter Elliot et al. 13 13 - 13 13 - Zanarini Rating Scale EPDS, BDI, Alcohol Use 4 Mothers with BPD were less accurate when
(12-23 months) situation scenario were videotaped and coded using the AFFEX coding system, alongside using DERS, AIM, DASS Higher levels of maternal intensity and reactivity, found in those with BPD, were linked with lower emotion regulation, blunted fear and more anger in their infants. Herr et al., (2008) (15 years) 70 461 354 with either MDD, Depressive Disorder, or both 70 461 354 from mothers with either MDD, Depressive Disorder, or both SCID-II KSADS-E, BDI, YCS, SPPA, Teacher Report of Youth Interpersonal Functioning, Bartholomew Attachment Prototypes Questionnaire, PPQ 4.2 Children of mothers with BPD found it hard to make friends and be socially accepted. Also had more fearful attachment cognitions. Rated their mothers as more likely to be hostile. Hobson et al., (2005) 10 22 - 10 22 - SCID-II Rated interactions using the global ratings for interactions 4.4 Mothers with BPD were found to be more intrusively insensitive. Infants whose mothers had
distress continued. Macfie & Swan (2009) (4-7 years) - - - 30 30 - SCID-II PPVT-III, ASCT, the MacArthur Story Stem Battery, coded using the same systems as Macfie, Swan, Fitzpatrick, Watkins & Rivas (2014) 4.4 Children of mothers with BPD expressed more fear of abandonment, role reversal and more negative expectations of parent-child relationships in a role-play situation. More likely to represent themselves as incongruent and shameful. More confusion between fantasy and reality. Newman et al., (2007) (mean 16 months) 20 - 14 20 - Independent clinical diagnosis of BPD, meeting DSM-IV criteria for BPD, and DIB-R Video interactions coded using EA scales 4 BPD mothers scored significantly higher on all SCL-90R psychopathology indices and on the EPDS. Mothers with BPD were less sensitive, and reported less satisfaction and more incompetence in their parenting. Infants whose mothers had BPD were less responsive to the mother,
and less eager to engage with her. Schacht et al., (2013) (39-61 months) 20 19 - 20 19 - Mothers needed to attract a BPD diagnosis on at least one of two administrations of SCID-II Mothers given BDI, Meins and Fernyhough's (2010) brief interview measure for Children given SCQ, BPVT-II, false-belief tasks, affective-labelling task, and a modified version of the causes of emotions interview 4.2 Mothers with BPD were more likely to report depressive symptoms. They also used significantly fewer mind-related comments to describe their children. Children who had mothers with BPD struggled to identify and describe causes of emotion, and had less understanding of mental states, doing less well in the Theory of Mind tasks. Weiss et al. (1996) (4+. Mean approx. 11 9 - 14 mothers with other personality disorders 21 - 23 from mothers with other personality disorders DIB-R FTRI, KSADS-E, CGAS and CDIB 4 Children of mothers with BPD had significantly more general psychopathology. Both groups had history of trauma.
years) White et al., (2011) (circa 3 months) 17 25 25 mothers with Major Depressive Disorder (MDD) and 20 mothers with BPD comorbid with MDD 17 25 25 from mothers with MDD, 20 from mothers with comorbid MDD and BPD SCID-IV and DIB-R BDI and BAI. Videotaped interactions coded using the Interaction Rating Scale. Children given the IBQ-R 4.2 Women with BPD, and those with comorbid MDD, consumed more alcohol during pregnancy than healthy controls. Smiled less at their infants than healthy controls. Mothers with BPD also touched their infants less, played fewer games with them, and imitated them less. Infants of mothers with BPD had higher levels of fear, were less soothable, and were classed as having higher environmental risk. Less frequent smiling and vocalisation.