Table 4

Summary of studies investigating the impact of maternal BPD on parenting, and on children

Study (children's ages)Number of mothersNumber of childrenHow BPD in the mother was diagnosedMeasuresQuality rating out of 5Summary of findings
With BPDHealthy controlsWith other disordersOf mothers with BPDOf healthy control mothersOf mothers with other disorders
Abela et al32 (6–14 years)20120 from mothers with MDDSCID-IIVerbal interviews, K-SADS, CASQ, CRSQ, SEQ, CDAS-R, CDEQ, IPPA and RSSC3.6Parental 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 al19 (11–18 years)1611636 mothers with depression
28 mothers with other personality disorders
2315647 from mothers with depression, 31 from mothers with Cluster C PDsSCID-IIDiagnostic Expert System for Psychiatric Disorders, SSAGA, and the Children Diagnostic Interview for Psychiatric Disorder. All given the CBCL, TCI, EMBU, YSR, and the Rosenberg Self-Worth Scale. Mothers interviewed using the Diagnostic Expert System for Psychiatric Disorders, and SSAGA4More comorbidity in the mothers with BPD. Described by their children as being overprotective. Children whose mothers had BPD had higher harm avoidance, more attention problems, more delinquency and aggression, social problems, and more self-ratings of depression, anxiety, emotional problems, suicidal tendencies and lower self-esteem
Crandell et al20 (2 months)812812Completion of the questionnaire and full interview section of the SCID-IIInteractions between mother and baby rated using the global ratings for mother–infant interactions (Murray et al38)4Mothers 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 and Newman15 (3–36 months)1517DIB-RAAI, Working Model of the Child Interview3.8Mothers with BPD reported higher levels of depression and parenting stress
Delavenne et al25 (3 months)17171717SIDP-IVUsed vocal recordings of interactions and used software to define interactional phrases3.8Mothers 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 al26 (3–14 months)13131313Zanarini Rating Scale for Borderline Personality DisorderEPDS, BDI, Alcohol Use Disorders Identification Test, CTQ, DERS, ECRS, PSI-SF, and PACOTIS4Mothers with BPD were less accurate when identifying emotions in infants. Higher scores for depression, total emotional dysregulation, and parenting stress. Lower perception of their own parenting competence
Feldman et al17 (4+. Mean age approx. 11 years)914 mothers with other personality disorders2123 from mothers with other personality disordersDIB-RFTRI, FES, and FSS3.8Mothers with BPD scored significantly lower than control mothers on measures of cohesion and organisation, and had lower satisfaction with their families. Children of mothers with BPD were exposed to more parental suicide attempts and reported low levels of familial satisfaction, independence and expressiveness
Gratz et al14 (12–23 months)23782378DIB-R, BESTInfant behaviours and the strange situation scenario were videotaped and coded using the AFFEX coding system, alongside using DERS, AIM, DASS4.4More depressive symptoms in mothers with BPD. Higher levels of maternal intensity and reactivity, found in those with BPD, were linked with lower self-focused emotion regulation, blunted fear and more anger in their infants
Herr et al29 (15 years)70461354 with either MDD, Depressive Disorder, or both70461354 from mothers with either MDD, Depressive Disorder, or bothSCID-IIKSADS-E, BDI, YCS, SPPA, Teacher Report of Youth Interpersonal Functioning, Bartholomew Attachment Prototypes Questionnaire, PPQ4.2Children 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 al21 (12 months)10221022SCID-IIRated interactions using the global ratings for mother-infant interactions (Murray et al, 1996)4.4Mothers with BPD were found to be more intrusively insensitive. Infants whose mothers had BPD displayed less availability for positive engagement, lower behavioural organisation and mood state, and they gave fewer positive looks to a stranger
Hobson et al23 (Unclear. Circa 1–2 years; average age 69 weeks)133115 mothers with depression133115 from mothers with depressionSCID-IIAMBIANCE4Mothers with BPD were more likely to have disrupted affective communication with their infants. Showed more disorientation and fear during infants’ attachment bids
Kiel et al22 (12–23 months)22772277BESTDERS, DASS, maternal affective and behavioural expressions were coded4Mothers with BPD had more emotion dysregulation. Took longer time to display positive affect in response to infant distress. Mothers with BPD were more likely to respond insensitively when infant distress continued
Macfie and Swan31 (4–7 years)3030SCID-IIPPVT-III, ASCT, the MacArthur Story Stem Battery, coded using the same systems as Macfie et al394.4Children 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 al13 (mean 16 months)14201420Independent clinical diagnosis of BPD, meeting DSM-IV criteria for BPD, and DIB-RVideo interactions coded using EA scales4Mothers with BPD 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 al16 (39–61 months)20192019Mothers needed to attract a BPD diagnosis on at least one of two administrations of SCID-IIMothers given BDI, Meins and Fernyhough's (2010) brief interview measure for mind-mindedness. Children given SCQ, BPVS-II, false-belief tasks, affective-labelling task, and a modified version of the causes of emotions interview4.2Mothers with BPD were more likely to report depressive symptoms. They also used significantly fewer mind-related comments to describe their children. Children of 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 al33 (4+. Mean approximately 11 years)914 mothers with other personality disorders2123 from mothers with other personality disordersDIB-RFTRI, KSADS-E, CGAS and CDIB4Children of mothers with BPD had significantly more general psychopathology. Both groups had history of trauma
White et al18 (c. 3 months)172525 mothers with MDD and 20 mothers with BPD comorbid with MDD172525 from mothers with MDD, 20 from mothers with comorbid MDD and BPDSCID-IV and DIB-RBDI and BAI. Videotaped interactions coded using the Interaction Rating Scale. Children given the IBQ-R4.2Women 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
  • AAI, Adult Attachment Interview; AFFEX, System for Identifying Affect Expression by Holistic Judgement; AIM, Affect Intensity Measure; AMBIANCE, Atypical Maternal Behaviour Instrument for Assessment and Classification; ASCT, Attachment Story Completion Task; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; BEST, Borderline Evaluation of Severity over Time; BPD, borderline personality disorder; BPVS-II, British Picture Vocabulary Scale II; CASQ, Children's Attributional Style Questionnaire; CBCL, Child Behaviour Checklist; CDAS-R, Children's Dysfunctional Attitudes Scale-Revised; CDEQ, Children's Depressive Experiences Questionnaire; CDIB, Child Diagnostic Interview for Borderlines; CGAS, Child Global Assessment Schedule; CRSQ, Children's Response Style Questionnaire; CTQ, Childhood Trauma Questionnaire; CTQ, Childhood Trauma Questionnaire; DASS, Depression, Anxiety, Stress Scales; DERS, Difficulties in Emotion Regulation Scale; DIB-R, Revised Diagnostic Interview for Borderlines; DSM, Diagnostic and Statistical Manual of Mental Disorders; EA, Emotional Availability Scales; ECRS, Experiences in Close Relationships Scale; EMBU, Swedish acronym for Own Memories Concerning Upbringing; EPDS, Edinburgh Postnatal Depression Scale; FES, Family Environment Scale; FSS, Family Satisfaction Scale; FTRI, Family Trauma and Resilience Interview; IBQ-R, Infant Behaviour Questionnaire, Revised; IPPA, Inventory of Parent and Peer Attachment; K-SADS, Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children; KSADS-E, Kiddie Schedule for Affective Disorders and Schizophrenia-Episodic Version; MMD, major depressive disorder; PACOTIS, Parental Cognitions and Conduct Toward the Infant Scale; PPQ, Perceived Parenting Quality Questionnaire; PD, personality disorder; PPVT-III, Peabody Picture Vocabulary Test, Third Edition; PSI-SF, Parenting Stress Index Short Form; RSSC, Reassurance-Seeking Scale for Children; SCID-II, Structured Clinical Interview for DSM-IV; SCL-90-R, Symptom Checklist 90 Revised; SCQ, Social Communication Questionnaire; SEQ, Children's Self-Esteem Questionnaire; SIDP-IV, Structured Interview for DSM-IV Personality; SPPA, Self-Perception Profile for Adolescents; SSAGA, Semi-Structured Assessment for the Genetics of Alcoholism; TCI, Temperament and Character Inventory; YCS, Youth Chronic Stress Interview; YSR, Youth Self-Report.