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

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.

A New Therapeutic Group To Help Women With Borderline Personality Disorder and Their Infants.

OBJECTIVES: Few treatments have been described to treat the population of women with borderline personality structure who present in a dysregulated state with their infants. Therefore, a new treatment program was developed for this target group. METHODS: A total of 45 women, who were identified clinically as meeting full or partial diagnostic criteria for borderline personality disorder (BPD) and having an infant younger than 3 years of age, were offered entry with their infant(s) into specialized dialectical behavior therapy groups, adapted to focus on parenting and the mother-infant relationship. Outcomes measured included maternal mood and anxiety, BPD functioning, parenting sense of competence, parental reflective functioning, and caregiver-infant interaction (CARE Index). Infants received high-quality child care while mothers attended each group, with dyadic reunions a further therapeutic focus each week. RESULTS: A total of 29 women who met clinical or self-report measures for BPD and were offered group therapy began the program, 21 (72%) of whom completed the 24-week group program, with complete premeasures and postmeasures available for 20 dyads. Of the 20 women, 15 met full diagnostic criteria for BPD and 5 met partial criteria. Significant improvements were noted in maternal mood, with positive changes on 2 subscales of the Parental Reflective Function Questionnaire (prementalizing and increased curiosity in mental states); significant reductions in anxiety and BPD symptomatology were also observed. Only a medium effect size was found for parenting sense of competence, and in smaller numbers of participants as this scale was introduced later. It should particularly be noted that 15 dyads showed substantial change on the CARE Index, indicating improvement in dyadic relationships. CONCLUSIONS: This innovative adaptation of mother-infant dialectical behavior therapy showed promising improvements in maternal BPD symptoms and caregiver-infant relationships. Given that the feasibility and safety of this method have been demonstrated, a more methodologically rigorous trial with further refinements appears warranted to help this troubled cohort of patients.

Infants of emotionally dysregulated or borderline personality disordered mothers: Issues and management in primary care

BACKGROUND: Knowledge has increased regarding the developmental needs and capabilities of infants, and parental behaviours that support optimum infant development. Despite a better understanding of the emotional dysregulation in borderline personality disorder (BPD) and its effects on infants, general practitioners have had few guidelines for how to recognise and help emotionally dysregulated mother-infant dyads. OBJECTIVE: This article focuses on the behaviours and needs of infants whose mothers have BPD, including knowledge and skills for primary care practitioners to help these troubled families. DISCUSSION: Understanding the adequacy of parenting and troubling infant signs, such as hypervigilance, can potentially lead to either more intervention in primary care, including support, reassurance, guidance regarding development and interaction, and enhanced family support or else specialist referral for enhanced infant care. Infants’ needs are urgent, and timely intervention can begin a better life trajectory for infant and mother.

Perinatal and infant mental health in Australia: moving forward towards REAL prevention and early intervention - can we do it?

OBJECTIVES: Australia has been at the forefront of appropriate early intervention. Prevention of mental illness in infants by early identification and intervention in the mental health of their mothers has stalled since the cessation of funding through the National Perinatal Depression Initiative (NPDI, 2009-2015). Whilst screening for maternal mental illness has been widely implemented throughout Australia during the last two decades, services are now diminishing and great opportunities to ride the crest of a wave for appropriate mental illness intervention are receding. Reviews of history and interventions internationally may help guide future directions. CONCLUSIONS: Advocacy through across-agency and across-political-party support has been markedly successful for perinatal and infant mental health in the United Kingdom. A solid foundation exists in Australia. Australian psychiatrists have the ability to continue to change the face of prevention and early intervention.