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.

Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder.

A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.

Treatment of postpartum psychosis in a mother-baby unit: do both mother and baby benefit?

OBJECTIVES: To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia. METHODS: A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted. RESULTS: A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge. CONCLUSIONS: The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.

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.

Clinical characteristics and mental health outcomes for women admitted to an Australian Mother-Baby Unit: a focus on borderline personality disorder and emotional dysregulation?

OBJECTIVE: To describe the clinical population of women admitted to a Mother-Baby Unit in Adelaide, South Australia and to evaluate changes during admission in both Axes I and II diagnoses of maternal mental health, and in mother-infant relationships. METHOD: Both clinical and self-report assessments of maternal mental health were made at admission and discharge, and self-report comparisons of the mother-infant relationship. RESULTS: Depressive illnesses (46.2%) were found to be the most prevalent conditions leading to admission, with rates of psychosis (10.3%) and bipolar disorder (3.4%) being lower. A high incidence of borderline personality disorder (23.1%) was found clinically, with almost half the admitted women showing features of borderline personality disorder on a self-report measure at admission. Significant improvements in maternal mental health and the mother-infant relationship were found at the time of discharge. CONCLUSIONS: Admission to this Mother-Baby Unit on mothers' self-report scales showed improvement in mothers' mental health and the relationship that they have with their infant. Given the high prevalence of borderline personality disorder and emotional dysregulation identified within the population, treatment implications and possible consequences for the infant are discussed for this client group.