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Helping mothers with borderline personality disorder urgent task: Review

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Many people with borderline personality disorder (BPD) are self-focused, meaning that instead of concentrating on their child’s needs, the situation can become about them.
 
In a clinical review, ‘Infants of emotionally dysregulated or borderline personality disordered mothers: Issues and management in primary care’ published in the April edition of the Australian Journal of General Practice (AJGP), Dr Gisèle Apter and her co-author, Dr Anne Sved Williams, point out that the needs of infants born to BPD mothers are both understudied and urgent – particularly since more than more than 1.4 million Australians have BPD.
 
‘Mothers with BPD show differences in parenting style from birth onwards, and their infants show the effects of these differences,’ Dr Apter said.
 
Existing evidence shows that infants born to mothers with BPD are more likely to experience issues of mental illness and signs of BPD themselves, according to Dr Apter. By the time they are a year old – when their attachment to caregivers can be properly measured – these infants show more difficulty dealing with their distress after being separated from their mother.
 
Perinatal mental health clinicians have reported that infants of BPD mothers may appear hypervigilant or stressed.
 
‘The infant may be “glued” to the mother’s face, while the mother glances back and forth. The infant seems to be attempting regulation of the mother rather than vice versa,’ the authors of the AJGP clinical review state.
 
‘When a mother is overwhelmed by her own emotions, her focus is herself and her inner turmoil. Many women with BPD describe painful memories of how they were parented, leaving them without clear templates of how to optimally parent their own infant.’
 
Dr Apter said care from healthcare professionals was vital.
 
‘Maternal BPD through an infant’s eyes could be experienced as confusing and frightening, or stifling,’ she said. ‘Timely intervention can begin a better life trajectory for both the infant and mother.’
 
So how can GPs provide that intervention?
 
Dr Apter said key early roles include to physically examine the infant at its developmental milestones, watch for age-appropriate play, and make sure the mother’s expectations are appropriate for the infant’s age.
 
Dr Apter suggested the following over the longer term dealing with mother–infant dyads:

• Ensure a focus on both mother and infant perspectives.
• Ensure appropriate physical and emotional infant development. Use developmental and interactional guidance when parenting is ‘good enough’.
• Use a strengths-based approach to address maternal problems of emotional dysregulation openly and with understanding, and validating the mother's concerns. Focus on what the mother already does well.
• Involve other family members. Paid childcare may help.
• Refer mother and infant to normal parenting services, and local mental health practitioners. Two-way communication with other services is important.
• Consider specialised mother–infant services.
• Involve child protection services when necessary.

The AJGP clinical review also found a surprising lack of clinical evidence, given the prevalence of the disorder.
 
Professor Tania Winzenberg, Chair of the RACGP Expert Committee – Research (REC–R), said more research is needed on mothers with BPD and their infants to support the development of guidelines for GPs to recognise and support emotionally dysregulated mother–infant relationships.
 
‘With approximately 6% of Australia’s population experiencing BPD, it is clearly important that GPs have access to evidence from high quality research to assist them in caring for families facing challenges from BPD,’ she said.

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ajgp australian-journal-of-general-practice borderline-personality-disorder

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