Academic journal article American Journal of Psychotherapy

The Borderline Mother and Her Child: A Couple at Risk

Academic journal article American Journal of Psychotherapy

The Borderline Mother and Her Child: A Couple at Risk

Article excerpt

The child whose mother is diagnosed with borderline personality disorder (BPD) is at risk for developing this disorder. The mother with BPD may be limited in her ability to negotiate a secure attachment with her baby. Mothers with BPD may have difficulties with bonding, internalization, affect attunement, and attachment. Because it is through mirroring and mentalization that a child can learn emotional regulation and master the early stages of development, the child may fail to develop object constancy and master the tasks of separation and individuation.

The authors present two cases of patients with BPD. The first case is of a patient with BPD who, after surrendering custody of her two children to their father, participated in weekly Dynamic Deconstructive Psychotherapy sessions for two years. The second case is a mother with BPD who presents for dyadic therapy with her three-month-old daughter.

In each case the mother developed insight regarding her relationship with her mother and how that relationship affected the relationship with her own child. The author concludes that psychiatry should consider prepartum screening for BPD and if necessary, early dyadic intervention.

KEYWORDS: borderline personality disorder; mother-child relations; mother-child communication; psychotherapy; mentalization

INTRODUCTION

The child of a mother diagnosed with borderline personality disorder (BPD) is at risk for developing this personality disorder (Zanarini, Frankenburg, Yong, Raviola, Reich et al, 2004; Feldman, Zelkowitz, Weiss, Vogel, Heyman & Paris, 1995; Gerull, Meares, Stevenson, Körner & Newman, 2008; Herr, Hammen & Brennan, 2008). The mother with BPD may be limited in her ability to negotiate successfully a secure attachment with her baby. In addition, the environment may not be supportive, since BPD traits are found more commonly in relatives of individuals with BPD (New, Hazlett, Buchsbaum, Goodman, Mitelman, et al. 2007; Kendle, Aggen, Czajkowski, Roysamb, Tambs et al., 2008; Siever, 2005; Torgensen, 2009). Psychiatrists should consider the ability of their pregnant patients who have BPD to meet the demands of being a mother.

Unfortunately, most women with BPD entering treatment do not discuss difficulties they may be having with their infant interactions, and may lack insight into those issues. Problematic maternal-infant interactions have been observed in mothers with postpartum depression (Barker, 2012; Rishel, 2012). Studying the psychodynamic underpinnings of a mother with a dysfunctional internalized object as she is transitioning to motherhood may positively impact her role as a maternal object. The clinician can intervene with early education and referrals to maternal child programs.

The author presents two cases of patients with BPD who underwent weekly Dynamic Deconstructive Psychotherapy (DDP). This treatment helps to connect patients to their experiences, to enhance authentic relatedness, and to remediate neurocognitive deficits in emotion processing (Gregory & Remen, 2008). It has been shown to improve symptoms and social interactions among individuals with BPD and concomitant alcohol use disorders (Gregory, Delucia-Deranja, & Mogie, 2010).

The first case presents a mother who received DDP treatment for two years after she surrendered custody of her two children to their father. During treatment the patient developed insights regarding her relationships both with her mother and her children, and how the former influenced the latter, including how she functioned as a mother. The second case describes a mother who presents for dyadic therapy with her three-month-old daughter. The patient had been receiving DDP therapy for one and a half years and welcomed parent-child intervention.

CASE I.

Beth entered therapy at the age of 24 years following multiple serious suicide attempts, chronic self-injurious behaviors, and a psychiatric history that included years of therapy for bipolar disorder, posttraumatic stress disorder (PTSD), dissociative identity disorder, and BPD. …

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