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Mothers with borderline personality disorder : parenting knowledge, perceptions, and emotional availability
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Eyden, Julie (2021) Mothers with borderline personality disorder : parenting knowledge, perceptions, and emotional availability. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3781067
Abstract
The impact of parenting on child development, and the association between parenting and mental health are widely acknowledged. Borderline personality disorder (BPD) is a particularly complex mental health disorder which affects emotion, relationship, and identity stability. The dysregulation and impulsivity experienced by individuals with BPD has far-reaching implications in parenthood; if one struggles to manage their own emotions, how difficult might it be to help an infant to regulate their behaviours? This thesis aimed to explore the parenting perceptions, parenting knowledge, and observed behaviours of mothers with BPD and their children.
Study one systematically reviewed all published studies pertaining to maternal BPD, following PRISMA reporting guidelines. Mothers with BPD were more likely to have insensitive, overprotective, and hostile parenting behaviours with their offspring compared to those without BPD. Their children had a number of adverse outcomes including BPD symptoms and insecure attachment patterns. Findings suggest maladaptive parenting is one potential pathway by which vulnerability may be transmitted from mother to child. For the empirical research, maternal parenting knowledge, parenting self-efficacy, and emotional availability (EA) were explored using questionnaires, Q-sort task, and observational methods (STROBE guidelines followed). Twenty-six mothers with BPD were compared to 25 clinical comparison (depression), and 25 healthy comparison (no mental health difficulty) mothers, with analysis at both a categorical (diagnostic) and dimensional (severity) level.
Study two found mothers with BPD had the same level of ideal sensitive parenting knowledge as mothers with depression and mothers with no mental health difficulties. Parenting self-efficacy was lower for mothers with BPD and depression compared with healthy comparison mothers and was strongly associated with severity of symptoms. Mothers with BPD know how to parent but thought they were not parenting well. In study three, observations of mothers interacting with their child confirmed this; mothers with BPD were less sensitive, less structuring, more intrusive, and more hostile than healthy comparison mothers, and were more likely to be categorised as complicated EA (inconsistent and ‘apparent’ sensitivity). Except for losing composure under stress, further analyses of the EA subscales revealed their maladaptive behaviours appeared to be largely well-intentioned but misguided. Children of mothers with BPD also had EA difficulties with responsiveness and involvement, and were more often categorised as complicated, detached, or problematic EA. Symptom severity was associated with maternal EA difficulties; parenting knowledge was also associated with intrusiveness and hostility. Child EA difficulties, however, were most strongly associated with maternal sensitivity over and above that of mother’s mental health difficulties. Multi-method coding highlighted the benefit of using a global assessment for clinical groups.
There are several implications for clinical intervention including improving maternal symptoms, perceived parenting efficacy, and maternal sensitivity. Parenting psychoeducation may help with reducing intrusive and hostile behaviours but may not be sufficient for sensitivity and structuring. Maternal sensitivity should be a key focus for intervention as findings suggest regardless of diagnosis, sensitivity may be important for improving child EA. Research to further understand why knowledge does not directly transfer to parenting behaviours is warranted.
Item Type: | Thesis (PhD) | ||||
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Subjects: | B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HQ The family. Marriage. Woman R Medicine > RC Internal medicine |
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Library of Congress Subject Headings (LCSH): | Borderline personality disorder, Borderline personality disorder -- Patients -- Family relationships, Mothers -- Mental health, Parent and child, Parenting -- Psychological aspects | ||||
Official Date: | September 2021 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Department of Psychology | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | MacCallum, Fiona | ||||
Format of File: | |||||
Extent: | 391 leaves : illustrations, charts | ||||
Language: | eng |
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