Mothers with borderline personality disorder (BPD) and their infants often have compromised relationships. To further understand the complexities, this study explored (a) the experiences of mothers with BPD in response to infant crying and (b) how these parenting responses impact on mothers’ interpersonal functioning with significant others. Six mothers with clinical BPD were recruited from a mother–baby psychiatric unit and interviewed using an interpretative phenomenological analysis (IPA) approach. Transcripts of the semistructured interviews were coded for themes and subthemes. Dominant themes revealed that mothers with BPD entered motherhood in a psychologically fragile state, hypersensitive to experiencing intense physiological–emotional pain and cognitive chaos in response to infant crying. Automatic maladaptive flight–fright responses including suicide attempts were common. A novel theme revealed some mothers’ split identity, and only the “mother” part could attend to infant crying. Finally, the data provided an understanding of the detrimental domino effect on close family. Mothers also highlighted gaps in accessibility of current mental health services and parenting programs, and their desire to prevent the intergenerational transmission of attachment problems and BPD symptoms to offspring. Clinical implications include antenatal BPD screening, psychoeducation about infant crying, and greater access for programs supporting the whole family to improve outcomes.

RESUMEN

Las madres con el Trastorno Limítrofe de la Personalidad (TLP) y sus infantes a menudo presentan relaciones puestas en peligro. Para comprender más las complejidades, este estudio exploró: I) las experiencias de madres con TLP en respuesta al llanto del infante; y II) cómo estas respuestas de crianza tienen impacto sobre el funcionamiento interpersonal de las madres con sus parejas. Se reclutaron seis madres con TLP clínico en una unidad siquiátrica de mamá-bebé y se les entrevistó usando el acercamiento del Análisis Fenomenológico Interpretativo (IPA). Las transcripciones de las semiestructuradas entrevistas fueron codificadas por temas y sub-temas. Los temas dominantes revelaron que las madres con TLP entraron a la maternidad en un estado sicológicamente frágil, hipersensibles a experimentar intenso dolor fisiológico-emocional y caos cognitivo como respuesta al llanto del infante. Fueron comunes las respuestas automáticas inapropiadas de defensa o escape, incluyendo el intento de suicidio. Un tema nuevo reveló la dividida identidad de algunas madres, y sólo la parte de ‘madre’ pudo atender el llanto del infante. Finalmente, la información suministró una comprensión del perjudicial efecto dominó sobre la familia cercana. Las madres también subrayaron vacíos en la accesibilidad a actuales servicios de salud mental y programas de crianza, así como su deseo de prevenir la transmisión intergeneracional de problemas de afectividad y síntomas de TLP a su niño. Entre las implicaciones clínicas se incluyen el examen antenatal para detectar la presencia de TLP, la educación sicológica sobre el llanto del infante, así como el mayor acceso a programas que apoyan a toda la familia para mejorar los resultados.

RÉSUMÉ

Les mères ayant un Trouble de la personnalité limite (TBL) et leurs nourrissons ont souvent des relations compromises. Afin de mieux comprendre toutes les complexités se présentant, cette étude a exploré : (1) les expériences des mères ayant un TBL par rapport aux pleurs du nourrisson ; et II) comment ces réactions de parentage impact le fonctionnement interpersonnel des mères avec leurs partenaires ou proches. Six mères ayant un TBL clinique ont été recrutées dans une unité psychiatrique mère-bébé et interviewées en utilisant une approche d'Analyse Interprétative Phénoménologique (AIP). Les retranscriptions des entretiens semi-structurés ont été codés pour les thèmes et les sous-thèmes. Les thèmes dominants ont révélé que les mères avec le TBL entraient dans la maternité avec un état psychologique fragile, hypersensible à l'expérience de la douleur physiologique-émotionnelle intense et au chaos cognitif en réaction aux pleurs du bébé. Des réactions automatiques de peur inadaptée, y compris des tentatives de suicide, ont été communes. Un nouveau thème a révélé l'identité éclatée de certaines mères et seule la partie « mère » pouvait prendre soin du nourrisson pleurant. Enfin, les données ont offert une compréhension de l'effet domino néfaste de la famille proche. Les mères ont aussi mis en évidence les fossés dans l'accessibilité aux services de santé mentale en place et aux programmes de parentage, et leur désir de prévenir la transmission intergénérationnelle de problèmes d'attachement et de symptômes de TBL à leurs enfants. Les implications cliniques incluent un dépistage de TBL avant la naissance, une psychoéducation sur les pleurs du nourrisson, et un accès plus grand aux programmes soutenant toute la famille afin d'améliorer les résultats.

ZUSAMMENFASSUNG

Mütter mit Borderline-Persönlichkeitsstörung (BPD) und ihre Säuglinge haben oft beeinträchtigte Beziehungen. Um die Komplexitäten weiter zu verstehen, untersuchte diese Studie: I) die Erfahrungen von Müttern mit BPD bezüglich ihrer Reaktion auf das Schreien von Säuglingen; und II) wie sich diese elterlichen Reaktionen auf die interpersonellen Fertigkeiten der Mütter mit bedeutenden Anderen auswirken. Sechs Mütter mit klinischer BPD wurden aus einer psychiatrischen Mutter-Baby-Einheit rekrutiert und nach dem Prinzip der „Interpretativen Phänomenologischen Analyse“ (IPA) befragt. Die Transkriptionen der halbstrukturierten Interviews wurden für Themen und Unterthemen kodiert. Dominante Themen offenbarten, dass Mütter mit BPD in einem psychisch fragilen Zustand ins Muttersein eintraten, überempfindlich gegenüber intensiven physiologisch-emotionalen Schmerzen waren und auf das Schreien von Säuglingen mit kognitivem Chaos reagierten. Automatische maladaptive Flucht- und Angstreaktionen, einschließlich Selbstmordversuche, waren verbreitet. Ein neuartiges Thema enthüllte, dass einige Mütter ihre Identität spalteten und nur der “Mutter”-Anteil sich dem Schreien des Säuglings widmen konnte. Schlussendlich trugen die Daten zum Verständnis des schädlichen Dominoeffekts auf die nahe Familie bei. Die Mütter wiesen auch auf Lücken in der Zugänglichkeit der derzeitigen psychischen Gesundheitsdienste und Elternprogramme hin, sowie auf ihren Wunsch, die intergenerationale Übertragung von Bindungsproblemen und BPD-Symptomen auf ihre Nachkommen zu verhindern. Klinische Implikationen beinhalten BPD-Screenings vor der Geburt, Psychoedukation über das Schreien von Säuglingen und ein besserer Zugang zu Programmen, die zur Verbesserung der Ergebnisse die ganze Familie unterstützen.

抄録

乳幼児の泣き声が境界性パーソナリティ障害と診断された母親に及ぼす影響:質的研究

境界性パーソナリティ障害 (BPD) と診断された母親と乳幼児の関係性はしばしば損なわれる。その複雑さをよりよく理解するために、この研究は、 Ⅰ) 泣く乳幼児に対応する際の BPD の母親の経験、そして Ⅱ) この育児反応が、重要な他者との母親の対人関係機能にどのように影響を及ぼすか、について検討した。母親-乳児精神科病棟に入院している BPD と診断された 6 名の母親が集められ、解釈的現象学的分析 (IPA) を用いた面接を受けた。半構造化面接録音の文字起こしから主題と副題がコード化された。主な主題は、 BPD の母親は泣く乳幼児に反応し、過敏に強烈な生理的-情緒的な痛みと認知的混乱を経験し、脆弱な心理状態のまま母親になることを明らかにした。自殺企図を含む、逃げるか脅えるかの不適切な自動的反応が通常であった。新規の主題は、泣く乳幼児に対し自己同一性を分裂してしまう母親がいて、その場合は『母親』の部分だけでしか関われなかった。最後に、肉親への有害なドミノ効果がデータから理解できた。母親らは、現在のメンタルヘルスサービスや育児プログラムの利用しやすさにはいろいろなギャップがあること、そして愛着の問題や BPD 症状がわが子に世代間伝達することを防ぎたい願いをもつことも強調していた。本研究の臨床的示唆としては、 BPD 産前スクリーニング、乳幼児の泣き声に関する心理教育、そして家族全体を支援するプログラムをより受けやすくすることがよりよいアウトカムを導くことが含まれる。

摘要

嬰兒哭鬧對邊緣人格障礙母親的影響:定性研究

患有邊緣型人格障礙（BPD）的母親及嬰兒的關係經常受到損害。為了進一步了解其複雜性，本研究探討了: I） BPD 母親應對嬰兒哭鬧的經歷; 和 II）這些養育方式如何影響母親與重要他人的人際交往能力。六名患有臨床 BPD 的母親從醫院母嬰精神病科招募，並使用解釋性現象學分析方法（IPA）進行訪談。半結構化訪談的記錄被編碼為主題和子主題。主流主題顯示，患有 BPD 的母親在心理脆弱的狀態下成為母親，對於經歷強烈的生理 – 情緒痛苦和對嬰兒哭鬧的認知混亂過敏。自動及適應不良的處事驚嚇反應包括自殺企圖很常見。一個新穎的主題揭示了一些母親的分裂身份，只有 “母親” 部分可以照顧嬰兒哭泣。最後，數據提供對親密家庭的有害多米諾骨牌效應的理解。母親們還強調當前心理健康服務和育兒計劃可及性方面的差距，以及她們希望防止依附問題和 BPD 狀傳給後代。臨床意義包括產前 BPD 篩查丶關於嬰兒哭泣的心理教育丶以及更多使用支持整個家庭改善結果的方案。

ملخص

تاثير بكاء الرضع علي الأمهات المصابات باضطراب الشخصية الحديه: دراسة وصفية

الأمهات المصابات باضطراب الشخصية الحدية وأطفالهن غالبا ما تتكون لديهم علاقات معقدة. ولفهم التعقيدات بشكل أكبر ، تناولت هذه الدراسة: أولا) تجارب الأمهات المصابات باضطراب الشخصية الحدية (BPD) استجابه لبكاء الرضع ؛ وثانيا) كيف تؤثر هذه الاستجابات الوالديه علي أداء الأم التفاعلي مع شريك الحياة . اشترك في الدراسة ستة أمهات مصابات باضطراب الشخصية الحدية من وحده للعلاج النفسي للأم والطفل وأجريت مقابلات معهن باستخدام نهج التحليل الظواهري التفسيري (IPA). وتم استخراج المواضيع الأساسية والفرعية من تفريغ المقابلات الشخصية معهم. وأظهرت الموضوعات الرئيسية أن الأمهات المصابات باضطراب الشخصية الحدية (BPD) دخلن الامومه في حالة من الهشاشة النفسية ،مع شعور بالحساسية الشديدة تجاه التعرض للألم الفسيولوجي والعاطفي الشديد والتشتت الذهني استجابه لبكاء الرضع. وكان من ضمن الاستجابات التلقائية الغير تكيفية محاولات الانتحار. وكشف موضوع جديد عن ازدوادج الهوية لدى بعض الأمهات ، حيث يكون جانب ' الام ' فقط هو الذي يستجيب لبكاء الرضع. وأخيرا ، قدمت بيانات الدراسة فهما للأثر السلبي الضار أفراد الأسرة المقربين. كما سلطت الأمهات الضوء علي الثغرات في امكانيه الوصول إلى خدمات الصحة النفسية الحالية وبرامج الرعاية الوالدية ، ورغبتهن في منع انتقال مشاكل التعلق عبر الأجيال واعراض اضطراب الشخصية الحدية إلى الأولاد. وتشمل التطبيقات الاكلينيكية فحص (BPD) قبل الولادة ، والتثقيف النفسي حول بكاء الرضع ، وزيادة الوصول إلى البرامج التي تدعم الاسره بأكملها لتحسين النتائج.

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare.

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May/June 2019

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Impact of infant crying on mothers with a diagnosis of borderline personality disorder: A qualitative study

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Impact of infant crying on mothers with a diagnosis of borderline personality disorder: A qualitative study

ABSTRACT

RESUMEN

RÉSUMÉ

ZUSAMMENFASSUNG

抄録

摘要

ملخص

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

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