Borderline Personality Disorder (BPD) diagnosis has been associated with challenges in parenting and parents with this diagnosis may be overrepresented in coming to the attention of children’s social care services. However, little is known about these parents’ perspectives on parenthood. In this study, we, therefore, explored in depth the parenting experiences of eight mothers who had been given a BPD diagnosis and had young children. Semi-structured interviews were conducted with eight mothers and analysed using Interpretative Phenomenological Analysis (IPA). All mothers described experiences of early adversity and trauma which left them lacking positive parental role models and grappling with a desire to give their children a better start in life than their own. They felt isolated in their parenting role and described negative intrusive thoughts, along with intense anxieties about bad things happening to them or their children. This contributed to feeling overprotective of their children, seeking close physical proximity with them, and experiencing difficulties setting boundaries. Several experienced ambivalent feelings towards their children, yet they often found comfort in the developing bond with their child and enjoyed playful interactions together. This research highlights the impact of early adversity and trauma on mothers’ experiences of parenting. We suggest that mothers with BPD diagnoses and children’s social care involvement face many challenges in their parenting role. Services need to consider how best they can support this population in a trauma-informed way, especially as the risk of child removal may exacerbate parents’ anxieties and distress.
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Borderline Personality Disorder (BPD) has been defined as being characterised by difficulties in behaviour and emotion processing and regulation (APA, 2013). Features of BPD are said to include unstable interpersonal relationships, mood instability, engaging in self-defeating behaviours that impair social functioning, and extremes of idealisation and devaluation of others (APA, 2013). Although the use of BPD as a diagnosis is contested, with concerns it is associated with stigmatising attitudes amongst healthcare providers, inequitable access to services, and a lack of therapeutic optimism (Sheridan-Rains et al., 2021; Troup et al., 2022), it remains widely used in adult mental health services, including those for parents where there is a risk of a child being removed from their care.
Fonagy et al. (2017) emphasise the role of a child’s early relationships with their primary caregivers in the aetiology of BPD. According to their model, the child comes to experience difficulties understanding their own and others’ emotional states in later life, because their primary caregivers could not understand the child’s own emotional states early on in life. Other researchers have associated BPD with adverse childhood experiences including trauma, abuse and neglect (Bradley et al., 2005; Ball & Links, 2009; Porter et al., 2019). The suggestion is that parents with a BPD diagnosis are more likely themselves to enter parenthood with a complex history of adversity, a lack of an internal safe parental model, and resultant difficulties coping with parenthood (Newman & Stevenson, 2005).
Most research has focused exclusively on mothers with this diagnosis, and findings—primarily from quantitative studies—have associated BPD with reduced maternal sensitivity, increased intrusivity, overprotection, lower parental ‘competence’, disrupted mother-child attachment and adverse developmental outcomes for children (Newman et al., 2007). It has been found that mothers with a personality disorder diagnosis are more likely to come to the attention of child protection services and to face custody loss (Neuman, 2012; Howard et al., 2003), though this may also reflect the stigmatised nature of the diagnosis.
Overall, despite the considerable research into the aetiology of BPD and adverse child and adult outcomes associated with this diagnosis, little research has focused on experiences of parenting among individuals with a BPD diagnosis. A few quantitative studies have found that mothers with a BPD diagnosis self-report lower satisfaction and increased stress in their parenting roles, difficulties in the parent-child relationship, and poorer mental health (Petfield et al., 2015; Eyden et al., 2016; Stepp et al., 2016; Boucher et al., 2017; Steele et al., 2020). While, these studies provide important insights, the use of questionnaires and self-report data do not provide as rich a source of information of parenting experiences as qualitative studies could.
Only a handful of studies have so far sought to understand how parents with BPD diagnoses understand and represent their own experiences using qualitative methodologies. Bartsch et al. (2016) used thematic analysis to explore perceptions of parenting among eleven mothers and one father with a past or present BPD diagnosis. They found that parenthood was experienced as both challenging and rewarding. In some cases, they identified similar themes to studies among parents with other severe mental health disorders, for example fear of being stigmatised and fear of losing custody of their children. However, parents with BPD diagnoses also described finding it difficult to maintain a stable environment, being physically and emotionally unavailable because of their own difficulties, struggling to connect and attach emotionally to their children and struggling to engage in play or child-centred activities. Some parents also reported intrusive and fearful thoughts of harming their children due to experiencing volatile and aggressive emotional states. On the other hand, parents also reported rewarding experiences in their relationships with their children. Some described how their relationship with their child gave them meaning and a purpose in life, and how their child’s unconditional love meant everything to them. This strong feeling of having a purpose encouraged them to feel that they needed to teach and guide their children. Finally, Bartsch et al. (2016) identified that cultural ideas of how parents should be to be accepted as “good” parents significantly affected the experiences of parents with a BPD diagnosis, as they felt inadequate and different from what society wanted them to be, which often led to them feeling judged by professionals and hindered their sense of self as parents. Based on interviews with 12 parents with a BPD diagnosis, Dunn et al. (2020) echoed many of Bartsch et al. (2016)’s findings. They identified that parents experienced stress and anxiety which impacted their emotional states. They often felt isolated and had a lack of internal positive parental models to draw upon in their own parenting.
Geerling et al. (2019) explored qualitatively the impact of infant crying on mothers diagnosed with BPD using semi-structured interviews and interpretative phenomenological analysis (IPA). They found that mothers with BPD diagnoses entered parenthood in a psychologically fragile state and that infant crying was experienced in a ‘hypersensitive’ way, creating physiological-emotional pain and cognitive ‘chaos’. Their responses often suggested they were in flight-fight mode, including suicide attempts. Some mothers were seen to have what the researchers called ‘split identity’ where they could attend partially to the crying, but their ‘inattentive’ part was not able to cope with the crying.
The above studies give noteworthy insights to the experiences of parents with BPD diagnoses or traits. However, to date no studies have focused specifically on the experiences of parents with children in the first years of life, even though it is increasingly recognised that the this is a critical period, when the foundations of future development are laid (Parliament, House of Commons Report, 2019). There has also been little research focused on the experiences of mothers with BPD diagnoses and have social care involvement even though, as outlined, these parents are overrepresented in the children’s social care system (Neuman, 2012). Understanding more about the needs of mothers’ parenting in this context of vulnerability can provide important insights into the experiences of a group of parents rarely included in research. It can give voice to mothers who typically may be stigmatised and unheard, helping understand their needs to help improve outcomes.
The aim of the present study was therefore to understand the experiences of mothers with BPD diagnoses of caring for a child under three on the edge of care.
Methods
Study Design
This study used qualitative methods, appropriate for understanding and exploring subjective experiences from the individual’s perspective. The qualitative methodology facilitated the in-depth exploration of parenting experiences amongst mothers with a BPD diagnosis, who had been referred to a specialist parenting programme to help reduce the risk of their child being taken into care.
Wider Context and Setting
This study was conducted as part of a wider evaluation of a specialist mentalization-based intervention within a therapeutic community setting, which ran from 2011 to 2020. Daum and Labuschagne (2018) described this intervention in further detail, though findings from the wider evaluation have not currently been published. The overall aim of the intervention was to enable parents who were referred by social services because of significant child protection concerns, to care for their children safely if possible, and to inform decision-making around whether the child could remain in the parent’s custody. As part of the wider evaluation, a range of qualitative and quantitative data were collected routinely and systematically at key timepoints during the intervention (Fig. 1).
Ethics approval for the wider evaluation was obtained from the University College London ethics committee (6821/001). Mothers gave written consent for the data to be gathered and analysed for research purposes. Participation was voluntary, and all mothers were informed of their right not to participate or to withdraw without any negative consequences.
Participants
For this study, eight mothers were included from the wider pool of parents enrolled in the programme. To access the intervention, mothers had to be over 18 years of age and have a child under 5 about whom there were significant child protection concerns. They could have a range of mental health diagnoses or none, but many parents in the intervention group had received a diagnosis of Personality Disorder (PD). To ensure balance, we purposively sampled mothers who had a completed, transcribed PDI and for whom relevant demographic data was complete. These mothers had joined the intervention at different time points but were included because they had all been given a main Personality (PD) diagnosis (n = 6) or an additional (secondary) Personality diagnosis (n = 2) of BPD and had transcribed interviews at baseline (i.e. before the start of the intervention). BPD diagnosis was based on therapists’/clinicians’ ratings, using the Shedler-Westen Assessment Procedure (SWAP, Shedler and Westen, 2007).
As shown in Table 1, mothers’ average age was 32, ranging from 21 to 47. Two of the mothers were of Black African ethnicity, five mothers were of Mixed White/Black Caribbean and one mother was White British. Each mother was referred by social services and their children (aged 0–3 years, 4 boys and 4 girls) were at the edge of care. Six of the mothers were single and 2 were in relationships, and all had children under the age of 3. All mothers were given pseudonyms to preserve confidentiality.
Table 1
Characteristics of mothers with a diagnosis of BPD and their children
Name
Ethnicity
Main or Additional BPD diagnosis
Alisha
Black African
Main
Jasmine
Mixed White/Black Caribbean
Main
Kimberley
Mixed White/Black Caribbean
Main
Margaret
Mixed White/Black Caribbean
Main
Nora
Black African
Main
Ruby
White British
Main
Violet
Mixed White/Black African
Additional
Anna
Mixed Black African/White Other
Additional
Data collection
Semi-structured interviews were gathered at the beginning, middle and end of the intervention. However, for the purpose of this study the focus was only on the baseline Parent Development Interview (PDI) collected before starting the programme, as the focus was on understanding the experiences of parents rather than the impact of the intervention.
The Parent Development Interview—Revised (PDI-R, Slade et al., 2004) is a semi-structured interview that assesses the parent-child relationship from the parent’s perspective focusing on their representational internal model and how they experience their child. It is usually used to quantitatively measure ‘reflective functioning’ (the capacity to understand ourselves and others in terms of intentional mental states) of parents. This is accomplished by using a mixture of ‘demand’ and ‘permit’ questions. Demand questions ask the participants to demonstrate their capacity for reflective functioning (for example, “describe a time in the last week when you and (your child) really weren’t ‘clicking’”). Permit questions (for example, “how do you think your relationship with your child is affecting his/her development or personality”) allows them to expand on the issues. Although the PDI is often coded quantitatively, it collects rich data from parents suitable for qualitative analysis. The current study explored parents’ responses to questions on the PDI to allow for in-depth understanding of experiences of parenting. Interviews were carried out by researchers working on the wider evaluation project or by clinicians and lasted roughly an hour.
Analysis
The interviews were audio-taped, then transcribed verbatim and prepared for data analysis. Interviews were de-identified to protect confidentiality. Interpretative Phenomenological Analysis (IPA; Smith et al., 2009) was utilised as it is explicitly idiographic and closely examines details of personal experiences which are emotionally laden. This qualitative approach provided the opportunity to explore in depth how parents perceive and make sense of the phenomenon of parenting and caring for their under-3 children, in the context of their child being identified as at risk of being removed from their care. IPA involves closely reading of each transcript to immersing oneself in the data (Smith et al., 2009). The researcher first examines the data of each individual initially in a descriptive way, mapping the participants’ use of words and their answers to specific questions. The next step involves seeking to understand the emotional meaning within participants’ words and developing early themes. In the final stage, the researcher considers relationships between themes, both within interviews and then across the dataset as a whole.
As this research was conducted as part of a Doctorate in Child and Adolescent Psychoanalytic Psychotherapy, the first author recognises the understanding and thinking of data through psychoanalytic lenses. A reflective diary and field notes were maintained throughout. Furthermore, To address potential biases, we implemented a validation process and validation checks were conducted by an independent peer student, who was also conducting a Doctorate in Child and Adolescent Psychoanalytic Psychotherapy. This student performed a ‘blind’ analysis of two transcripts, which was later compared with the analysis conducted by the primary author. Although some minor discrepancies surfaced, they were thoughtfully deliberated upon and subsequently brought to the attention of the group for further review. As a result, appropriate adjustments were made. Several of the peer student’s valuable insights and ideas were integrated into the analysis, and certain subthemes were refined as necessary. This ensured that the data were faithfully and meaningfully represented to our complete satisfaction.
Findings
Four key themes were identified from the data that were not entirely separate or distinct: Haunting Past Experiences, Overwhelming emotional experiences, Idealising and denigrating—difficulties in integrating both experiences and Bodily states and the need for physical proximity. In addition, several subthemes were identified.
Haunting Past Experiences
A dominant theme identified in all mothers’ accounts was the experience of childhood adversity, which they felt left them lacking positive parenting role models. Jasmine, who herself had been adopted, recalled her difficult experiences in her family:
“I think life generally was just difficult with my adoptive mother because she was an alcoholic and would be shouting most of the times”. (Jasmine)
A number of mothers spoke of emotional, physical, verbal and sexual abuse in their childhoods, experiencing unstable and unpredictable family environments in which they felt unsafe and confused. Alisha described a lifetime of abuse and unpredictability as a child:
“… you know my dad would tell me to go back to my mum, chuck me out, so drag me on my hair and put me in the bus to go back to my mum … I go to my dad, he throws me out as well, I go back to my mum so I feel rejected”. (Alisha)
These inconsistent and abusive environments left mothers feeling rejected and invalidated. Ruby described feelings of insecurity and sensitivity in herself as a mother linked to her experience of not feeling safe or secure in her own family:
“Inconsistency. One minute she [her mother] would be really nice, and another minute she would be really neglectful or cold or her moods changed very quickly. –[I am] insecure definitely, emotional over emotional, sensitive. I’m very insecure with my family um I don’t feel safe around them that’s-, I’ve never really felt safe, there’s something wrong.” (Ruby)
While Ruby spoke about wanting to be a consistent, safe and reliable presence for her own son, she felt her early experiences affected her ability to bond with him:
“I found it very difficult to bond with him a lot, a lot of the time umm. … so the difficulty with bonding with him, would have been because of my experience as a child with my mother and my father to some extent and just the abandonment issues and the fact that I was left a lot to cry alone in a cot.”(Ruby)
Feelings of being unloved, rejected and abused created a strong desire in mothers not to be like their parents: they wanted to be different with their own children and to have different parenting qualities. However, many, like Ruby, found their past experiences with their own parents came back to haunt them in motherhood and were difficult to move on from.
Margaret expressed a strong wish not to be like her mother, yet recognised ways in which she was similar to her:
“(my parents) were very strict. I am like her (my mother) in the fact that I shout a lot. I shout a hell of a lot. And I don’t want to. … (I feel so guilty) when I have to say no and then I get him what he wants and I feel really guilty”(Margaret)
In this instance, Margaret describes the tensions that several mothers described when attempting to create a different environment for their own children than they had experienced themselves. They described feelings of guilt for perceiving themselves to be similar to their parents, which in turn could lead to overcompensation and difficulties setting boundaries for their children in case they were perceived as punitive.
Haunting experiences were described by all mothers and left them feeling persecuted by feelings of inadequacy in their parenting skills, or as one mother, Violet put it, fearing they were “the best parent”. These haunting experiences could set in motion a spiral of overwhelming emotional experiences.
Overwhelming Emotional Experiences
Several mothers described experiencing intense and difficult feelings as mothers.
Feeling Lonely
All mothers described feeling isolated and alone. These feelings were particularly acute when they felt low or during difficult encounters with their children. As outline, the majority of mothers were single parents, and they often wished that someone could be there helping them. When asked to describe a difficult experience as a mother Nora said:
“Dealing with things on my own cause there’s only me, I’ve got no one to help me”(Nora)
Similarly, Ruby also described feeling lonely and in need of emotional support:
“I wish I didn’t have to do so much on my own and that there was more people around. There are people around it’s just they’re not-, they are distant so they’re not- not always able to come and help out or just keep me company um, but it would make a big difference if they did” (Ruby)
Violet and Anna were the only two mothers who were in relationships, yet they also described feelings of loneliness and of being unable to share their feelings with anyone. For example, Violet explained:
“I’m kind of like, feel a bit lonely you know and that and I don’t know how to speak to him [partner] about it. And stuff like that and I’m really worried. I have been wanting to speak to someone. I felt so alone. I’ve been feeling alone. (Violet)
Preparing for the worst
Mothers sometimes connected their feelings of being alone to experiencing intrusive negative thoughts about something bad happening to them or their children. For example, Margaret described her struggles when her children were asleep and she was alone saying:
“It’s at those times when I am not busy and alone, intrusive bad thoughts come to my mind that something bad will happen”. (Margaret)
Violet similarly spoke about how intrusive thoughts about bad things happening to her or her child could make her feel very low:
“I just- sometimes I have a drink. Umm sometimes I get so depressed and wrapped up in my own thoughts and feelings and stuff…
… I fear losing her. I- I fear like uh I think all these things.” (Violet)
It seems likely that mothers’ fears around loss may have been exacerbated not only by their challenging past and present circumstances, but also by the context of their involvement with children’s social services. Alisha, for example, described experiencing overwhelming fears about someone taking her child away, and not being able to protect him:
“I just think that someone is gonna come in my house and take him or someone is gonna do something to me or I am gonna die or something is gonna happen to me and then he is gonna be left in the flat just screaming by himself and I just have overwhelming feelings on daily basis that stuff is gonna happen. (Alisha)
These powerful fears and intrusive thoughts worsened mothers’ feelings of not being good-enough mothers, making them feel guilty. They often managed their feelings by becoming more overprotective of their children. For example, Margaret said that she felt “very protective. [I am] Very very protective as a parent”.
Angry when not in control
In this context, some mothers described really struggling when their children did not listen or ignored them. When reflecting on these moments, they felt angry and thought their children were making them feel worse on purpose. When asked what made her angry, Violet said;
“It’s just like playing, not listening to me. Messing up my house when I go- when I tidy up. Spilling things, shaking her bottle around. … I know she’s two years old but she can manipulate me as well.” (Violet)
Mothers found that when their children were not listening to them, they did not feel in control and found it very difficult to deal with.
“They can sense when I’m angry and that. And they play on it. They wind me up. I think they find it funny”. (Margaret)
Idealising and Denigrating – Difficulties in integrating both experiences
During the interviews, it became evident that each mother alternated between idealised descriptions when discussing their relationships with their children and expressing a lack of emotional connection during moments of negativity and distress. In these latter instances, they depicted their relationships with their children as less than perfect. This dual portrayal, wherein each mother shifted between idealisation and denigration, highlighted the ambivalence in their feelings towards their children. Nonetheless, it is important to consider that these ambivalent feelings could be understood within the context of the challenging situation they faced; entering an intervention where their parenting skills were being assessed, a circumstance that likely contributed to their mixed emotions.
“You are my everything”
At times, mothers described their children as perfect and perceived them almost as their saviours, giving meaning to their lives.
“Oh my god, yes if it wasn’t for (child’s name) I wouldn’t be here today, he is giving me life again [Kimberley]
Nora described her little girl as being everything to her, fulfilling all kinds of roles and needs unmet by other people in her life.
“She’s my everything, like she’s my daughter, my love, she’s my best friend, she’s, she’s everything to me, she’s my dad, she’s my brother, she’s everything” (Nora)
Margaret also described how having a child had made her develop and mature.
“It’s made me grow up a lot. It’s made me understand a lot in-, like within myself and things. It has umm it definitely tames me a lot. Made me grow up and mature.” (Margaret)
Both mothers talked of how much their children made them develop and grow and that they were what kept them alive. For some mothers their children seemed to represent and fulfil other relationships that were missing.
“I could not love him”
At other times, mothers would describe difficulties with bonding with their children. Kimberley described how her negative intrusive thoughts and her guilt prevented her from feeling connected with her child.
“Very low, very emotional, not fully attached, you know what I mean, like I should be. I was taking care of him but I wasn’t loving him as much as I should have been, sitting with him, you know and holding him like I do when I am well. … You know my mind was constantly racing just thinking of negative, bad things and feeling guilty because feeling guilty looking at (the child). and feeling guilty then for a short period wishing that I just didn’t have to have him to take him out.” (Kimberley)
On the other hand, Violet and Anna - who were the only two mothers living with partners - presented with a more integrated view, describing both difficult and rewarding experiences of their relationships with their children:
“But umm yeah to be honest yeah it’s frustrating, it’s rewarding. It’s a whole load of things you know umm being a parent but I wouldn’t change it. I wouldn’t change [child] and that. Umm what I do I think? It’s very, very fulfilling. (Violet)
Bodily states and the need for physical proximity
Mothers at times seemed to have difficulty integrating the idea that their children had both emotional and bodily needs. The majority of mothers described their children only as having bodily needs, overlooking or denying their emotional needs.
“He is only two, he doesn’t feel yet”
Most of the mothers when asked about the impact of their own emotional states on their children, said that their children do not understand emotions because they are very young. They focused more on the physical demands of their toddlers, like being cleaned and fed. Kimberley said;
“He is content when he is fed, and cleaned (laughing). Yeah that’s how I would describe him, he is very easily pleased. And they are the three things as long as he is fed … and he’s got a clean bum he is happy” (Kimberley)
Similarly, Nora said
“… feeding her, changing her nappy, uhh physical stuff. Upset? But she’s still a baby, she can’t be upset, but if she needs something she will let me know” (Nora)
Although most mothers found it difficult to think of their children as emotional beings, Ruby gave a moving description of her child as both a creature with physical and emotional needs. This may have partly stemmed from the researcher’s interviewing stance as it was clear in this case that the interviewer often reflected back and validated her experiences.
“…very sensitive to noise and very sensitive to my moods and his dad’s moods. That’s-, if I’m anxious he will notice straight away um and when he when I was going through a period of crying a lot it got to stage where he was actually looking at me if I just did it, mucking around made a crying noise ‘wahhhaha’ he would look at me to say mummy shut up now I’ve had enough of it. So he’s very aware and very sensitive. Maybe aware would be a better word”. (Ruby)
The need for physical proximity and difficulties in separating
Perhaps in part because of their focus on their children’s physical needs, mothers often presented a need to be physically close to their children. These feelings may also have been related to mothers’ involvement with children’s social care: their anxiety of their children being removed seemed to exacerbate their feelings of needing to retain a close physical distance to protect their children. Margaret described a sense of loss when her child was not with her, revealing also the difficulties she experienced in separating from her.
“Like when he goes to nursery I’m just like well where’s my little sidekick? Like where’s he gone? Like I feel lost without him. Like I just love him so much and he definitely feels the same about me.” (Margaret)
Similarly, Nora described;
“And then, but obviously I can’t resist her, I do pick her up after a while but I don’t like hold her like I used to all the time, as in like when she’s eating, I’m holding her, she falls asleep in my hands.” (Nora)
Nora and Margaret both described a sense of missing and needing to be very close to their child, finding it difficult to separate. Kimberley’s account suggests this could come from a fear of feeling left out and not needed as a mother anymore: she described very vividly her fear of not being important as her child grows in independence and the fear of something bad happening to the child if not physically close to her;
“I don’t want him to get too independent ‘cause I want him to need me, do you know what I mean? I want him to want me in his life. But I do like it; I feel proud of him” (Kimberley)
The two mothers that had some support at home and were in a relationship, seemed more able to reflect on the positives of separating as their children grew up. When asked what she finds brings her most joy in being a mother, Violet gave a qualitatively different account to Kimberley’s saying;
“Just seeing my daughter growing up. Seeing how she’s developing. Seeing you know. Umm having the memories and things you know.”(Violet)
Mothers presented with a real need to be physically close to their children, which led to anxieties about separation but also provided them with a positive experience and helped them to feel more attached and bonded to their children.
Kisses, cuddles and playing - “That’s all I need”
Although most mothers showed difficulties in separating, this physical closeness provided them with playful and much needed interactions. Kimberley described how being close to her child created a joyful moment between them.
“That was just lovely, do you know what I mean? I don’t know, I can’t explain it, he just laughs and comes back to me, comes back to me, then he comes up at me, cuddles and, you know.” (Kimberley)
Similarly, Jasmine described a loving playful moment; they both played and she found this an important moment in her positive experience in bonding with her child;
“She was in the bath and she put all the bubbles all over and on my face … she was really laughing and I was laughing too.” (Jasmine)
All the descriptions above show the importance of the physicality of playfulness which is also appropriate for this age group. Violet described such experiences;
“And I give cuddles and I tickle her everything and yeah we do play a lot together and I sing to her and stuff. That’s why that’s-, that’s fun” (Violet)
This sense of closeness and being together with their children, seemed to give parents a sense of belonging and meaning in their lives, something that perhaps was missing early on in their own lives.
Discussion
This qualitative study explored the experiences of mothers with BPD diagnoses and children under 3 on the edge of care. The IPA methodology allowed for an in depth exploration of parenting experiences and mothers’ narratives provided details of their emotional and behavioural experiences. Both challenging and rewarding experiences were described and while differences were identified, there were also considerable shared experiences between them. Four main themes were identified, which overlapped and interacted with each other: ‘Haunting past experiences’, ‘Overwhelming Emotional Experiences’, ‘Idealizing and Denigrating - difficulties integrating experiences’, and ‘Bodily states and the need for physical proximity’.
The first theme, ‘Haunting past experiences’, was evident in all mothers’ descriptions of parenting and being parented. All mothers talked of early adverse experiences which left them feeling confused, unsafe, invalidated and rejected, resulting in them entering motherhood already in a fragile state. In previous studies a majority of parents with a BPD diagnosis have been found to have experienced early adversity, impacting on their attachment, emotional and cognitive development (Gunderson & Lyons-Ruth’s, 2008; Petfield et al., 2015; Geerling et al., 2019). Newman and Stevenson (2005) argue that early traumas that have not been ‘resolved’ may continue to operate in adult relationships, either as re-enactments or reparative attempts to change disturbing relationship dynamics. In this study, mothers’ reparative attempts were evident by their strong wish not to be like their parents. However, they also felt guilty when they recognised similar characteristics between their own parenting and that of their parents, which sometimes in turn resulted in difficulties putting appropriate boundaries in place with their children for fear of seeming punitive. This contributed to their struggles at times feeling close and bonded to their children.
In the context of their experiences—and in many cases limited social support—mothers often described parenting as a lonely and isolating experience, accompanied by intrusive negative thoughts about bad things happening to them or their children that felt repetitive and daily. This is in accordance with other studies that describe the emotional and cognitive turmoil of mothers with BPD diagnoses (Cook et al., 2003; Geerling et al., 2019). Some mothers expressed ambivalence towards their children or had thoughts of not wanting them which resulted in severe guilt. To manage and compensate for such emotions, mothers described becoming overprotective and hyper vigilant, and preparing for the worst, as mentioned in previous studies (Beebe & Lachman, 1988; Bartsch et al., 2016). However, in this study fears about loss and of bad things happening were arguably particularly acute in light of mothers’ involvement with children’s social care and the very real risks they faced of losing custody of their children. These fears could make parenting more difficult for mothers, with mothers describing strong fears about any separations from their children. As found in past research too, this could in turn worsen their mental health and feelings of distress in a vicious cycle (Kenny, 2017).
A novel theme in this study is “Bodily states and the need for physical proximity”. All mothers with BPD as a primary diagnosis showed some difficulties in accepting or understanding their children as emotional beings. Similar findings were also evident in Geerling et al. (2019) study exploring the overwhelming impact of infants’ crying on mothers with BPD diagnoses. Mothers’ coping mechanism was to “split their self”, attending only to the physical needs of their babies in a practical way, and avoiding emotional experiences at heightened emotional moments. Similarly, in this study mothers at times could seem preoccupied with their children’s bodily functions, expressing the view that their children were not old enough to experience emotions, or oscillating between idealised depictions of their children and intense negative feelings. Attachment theory on the mother-child relationship suggests that when mothers are both emotionally and physically available to their children, the child is able to hold and develop a belief that the mother is available when needed and secure attachment is formed (Bowlby, 1973; Ainsworth, 1990; Kobak & Madsen, 2008). It is possible that mothers’ experiences of previous and ongoing adversity, lack of internal positive parenting models, and anxieties about their own parenting competencies compromised their ability to accept or express a more holistic internal image of their children. It was also conspicuous that the two mothers who were in relationships and perhaps therefore able to have some support and fewer stresses in their day-to-day caring for their children appeared to express a more integrated view of their children.
Despite these difficulties, it was also patent that mothers found comfort and security in being physically close to their children. Mothers with BPD diagnoses have been heavily criticised for their difficulties in relating to their children and their lack of mentalizing capacities and emotional insights (Fonagy & Luyten, 2009; Dunn et al., 2020). While a desire for physical proximity to their children may be understood in part as a way to deal with understandable fears of loss among mothers on the edge of care, the playfulness and physical closeness mothers described with their children also seemed to play a vital role in bonding and feeling a purpose in their sense as mothers. This unique theme needs further exploration to understand the experience and impact of physical closeness in this population further.
Strengths and limitations
A dearth of studies have explored qualitatively the experiences of mothers with BPD diagnoses who have children under 3 on the edge of care. The IPA methodology facilitated an in-depth explorations of their experiences.
Nevertheless, there were several limitations of this study that need consideration before generalising findings to a wider population. It is important to acknowledge that this study is part of a larger study involving parents who had been referred by social services to a specialist mentalization-based intervention. Consequently, it is essential to understand the findings in this context, recognising for example that the views of participating mothers may not represent a direct reflection of their experiences, and could have been influenced by social desirability bias: in particular, mothers may have felt under scrutiny for their parenting skills or feared adversely affecting clinicians’ decision-making around their children and this could have affected their responses in various ways.
This model of analysing data provides rich themes derived from looking at each participant’s accounts in depth. For this reason, sampling in this study is small, which is not unusual for IPA studies (Smith et al., 2009). The sample for this study was very distinct, including mothers who entered a community intervention program with children under 3 at the edge of care. It is unknown if the results can be generalised to mothers in other contexts. The socio-cultural make-up of participants was also striking. Most mothers were mixed Carribean or Mixed/Black African and only one mother was White British. Bywaters et al. (2017) have found that Black mothers might be overrepresented in social work proceedings, while other research has questioned whether mothers from Black, minoritised or deprived backgrounds may also be more likely to attract a diagnosis of BPD and face discrimination within services (Bacon et al., 2023; Dubriwny, 2010; Sweeney & Lever Taylor, 2019). Further research is needed to better understand the influence of sociocultural status in this context. A wider cross-section of participants which should also include fathers would also increase generalizability as most research to date has focused on mothers (Newman et al., 2007). Another limitation was the different researchers/clinicians that did the interviews which could have evoked different responses in the individuals if, for example, the researcher was more or less validating the mother’s experiences and emotions, which could either make the participants open up or close down. Also, the mothers might be at different stages in their lives and some could have received more support than others before joining this community intervention. Thus some of the differences in the reflecting capacities between the parents could be because of attending other interventions previously.
Implications and recommendations
If replicated there are a number of implications for clinical practice and research. Firstly, understanding the role of trauma on the parenting experiences of mothers with BPD diagnoses is vital. Clinicians working with such mothers also need to be aware of how social services’ involvement may increase pressure on mothers, affecting their parenting and behaviours towards their children (Mason et al., 2020). Clinicians working with this population need to provide a validating and safe environment where such mothers are more able to discuss their struggles. Psychoeducation on babies’ and toddlers’ emotional and physical development might be useful in parallel with an intervention as developed by Sprengeler et al. (2021), suggesting short-term psychodynamic parent-infant/toddler psychotherapy. In addition, the importance of parent education on child development and infant and early childhood mental health (IECMH) could help parents understand social-emotional development in these early stages. Such interventions could include for example the Circle of Security (Powell, et al., 2009), in helping parents attend to both the bodily and emotional experiences of their children and strengthen the attachment between them. Furthermore, due to mothers feeling isolated and lonely, strengthening their support networks seems important.
It is important though, to acknowledge that certain experiences described in this study, such as feelings of loneliness, separation anxiety, and the need for physical closeness, are emotions and experiences that might be universally shared among many parents. Consequently, interventions tailored to address these common experiences could potentially offer applicability and benefits to parents coping BPD as well.
Conclusion
In conclusion, this study provides insights into the parenting experiences of mothers with BPD diagnoses and their under 3 children on the edge of care. Early adversity appeared to have a significant impact on mothers who entered parenthood already haunted by past experiences. All mothers felt isolated in their role as parents and described negative intrusive thoughts, along with intense anxieties of bad things happening to them or their children. This sets in motion a dynamic interplay of overwhelming guilt, difficulties in integrating idealising or denigrating experiences of their children, overprotection and needing to feel physically close to their children in case something bad happened to them. In addition, they found it difficult putting in place boundaries, and at times regarded their children as compensating for other relationships mothers found they were lacking or found it difficult to develop and maintain. The majority of mothers focused heavily on the physical needs of their children, rather than seeing them as emotional human beings. However, mothers also found much comfort in being physically close to their children and this could help the developing bond between mother and child. Mothers’ anxiety, fear of losing control and mechanisms of overprotection should be considered also in the context of these mothers being on the edge of care with the fear of losing custody of their children experienced as a catastrophic consequence for them. We found that having children’s social care exacerbated parents’ anxieties and distress and, for this reason too, services need to consider how best they can support this population in a trauma-informed way.
Acknowledgements
This study was approved by the appropriate ethics committee, as detailed in the article. The authors would like to express their gratitude to the mothers who took part in this programme and study, for sharing their time, trust and personal journey, the researchers and the clinicians for the data gathering and colleagues for their help and guidance with this project.
Compliance with ethical standards
Ethics approval
Ethics approval for the wider evaluation of the project was obtained from the University College London ethics committee (6821/001). Participants gave written consent for the data to be gathered and analysed for research purposes. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflict of interest
The authors declare that they have no conflict of interest.
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