Mothers With Borderline Personality Disorder Often Experience Trauma

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To read the connecting article, see "Motherhood and the 4 Symptom Domains of Borderline Personality Disorder."

Mothers with borderline personality disorder (BPD) often have experienced early-life trauma, especially attachment trauma. BPD is a clinical challenge for several reasons and is associated with treatment-refractory depression and anxiety.^1,2 Limited symptom improvement is often seen with psychotropic medications.^3,4 Effective psychotherapy, such as dialectical behavioral therapy, is intensive, often expensive, and frequently difficult to access.⁵

BPD symptoms can directly limit patients’ ability to consistently engage in treatment. Additionally, BPD is associated with prominent safety concerns, with self-harm behaviors common and seen in around 50% of patients.⁶ Patients with BPD often struggle with safety-interfering behaviors like substance use.⁶ BPD is associated with a high rate of completed suicide, commonly cited at up to 10%.⁷ Although there are limited data about how BPD symptoms shift over the life span, we know that as a complete diagnostic entity, it has low prospective diagnostic stability, cited at 37% in 1 study across a study period of 18 years.⁸ Some theorize a burnout over time, in which symptoms may become less prevalent with age, with the largest change seen after age 44.⁸

Some studies describe a more nuanced life span process, wherein affective lability, relationship challenges, and impairments in sense of self persist, but impulsivity improves over time.⁸ Overall, little is known about fluctuations in symptoms and diagnosis across the reproductive period and in relation to the experience of motherhood.⁸

References

1. Grilo CM, Stout RL, Markowitz JC, et al. Personality disorders predict relapse after remission from an episode of major depressive disorder: a six-year prospective study. J Clin Psychiatry. 2010;71(12):1629-1635.

2. Young M. Treatment-resistant depression: the importance of identifying and treating co-occurring personality disorders. Psychiatr Clin North Am. 2018;41(2):249-261.

3. Ceresa A, Esposito CM, Buoli M. How does borderline personality disorder affect management and treatment response of patients with major depressive disorder? A comprehensive review. J Affect Disord. 2021;281:581-589.

4. Lieb K, Völlm B, Rücker G, et al. Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry. 2010;196(1):4-12.

5. Cristea IA, Gentili C, Cotet CD, et al. Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry. 2017;74(4):319-328.

6. Sansone RA, Wiederman MW, Sansone LA, Monteith D. Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples. Gen Hosp Psychiatry. 2000;22(3):174-178.

7. Paris J, Zweig-Frank H. The 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42(6):482-487.

8. Videler AC, Hutsebaut J, Schulkens JEM, et al. A life span perspective on borderline personality disorder. Curr Psychiatry Rep. 2019;21(7):51. ❒