Kasiviswanathan Karthika, Lee Jessica, Rao Sathya, Broadbear Jillian H
Spectrum Personality Disorder and Complex Trauma Service, Centre for Research and Innovation, 110 Church Street, Richmond, VIC, 3121, Australia.
Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill, VIC, Australia.
Borderline Personal Disord Emot Dysregul. 2025 Jun 3;12(1):22. doi: 10.1186/s40479-025-00291-6.
Emotional dysregulation, impulsivity, and interpersonal difficulties are some of the severe and debilitating symptoms of borderline personality disorder (BPD). Parenting while living with BPD is associated with high levels of parental distress, which may exacerbate symptoms of BPD and contribute to parental struggles navigating their relationship with their child/ren. This can in turn influence the child/ren's attachment and behavioural patterns, contributing to the intergenerational transmission of BPD and/or other mental health difficulties. To date, no previous research has systematically reviewed qualitative studies of the experiences of parents with BPD. The aim of this meta-ethnography is to holistically interpret the findings of existing qualitative research and thereby conceptually understand the experiences of parents with BPD and propose supports that would benefit them.
Following a systematic search of peer-reviewed research, independent eligibility screening and risk appraisal, nine relevant studies were selected for inclusion. The reviewers read and re-read these papers and identified key concepts for translation. Relationships between the key concepts were identified by the primary reviewer using NVivo, and a synthesis of the translation was performed.
Six papers focused on the experiences of mothers with BPD, one on fathers, and two included both. The review identified some key challenges, including the pressure parents with BPD feel to adhere to their own and others' expectations, their struggle with managing difficult emotions such as shame and uncertainty, a lack of social support, and difficulties accessing adequate formal support. Three papers reported findings on the same intervention (Mother-Infant Dialectical Behaviour Therapy) describing benefits of the intervention, subsequent improvements, and the importance of peer support.
Taken together, we determined that shame is a key driver underpinning many of the challenges experienced by parents with BPD. Mothers and fathers with BPD shared similar experiences, however, their conceptualisations of being a 'good' parent were differentially shaped by societal norms. Our review confirmed gaps in current practice, including the paucity of evidence-based interventions available for parents with BPD. Parents with BPD may benefit from interventions that help them to set realistic expectations and address shame as a specific treatment objective.
情绪失调、冲动和人际关系困难是边缘型人格障碍（BPD）的一些严重且使人衰弱的症状。患有BPD的同时养育子女与高水平的父母困扰相关，这可能会加剧BPD的症状，并导致父母在处理与子女的关系时陷入困境。这反过来又会影响子女的依恋和行为模式，导致BPD和/或其他心理健康问题的代际传递。迄今为止，尚无先前的研究系统地综述过关于患有BPD的父母经历的定性研究。本元民族志的目的是全面解释现有定性研究的结果，从而从概念上理解患有BPD的父母的经历，并提出对他们有益的支持措施。
在对同行评审研究进行系统检索、独立的合格性筛选和风险评估后，选择了九项相关研究纳入。评审人员反复阅读这些论文，并确定了用于翻译的关键概念。主要评审人员使用NVivo确定关键概念之间的关系，并对翻译进行了综合。
六篇论文关注患有BPD的母亲的经历，一篇关注父亲，两篇同时涉及父母双方。该综述确定了一些关键挑战，包括患有BPD的父母感到要符合自己和他人期望的压力、他们在管理诸如羞耻和不确定性等困难情绪方面的挣扎、缺乏社会支持以及难以获得足够的正式支持。三篇论文报告了关于同一干预措施（母婴辩证行为疗法）的研究结果，描述了该干预措施的益处、随后的改善情况以及同伴支持的重要性。
综合来看，我们确定羞耻是患有BPD的父母所经历的许多挑战的关键驱动因素。患有BPD的母亲和父亲有相似的经历，然而，他们对成为“好”父母的概念化受到社会规范的不同影响。我们的综述证实了当前实践中的差距，包括针对患有BPD的父母的循证干预措施匮乏。患有BPD的父母可能会从有助于他们设定现实期望并将解决羞耻作为特定治疗目标的干预措施中受益。
