Borderline Personality Disorder, Mother–Infant Interaction and Parenting Perceptions: Preliminary Findings

Abstract

Parents diagnosed with borderline personality disorder (BPD) are likely to find the emotional aspects of parenting challenging. Research into the difficulties that these parents experience, however, is lacking. The aims of the present study were to (i) gain an understanding of the interactional patterns of mothers with BPD and their infants and (ii) to explore the parenting perceptions of mothers with BPD.
Two groups of mother-infant dyads were recruited: mothers with BPD and their infants; and community mothers and their infants. Groups were compared on mother-infant interaction patterns and on maternal self-perceptions of parenting.
Mothers with BPD were found to be less sensitive and demonstrated less structuring in their interaction with their infants, and their infants were found to be less attentive, less interested and less eager to interact with their mother. Furthermore, mothers with BPD reported being less satisfied, less competent and more distressed.
Early intervention needs to be provided to mothers with BPD to promote maternal sensitivity and maternal perceptions of competence.

Full text

Borderline personality disorder, mother

infant
interaction and parenting perceptions: preliminary
findings
Louise K. Newman, Caroline S. Stevenson, Lindy R. Bergman,
Philip Boyce
Objective: Parents diagnosed with borderline personality disorder (BPD) are likely to find
the emotional aspects of parenting challenging. Research into the difficulties that these
parents experience, however, is lacking. The aims of the present study were to (i) gain an
understanding of the interactional patterns of mothers with BPD and their infants and (ii) to
explore the parenting perceptions of mothers with BPD.
Method: Two groups of mother infant dyads were recruited: mothers with BPD and their
infants; and community mothers and their infants. Groups were compared on mother
infant interaction patterns and on maternal self-perceptions of parenting.
Results: Mothers with BPD were found to be less sensitive and demonstrated less
structuring in their interaction with their infants, and their infants were found to be
less attentive, less interested and less eager to interact with their mother. Furthermore,
mothers with BPD reported being less satisfied, less competent and more distressed.
Conclusions: Early intervention needs to be provided to mothers with BPD to promote
maternal sensitivity and maternal perceptions of competence.
Key words: borderline personality disorder (BPD), maternal sensitivity, mother infant
interaction, parenting self-perceptions, structuring.
Australian and New Zealand Journal of Psychiatry 2007; 41:598

605
Individuals with a diagnosis of borderline person-
ality disorder (BPD) typically have difficulties in the
regulation of affect, impulse control and interper-
sonal functioning [1]. Their attachment relationships
tend to be unstable and fluctuate between idealization
and devaluation of other, which is indicativeofa
fundamental difficulty in balancing the needs for both
autonomy and intimacy [2]. The majority have
experienced significant early relational trauma, which
remains unresolved and continues to disorganize their
mental functioning [3]. Attachment theory suggests
that early trauma and disorganization of attachment
are related to later personality dysfunction, and
specifically to difficulties in interpersonal functioning,
deficits in reflective function (the capacity to envision
mental states in the self and others) and poor
tolerance of negative affect [3]. Given these pervasive
psychological and emotional deficits, it is likely then
that parents diagnosed with BPD will experience
difficulties in fulfilling their parenting role and in
the promotion of secure attachment with their
children [4]. Although there is increasing research
interest into the aetiology [5] and treatment of BPD
[6,7], parenting issues for adults with BPD have been
relatively neglected.
Caroline S. Stevenson, Research Coordinator (Correspondence); Louise
K. Newman, Director; Lindy R. Bergman, Research Officer
NSW Institute of Psychiatry, Locked Bag 7118, Parramatta BC, NSW
2150, Australia. Email: caroline.stevenson@nswiop.nsw.edu.au
Philip Boyce, Professor of Psychiatry
Department of Psychological Medicine, University of Sydney, Sydney,
New South Wales, Australia
Received 20 August 2006; accepted 3 January 2007.
# 2007 The Royal Australian and New Zealand College of Psychiatrists

Clinically, mothers with BPD report feeling es-
tranged, anxious, overwhelmed or even angry with
their infant from birth [4]. They are often inconsistent
in their responses to their child’s needs and they have
difficulties in accurately interpreting infant affect [8].
Consequently, mothers with BPD are at risk of
repeating disturbing and potentially traumatizing
interactional patterns with their infant. Despite the
potentially significant implications of these disturbed
interactions on child development, direct research
into describing the relational disturbances of this
group is lacking.
To date, only two studies haveinvestigated the
interaction patterns of mothers with BPD and their
offspring. Crandell et al. compared eight mothers
diagnosed with BPD to mothers with no psychiatric
disorder [9]. Mothers were video-recorded interacting
with their 2-month-old infants using the Still-Face
Procedure (SFP) [10]: mothers maintain a still,
neutral facial expression and refrain from interacting
with their infant and then re-engage their infant and
return to natural interaction. In the standard SFP, it
is expected that infants will be disturbed by their
mother’s lack of animation and attempt to re-engage
her through vocalizing, gesturing and smiling [11].
However, in that study mothers with BPD were
intrusively insensitive during the interaction with
their infants, and their infants responded with dazed
facial expressions rather than attempting to re-engage
their mothers. That study offers preliminary evidence
that mothers with BPD have interactional difficulties
with their newborn infant.
In a further study, Hobson et al . examined attach-
ment status and interpersonal relatedness in infants of
10 mothers with BPD and 22 non-clinical control
mothers [12]. Using the Strange Situation Procedure
(SSP), 50% of infants of mothers with BPD were
‘disorganized’, compared to 27% of comparison
infants. Mothers with BPD were significantly more
intrusive and insensitive than control mothers,
and infants of BPD mothers were found to be less
available for positive engagement. These infants
scored lower on behavioural organization and mood
state than control infants, and gave fewer positive
looks during observation. Again, that study supports
the view that mothers with BPD have difficulties with
emotional parenting.
Clearly, research on parenting issues for mothers
with BPD requires further study. Patterns of early
interaction can be assessed in a number of ways. An
alternative approach to the SFP and the SSP is
to assess precursors to the development of a secure
attachment relationship, such as sensitivity and emo-
tional availability. The Emotional Availability (EA)
Scale integrates attachment theory and emotional
availability perspectives; assessing a mother’s emo-
tional responsiveness and affective attunement to
their child’s needs and goals, and the child’s ‘secure
base behaviours’ and affectiveavailability to their
parent [13]. Thus, the EA presents an alternative
method for assessing the interaction for mothers with
BPD with their infants.
In addition to the EA, self-report measures that
assess parenting perceptions provide insight into how
a mother’s sense of self impacts on her parenting
skills. Parents who lack a sense of efficacy in their
ability to parent do not show persistence in parenting
in the face of adversity [14]. Likewise, parents who
report being stressed in relation to their parenting
role have been shown to have a reduced capacity to
parent optimally [15]. Without a positive and emo-
tionally valued sense of self as a parent, affective
competence, the parent’s capacity to engage empathi-
cally with the infant, and their ability to establish
patterns of emotionally responsive interaction, can be
compromised.
Understanding the interaction patterns and parent-
ing perceptions of parents with BPD is vital for
providing appropriate interventions to this high-risk
group of parents. Consistent with recommendations
for assessing parenting in the literature [16], the
present study used both observational and self-report
methods in combination to understand the parenting
dynamics of mothers with BPD.
Method
Participants
Mothers with BPD (n17) were recruited within the Western
Sydney Area Health Service. To be eligible for the study, mothers
with BPD had to (i) have an independent clinical diagnosis of BPD;
(ii) meet DSM-IV criteria for BPD [1]; and (iii) score ]8 on the
Revised Diagnostic Interview for Borderlines (DIB-R; a semi-
structured interview that reliably distinguishes BPD from other
personality disorders [17]). It should be noted that the DIB-R was
available for 11 participants. The first two authors (LN and CS)
then reached a consensus agreement on BPD diagnoses. One
mother was excluded because she presented with severe dissocia-
tive symptomatology precluding completion of the protocol. At the
time of the study, no mother was in concurrent treatment (it is
L.K. NEWMAN, C.S. STEVENSON, L.R. BERGMAN, P. BOYCE 599

estimated that 50 60% had had some prior psychotherapy, albeit
none had attended mother infant therapy).
Control mothers (n21) were recruited from the community in
Western Sydney. Control mothers had to (i) report no history of
mental health problems; and (ii) score B13 on the Edinburgh
Postnatal Depression Scale (EPDS [18]). One mother was excluded
based on these criteria.
The following criteria also applied to all dyads: (i) infants were
full-term and had no developmental delay or known neurological
impairment; and (ii) infants were aged between 3 and 36 months.
Based on these additional criteria, two mother  infant dyads from
the BPD group were excluded. The final sample consisted of
14 mothers diagnosed with BPD and 20 community mothers.
Demographic characteristics of the sample are presented in
Table 1. The observed differences in relationship status, education
and employment status were consistent with DSM-IV (i.e. broken
marriages, interrupted education and recurrent job losses are
characteristic of BPD). Importantly, we explored whether
the social disadvantage apparent in the BPD group could account
for the results reported herein. We calculated a social disadvantage
score for each participant by collapsing the following variables:
relationship status, level of education, employment status and
income. For both groups, we found no significant correlations
between socioeconomic disadvantage and parenting observational
and self-report results; thus social disadvantage is not an explana-
tion for the findings.
Assessment procedure
Dyads attended two assessment sessions. In the first session a
brief history was taken and mothers completed the following self-
report measures: the EPDS [18] and the Symptom Checklist 90 
Revised (SCL-90-R) [19] to assess their mental health; and the
Parenting Stress Index Short Form (PSI-SF) [15] and the Parent-
ing Sense of Competence Scale (PSOC) [20] to assess their
perceptions of parenting. In the second session, dyads were
video-recorded during 10 min of free play interaction. The inter-
action was then coded according to the EA guidelines [21] by a
reliable, trained and blinded independent coder.
Measures of maternal mental health
The 10-item EPDS screens women for depression after childbirth
[18]. The EDPS has demonstrated satisfactory validity and
reliability [22]. We used high scores on the EDPS to screen out
control mothers experiencing depressive symptoms but did not
apply this criterion to mothers with BPD. We felt that excluding
these mothers would have produced a biased and unrepresentative
sample because affective dysregulation is recognized as a compo-
nent of BPD; namely, depression in BPD is closely associated with
feelings of loneliness and unfulfilled longings for close interpersonal
relationships [23].
The SCL-90-R consists of 90 questions and assesses nine
domains of general psychopathology: somatization, obsessive
compulsions, interpersonal sensitivity, depression, anxiety, hosti-
lity, phobic anxiety, paranoid ideation and psychoticism [19]. The
SCL-90-R has been widely validated in many populations and has
established psychometric properties, with good internal consistency
and high test retest reliability [24,25].
Measure of mother

infant interaction
The EA assesses mother  infant interactions along six dimen-
sions of emotional availability: four parent scales (sensitivity,
structuring, non-intrusiveness and non-hostility) and two child
scales (responsiveness and involvement) [21]. Mothers are rated on
their ability to respond appropriately to cues from their child,
display appropriate and authentic affect and structure their child’s
activities, while infants are rated on their response to their parent’s
interaction both overtly and affectively and their ability to engage
their parent during interaction. The psychometric properties of the
EA are established [26]. The non-intrusiveness scale was not used
because this scale does not distinguish between parents
who actively allow their child to lead the interaction, from parents
who are neglectful, withdrawn or passive and disengaged.
Table 1. Maternal demographic and infant characteristics
Mothers with BPD Control mothers
(n14) (n20) Test statistic
(Mean9SD) (Mean9SD) U
Mother age (years) 28.5796.90 33.3594.36 81.00*
Infant age (months) 15.6497.76 16.0596.29 138.00
Ratio Ratio x
2
Infant sex (male:female) 6:8 9:11 0.015
Relationship status (married/de-facto:single) 2:12 20:0 26.49***
Education (high school completed:not completed) 6:8 19:1 7.22*
Current Employment (employed:unemployed) 3:11 10:10 2.85
Annual income (B$40 000:$40 000) 10:2 1:17 18.73***
BPD, borderline personality disorder; Annual income data are not presented for mothers who were unsure of their income; *pB0.05;
***pB0.001 with Bonferroni correction.
600 BORDERLINE PD AND PARENTING

Measures of parenting perceptions and stress
The PSOC consists of 16 questions and assesses parental
competence on two subscales: satisfaction and efficacy [20]. Both
subscales have good internal consistency [27].
The PSI-SF contains 36 questions and assesses three dimensions
of parenting stress: parental distress, parent child dysfunctional
interaction and child difficulty [15]. These dimensions sum to a
total stress score. The PSI-SF scales have demonstrated high
internal consistency and adequate test retest reliability [15].
Data analysis
Data were analysed using SPSS for Windows version 13.0 (SPSS
Inc., Chicago, IL, USA). Parametric and non-parametric tests were
conducted as appropriate, with a Bonferroni correction applied to
each family of comparisons. We used one-tailed tests of significance
because we were predicting that mothers with BPD would have
more mental health problems, more difficulties interacting with
their infant and report less satisfaction, less competency and more
distress in their parenting role.
Results
Mothers’ mental health
Mothers with BPD scored higher on the EPDS (mean13.00,
SD4.97) than control mothers (mean4.25, SD2.75), t(18)
5.97, indicating greater psychological distress. As can be seen in
Table 2, statistically significant differences were found between the
two groups on all SCL-90-R subscales, with mothers with BPD
scoring higher on all indexes of psychopathology. These results are
consistent with identifiable BPD symptomatology because mothers
scored highly on the SCL-90-R impulsivity, affective and cognitive
domains [28].
Comparison of mother and infant interaction styles on
the EA
As can be seen in Table 3, statistically significant differences were
found between the two groups on two of the three parent scales of
the EA (sensitivity and structuring) and both child scales (respon-
siveness and involvement). An inspection of the data revealed the
following:
Sensitivity scale
Most mothers with BPD (64.3%; n 9) were rated as ‘incon-
sistently sensitive’, ‘somewhat insensitive’ or ‘highly insensitive’ in
comparison to the majority of control mothers (80%; n16) who
were rated as either ‘highly’ or ‘generally’ sensitive.
Structuring scale
Five mothers with BPD (35.7%) were rated as either ‘incon-
sistent’ or ‘non-optimal’ in their attempts at structuring their
infant’s activities compared to three control mothers (15%) who
received a (lowest) rating of ‘inconsistent’.
Non-hostility scale
Three mothers with BPD (21.4%) were rated as displaying
‘slight’ to ‘covert hostility’ toward their infant compared to two
control mothers (10%) who received such ratings.
Child responsiveness scale
Three infants of mothers with BPD (21.4%) were rated as
‘somewhat non-optimal’ in their response to their mother’s bids
for interaction compared to only one control infant (5%). Addition-
ally, it is noteworthy that no infant of a mother with BPD was rated
as ‘optimally responsive’ (c.f. 11 control mothers’ infants; 55%).
Table 2. Maternal mental health
Mothers with BPD Control mothers
(n13) (n20)
SCL-90-R Subscale T scores (Mean9SD) (Mean9SD) t-statistic
Somatization (SOM) 61.23911.94 46.8596.92 4.38***
Obsessive Compulsive (OC) 65.69911.85 50.35911.04 3.79***
Interpersonal Sensitivity (I-S) 65.69911.36 46.9598.63 5.38***
Depression (DEP) 64.15912.03 49.5599.74 3.84***
Anxiety (ANX) 59.77913.64 42.8097.44 4.11***
Hostility (HOS) 63.77912.59 48.5097.76 3.91***
Phobic anxiety (PHOB) 58.31911.43 44.8593.80 4.90***
Paranoid ideation (PAR) 65.38910.65 46.7597.53 5.90***
Psychoticism (PSY) 64.92912.80 45.9595.83 5.01***
BPD, borderline personality disorder; SCL-90-R, Symptom Checklist 90  Revised; SCL-90-R data are presented for 13 of the 14
mothers with BPD because one mother did not complete the SCL-90-R; ***pB0.001 with Bonferroni correction.
L.K. NEWMAN, C.S. STEVENSON, L.R. BERGMAN, P. BOYCE 601

Child involvement scale
Ten infants of mothers with BPD (71.4%) were rated as
displaying ‘moderately optimal’ to ‘somewhat non-optimal’ invol-
ving behaviours toward their mother compared to four infants of
control mothers (20%) whose behaviours received a (lowest) rating
of ‘moderately optimal’. Additionally, no infant of a mother with
BPD was rated as displaying ‘optimally involving’ behaviour (c.f.
16 control mothers’ infants; 80%).
Mothers’ self-perceptions of parenting and parental
stress
As can be seen in Table 4, statistically significant differences were
found between the two groups on the two subscales of the PSOC
(satisfaction and efficacy) and three scales of the PSI-SF (parental
distress, parent  child dysfunctional interaction and total stress).
These results indicate that mothers with BPD perceive themselves
to be less satisfied and less competent as parents, experience more
difficulties in coping with their parenting role, feel less satisfied
during and disappointed with their interaction with their infant,
and experience significant stress. It is notable that three mothers
with BPD (21.4%) scored above the 95th percentile on the PSI-SF
parent child dysfunctional interaction scale, while no control
mothers scored in this range. According to Abidin, these high
scores suggest the potential for child abuse in the form of neglect,
rejection or episodes of physical abuse triggered by frustration [15].
Likewise, all mothers with BPD had scores approaching or above
the 90th percentile on the PSI-SF total stress scale, while no control
mothers scored in this range. This indicates that these mothers
are experiencing clinically significant levels of stress in their
parenting role.
Trends in parenting indexed by observational and
self-report measures
As can be seen in Table 5, correlations were conducted to
establish the relationship between measures of parenting. Two
Table 3. Descriptive statistics for mothers’ and infants’ interaction styles on the EA
Mothers with BPD Control Mothers
(n14) (n20)
EA Scale (Mean9SD) Range (Mean9SD) Range t-statistic
Mother
Sensitivity 5.1491.38 2 7 6.4790.94 5  8 3.14*
Structuring 3.8990.81 2 5 4.3590.63 3  5 1.76*
Non-hostility 4.6890.69 3 5 4.7790.50 3  5 0.46
Child
Responsiveness 5.1491.00 3 6.5 5.8290.78 4.5 7 2.12*
Involvement 5.0490.93 3 6.5 6.1090.70 5  7 3.62*
BPD, borderline personality disorder; EA, Emotional Availability; For t-statistic, equal variances not assumed; *pB0.05 with Bonferroni
correction.
Table 4. Parenting perceptions
Mothers with BPD Control mothers
(n14) (n20)
(Mean9SD) (Mean9SD) t-statistic
PSOC
Satisfaction 30.2897.89 40.8094.89 4.43***
Efficacy 25.9396.34 32.1094.54 3.31***
PSI-SF
Parental Distress (PD) 36.5098.56 24.9596.85 4.37***
Parent Child Dysfunctional Interaction (P-CDI) 21.0097.58 16.7593.78 1.93*
Difficult Child (DC) 27.7899.66 24.0096.81 1.34
Total Stress 84.57919.50 66.20912.74 3.33***
BPD, borderline personality disorder; PSI-SF, Parenting Stress Index  Short Form; PSOC, Parenting Sense of Competence Scale;
*pB0.05; ***pB0.001, with Bonferroni correction.
602 BORDERLINE PD AND PARENTING

observations are noteworthy. First, there is a relationship between
increased parental distress (on the PSI-SF) and increased feelings of
dissatisfaction and incompetence in parenting (on the PSOC).
Second, parents who express more parental distress (PSI-SF) are
less sensitive in parenting (EA).
Discussion
The present study examined the parenting attri-
butes of mothers with BPD by assessing their
interaction with their infant and their parenting
perceptions. When compared to community controls,
mothers with BPD were found to be less sensitivein
their interaction with their infants and to be less
effective in structuring their infant’s activities. More-
over, the infants of mothers with BPD were less
responsive to the mother’s attempts at interaction and
less willing or eager to engage their mother. On self-
report measures, mothers with BPD reported dissa-
tisfaction and incompetence in their parenting role
and were more distressed than mothers from the
community.
This research replicates existing research [9,12] by
demonstrating similar patterns of interactions albeit
with a different measurement (the EA) and in an
older age group of infants. Further, it extends the
literature by reporting on the largest sample of
mothers with BPD to date and by providing a more
comprehensiveoverview of the parenting difficulties
experienced.
These results support the long-held view of clin-
icians that mothers with BPD have significant
problems with parenting. Parental sensitivity is con-
sidered a precursor to a secure attachment and a
child’s emotional and social development [21]. Par-
ental structuring provides the necessary framework
for interaction and the encouragement of a child’s
self-regulatory attempts [21]. Thus, the lack of
parental sensitivity and poor structuring of mothers
with BPD is of major concern when child outcome is
considered. In addition, the infants of mothers with
BPD do not orientate their behaviours toward their
mother, appear disinterested in engaging their mother
in interaction and are less responsive to the mother’s
bids for interaction. These findings indicate that the
infants of mothers with BPD are withdrawing from
social activities with their parents. The long-term
consequences of this behaviour are that the infants of
mothers with BPD could be developing avoidant
patterns of interpersonal relatedness.
It was surprising that no significance difference was
found between mothers with BPD and control
mothers on the EA non-hostility scale. One explana-
tion, which is consistent with the present sample of
mothers, is that mothers with histories of trauma can
either be ‘frightening to’ or ‘frightened of’ their
infants [28]. In the present sample, rather than being
actively hostile and displaying frightening or threa-
tening behaviours, most mothers with BPD appeared
‘frightened of’ and withdrawn from their children.
With a larger sample size, it is possible that more
active hostility would be observed in mothers with
BPD.
A strength of the present study was the combined
use of observational and self-report measures. Self-
report measures can tap into the ideas that parents
have about themselves as parents, an important
concept to consider when working with adults with
BPD. Compared to control mothers, mothers with
BPD perceived themselves to be less satisfied and less
competent. The lower satisfaction scores of mothers
with BPD suggest that they are more frustrated,
anxious and unmotivated in their parenting role,
while their lower efficacy scores imply that they
perceive themselves to be less competent or capable
Table 5. Zero-order correlations among maternal observational and self-report indices
234567
1. EA Sensitivity 0.79*** 0.34 0.20 0.40* 0.01 0.19
2. EA Structuring 0.41*** 0.35*** 0.40* 0.15 0.25
3. PSOC Satisfaction 0.60*** 0.79*** 0.47*** 0.62***
4. PSOC Efficacy 0.56*** 0.43* 0.56***
5. PSI Parental Distress 0.33 0.58***
6. PSI Dysfunctional Interaction 0.36*
7. PSI Difficult Child
EA, Emotional Availability; PSI, Parenting Stress Index; PSOC, Parenting Sense of Competence Scale; Correlations are presented
only for variables for which a significant difference was found between groups; *pB0.05; ***p B0.001.
L.K. NEWMAN, C.S. STEVENSON, L.R. BERGMAN, P. BOYCE 603

as parents. These findings are concerning given that
parents with low-self efficacy have been found to feel
overburdened by their parental duties and as a result
frequently become immobilized by the emotional and
physical tasks involved [15]. The implication of this is
that children of these parents are at greater risk of
abuse or neglect.
In addition to rating themselves poorly as mothers,
mothers with BPD reported higher levels of stress
and, consistent with other studies [29], we found that
high stress correlated with low self-efficacy. On the
PSI-SF, mothers with BPD rated their role as a
parent as stressful and their interaction with their
child as stressful. High self-perceptions of stress in the
parenting role are believed to haveanadverse effect
on the mother infant relationship and the capacity to
parent optimally. Moreover, high levels of parenting
stress are associated with a negative authoritarian
parenting style. This style of parenting has been
associated with disruptive and later oppositional
behaviour in children [15]. Thus the parenting style
of mothers with BPD is likely to haveanadverse
outcome on child development and behavioural
regulation.
A limitation of the present study was the use of
community group for comparison rather than a
group with another diagnosis (i.e. depression or
personality disorder); but it was beyond the scope
of this preliminary study to include such a group.
Thus we acknowledge that depression in the BPD
group may have contributed to the observed out-
comes. In addition, the present study used a cross-
sectional design to gain an understanding of the types
of parenting challenges experienced by mothers with
BPD. The next step would be to conduct a long-
itudinal study to explore the long-term impact of
having a parent with BPD, for child outcome.
Interestingly, Rutter and Quinton in the 1980s
predicted that mothers with personality disorders
would have more challenges with parenting than
those mothers with Axis 1 conditions [30] and yet
this area of research has been neglected.
Conclusions
The present study provides significant insight into
and furthers understanding of the impact of BPD on
parenting. Overall, our results indicate that the
parenting role for mothers with BPD is challenging
and stressful and as a consequence their interactions
with their infant lack emotional responsivity and
structure. Likewise, their children showed early signs
in interaction that they are likely to be socially and
emotionally developmentally disadvantaged. Obser-
vational and self-report methods provided insight
into how the maternal state of mind directly influ-
enced parenting behaviours (observed emotional
interactions) and cognitive representations (percep-
tions of the self as a parent). Importantly, despite
50 60% of the present BPD sample having had prior
psychotherapy, a clear implication of the present
study is that mothers with BPD need to be identified
early, with intervention targeted at that interaction
with their infant and their self-perceptions of parent-
ing. Currently, the authors are developing such an
intervention programme known as ‘Getting to know
you’ [31]. This programme uses video examples to
support mothers with newborn babies to interpret
and respond to their baby’s early attempts at com-
munication. Such intervention may protect their
infants from social and emotional difficulties later
in life. Clearly, further research is needed to identify
and understand the parenting difficulties of mothers
with BPD that directly impact on their children’s
developmental outcomes.
Acknowledgements
The present study forms part of a series of studies
into mothers with BPD and their infants. We would
like to thank the all the mothers and infants who
volunteered to participate. We are also grateful to
Sophie Rabone and Rochelle Dempsey for assisting
with data collection.
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