Borderline Personality Disorder

NERD ALERT!!! This is a posting of an old assignment I did in school & represents an attempt, on my part, to refamiliarize myself with various DSM-5 diagnoses.

Borderline Personality Disorder (BPD) is a “pervasive pattern of instability of interpersonal relationships, self-image, and affect [with] marked impulsivity” (American Psychiatric Association, 2013, p663). Over the years, I’ve noticed that RN’s at work frequently mention BPD as one of the most difficult diagnoses to and manage. What follows is an overview of (1) how a BPD might influence an individual’s parenting styles, and (2) how this affects their child’s development.   Insights from an article titled “Children and Mothers with Borderline Personality Disorder”, have been included (Stepp, et al, 2012)

Affects of BPD Parenting

Fear of Abandonment

Criterion 1A of the DSM-5 manual describes fear of abandonment as a key characteristic of this disorder (American Psychiatric Association, 2013).   This fear can produce extreme frantic reactions in the face of perceived rejection and separation.   Underlying role confusion between parent and child is a potential byproduct.   Stepp, et al, (2012), states that BPD parents can reinforce an alternating parent/friend role for their children.

Dramatic Interpersonal Shifts

BPD also involves dramatic and unpredictable shifts in how oneself and/or others are perceived.   For example, the DSM-5 Manual suggests that BPD parents can vacillate between “needy supplicant…[or] righteous avenger (American Psychiatric Association, p664). Ultimately, this unpredictability is the consequence of how others are perceived in accordance with BPD-defined fears.   Stepp, et al, (2012) state that: “oscillations between extreme forms of hostile control and passive aloofness in their interactions with their children may be unique to mothers with BPD (p76). The consequences of this for BPD offspring, include unstable attachments, higher levels of depressive symptoms, and an overall global impairment (Stepp, et al, 2012, p79)

Affective Instability

Marsha Linehan’s work is helpful in understanding the consequences of BPD-related affective stability on parenting. According to DBT, chronic invalidation in childhood produces an environment of poor emotional socialization. Since BPD parents often come from this background, the result is an impaired ability to understand emotions and affective instability. Interpersonal vulnerability and insecure attachments are common consequences for BPD offspring (Stepp, et al, 2012).   Additionally, chronic-stress is frequently observed BPD offspring as a due to unpredictable parental hostility (Stepp, et al, 2012).

Impulsivity

BPD also involves self-destructive impulsive behaviors that involve activities such as gambling, substance abuse, suicidality, self-harm, or unsafe sex practices (American Psychiatric Association, 2013). An unstable home environment is a likely byproduct of this BPD-related symptom.

Conclusion

Treating a child with a behavior problem who has a parent with BPD is problematic at best, in light of the all this.   In order to counsel and treat a client like this, it would be important to ensure that the parent is also receiving ongoing treatment. The effectiveness of any interventions for this child would depend on willing parental participation.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., & Levine, M. D. (2012; 2011). Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention. Personality Disorders, 3(1), 76-91. doi:10.1037/a0023081

 

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