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Mothers with borderline personality disorder often have experienced early-life trauma. How can you help?
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
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. ❒