Navigating parenthood in people living with borderline personality disorder: a meta-ethnography.

backgroundEmotional 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.

methodsFollowing 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.

resultsSix 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.

conclusionTaken 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.