Different approaches assessing mental representations of the mother-child-relationship in borderline personality disorder: how do mothers talk about their children?

Abstract

Mothers with borderline personality disorder (BPD) are assumed to perceive difficulties in the relationship towards their children. However, a detailed and comprehensive investigation on how mothers with BPD reflect and speak about their children as an indicator for mental representations of the mother-child relationship is yet missing. In two articles drawing from a cross-sectional data set of a multi-center study, we examined these aspects in mothers with BPD compared with a healthy and a clinical control group comprising mothers with anxiety disorders, depression, or both. Using the Five Minute Speech Sample, we focused on Expressed Emotion (EE), Narrative Coherence (NC) - both in the primary data analysis - and an extended assessment of Mind-Mindedness (extended MM) in the secondary data analysis. This article mainly addresses the similarities and differences between the three constructs on a conceptual level and regarding the respective study results, and additionally discusses the overall results from both studies. When comparing the three constructs, we identified differences regarding the level of analyzed content (i.e., characteristics of speech vs. characteristics of representation) and the level of orientation (i.e., reference to the mother herself vs. reference to the child). Three aspects are assessed via all operationalizations: (1) reporting negatively about characteristics or behaviors of the child, (2) reporting weaknesses of the child, and (3) descriptions of relationship quality. Mothers with BPD were more likely to express overt criticism (EE) and express more mental attributes with negative valence (extended MM) than both the clinical and healthy control groups. Given that we found particularities in the parent-child relationship in mothers with BPD across all three coding systems, we assume the overlap to be grounded in a tendency towards greater disapproval of child characteristics and reports of challenges in relationship quality. Considering the results of both studies, this article provides the most a comprehensive examination of these relational aspects in mothers with BPD, including comparisons with both healthy and clinical control groups. These insights contribute to a deeper understanding of the complexities underlying mental representations of the mother-child relationship in the context of BPD.