Prevalence and characteristics of women with borderline personality pathology referred to a perinatal consultation liaison service

Abstract

Objective: To examine the prevalence and characteristics of pregnant women with borderline personality pathology (defined as borderline personality disorder and borderline personality traits) referred to a perinatal consultation-liaison psychiatry service. Method: Socio-demographic and clinical data, and diagnoses made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria were recorded for all women referred to and seen by the perinatal consultation-liaison psychiatry service over an 18-month period. Data were analysed using descriptive statistics and logistic regression analysis. Results: A total of 318 women were seen. The most common diagnoses found were depressive disorder (25.5%) and anxiety disorder (15.1%). Borderline personality disorder was found in 10.1% of women and almost one in five women had two or more borderline personality traits (19.5%). When compared to women with other diagnoses, women with borderline personality pathology had higher rates of unplanned pregnancy, being unpartnered, substance use during pregnancy and higher rates of child safety services involvement as a child or in a previous pregnancy. Over 40% of women with borderline personality pathology were referred to child safety services in the current pregnancy and a diagnosis of borderline personality pathology increased the risk of child safety services involvement by almost sixfold (odds ratio: 5.5; 95% confidence interval = [1.50, 20.17]). Conclusion: The prevalence of borderline personality pathology in antenatal women identified at antenatal screening and the recognition that women with borderline personality pathology are ‘high-risk’ caregivers argue for borderline personality pathology to be recognised as a high priority for investment in service development.

Interventions for perinatal borderline personality disorder and complex trauma: a systematic review

“…This included current use of alcohol and/or drugs, and frequent high risk to life behaviours such as “cutting, overdosing or endangering life including excess use of alcohol and/or non-prescribed medication”. Given BPD/trauma is frequently characterised by substance use and self-harm (Dunn et al, 2020 ; Nagel et al, 2021 ; Sved Williams & Apter, 2017 ), sample representativeness and consequently outcomes may be questionable. It is additionally noted that some BPD/trauma behaviours are incompatible with eastern and collectivist societies, for example substance use and promiscuous sex in China (Wang et al, 2012 ).…”

Outcomes for pregnant women with Borderline Personality Disorder who attended a specialist antenatal service

“…BPD is also a disorder that commonly affects women of reproductive age, with presentations often occurring in the perinatal setting with potential downstream consequences on the development of their offspring. Prasad et al 5 found the pooled prevalence of BPD in perinatal women to be 14% while Nagel et al 6 in their study at a tertiary maternity hospital found 10.1% met BPD criteria while 19.5% had BPD traits. To the best of our knowledge there have been only four studies examining the obstetric, neonatal, and social outcomes for pregnant women with BPD.…”

“…The studied population also displayed high rates of substance abuse and child protection involvement. Another study by Nagel et al 6 found that when compared to unmatched controls, pregnant women who met the clinical criteria for BPD and those with subthreshold BPD traits had high rates of unplanned pregnancy, being unpartnered, having substance use, and child protection involvement during pregnancy. This study also highlighted the diagnostic challenge of BPD in the perinatal period with psychiatric comorbidity being common.…”