Contextualizing motherhood in persons with borderline personality vulnerabilities: cultural adaptation of the Parent Development Interview-Revised in an Indian context

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An understanding of the complex intersection of borderline personality vulnerabilities and motherhood calls for an integrative and culture-sensitive lens in assessment and therapeutic interventions. The aim of the study was to explore constructions of motherhood in an Indian context to inform the adaptation of the Parent Development Interview-Revised (PDI-R) for use with mothers with borderline personality vulnerabilities. A stepwise framework was followed to obtain conceptual, semantic, and operational equivalences for the PDI-R adaptation. Interviews on contextualised aspects of motherhood were conducted with a sample of eight mental health practitioners specializing in borderline personality disorders, women’s mental health or child psychology, two cultural psychologists, one gynaecologist and one paediatrician. Six emergent themes were identified through thematic analysis, ‘The ideal mother and her search for identity,’ ‘Mothering the mother and the vicissitudes of care,’ ‘Not just mine - negotiating boundaries,’ ‘Mother knows best,’ ‘Food, feeding and embodied nurturing,’ and ‘Approaching motherhood in the clinic.’ The proposed adaptations to the PDI-R were further reviewed by two experts; a clinical psychologist and a psychiatrist specialised in perinatal services. This was followed by the process of operational equivalence through administration of PDI-R with two mothers with borderline personality vulnerabilities and two mothers from the community. The expert review and the administration informed the final adaptation of the PDI-R. A systematic process of adaptation can support the use of measures like the PDI-R in different cultures. A contextual understanding of constructions of motherhood and borderline personality has potential to support meaningful assessment and targeted parenting interventions.

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Aber, J. L., Slade, A., Berger, B., Bresgi, I., & Kaplan, M. (1985). The Parent Development
Interview. Unpublished Manuscript. Barnard College, Columbia University, New York.
Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment studies with borderline patients: A Review. Harvard Review of Psychiatry, 12(2), 94-104. DOI: https://doi.org/10.1080/10673220490447218
Allen, J. G. (2018). Mentalizing in the development and treatment of attachment trauma. London, England: Routledge. DOI: https://doi.org/10.4324/9780429477263
Aneja, A., & Vaidya, S. (2016). Embodying motherhood: Perspectives from contemporary India (pp.1-29). New Delhi, India: Sage Publications India.
Bartsch, D. R., Roberts, R. M., Davies, M., & Proeve, M. (2015). Borderline personality disorder and parenting: clinician perspectives. Advances in Mental Health, 13(2), 113-126. DOI: https://doi.org/10.1080/18387357.2015.1065554
Barone, L. (2003). Developmental protective and risk factors in borderline personality disorder: A DOI: https://doi.org/10.1080/1461673031000078634
study using the Adult Attachment Interview. Attachment & Human Development, 5(1), 64-77
Barnow, S., Aldinger, M., Arens, E. A., Ulrich, I., Spitzer, C., Grabe, H. J., & Stopsack, M. (2013). Maternal transmission of borderline personality disorder symptoms in the community-based Greifswald Family Study. Journal of Personality Disorders, 27(6), 806-819. DOI: https://doi.org/10.1521/pedi_2012_26_058
Beatty, P. C., & Willis, G. B. (2007). Research synthesis: The practice of cognitive interviewing. Public Opinion Quarterly, 71(2), 287-311. DOI: https://doi.org/10.1093/poq/nfm006
Benbassat, N., & Priel, B. (2012). Parenting and adolescent adjustment: The role of parental reflective function. Journal of Adolescence, 35(1), 163-174. DOI: https://doi.org/10.1016/j.adolescence.2011.03.004
Bhatti, F., & Jeffery, R. (2012). Girls' schooling and transition to marriage and motherhood: exploring the pathways to young women's reproductive agency in Pakistan. Comparative Education, 48(2), 149-166. DOI: https://doi.org/10.1080/03050068.2011.608894
Borelli, J. L., St John, H. K., Cho, E., & Suchman, N. E. (2016). Reflective functioning in parents of school-aged children. American Journal of Orthopsychiatry, 86(1), 24-36. DOI: https://doi.org/10.1037/ort0000141
Bornstien, M.H (2018). Some metatheoretical issues in culture, parenting and developmental science. In: Jing, Q., Rozenweig, M.R., d’Yewalle, G., Zhang, H., Chen, H., & Zhang, K (eds.), Progress in Psychological Science around the World, vol.2 (pp. 85-94). New York: Routledge
Blankley, G., Galbally, M., Snellen, M., Power, J., & Lewis, A. J. (2015). Borderline personality disorder in the perinatal period: early infant and maternal outcomes. Australasian Psychiatry, 23(6), 688-692. DOI: https://doi.org/10.1177/1039856215590254
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. DOI: https://doi.org/10.1191/1478088706qp063oa
Buchheim, A., & Diamond, D. (2018). Attachment and borderline personality disorder. Psychiatric Clinics, 41(4), 651-668. DOI: https://doi.org/10.1016/j.psc.2018.07.010
Cano, K., Sumlin, E., & Sharp, C. (2021). Screening for borderline personality pathology on college campuses. Personality and Mental Health. 16(3), 235-243. DOI: https://doi.org/10.1002/pmh.1534
Chodorow, N. (1978). The reproduction of mothering. University of California Press. DOI: https://doi.org/10.1525/9780520924086
Choi, P., Henshaw, C., Baker, S., & Tree, J. (2005). Supermum, superwife, supereverything: performing femininity in the transition to motherhood. Journal of Reproductive and Infant Psychology, 23(2), 167-180. DOI: https://doi.org/10.1080/02646830500129487
Chaudhary, N., & Bhargava, P. (2006). Mamta: The transformation of meaning in everyday usage. Contributions to Indian Sociology, 40(3), 343-373. DOI: https://doi.org/10.1177/006996670604000303
Chaudhary, N., (2015). Mothers and others: the cultural construction of obvious and obscure identities in Cabell, K. R., Marsico, G., Cornejo, C., & Valsiner, J. (Eds.) Making meaning, making motherhood (1st ed., pp. 388). Information Age Publishing.
Choudhry, U. K. (1997). Traditional practices of women from India: pregnancy, childbirth, and newborn care. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 26(5), 533-539. DOI: https://doi.org/10.1111/j.1552-6909.1997.tb02156.x
Choudhary, S., & Gupta, R. (2020). Culture and borderline personality disorder in India. Frontiers in Psychology, 11, 714. DOI: https://doi.org/10.3389/fpsyg.2020.00714
Dunn, A., Cartwright-Hatton, S., Startup, H., & Papamichail, A. (2020). The parenting experience of those with borderline personality disorder traits: Practitioner and parent perspectives. Frontiers in Psychology, 11, 1913. DOI: https://doi.org/10.3389/fpsyg.2020.01913
Ellison, W. D., Rosenstein, L., Chelminski, I., Dalrymple, K., & Zimmerman, M. (2016). The
clinical significance of single features of borderline personality disorder: Anger, affective
instability, impulsivity, and chronic emptiness in psychiatric outpatients. Journal of
Personality Disorders, 30(2), 261–270.
Eyden, J., Winsper, C., Wolke, D., Broome, M. R., & MacCallum, F. (2016). A systematic review ofthe parenting and outcomes experienced by offspring of mothers with borderline personalitypathology: Potential mechanisms and clinical implications. Clinical Psychology Review,47 (2), 85–105. DOI: https://doi.org/10.1016/j.cpr.2016.04.002
Florange, J. G., & Herpertz, S. C. (2019). Parenting in patients with borderline personality disorder, sequelae for the offspring and approaches to treatment and prevention. Current Psychiatry Reports, 21(2), 1-8. DOI: https://doi.org/10.1007/s11920-019-0996-1
Fonagy, P., Steele, M., Steele, H., Moran, G. S., & Higgitt, A. C. (1991). The capacity for
understanding mental states: The reflective self in parent and child and its significance for
security of attachment. Infant Mental Health Journal, 12(3), 201–218.
Fornells, M. G., Téstor, C. P., & Baró, M. S. (2018). The Spanish and Catalan versions of the Parent Development Interview-Revised (PDI-R): Adaptation and validation process. Contemporary Family Therapy, 40(4), 338-345. DOI: https://doi.org/10.1007/s10591-018-9457-y
George, C, Kaplan, N., & Main, M. (1985) The adult attachment interview. Unpublished manuscript. University of California at Berkeley. DOI: https://doi.org/10.1037/t02879-000
Hambleton, R. K. (2001). The next generation of the ITC test translation and adaptation guidelines. European Journal of Psychological Assessment, 17(3), 164-172. DOI: https://doi.org/10.1027//1015-5759.17.3.164
Handeland, T. B., Kristiansen, V. R., Lau, B., Håkansson, U., & Øie, M. G. (2019). High degree of uncertain reflective functioning in mothers with substance use disorder. Addictive Behaviors Reports, 10, 100193. DOI: https://doi.org/10.1016/j.abrep.2019.100193
Harkness, S., & Super, C. M. (2002). Culture and parenting. In: Bornstein M.H (ed) Handbook of parenting, vol 2. (pp. 253-280). Mahwah, New Jersey: Lawrence Erlbaum Associates.
Kaess, M., Fischer-Waldschmidt, G., Resch, F., & Koenig, J. (2017). Health related quality of life
and psychopathological distress in risk taking and self-harming adolescents with full-
syndrome, subthreshold and without borderline personality disorder: rethinking the clinical
cut-off? Borderline Personality Disorder and Emotion Dysregulation, 4(1), 1-12.
Kağitçibasi, Ç. (1996). The autonomous-relational self: A new synthesis. European Psychologist, 1(3), 180. DOI: https://doi.org/10.1027/1016-9040.1.3.180
Keller, H., Bard, K., Morelli, G., Chaudhary, N., Vicedo, M., Rosabal‐Coto, M., ... & Gottlieb, A. (2018). The myth of universal sensitive responsiveness: Comment on Mesman et al. (2017). Child Development, 89(5), 1921-1928. DOI: https://doi.org/10.1111/cdev.13031
Kerr, M. L., Fanning, K. A., Engbretson, A. M., Butitta, K. V., Borelli, J. L., Smiley, P. A., & Rasmussen, H. F. (2022). Fathers’ emotional experiences while parenting toddlers: A qualitative exploration. Early Child Development and Care, 192(12), 1982-1997. DOI: https://doi.org/10.1080/03004430.2021.1960517
Korfine, L., & Hooley, J. M. (2009). Detecting individuals with borderline personality disorder in the community: An ascertainment strategy and comparison with a hospital sample. Journal of Personality Disorders, 23(1), 62-75. DOI: https://doi.org/10.1521/pedi.2009.23.1.62
Krueger, R. F., Eaton, N. R., Clark, L. E., Watson, D., Markon, K. E., Derringer, J., Livesley, W. J. (2011). Deriving an empirical structure of personality pathology for DSM-5. Journal of Personality Disorders, 25 (2), 170-191. DOI: https://doi.org/10.1521/pedi.2011.25.2.170
León, E., Steele, M., Palacios, J., Román, M., & Moreno, C. (2018). Parenting adoptive children: Reflective functioning and parent-child interactions. A comparative, relational and predictive study. Children and Youth Services Review, 95, 352-360. DOI: https://doi.org/10.1016/j.childyouth.2018.11.009
Loranger, A. W. (1999). International Personality Disorder Examination: IPDE; DSM-IV and ICD-10; Interviews. PAR.
McCarthy, K. L., Lewis, K. L., Bourke, M. E., & Grenyer, B. F. (2016). A new intervention for people with borderline personality disorder who are also parents: a pilot study of clinician acceptability. Borderline Personality Disorder and Emotion Dysregulation, 3(1), 1-9. DOI: https://doi.org/10.1186/s40479-016-0044-2
Mosquera, D., Gonzalez, A., & Leeds, A. M. (2014). Early experience, structural dissociation, and
emotional dysregulation in borderline personality disorder: the role of insecure and
disorganized attachment. Borderline Personality Disorder and Emotion Dysregulation, 1(1),1-8.
Morey, L. (1991). Personality Assessment Inventory professional manual. Odessa, FL: PAR, Inc. DOI: https://doi.org/10.1037/t03903-000
Newman, L., & Stevenson, C. (2005). Parenting and borderline personality disorder: ghosts in the nursery. Clinical Child Psychology and Psychiatry, 10(3), 385-394. DOI: https://doi.org/10.1177/1359104505053756
Quek, J., Newman, L. K., Bennett, C., Gordon, M. S., Saeedi, N., & Melvin, G. A. (2017). Reflective function mediates the relationship between emotional maltreatment and borderline pathology in adolescents: A preliminary investigation. Child Abuse & Neglect, 72, 215-226. DOI: https://doi.org/10.1016/j.chiabu.2017.08.008
Raman, S., Srinivasan, K., Kurpad, A., Dwarkanath, P., Ritchie, J., & Worth, H. (2014). ‘My Mother… My Sisters… and My Friends’: Sources of maternal support in the perinatal period in urban India. Midwifery, 30(1), 130-137. DOI: https://doi.org/10.1016/j.midw.2013.03.003
Reichenheim, M. E., & Moraes, C. L. (2007). Operationalizing the cross-cultural adaptation of epidemological measurement instruments. Revista De Saúde Pública, 41, 665-673. DOI: https://doi.org/10.1590/S0034-89102006005000035
Rishede, M. Z., Juul, S., Bo, S., Gondan, M., Bjerrum Møeller, S., & Simonsen, S. (2021). Personality functioning and mentalizing in patients with subthreshold or diagnosed borderline personality disorder: Implications for ICD-11. Frontiers in Psychiatry, 12, 634332. DOI: https://doi.org/10.3389/fpsyt.2021.634332
Roland, A. (1987). The familial self, the individualized self, and the transcendent self: Psychoanalytic reflections on India and America. Psychoanalytic Review, 74(2), 237-250.
Sheehan, D. V. (2014). The M.I.N.I - International Neuropsychiatric Interview, version 7.0 for DSM-5 (MINI 7.0). Jacksonville, FL: Medical Outcomes Systems.
Slade, A., Aber, J.L., Berger, B., Bresgi, I., & Kaplan, M. (2003a). The Parent Development Interview – Revised. Unpublished manuscript, City University of New York
Slade, A., Bernbach, E., Grienenberger, J., Wohlgemuth, D., & Locker, A. (2003b). Addendum to reflective functioning scoring manual for use with the parent development interview. New York (unpublished manuscript).
Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005b). Maternal reflective functioning, attachment, and the transmission gap: A preliminary study. Attachment & Human Development, 7(3), 283-298. DOI: https://doi.org/10.1080/14616730500245880
Slade, A. (2011). The Pregnancy Interview - Revised (Unpublished manuscript). The City University of New York, New York, NY.
Sleed, M., Slade, A., & Fonagy, P. (2020). Reflective Functioning on the Parent Development Interview: Validity and Reliability in relation to socio-demographic factors. Attachment & Human Development, 22(3), 310-331. DOI: https://doi.org/10.1080/14616734.2018.1555603
Srinivas, T. (2006). As Mother Made It': The Cosmopolitan Indian Family, Authentic Food and The Construction of Cultural Utopia.’ International Journal of Sociology of The Family, 32(2), 191-221.
Stepp, S. D., Whalen, D. J., Pilkonis, P. A., Hipwell, A. E., & Levine, M. D. (2012). Children of mothers with borderline personality disorder: identifying parenting behaviors as potential targets for intervention. Personality Disorders: Theory, Research, and Treatment, 3(1), 76. DOI: https://doi.org/10.1037/a0023081
Steele, K. R., Townsend, M. L., & Grenyer, B. F. (2019). Parenting and personality disorder: an overview and meta-synthesis of systematic reviews. PloS one, 14(10), e0223038-1-e0223038-26. DOI: https://doi.org/10.1371/journal.pone.0223038
Triandis, H. C. (1996). The psychological measurement of cultural syndromes. American Psychologist, 51(4), 407-415. DOI: https://doi.org/10.1037/0003-066X.51.4.407
Trull, T. J., & Widiger, T. A. (1991). The relationship between borderline personality disorder criteria and dysthymia symptoms. Journal of psychopathology and behavioral assessment, 13(2), 91-105. DOI: https://doi.org/10.1007/BF00961425
Tuli, M. (2012). Beliefs on parenting and childhood in India. Journal of Comparative Family Studies, 43(1), 81-91. DOI: https://doi.org/10.3138/jcfs.43.1.81
Uberoi, P. (1993). Reciprocity in Social Science: Gender Issues. The Indian Journal of Social Science, 6(3), 243-58.
Vidhatri Raval, V., & Martini, T. S. (2009). Maternal socialization of children's anger, sadness, and physical pain in two communities in Gujarat, India. International Journal of Behavioral Development, 33(3), 215-229. DOI: https://doi.org/10.1177/0165025408098022
Wilson, E. O. (1975). Sociobiology: The New Synthesis. Cambridge, Massachusetts.: Belknap Press of Harvard University Press.
Zalewski, M., Stepp, S. D., Scott, L. N., Whalen, D. J., Beeney, J. F., & Hipwell, A. E. (2014). Maternal borderline personality disorder symptoms and parenting of adolescent daughters. Journal of Personality Disorders, 28(4), 541-554. DOI: https://doi.org/10.1521/pedi_2014_28_131
Zimmerman, M., Chelminski, I., Young, D., Dalrymple, K., & Martinez, J. (2013). Is dimensional
scoring of borderline personality disorder important only for subthreshold levels of
severity? Journal of Personality Disorders, 27(2), 244.

How to Cite

Mehrotra, K., Bhola, P., & Desai, G. (2023). Contextualizing motherhood in persons with borderline personality vulnerabilities: cultural adaptation of the <i>Parent Development Interview-Revised</i> in an Indian context. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(1). https://doi.org/10.4081/ripppo.2023.675