Reflective function is an ability to think about and learn from past experiences.

too frightening or painful. For example, perceiving a caregiver as wanting to harm them, for example, “my mummy wants to hurt me”.

As infants have not had the opportunity to develop the aforementioned capacities, they are likely to grow up experiencing re-traumatisation (van der Kolk, 1989), by re-enacting the trauma with others, as a victim or perpetrator. Individuals who have been traumatised also employ self-damaging coping strategies to (1) self- soothe and numb the experiences o f intense emotions, e.g. alcohol use, (2) to “feel alive” when one feels numb, e.g. cutting. Individuals who have been traumatised may oscillate between the two states o f numbness and hyper-arousal, finding it difficult to find an affective equilibrium (Horowitz, 1976), thus they develop self­ damaging coping strategies to regulate emotions.

Van der Kolk’s description coincides with someone who would be given a diagnosis o f BPD, but with a contextual understanding o f why these difficulties may occur. Similar to the attachment models, the developmental trauma literature provides a life-span understanding o f those diagnosed with BPD.

4.34 Intergenerational patterns in systems

Theory and research repeatedly suggests that the development o f affect regulation is learned through interactions with caregivers (e.g. Schore, 2001) and is linked to maternal sensitivity (e.g. Kogan & Carter, 1996). This could suggest an intergenerational transmission of difficulties with affect regulation. How can mothers teach their infants to regulate their affect if mothers are unable to regulate their own? Byng-Hall (1985) proposed the idea o f “family scripts” from intergenerational family therapy sessions. This concept suggests that individuals build up and store sequences o f memories related to particular events. When each member o f a family unit holds a particular sequence as a script, it becomes known as a “family script” (Byng-Hall,

1985). Family scripts enable an individual to decide upon an action in a given situation without too much process, hence it saves energy for individuals to focus on novel situations.

When new generations adopt the same role as their parents it is deemed a "replicative script”; when individuals repeat the same patterns o f care-giving and care-seeking they experienced in their own early relationships. Alternatively, new generations can choose to correct the errors their parents made, thus developing a corrective script (Byng-Hall, 1985). As each individual brings to a new relationship their own family scripts this will result in a blend o f family scripts from the two individuals, thus resulting in both replicative and corrective scripts. The number of replicative scripts will depend on the concordance between the family scripts and the belief systems o f the two individuals.

Linking the concept of family scripts to early adverse experiences and affect regulation, research evidence suggests that adverse early experiences are repeated across generations, whereby those who have been exposed to early traumatic events can experience a “compulsion to repeat”, including re-enacting the trauma they experienced as the perpetrator rather than the victim (van der Kolk, 1989). Studies investigating attachment styles o f mothers and their children have found correspondence between the two (van IJzendoom, 1995), suggesting an intergenerational transmission of attachment style, potentially related to replicative family scripts. Linking back to Bowlby and Crittenden’s models, those exposed to early adversity typically have limited, maladaptive strategies to manage novel interpersonal situations, due to their own early attachment relationships. This will inevitably limit the strategies an individual has in the mother-infant relationship, potentially leading them to rely on replicative family scripts. This puts mothers

diagnosed with BPD at risk o f repeating their own early adverse experiences. Furthermore, as attachment and emotion regulation is developed in the context of a family (Bowlby, 1969), it is possible that attachment style, and subsequently emotion regulation, will also transmit across generations.

There are, however, instances where this is not necessarily the case; known as the “transmission gap”. A significant finding linked to transmission o f attachment style is the concept of maternal reflective function; a mother’s ability to consider her own and her infant’s behaviours in the context o f internal states, specifically cognition and affect. Maternal reflective function has been found to predict infant attachment security to a higher degree than a mother’s own attachment style (Fonagy & Target, 2005). Research also suggests that social support and life stressors can also influence adult attachment styles (Sroufe, Egeland, Carlson & Collins, 2005).

4.4 Theories of parenting/caregiving

While there are a growing number o f treatments for individuals diagnosed with BPD (e.g. Linehan, 1993; Bateman & Fonagy, 2004), there are no identified theories related to BPD and parenting. Theories of parenting in the context o f early adversity and poor attachment relationships, however, have been put forward to identify what leads to the development of different parenting styles.

4.41 Adult attachment style and care-giving

Drawing on the attachment literature, George (1996) suggests that internal working models developed in childhood influence parenting styles. Parents who have a secure attachment style provide a secure base for their children, allowing them to explore the environment, and comforting them when they feel unsafe. They are flexible in their care-giving behaviour, suggesting multiple strategies in managing relationships (George & Solomon, 1996).

Howe, Brandon, Hinings & Schofield (1999) apply adult attachment styles to parents who maltreat their children. They identify that carers who go on to be physically abusive to towards their children are likely to have a dismissing attachment style, with low emotional expression. The punitive parenting they received as a child is perceived to be an appropriate form of care for their own children. With high expectations o f their children, they provide low support and interact minimally with their children.

In contrast, neglecting caregiving is formulated around a helpless internal working model, based on a passive and ambivalent attachment style. The carer is likely to have high dependency on others but a low ability to cope, providing an unstimulating environment for their children.

Finally, the abusing and neglecting caregiving style reflects an unresolved attachment in parents. This is identified as related to the caregiver’s own experiences o f early unresolved trauma or mental health difficulties. Their internal working model is based on control and rejection (mirroring their caregiver’s style), with the combined fear of being rejected by the child. They may subsequently perceive the child as threatening. They can fluctuate between non-responsive and punitive, feeling out o f control both in relation to the self and their children. Caregivers might be reminded of their own early experiences o f care-seeking in their role as a parent, which may limit how able they are to provide care to another.

4.42 C rittenden’s approach to parenting

Based on the Dynamic Maturational Model (DMM), Crittenden identified the protective strategies that parents may adopt that can lead to maltreatment o f children (Crittenden, 2006b; Crittenden, 2008). Crittenden identified distortions that influence parenting depending on how close to reality one’s perceptual information is, as

described in the DMM section of this review. Depending on the level o f distortion the parent will vary in how much emphasis they place on protecting the self versus protecting the child. She identified three parenting styles that linked into type A dispositional representations; with an emphasis on cognitive information in processing danger. A further three parenting styles were linked to the type C dispositional representations; where the emphasis is on affective information in processing danger. Individuals with a diagnosis o f BPD are defined by their difficulties in emotion regulation (APA, 2013) and show elevated levels o f emotional arousal at baseline, and steeper levels o f emotional arousal following a stressor (Linehan, 1993). As Type C parenting styles relate to parents who are heavily influenced by affective information, these were selected as part o f the review. Appendix E contains a summary table o f each o f the types o f parenting and the impact on the child.