Table 1 Summary of included sources (descriptive information)

Blizard (2003), USA, Journal Article [55]

Non-systematic review and opinion

Not explicitly stated. To present a theoretical model of disorganized attachment and dissociation, and a treatment model based on findings

N/A

Theoretical discussion and synthesis and presentation of case material

Theoretical discussion with explicit theoretical basis

Crandell (2003), UK, Journal Article [56]

Non-randomised experimental study

To investigate mother-infant relations when mothers have borderline personality disorder

Mothers with borderline personality disorder + their infants; control group of mothers with no history of disorder + their infants

No dissociation measures. Videotape analysis and rating by blinded rater based on previous study criteria. Measured pre- and post-still-face procedure, and during face-to-face play post-still-face

Observation of behaviour with implicit idea

Haltigan (2019), Canada, Journal Article [57]

Latent trait modelling analysis of AMBIANCE measure (factor analysis)

To apply the Item Response Theory (IRT) modelling techniques to the Atypical Maternal Behaviour Instrument for Assessment and Clarification (AMBIANCE)

Item-level AMBIANCE data; 6 subsamples (pooled n = 343) from various parent studies conducted in western countries

Item level data on the AMBIANCE measure pooled; transformed to binary scale and analysed

Observation of behaviour with explicit focus or mention

Hesse (2000) USA, Journal Article [39]

Non-systematic review and opinion

Provide a descriptive account of processes that identify disorganized attachment status across lifespan

Presentation of cases and summary synthesis of literature regarding disorganised attachment

Presentation and synthesis of ideas relating to attachment, disorganised attachment, and dissociation

Observation of behaviour with explicit focus or mention; Theoretical discussion where there is no explicated model

Hobson (2005), UK, Journal Article [58]

Non-randomised experimental study

Assessment of interactional quality and attachment of 12-month-old infants of mothers with BPD; evaluation of maternal intrusive insensitivity

Mother infant Dyads with 12-month old infants. 10 mothers with BPD; 22 control mothers without psychopathology

Modified set situation was applied to each mother infant dyad. Still face phase (90 s). Rapprochement and spatula phase then administered. Rating of whole situation then applied

Observation of behaviour with implicit idea

Hobson (2009), UK, Journal Article [59]

Non-randomised experimental study

To assess how women with borderline personality disorder engage with their 12 to 18-month-old infants in separation– reunion episodes

Mother infant Dyads. Cohort 1: 12-month-old infants. 10 mothers with BPD; 22 control mothers without psychopathology (n = 32). Cohort 2: 27 mother-infant dyads, where the mothers had BPD

Modified set situation was applied to each mother infant dyad. Still face phase (90 s). Rapprochement and spatula phase then administered. Rating of whole situation then applied

Administration of validated measure

Hulette (2011), USA, Journal Article [60]

Cohort study

Investigate the intergenerational relationships between trauma and dissociation

67 mothers and their children aged 7–8 years old. 36 boys, 31 girls

Brief Betrayal Trauma Survey (BBTS) and Brief Betrayal Trauma Survey—Parent report (BBTS—Parent) administered. Categorised based on responses to 'high betrayal trauma', 'low betrayal trauma' or 'no betrayal trauma' conditions. Parents dissociation assessed via Dissociative Experiences Scale (DES). Children's dissociation was assessed by the administration of the Child Dissociative Checklist (CDC)

Administration of validated measure

Kiel (2011), USA, Journal Article [21]

Non-randomised experimental study

investigate the association between borderline personality pathology and at-risk parenting. Investigation the nature of parenting in response to infant distress in mothers with and without borderline personality pathology

99 infants and their mothers; divided into ''high borderline personality" and "low borderline personality groups". Infants range from 12–23 months

Mothers screened with Borderline Evaluation of Severity over Time (BEST); Difficulties in emotion regulation scale (DERS); Depression, Anxiety, Stress Scales (DASS-21); 1180 s of reunion in the "Strange situation" was coded. Infant affect, maternal affect, maternal behaviour were all scored. Demographic testing revealed no significant differences between high BP and low BP conditions. Micro-analysis of interactions

Administration of validated measure

Lewis (2020), USA, Journal Article [61]

Non-randomised experimental study

Examining parent factors related to changes in dissociation symptoms in childhood

68 Mothers (‘likely BPD’ and other) and their preschool aged children

Dyads completed assessment two years apart (T1 and T2). 2.5 h assessment session. Mothers completed a battery of self-report questionnaires about their and their children’s mental health symptoms. Mothers administered DERS at T1 and T2; DES administered at T2 only Child dissociation was assessed using a modified subscale for the Child Behaviour Checklist at T1 and T2

Theoretical discussion with explicit theoretical basis

Liotti (2004), Italy, Journal Article [36]

Non-systematic review and opinion

Review findings suggesting that disorganised attachment is central to trauma-related disorders, and dissociation is related to disorganisation of early attachment

N/A

Summary and synthesis of evidence and theoretical opinion

Theoretical discussion with explicit theoretical basis

Liotti (2009) Italy, Book Chapter [62]

Non-systematic review and opinion

Book Chapter. Discussion of the relationship between attachment and dissociation

N/A

Summary and synthesis of evidence and theoretical opinion

Theoretical discussion where there is no explicated model

Lyons-Ruth (2012), USA, Commentary Article [27]

Non-systematic review and opinion

Commentary article on Stepp, Whalen, Pilkonis, Hipwell, and Levine (2011)

N/A

Response article

Theoretical discussion

Macfie (2014), Spain, Book Chapter [63]

Non-systematic review and opinion

Review of evidence whether BPD has its origins in part due to failure to negotiate early childhood tasks, focusing on the role of parenting

N/A

Summary and synthesis of evidence and theoretical opinion; review of evidence for role of parenting in aetiology of BPD

Theoretical discussion with explicit theoretical basis

Mosquera (2014), Spain, Journal Article [64]

Non-systematic review and opinion

Explicate pathway(s) from attachment disruption to specific symptomatology in BPD patients

N/A

Summary and synthesis of evidence and theoretical opinion; integration of the Theory of Structural Dissociation of the Personality with mother-infant attachment in BPD context

Theoretical discussion with explicit theoretical basis

Mucci (2021), Italy, Journal Article [65]

Non-systematic review and opinion

To clarify the effects of intergenerational psychological traumatization, stratifying into two levels: 1) human agency (lack of attunement) and 2) actual abuse, maltreatment or incest as seen in Borderline pathology

N/A

Summary and synthesis of evidence and theoretical opinion

Administration of validated measure

Ozturk (2006), Turkey, Journal Article [66]

Cohort study

To assess the dissociative experiences, including borderline personality disorder, among first degree relatives of dissociative patients

24 Dissociative patients (18 diagnosed with DID; six with DDNOS). 50 family members, first degree relatives, of these patients were contacted

Family members administered Dissociative experiences scale Structured Clinical Interview for DSM-III-IV Personality Disorders (SCID-II) Borderline Personality Disorder Section—Turkish version Childhood Trauma Questionnaire (CTQ) Three (3) family members who had a DES score > 25 were administered the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)

Administration of validated measure

Reinelt (2014), Germany, Journal Article [25]

Cohort study

To test longitudinally and in a community-based sample if maladaptive mother–child interactions (conceptualized by an insensitive parenting style and discrepancies in the perception of psychopathological problems of the offspring) mediate the relationship between maternal borderline symptomatology and BPD symptoms of the offspring about 5 years later. (p.11)

230 families comprising 295 Children and their biological mothers; all families involved in the Griefswald family study

Assessed with instruments at two timepoints; initial time T0 and T1 (approx. 5 years on). Maternal BPD symptoms assessed with the self-rating part of the German version of the SCID for DSM-III-R (SCID-II)

Perceived insensitive habitual parenting style of the mothers, adolescents completed the EMBU ('own memories concerning upbringing') scale. Self-report questionnaire consisting of three scales (rejection, emotional warmth, and overprotection). 4-point Likert scale. Primary caregiver filled out the Child Behaviour Checklist (CBCL) and offspring filled out the corresponding Youth Self Report (YSR). BPD symptoms of adolescents / young adults were examined using the German version of the SCID-II interview for DSM-IV

Theoretical discussion with explicit theoretical basis

Schore (2001), USA, Journal Article [67]

Non-systematic review and opinion

To describe the negative impact of traumatic attachment on neurodevelopment and infant mental health, summarise the neurobiology of infant trauma and the neuropsychology of disorganised / disoriented attachment

N/A

Overview of the neurobiological consequences of early relational trauma on brain development, affect regulation and infant mental health including dissociative response and issues

Theoretical discussion where there is no explicated model

Stepp (2012), USA, Journal Article [68]

Non-systematic review and opinion

To describe the parenting strategies that might explain transmission of intergenerational trauma from mothers with BPD to their offspring

N/A

Summary and synthesis of evidence and theoretical opinion; parenting strategies (behavioural) and their relation to transmission of trauma from BPD mothers to their offspring

Theoretical discussion where there is no explicated model

Zalewski (2014), USA, Journal Article [26]

Cohort study

To examine the associations between maternal BPD and parenting of 14-17yo girls, and their mothers through assessment of several different cohorts longitudinally

Girls from the Pittsburgh Girls Study (PGS, N = 2,451). Urban community, girls aged 15–17; biological mothers and their adolescent daughters n = 1,598. 3 cohorts, collected in 3 waves from 7, 8, 9 years – 15,16, 17 years. Biological mothers only sampled

Tests administered at 1-year intervals. In home interviews conducted separately by trained interviewers. Mothers reported on own psychopathology and their daughters' temperaments. Daughters reports on their parents' use of psychological and behavioural control. Parent Behaviour Inventory. Three subscales were intrusiveness, control through guilt and acceptance of individuation. Behavioural control: parent report on the Conflict Tactics Scale: Parent–Child Version

Maternal BPD symptoms: The International Personality Disorders Examination Negative emotionality: parent report when girls were age 15; used emotionality, activity, and sociability temperament survey

Theoretical discussion where there is no explicated model