Borderline Personality Disorder (BPD) is a chronic and debilitating mental health condition characterized by intense emotional dysregulation, mood instability, difficulties in interpersonal relationships, and increased sensitivity to perceived rejection or abandonment. [1, 2] Individuals with BPD often engage in self-harming behaviors, substance misuse, and suicidal ideation or attempts, which significantly impair their physical and mental health and result in substantial economic costs. [3, 4]  Although there remains debate around the nosology and diagnosis of BPD, there is consensus that it involves persistent difficulties in emotion regulation, impulsivity, and interpersonal dysfunction. These individuals often exhibit poor empathy, unstable and high-conflict relationships, and pervasive fears of abandonment. [5] Comorbid anxiety and depression are also frequently reported.

The etiology of BPD is multifactorial, involving a complex interplay of genetic, neurobiological, and environmental factors. While some genetic predispositions have been suggested, evidence points strongly toward adverse childhood experiences such as trauma, abuse, and neglect as significant contributors to the development of BPD. [6, 7] Consequently, individuals with BPD who become parents often do so without having internalized healthy parenting models, having experienced dysfunctional caregiving themselves. Combined with ongoing emotional instability and life stressors, these parents may struggle to meet their children’s emotional and developmental needs effectively.

Emerging research has initiated to explore the impact of BPD on parenting practices and child outcomes. Parents with BPD are more likely to exhibit behaviors that undermine the parent-child relationship, including inconsistent caregiving, emotional invalidation, and difficulty recognizing or appropriately responding to a child’s emotional cues. [8, 9] Such parenting behaviors may hinder the child’s socioemotional development and increase vulnerability to mental health disorders. Despite growing recognition of the impact of parental psychopathology on child development, there remains a notable gap in the literature specifically focusing on the parenting capacities of individuals with BPD and the outcomes experienced by their children. While a few narratives and limited systematic reviews have touched upon this subject, comprehensive and updated syntheses of available evidence remain scarce. Given the unique and complex challenges associated with BPD such as emotional dysregulation, relational instability, and impulsivity it is critical to understand how these traits influence parenting behaviors and, in turn, affect children’s emotional, behavioral, and psychological development. A clearer understanding of these intergenerational effects is essential for designing effective clinical interventions and support systems for both parents and their children. Therefore, this systematic review was conducted to collate, evaluate, and synthesize the current evidence on parenting behaviors in individuals with BPD and the associated developmental and psychological outcomes in their children.

The protocol for this systematic review was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, ensuring methodological transparency and consistency. All amendments to the protocol were systematically recorded. The review itself was conducted following the methodological framework outlined in the Cochrane Handbook for Systematic Reviews of Interventions, and the final reporting adhered to PRISMA standards.

Although the review protocol was not registered in a formal registry (e.g., PROSPERO), a comprehensive literature search was performed across multiple electronic databases, including MEDLINE, PubMed, Google Scholar, Cochrane Library, Web of Science, and Scopus, among others. This extensive search strategy enabled the identification and inclusion of a broad spectrum of relevant peer-reviewed literature.

Search terms and keywords such as Borderline personality disorder, Children Outcomes, Parenting and DSM criteria were restricted to studies published in the English language. It is important to highlight that the search syntax was customized to meet the specific requirements and guidelines of each database. During the study selection procedure, a number of eligibility factors were considered including inclusion and exclusion criteria.

Eligibility criteria

The inclusion and exclusion criteria were established based on predefined eligibility parameters. For the purposes of this review, only studies that satisfied all inclusion criteria were selected for analysis.

Inclusion Criteria

The inclusion criteria for this review were as follows: studies published between 2014 and 2025, full-text articles available in the English language, and literature focusing on BPD in parents. Eligible studies specifically included those that examined mothers with a clinical diagnosis of BPD or with BPD symptoms, drawn from either clinical or community samples, as well as studies involving their offspring of any age. The selected studies were required to highlight both parenting characteristics and the associated developmental, emotional, or psychological outcomes in children of mothers with BPD.

Exclusive Criteria

The exclusion criteria for this review included: case reports, case series, incomplete or inaccessible full-text articles, publications prior to 2014, and non-English literature. Additionally, letters to the editor, book chapters, short communications, conference abstracts or proceedings, patents, and duplicate publications were excluded. Studies that did not involve parents or children with BPD were also excluded from the analysis.

Study selection:

Following an initial search, 702 publications were found for the current systematic review; 58 duplicate records and 110 records were eliminated. For this analysis, 534 published studies were evaluated. An additional 319 articles were eliminated during detail screening due to missing criteria. Out of the total articles reviewed, 108 were found to be irrelevant to the current review, 22 were case reports, 22 were letters to the editor, and 55 were excluded for other reasons. A total of 215 articles were initially evaluated for inclusion in the review. However, a number of factors, such as small sample sizes, case reports/case studies, letters to the editor, and missing or irrelevant data, led to the exclusion of full-text papers. Eight studies were finally chosen for this systematic review after a rigorous screening and data processing process. (Refer to Fig 1).

Study description:

In this review article, after a thorough examination, a total of eight articles published between 2014 and 2025 were included in the review. These investigations were carried out throughout Australia, Canada, UK, and USA. Among them, two studies were qualitative, two was case control, one was systematic review, one was cross sectional and two was unspecified study. (Table no. 1)

Bias assessment in individual studies

Selection bias (random sequence generation and allocation concealment), performance bias (blinding), detection bias (assessor blinding), attrition bias (incomplete outcome data), and reporting bias (selective reporting) were among the domains on which the criteria for judging and rating, as well as categorizing and ranking cumulative bias as high, uncertain, or low risk, were based. Each study was classified based on the particular domains and criteria as either high, unclear, or low risk. The assessment of risks in the study revealed that 28.57%, were categorized as having a low risk, while 39.29% had an unclear risk. Additionally, 32.14%, were classified as high risk.

The findings from the reviewed studies indicate that parents with BPD face a range of significant challenges in their caregiving roles. A consistent outcome across studies was the presence of high levels of parenting stress and notably low parental self-efficacy. These parents often struggled with emotional attunement, showing difficulties in recognizing and appropriately responding to their children's emotional needs. Impaired interpersonal boundaries were also common, resulting in unstable and inconsistent parent-child interactions. Parenting styles were frequently marked by emotional intensity, reactivity, and unpredictability. Additionally, many parents with BPD experienced social isolation and a lack of positive parenting role models, which further impacted their ability to engage in effective parenting.

The impact on children was equally concerning. Children of parents with BPD were more likely to experience emotional and behavioral dysregulation, including internalizing and externalizing symptoms, insecure attachment patterns, and heightened expressions of anger or distress from an early age. Developmental disruptions, particularly in the promotion of autonomy and healthy relatedness, were also observed, especially in adolescence. Beyond psychological and emotional effects, the review highlighted increased rates of adverse perinatal outcomes among mothers with BPD, such as premature births, low Apgar scores, and referrals to neonatal care. Moreover, when compared to other mental health conditions like postnatal depression, parents with BPD were consistently perceived as having lower parenting capacity. Overall, a distinct pattern of maladaptive parenting behaviors characterized by hostility, overprotection, emotional insensitivity, and inconsistency was identified, underscoring the need for targeted support and intervention for this vulnerable population.

Bartsch et al., [10] highlighted the dual nature of parenting in individuals with BPD, representing it as both deeply rewarding and significantly challenging. This perspective aligns with broader parenting literature, such as research by Nomaguchi and Milkie et al., [18] which emphasizes the inherent complexities and emotional uncertainty often experienced in the parenting role. Similarly, Dunn et al., [11] emphasized that many parents with BPD lacked positive parenting experiences themselves, often reporting histories of trauma, abuse, and emotional neglect. Both parents and practitioners acknowledged that these adverse formative experiences shaped current parenting behaviors, particularly in the areas of emotional validation, discipline, and overprotection. These findings are supported by Petfield et al., [19] who identified emotional invalidation and the absence of nurturing models as significant barriers in effective parenting among individuals with BPD. In terms of attachment and emotional development, the review revealed consistent disruptions in the parent-child bond. Frankel-Waldheter et al., [13] reported that BPD symptoms interfered with the promotion of autonomy and secure attachment, while Elliot et al., [15] highlighted diminished maternal sensitivity to infant emotional indications potentially hindering healthy emotional development from infancy.

Overall, the findings of this review emphasize the complex interplay between BPD symptomatology, parenting behavior, and child developmental outcomes. Parents with BPD often face deeply rooted emotional and relational challenges that interfere with effective caregiving. Their children, in turn, are at elevated risk for a range of psychological difficulties. These insights underline the urgent need for targeted, trauma-informed interventions that address the unique parenting challenges posed by BPD.

This systematic review highlights that parent with BPD face significant challenges in caregiving, including high stress, emotional dysregulation, and low parental self-efficacy. These difficulties often lead to maladaptive parenting behaviors such as inconsistency, emotional insensitivity, and overprotection. Children of parents with BPD are at increased risk for emotional, behavioral, and attachment-related problems, starting as early as infancy and extending into adolescence. Additionally, mothers with BPD may experience adverse perinatal outcomes.

The review also reveals that many of these parents have histories of trauma and lack positive parenting role models, perpetuating intergenerational cycles of dysfunction. Compared to other psychiatric conditions, BPD is consistently linked with lower

perceived parenting capacity. These findings underscore the need for targeted, trauma-informed interventions to support parents with BPD and promote healthier developmental outcomes for their children.

1. Cheng AT, Mann AH, Chan KA. Personality disorder and suicide: A case-control study. The British Journal of Psychiatry. 1997 May;170(5):441-6.
2. Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ. The borderline diagnosis I: psychopathology, comorbidity, and personaltity structure. Biological psychiatry. 2002 Jun 15;51(12):936-50.
3. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G, Weinberg I, Gunderson JG. The 10‐year course of physically self‐destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatrica Scandinavica. 2008 Mar;117(3):177-84.
4. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Psychosocial functioning of borderline patients and axis II comparison subjects followed prospectively for six years. Journal of personality disorders. 2005 Feb 1;19(1):19-29.
5. Diagnostic and Statistical Manual of Mental Disorders. 5th edn. Washington DC: American Psychiatric Association, 2013.
6. Chanen AM, Kaess M. Developmental pathways to borderline personality disorder. Current psychiatry reports. 2012 Feb;14(1):45-53.
7. Belsky DW, Caspi A, Arseneault L, Bleidorn W, Fonagy P, Goodman M, Houts R, Moffitt TE. Etiological features of borderline personality related characteristics in a birth cohort of 12-year-old children. Dev Psychopathol. 2012 Feb;24(1):251-65.
8. Florange JG, Herpertz SC. Parenting in patients with borderline personality disorder, sequelae for the offspring and approaches to treatment and prevention. Current psychiatry reports. 2019 Feb;21:1-8.
9. Kiel EJ, Viana AG, Tull MT, Gratz KL. Emotion socialization strategies of mothers with borderline personality disorder symptoms: The role of maternal emotion regulation and interactions with infant temperament. Journal of personality disorders. 2017 Jun;31(3):399-416.
10. Bartsch DR, Roberts RM, Davies M, Proeve M. Understanding the experience of parents with a diagnosis of borderline personality disorder. Australian Psychologist. 2016 Dec 1;51(6):472-80.
11. Dunn A, Cartwright-Hatton S, Startup H, Papamichail A. The parenting experience of those with borderline personality disorder traits: practitioner and parent perspectives. Frontiers in Psychology. 2020 Aug 7;11:1913.
12. Gratz KL, Kiel EJ, Latzman RD, Elkin TD, Moore SA, Tull MT. Emotion: Empirical contribution: Maternal borderline personality pathology and infant emotion regulation: Examining the influence of maternal emotion-related difficulties and infant attachment. Journal of Personality Disorders. 2014 Feb;28(1):52-69.
13. Frankel-Waldheter M, Macfie J, Strimpfel JM, Watkins CD. Effect of maternal autonomy and relatedness and borderline personality disorder on adolescent symptomatology. Personality Disorders: Theory, Research, and Treatment. 2015 Apr;6(2):152.
14. Blankley G, Galbally M, Snellen M, Power J, Lewis AJ. Borderline personality disorder in the perinatal period: early infant and maternal outcomes. Australasian Psychiatry. 2015 Dec;23(6):688-92.
15. Elliot RL, Campbell L, Hunter M, Cooper G, Melville J, McCabe K, Newman L, Loughland C. When I look into my baby's eyes... Infant emotion recognition by mothers with borderline personality disorder. Infant Mental Health Journal. 2014 Jan;35(1):21-32.
16. Laporte L, Paris J, Zelkowitz P. Estimating the prevalence of borderline personality disorder in mothers involved in youth protection services. Personality and mental health. 2018 Feb;12(1):49-58.
17. Eyden J, Winsper C, Wolke D, Broome MR, MacCallum F. A systematic review of the parenting and outcomes experienced by offspring of mothers with borderline personality pathology: Potential mechanisms and clinical implications. Clin Psychol Rev. 2016 Jul;47:85-105. doi: 10.1016/j.cpr.2016.04.002. Epub 2016 Apr 21. PMID: 27261413.
18. Nomaguchi KM, Milkie MA. Costs and rewards of children: The effects of becoming a parent on adults' lives. Journal of marriage and family. 2003 May;65(2):356-74.
19. Petfield L, Startup H, Droscher H, Cartwright-Hatton S. Parenting in mothers with borderline personality disorder and impact on child outcomes. Evid Based Ment Health. 2015 Aug;18(3):67-75.