Transmission Of Trauma Research Articles

The Effectiveness of Trauma-Informed Parenting Programs for Traumatized Parents and Their Components: A Meta-Analytic Study.

Parents who have been exposed to trauma face distinct challenges in parenting that can lead to negative child developmental outcomes and intergenerational transmission of trauma. Parenting programs for traumatized parents seem promising, but the existing evidence on their effectiveness has not yet been synthesized. This study aimed to examine the overall effect of trauma-informed parenting programs on (a) parenting and (b) parental mental health outcomes by conducting two three-level meta-analyses. Moderator analyses were performed to identify whether program components, delivery techniques, and other study and program characteristics were associated with effectiveness. A literature search conducted up to August 2024 yielded 15 studies reporting on 110 effect sizes. Significant overall effects were found of trauma-informed parenting programs on both parenting outcomes (d = 0.75, 95% CIs = [0.09, 1.15], p = .027) and parental mental health outcomes (d = 0.21, 95% CIs = [0.09, 0.32], p < .001). The first meta-analysis on parenting found no significant moderators, while the second meta-analysis on parental mental health indicated that programs emphasizing child disciplining skills yielded smaller effects (d = 0.04) compared to programs without this component (d = 0.31). Programs using modeling techniques yielded larger effects (d = 0.32) compared to programs without (d = 0.14). Larger program effects on parental mental health were also found for programs with longer durations and when individual sessions were used. Thus, evidence supports the effectiveness of trauma-informed parenting programs in improving parenting and reducing parental mental health problems.

Gaza’s hidden crisis: adults, children, and generations of psychological torment to come

ABSTRACT For more than a year, the world has been exposed to the ongoing conflict in Gaza, and the destruction, medical devastation, and the death toll of this crisis. What has been largely missing from the picture, has been an attention to the long-term mental health impact of the ongoing trauma among the Palestinian civilians and the Israeli hostages in Gaza. This article anticipates the enduring generational impact of war trauma on mental health of the civilians in Gaza, drawing from the author’s clinical and research experiences of Iraqi, Syrian, Afghan, African, and Ukrainian war-exposed civilians, refugees, and survivors of torture. Across most different studies, war exposure leads to PTSD in nearly 30–50% of adult civilians, and similar rates of depression and anxiety. Civilians in Gaza, facing daily horrors and a profound sense of helplessness, are likely experiencing even greater psychological distress. Children, significantly affected during critical developmental stages, are at risk of long-term mental and physical health issues. The psychological, cultural, and epigenetic aspects of the intergenerational transmission of trauma can lead to psychological torment across generations. Addressing the mental health needs of these populations is crucial to mitigating the profound and lasting impact of war.

Tracing Memory, Trauma, and Childhood: The Bangladesh Liberation War in Sorayya Khan’s Noor

This article addresses the representation of childhood memory and trauma in Sorayya Khan’s novel Noor (2003) against the backdrop of the 1971 Bangladesh Liberation War. It discusses how personal recollections of public events contribute to the collective memory of the nation-state. The exploration includes the intergenerational transmission of trauma, employing Marianne Hirsch’s concept of ‘Postmemory,’ which describes how traumatic experiences are passed down, particularly in the context of the Holocaust. This framework has been contextualized within the 1971 Bangladesh Liberation War and its aftermath on children, carrying the memories of war trauma forward, as illustrated in the novel through Noor and Sajida’s experiences. Through a close reading of the novel, this article aims to extricate the underlying patterns of childhood war memory and personal experiences that often get subsided in historical representations and emphasizes the pertinence of reading a representational narrative of the 1971 Bangladesh Liberation War even after half a century.

Maternal trauma exposure is linked to adult offspring's cognitive functioning in the context of mass violence.

This study aimed to examine whether mothers' level of trauma exposure and posttraumatic stress disorder (PTSD) symptoms are related to their offspring's cognitive functioning. Mothers exposed to the 1994 genocide perpetrated against the Tutsi (N = 181) and one of their adult offspring were recruited in Rwanda. Mothers and their offspring answered questionnaires on sociodemographic information, the level of trauma exposure, and PTSD symptoms. They also performed a backward digit span task and a similarity task to assess their working memory and abstract reasoning, respectively. Hierarchical regression models were used to analyze the data. Mothers' level of trauma exposure, but not PTSD symptoms, was significantly related to their offspring's abstract reasoning performance after controlling for offspring's age, sex, and economic status. The relationship between mothers' level of trauma exposure, PTSD symptoms, and their offspring's working memory performance was not significant. Offspring's education was significantly linked to their working memory and abstract reasoning performance. The findings demonstrate that the intergenerational transmission of trauma can impact the cognitive functioning of the next generation. These results also illustrate the profound and long-term human impact of mass violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

“In the Footsteps of Our Ancestors” Polish Traditions of Westward Migration Meets Modern Epigenetics of Trauma

For several years, there have been ongoing considerations regarding the interdisciplinary connections between the natural sciences and the humanities. The same holds true for the question as to whether trauma can be inherited biologically as well as culturally. Today, this topic is increasingly steering the scientific debate in the direction of epigenetic research, which currently combines molecular biology and social psychology with their respective hallmarks. Can culture-related traumas be inherited and, if this was possible, can transgenerational consequences of trauma be passed on to subsequent generations? The focus remains on educational and socialization-related conduct as well on biologically inherited processes of how individual deals with their own trauma. Can migration be inherited by subsequent generations via transgenerational transmission of trauma? In order to answer this question, both consequences and causes of the long-running migration from Poland to Western European countries need to be considered. This article thus seeks to establish a connection between now and then, while also focusing on tragic passages in Poland’s history that were characterized by suffering, statelessness, and occupation (until 1989). Consequently, multi-layered and repeated habitus breakages as well as specific Polish “worldviews” may have emerged, which tend to favour migration. The causal links between the transgenerational transmission of such traumas and their causal connections to ongoing migration from Poland to countries such as Germany are addressed by using modern epigenetics.

The role of maternal postmigration living difficulties in intergenerational trauma transmission among asylum-seeker mother-child dyads: Exploring complex posttraumatic stress disorder as a mechanism.

Among forcibly displaced people, maternal trauma and stress have been implicated in poor child socioemotional outcomes via intergenerational trauma transmission. This study explored the role of maternal postmigration living difficulties (PMLD) in the pathway linking maternal trauma, trauma-related psychopathology, and child socioemotional outcomes among mother-child dyads seeking asylum in a high-risk urban setting. Participants were East African (Eritrean) mothers (N = 127) of preschool-aged children seeking asylum in Israel. Using moderated mediation analysis, we tested whether and how PMLD may moderate the mediating role of current maternal International Classification of Diseases, 11th revision (ICD-11) posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder disturbances in self-organization (DSO) symptoms between past maternal trauma exposure and current postdisplacement child internalizing and externalizing difficulties. Children's direct exposure to adverse life experiences was controlled for. Maternal PTSD symptoms mediated the association between past maternal trauma exposure and child internalizing difficulties, but not externalizing difficulties, across all levels of current maternal PMLD. However, maternal DSO symptoms mediated internalizing and externalizing child outcomes, but only among mothers reporting high levels of current PMLD. This study provides novel evidence that PMLD may amplify the toxicity of past maternal trauma exposure for poor child socioemotional outcomes via ICD-11 DSO symptoms. The intergenerational transmission pathway via the narrower fear-based ICD-11 PTSD, however, is independent of the degree of maternal PMLD. Findings suggest that policies designed to buffer intergenerational trauma transmission among forcibly displaced people may need to consider the toxicity of PMLD as well as enable mothers to heal from PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

From Hinengaro to Hineora: Tracing the origins of Intergenerational Trauma to attain Intergenerational Healing

In Aotearoa New Zealand, colonisation continues to impact Indigenous Māori lived realities. However, Māori have been steadily progressing towards reclamation of all that was suppressed during colonisation, including tūpuna (ancestor) understandings of trauma and healing, of which wairua (referring to spirit) is at the centre. My research aimed to understand the role of wairua in the intergenerational transmission of trauma and healing through exploring my own lived experiences of trauma and healing. My methodology was developed based on tūpuna knowledge, resulting in the implementation of a Rongo-ā-Wairua Framework, a Whakapapa Methodological Approach, Whakapapa Wānanga and Te Pūtake: An Origin Analysis. Through this application of tūpuna knowledge and the centring of wairua within the research process, I uncovered the origins of the soul wounds I had inherited, enabling me to transform from Hinengaro, The Obscured Daughter into who I am now – Hineora, The Daughter of Healing.

An epigenome-wide study of a needs-based family intervention for offspring of trauma-exposed mothers in Kosovo.

Maternal stress and trauma during pregnancy have been shown to influence cortisol levels and epigenetic patterns, including DNA methylation, in the offspring. This study aimed to determine whether a tailor-made family intervention could help reduce cortisol levels in children born to traumatized mothers, and to determine whether it effected offspring DNA methylation. The secondary aim was to determine whether the family intervention influenced DNA methylation aging, a marker of biological aging. A needs-based family intervention was designed to help address relational difficulties and family functioning, and included a focus on family strengths and problem-solving patterns. Women survivors of sexual violence during the Kosovar war in 1998-1999, and their families (children with or without partners) were randomly assigned to 10 sessions of a family therapy over a 3-5-month period, or to a waitlist control group. Both mothers and children completed assessments prior to and after the intervention phase. Children's blood samples collected at these two time points were used to measure cortisol and epigenome-wide DNA methylation patterns (Illumina EPIC array). Cortisol levels, and genome-wide DNA methylation changes pre-/postintervention were compared between children in the intervention and the waitlist groups. DNA methylation age and accelerated biological aging were calculated. Sixty-two women-child dyads completed the study, 30 were assigned first to the intervention group, and 32 to the waitlist control group. In adjusted linear regression, the family intervention was associated with a significant decline in cortisol levels compared to the waitlist control (β=-124.72, 95% confidence interval [CI]: -197.4 to -52.1, p=.001). Children in the intervention group, compared to the waitlist control group, showed >1% differential methylation degree at 5819 CpG (5'-C-phosphate-G-3') sites across the genome (p<.01), with the largest methylation difference being 21%. However, none of these differences reached genome-wide significant levels. There was no significant difference in DNA methylation aging between the two groups. We find evidence that a tailored family-based intervention reduced stress levels in the children (based on cortisol levels), and modified DNA methylation levels at a number of sites across the genome. This study provides some preliminary evidence to suggest the potential for tailored interventions to help break the intergenerational transmission of trauma, however, large studies powered to detect associations at genome-wide significant levels are needed.

Intergenerational effects of racism on amygdala and hippocampus resting state functional connectivity

Racism is an insidious problem with far-reaching effects on the lives of Black, Indigenous, and People of Color (BIPOC). The pervasive negative impact of racism on mental health is well documented. However, less is known about the potential downstream impacts of maternal experiences of racism on offspring neurodevelopment. This study sought to examine evidence for a biological pathway of intergenerational transmission of racism-related trauma. This study examined the effects of self-reported maternal experiences of racism on resting state functional connectivity (rsFC) in n = 25 neonates (13 female, 12 male) birthed by BIPOC mothers. Amygdala and hippocampus are brain regions involved in fear, memory, and anxiety, and are central nodes in brain networks associated with trauma-related change. We used average scores on the Experiences of Racism Scale as a continuous, voxel-wise regressor in seed-based, whole-brain connectivity analysis of anatomically defined amygdala and hippocampus seed regions of interest. All analyses controlled for infant sex and gestational age at the 2-week scanning session. More maternal racism-related experiences were associated with (1) stronger right amygdala rsFC with visual cortex and thalamus; and (2) stronger hippocampus rsFC with visual cortex and a temporo-parietal network, in neonates. The results of this research have implications for understanding how maternal experiences of racism may alter neurodevelopment, and for related social policy.

Psycho-social Stressors Experienced by Young war Refugees in Developed Countries: A Scoping Review.

Refugees escaping political unrest and war are an especially vulnerable group. Arrival in high-income countries (HICs) is associated with a 'new type of war', as war refugees experience elevated rates of psycho-social and daily stressors. The purpose of this scoping review is to examine literature on psycho-social stressors amongst young war refugees in HICs and impact of stressors on intergenerational transmission of trauma within parent-child dyads. The secondary objectives are to identify the pre-migration versus post-migration stressors and provide a basis to inform future research projects that aim to lessen the burden of stress and inform evidence-based improvements in this population. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension (PRISMA-ScR) guided the reporting of this review that was performed using a prescribed scoping review method. Extracted from five databases, 23 manuscripts published in 2010 or later met the inclusion criteria. Three themes emerged: pre-migration stressors, migration journey stressors and uncertainty, and post-migration stressors. While post-migration environments can mitigate the health and well-being of war refugees, socio-cultural barriers that refugees often experience at the host country prevent or worsen their psycho-social recovery. To assist the success of war refugees in HICs, therapeutic interventions must follow an intersectional approach and there needs to be a wider application of trauma informed models of care. Findings of this review may help inform future intervention studies aiming to improve the psycho-social health of this population.

Original Sin and Transmission of Trauma: A Dialog between Kierkegaard’s Hamartiology and the Phenomenon of Transgenerationality

Abstract This article explores the psychological phenomenon of the transgenerational transmission of trauma. Søren Kierkegaard’s conception of original sin serves as a template for the argument. After outlining the complex psychological process of trauma transmission, the article gleans insights regarding the transgenerationality of trauma as found in Kierkegaard’s thinking. With a focus on The Concept of Anxiety, the article highlights parallel structures of displaying and penetrating original sin and the transmission of trauma. The article argues that the Christian perspective on salvation proves to be a substantial dialog partner for the secular understanding of posttraumatic healing.

Maternal insecure attachment representation as a long-term risk factor for disrupted mother–child-interaction and child mental health

Maternal childhood maltreatment (CM) represents an important factor in the transmission of trauma that may lead to impaired child mental health. Apart from childhood maltreatment insecure attachment has been identified as a risk factor for insensitive caregiving behavior, which may affect child's mental health. The aim of this study is to identify the working mechanisms in the relationship between maternal CM and child mental health, considering maternal attachment representation, mother–child-interaction und maternal helplessness and fear. N = 103 mother–child-dyads from a longitudinal cohort study were examined at four different measuring points. Data was assessed using self and external report questionnaires as well as the AMBIANCE scales during the Strange Situation Procedure and the Adult Attachment Projective Picture System (AAP). Maternal CM experience did not predict an insecure attachment representation (OR = 2.46 [0.98, 6.53], p = .060). Maternal insecure attachment was associated with higher AMBIANCE scores (F(8, 94) = 11.46, p < .001), which indicates more disrupted communication between mother and child. AMBIANCE scores in turn predicted higher self-perceived helplessness (F(9, 93) = 8.62, p < .001) and fear (F(9, 93) = 7.40, p < .001) in mothers. Helplessness and fear both were associated with higher SDQ-scores, indicating more mental health problems in children (F(10, 92) = 3.98, p < .001; F(10, 92) = 3.87, p < .001). The results of this study highlight how even insecure attachment in a low-risk sample has a long-term impact on parenting behavior and child mental health, therefore underlining the need of early intervention programs in affected and at-risk families.

Transgenerational trauma: Perceived parental style, children's adaptational efforts, and mental health outcomes in second generation and third generation holocaust offspring in Hungary.

The intergenerational impact of genocide has been studied in various contexts, however, the mechanisms of trauma transmission remain unclear. The present study aimed to better understand the relationship between parental trauma and offspring mental health by exploring mechanisms of trauma transmission in the children (n = 599) and grandchildren (n = 311) of Holocaust survivors (HS) in Hungary. In a cross-sectional online survey study, we used the paradigm developed by Danieli, Norris, Lindert, Paisner, Engdahl, et al. (2015) and Danieli, Norris, Lindert, Paisner, Kronenberg, et al. (2015) to assess HS parental styles (i.e., parenting impacted by efforts to cope with past traumatic experiences), as reported by offspring participants, as well as participants' reported level of adaptational impact, that is, their efforts to cope and adapt, and current mental health symptoms posttraumatic stress disorder (PTSD, complex PTSD [C-PTSD], anxiety, depression). We found differences in parental styles reported by generation; however, the mechanism of how it impacted offspring mental health was similar. Mediation analyses showed that more intense parental styles were associated with higher adaptational impact, which, in turn, was related to more mental health symptoms, in both generations. This is the first study to apply the Danieli paradigm in a third-generation sample and the first to assess the psychological impact of the Holocaust in an Eastern European country (Hungary), using systematic quantitative assessment. Our findings highlight the Holocaust's continued impact on the third generation, and the importance of raising awareness of the impact of collective traumas through educational programs, enhancing culturally sensitive and transgenerational trauma-informed mental health services, and fostering tolerance and diversity in public policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma in Publishing

We live in an extraordinary time in human history. Arguably, the most significant social changes have taken place in recent decades, including changes in policy and attitudes towards human rights, how we educate and treat children, towards sexual violence and abuse, sexuality and gender identification, to name just a few. In Australia, we have witnessed public responses through Royal Commissions and other public inquiries that have given voice to generations of people whose suffering had been silenced by formal and informal social mechanisms. Now, in the twenty-first century, the proliferation of new technologies, social media and social campaigns designed to engage people online as well as offline have empowered citizens to take control of their narratives, to tell their own stories. In the published literature, a great many have begun to reveal the nature and extent of traumas experienced by individuals, families, groups and entire communities. In the publishing industry, scant attention is given to the occupational risks faced by the workforce charged with disseminating these trauma stories: the editors, literary agents, proofreaders, publicists and other publishing personnel who are repeatedly exposed to trauma narratives. Even as publishing facilitates healing through story, it is also perpetuating—or at the very least enabling—the transmission of trauma: from author to publishing personnel, and quite possibly also from industry to reader. This paper posits that publishing as an industry is awash with trauma. Through the perspective of an industry insider, it explores the three faces of trauma in the publishing context: recounting trauma as a vehicle for healing and reconciliation, the trauma narrative as a commodity and vicarious trauma as an occupational hazard.

Intergenerational mental health effects of traumatic victimization in Nepal: A 3-D theory study

BackgroundIntergenerational transmission of trauma is a major focus of international research. Epigenetic, complex-trauma, and intergenerational abuse pattern transmission theoretical explanations all have existing empirical support. Three-D theory argues that in addition to trauma victimization severity, victimization invasiveness and exploitativeness have important independent effects. Moreover, 3-D theory claims that a positive 3-way interaction occurs between trauma victimization invasiveness, exploitativeness, and severity. This study examines the 3-D hypotheses in the context of intergenerational trauma effects on adolescent depression symptoms and suicidal ideation in generation two. Three-D theory may play a particularly important role in intergenerational trauma effects for female victims in the context of conservative South Asian sex role norms. ObjectiveTest for main effects, two-way, and three-way interaction effects of invasiveness, exploitativeness, and severity of traumatic victimization on intergenerational transmission to adolescent depression and suicidal ideation in generation two. Pathways from maternal depression and borderline personality symptoms as well as physical and sexual abuse and neglect of the adolescent child were also tested. Participantsand setting. Participants were a nationally representative, random, multi-stage cluster sample of 1089 Nepali mothers and their 15–17 year old adolescent children. MethodsRegression models with adjustments for clustering within municipality were used to test the hypotheses. ResultsOne in four Nepali adolescents had considered suicide; more than half had high depression scores. A three-way interaction effect between maternal trauma invasiveness, exploitativeness, and severity was positively associated with adolescent depression symptoms. A two-way interaction effect between exploitativeness and severity of maternal trauma was positively associated with adolescent suicidal ideation. Maternal depression, BPD symptoms, and very severe physical abuse of the adolescent were also associated with adolescent depression symptoms. ConclusionFurther research is needed to measure and investigate invasiveness, exploitativeness, and severity of traumatic victimization as they bear on intergenerational transmission of trauma. Examination of intergenerational transmission of self-concept as a potential vector is recommended.

The intergenerational transmission of military trauma and Winnicott’s principle of being: confusion in the sense of aliveness and deadness

ABSTRACT This work elucidates the unconscious destruction of a sense of being as a result of an obliteration (in the first generation due to direct exposure to military trauma) and rejection (in the second generation due to this trauma being intergenerationally transmitted) of the internal connection with the female element – as conceptualised by Winnicott in his book, ‘Playing and reality’. The rejection of this aspect of the psyche, which is responsible for the experience of aliveness and being, causes the subject significant confusion in the sense of aliveness and deadness. The result is that survivors of both generations become threatened by a sense of aliveness and being – by life itself. Everything that causes a sense of richness, fullness, intensity, a feeling of vitality and existence, is perceived to be a threat, resulting in an unconscious need to reject such states. These dynamics are explored in the case of an adolescent boy who was experiencing anxiety about becoming a paedophile. His fear, as signified by the image of a paedophile, rather than being a response to the difficulties of his developing sexuality, could be understood as connected to his father’s dissociated war trauma (the fear that he might have killed children), and also to a dissociative imperative to obliterate psychic affiliation with a quiet state of being.

Transgenerational trauma and attachment.

An integrative approach is presented to understand the transmission mechanisms of attachment trauma and the quality of the internal working model through manifestations of bodily symptoms concerning physical and mental health. A case of dissociative symptomatology is described in a woman whose ancestors experienced individual and collective trauma related to the political regime. The approach allows for an analytical view beyond the standard complaints of anxiety, depression, post-traumatic symptoms, eating disorders, etc. A brief description of the transgenerational transmission of trauma is presented.

Intergenerational trauma transmission through family psychosocial factors in adult children of Rwandan survivors of the 1994 genocide against the Tutsi

Thirty years after the 1994 genocide against the Tutsi in Rwanda, children of survivors are being increasingly documented to be at higher risk compared to their peers for adverse mental health outcomes. However, no studies in Rwanda have empirically explored family psychosocial factors underlying this intergenerational transmission of trauma. We investigated family psychosocial factors that could underlie this transmission in 251 adult Rwandan children of survivors (mean age = 23.31, SD = 2.40; 50.2% female) who completed a cross-sectional online survey. For participants with survivor mothers (n = 187), we found that both offspring-reported maternal trauma exposure and maternal PTSD were indirectly associated with children's PTSD via maternal trauma communication (specifically, nonverbal and guilt-inducing communication), and that maternal PTSD was indirectly associated with children's PTSD, anxiety, and depression symptoms through family communication styles. For participants with survivor fathers (n = 170), we found that paternal PTSD symptoms were indirectly associated with children's anxiety and depression symptoms via paternal parenting styles (specifically, abusive and indifferent parenting). Although replication is needed in longitudinal research with parent-child dyads, these results reaffirm the importance of looking at mass trauma in a family context and suggest that intergenerational trauma interventions should focus on addressing family communication, trauma communication, and parenting.

Toward a multi-level approach to the study of the intergenerational transmission of trauma: Current findings and future directions.

A central goal in the field of developmental psychopathology is to evaluate the complex, dynamic transactions occurring among biological, psychological, and broader social-cultural contexts that predict adaptive and maladaptive outcomes across ontogeny. Here, I briefly review research on the effects of a history of childhood maltreatment on parental, child, and dyadic functioning, along with more recent studies on the intergenerational transmission of trauma. Because the experience and sequelae of child maltreatment and the intergenerational transmission of trauma are embedded in complex biopsychosocial contexts, this research is best conceptualized in a developmental psychopathology framework. Moreover, there is a pressing need for investigators in this area of study to adopt dynamic, multi-level perspectives as well as using developmentally guided, sophisticated research methods. Other directions for research in this field are suggested, including the implementation of collaborative interdisciplinary team science approaches, as well as community-based participatory research, to increase representation, inclusion, and equity of community stakeholders. A greater focus on cultural and global perspectives is also recommended.

Dissociation in mothers with borderline personality disorder: a possible mechanism for transmission of intergenerational trauma? A scoping review

BackgroundDissociation is a feature of Borderline Personality Disorder (BPD), but rarely a focus for research, particularly in the perinatal literature. BPD partly has its aetiology in childhood and is characterised by emotional changes and difficulty with self-coherence that impacts on the processes of caregiving.MethodsA scoping review was conducted to synthesise current perspectives on the effect of dissociation in caregivers with BPD, particularly regarding the impact of caregiver dissociation on the interactional quality of relationship within parent–child dyads. Studies were included if they explicitly mentioned dissociation in the target population, or if dissociation was implied. A thematic analysis was conducted.Results20 studies were included; 10 experimental or quasi-experimental; 2 presenting case material; and 8 non-systematic review articles. 4 studies used the Dissociative Experiences Scale (DES) to measure dissociation, while 2 studies included a ‘dissociative behaviour’ subscale as part of an observational measure. The remaining studies did not measure dissociation but referenced directly or indirectly a concept of dissociation.ConclusionsFindings suggested there was some evidence that dissociation plays a unique role in BPD caregivers’ interactions with their offspring, however any findings should be interpreted with caution as the concept has been poorly operationalised and defined.