Motherhood has been deemed a normal crisis, given the significant psychological, biological, and neural changes surrounding pregnancy and the postpartum period. These challenges can become more complex as they are closely related to the parent’s own selfdevelopment and sense of self-efficacy grounded in their personality prior to parenthood. The normal crisis of motherhood may be further complicated by addiction. Considering the evidence of the negative impact and poor developmental outcomes of children born to mothers with substance use disorders, special attention must be paid to addiction in this context. This paper is a review of evidence on the challenges of parenthood, particularly when affected by addiction. We explore the centrality of object relations in personality development and parenting practices and discuss the problem of maternal addiction from multiple perspectives, particularly Blatt’s (1991a) two-polarities model of personality development. Key words: motherhood, addiction, psychoanalysis, object relations, personality. PERSONALITY AND MATERNAL ADDICTION 3 Introduction Mothers are the first environment their offspring encounter in their process of development; therefore, it is essential to understand how maternal behavior, sensitivity, and personality interplay with the developing psyche of the child. Motherhood can be a very challenging task given the significant psychological, biological, and neural changes surrounding pregnancy and the postpartum period. The transition to parenthood is also characterized by changes in interpersonal interactions, social demands and expectations of being a parent, conscious and unconscious wishes and fantasies related to their child and the parental experience, and sometimes disappointments from not meeting the individual parenthood ideals (Priel & Besser, 2001; Von Mohr, Mayes, & Rutherford, 2017). These challenges –typical of parenthood– can become more complex as they are closely related to the parent’s own self-development and sense of self-efficacy, grounded in their personality prior to parenthood. Therefore, maternity could be thought of as a particularly vulnerable period for women already struggling with self-control and emotion dysregulation and this may be particularly true in mothers with substance use disorders (SUDs). Considering the growing evidence underscoring the negative impact and poor developmental outcomes of children born to mothers with SUDs (e.g. Salo & Flykt, 2013), special attention must be paid to addiction in the context of maternity in order to minimize risk and prevent the perpetuation of SUDs across generations. The structural-developmental psychodynamic –or “two polarities”– model of personality development (Blatt, 1991a) offers a valuable framework to consider addiction in the context of motherhood. Grounded on cognitive, humanistic, and psychodynamic theories of development, the model was initially developed to empirically study depression (Shahar & Mayes, 2017). Blatt PERSONALITY AND MATERNAL ADDICTION 4 (1991a) proposed that as human beings develop, they are faced with the dialectic transaction between fostering and tending to relationships and attachment bonds (i.e., interpersonal relatedness or anaclitic processes), and developing an independent and fully differentiated sense of self (i.e., self-definition or introjective process). Extreme reliance on one process over the other may lead to psychopathology or severe distortions of experiences and result in extremely dependent or self-critical strategies in interpersonal interactions (Berman, 2017; Blatt, 1991a; Blatt & Luyten, 2009). However, under favorable circumstances, humans are able to integrate both polarities into a mature, integrated, and socially embedded sense of self. While the two polarities model was originally focused on individual personality development and initially focused on the first 11 years of life, it was later expanded to consider development across the lifespan (Blatt & Luyten, 2009). Further, it has been argued that the model might facilitate understanding of the intergenerational transmission of attachment styles and psychopathology, including SUDs (Beebe & Lachman, 2017; Priel & Besser, 2001; Blatt and Luyten, 2013; Liden & Suchman, 2013; Luyten, 2017; Soenens, Vansteenkiste, & Luyten, 2010). This paper is a review of evidence on the challenges of motherhood, specifically in relation to substance abuse. The paper will explore the centrality of object relations in personality development and parenting practices. Next, in line with recommendations by Blatt and Luyten (2009) inviting research efforts to be oriented towards the examination of the impact of neurobiological and genetic dimensions on psychological development, we discuss the problem of addictions from multiple perspectives, incorporating object relations, Blatt’s (1991a) personality organizations, and a recently proposed developmental model of addiction (AlvarezMonjaras, Mayes, Potenza, Rutherford, 2018). Motherhood: A normal crisis PERSONALITY AND MATERNAL ADDICTION 5 Motherhood has been considered a “normal crisis” (Pines, 1972). Although highly rewarding and meaningful under ideal circumstances, becoming a parent may also be stressful and overwhelming. The complexity of the emotional experiences surrounding motherhood reflects both the hormonal, neurobiological, social, and intrapsychic processes that take place during the transition to motherhood, as well as this being a period of time where mothers revisit their own memories and representations of being parented to (1) internalize the newborn, (2) resolve early conflict, and (3) identify available resources to apply in the new caregiving tasks (Pines, 1972; Priel & Besser, 2001; Von Mohr et al., 2017) In line with Blatt’s (1991a) model, the internal world of mothers and their children –both during and after pregnancy– are essential to understand motherhood (Blum, 2017). Object relations are dynamic systems or “internal working models” that guide behaviors, attitudes, and expectations, and help an individual make sense of themselves, others, and relationships (Auerbach & Diamond, 2017). Even before birth, an expectant mother may hold a mental representation of the newborn, with a series of conscious and unconscious fantasies associated with them. Some mothers, for instance, may have idealized phantasies of their unborn child (e.g., “perfect in every way”, “a fulfilment of my life”, Sorenson & Schuelke, 1999), others may talk about fantasies of symbiosis or fusion (e.g., envisioning themselves encompassing the fetus, Blum, 2017), or be more anxious and concerned by persecutory fantasies (e.g., parasitic fetus or depletion, Raphael-Leff, 1996). Considering that these representations guide behaviors and attitudes, some mothers might feel better prepared than others to take on the caregiving task. In line with this, studies have shown that the content of internal representations can have a considerable impact on mother-child interactions. For instance, fantasies around childbirth can impact the decision of primiparous mothers regarding whether or not to request cesarean section PERSONALITY AND MATERNAL ADDICTION 6 –this was especially true for mothers that were more inclined to project negative or unwanted thoughts, feelings, fantasies, and motives (Handelzalts, Fisher, Sadan & Goldzweig, 2017). Likewise, other studies have reported that mental representations of breastfeeding and the feeding interaction (e.g., comfort, rejection, crying, etc.) may also impact how mothers approach breastfeeding, and even the decision to switch to bottle-feeding (Kronborg et al., 2015; Sayre et al., 2001). Mental representations impacting parenting behavior extend beyond infancy, including during play interactions and in relation to parental control practices (Crawford & Benoit, 2009; Soenens et al., 2010). The quality (i.e., coherence, flexibility, and richness) of internal representations may also affect a mother’s capacity to make sense and adapt their own behavior to sensitively and appropriately respond to their child’s preverbal demands and mental states (Alvarez-Monjaras, McMahon & Suchman, 2017; Fonagy, Gergely & Target, 2007; Fonagy, Steele, Steele, Moran, & Higgitt, 1991). For instance, mothers with disengaged representations in the Adult Attachment Interview (George, Kaplan, & Main, 1985) tend to be less sensitive, more passive, and less encouraging, while those with more coherent representations engage in less negative (e.g., aggressive or intrusive) and more positive (e.g., warm or soothing) parenting practices (Slade, Belsky, Aber & Phelps, 1999; Sokolowsky, Hans, Bernstein, & Cox, 2007). Thus, the overall quality of mental representations allows for mothers to engage more sensitively with their child. Maternal object relations and the internal world of the child Recent studies have argued that not only do these object representations influence maternal behaviors but they might also be passed on across generations via the mother’s capacity to think about and interpret their own and their infant’s behavior in terms of mental states and intentions (termed reflective functioning; Fonagy et al., 2007). A caregiver’s reflective PERSONALITY AND MATERNAL ADDICTION 7 functioning –inherently associated with mental representations (Alvarez-Monjaras et al., 2017)– has been considered the missing link in the well-known intergenerational transmission of attachment patterns and relational knowledge (Fonagy & Allison, 2014). Through these marked, ostensive, and contingent feedback reactions towards the infant’s automatic behavioral expressions (i.e., parental sensitivity), the caregiver slowly sensitizes the child to primary and secondary mental states and intentions in oneself and others (Fonagy & Bateman, 2008; Fonagy et al., 2007). This “natural pedagogy” (Csibra & Gergely, 2009) fosters self-awareness and selfregulation capabilities by allowing

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人格组织和母性成瘾：结构发展的心理动力学贡献。

考虑到围绕怀孕和产后期间的重大心理、生理和神经变化，母性被认为是一种正常的危机。这些挑战可能会变得更加复杂，因为它们与父母自己的自我发展以及基于他们在成为父母之前的个性的自我效能感密切相关。母性的正常危机可能因成瘾而进一步复杂化。考虑到物质使用障碍母亲所生儿童的负面影响和不良发育结果的证据，在这种情况下必须特别注意成瘾问题。本文回顾了有关为人父母的挑战的证据，尤其是在受成瘾影响时。我们探讨了客体关系在人格发展和育儿实践中的中心地位，并从多个角度讨论了母性成瘾问题，特别是 Blatt (1991a) 的人格发展的两极模型。关键词：母性，成瘾，精神分析，客体关系，个性。人格和母性成瘾 3 引言 母亲是后代在发育过程中遇到的第一个环境；因此，必须了解母亲的行为、敏感性和个性如何与儿童心理发展相互作用。鉴于怀孕和产后期间的重大心理、生理和神经变化，做母亲可能是一项非常具有挑战性的任务。为人父母的过渡还表现为人际交往、社会需求和作为父母的期望、与孩子和父母经历相关的有意识和无意识愿望和幻想的变化，有时还会因未能满足个人为人父母的理想而感到失望（Priel &贝塞尔，2001 年；冯·莫尔、梅耶斯和卢瑟福，2017 年）。这些挑战——典型的为人父母——可能变得更加复杂，因为它们与父母自己的自我发展和自我效能感密切相关，植根于他们成为父母之前的个性。因此，对于已经在自我控制和情绪失调中挣扎的女性来说，生育可以被认为是一个特别脆弱的时期，对于患有物质使用障碍 (SUD) 的母亲来说尤其如此。考虑到越来越多的证据强调了患有 SUD 的母亲所生的孩子的负面影响和不良的发育结果（例如 Salo 和 Flykt，2013），必须特别注意孕产期的成瘾问题，以尽量减少风险并防止其长期存在。跨代的 SUD。结构发展心理动力学——或“两极”——人格发展模型（布拉特，1991a）提供了一个有价值的框架，可以在母性的背景下考虑成瘾。该模型基于认知、人文和心理动力学发展理论，最初开发用于实证研究抑郁症 (Shahar & Mayes, 2017)。Blatt 人格与母性成瘾 4 (1991a) 提出，随着人类的发展，他们面临着培养和倾向于关系和依恋纽带（即人际交往或 anaclitic 过程）与发展独立且完全分化的自我意识（即自我定义或内射过程）之间的辩证交易。对一个过程的过度依赖可能会导致心理变态或经历的严重扭曲，并导致人际交往中极度依赖或自我批评的策略（Berman，2017；Blatt，1991a；Blatt & Luyten，2009）。然而，在有利的环境下，人类能够将两极整合成成熟的、整合的、社会嵌入的自我意识。虽然两极模型最初侧重于个体人格发展，最初侧重于生命的前 11 年，后来扩展到考虑整个生命周期的发展（Blatt & Luyten，2009）。此外，有人认为该模型可能有助于理解依恋风格和精神病理学的代际传递，包括 SUD（Beebe & Lachman，2017；Priel & Besser，2001；Blatt 和 Luyten，2013；Liden &suchman，2013；Luyten ，2017 年；Soenens、Vansteenkiste 和 Luyten，2010 年）。本文回顾了有关孕产挑战的证据，特别是与药物滥用有关的证据。本文将探讨客体关系在人格发展和育儿实践中的核心地位。下一个，根据 Blatt 和 Luyten（2009 年）邀请研究工作转向检查神经生物学和遗传维度对心理发展的影响的建议，我们从多个角度讨论成瘾问题，结合客体关系，Blatt 的（1991a）人格组织，以及最近提出的成瘾发展模型（AlvarezMonjaras、Mayes、Potenza、Rutherford，2018 年）。母性：正常的危机 人格和母性成瘾 5 母性被认为是一种“正常的危机”（Pines，1972）。尽管在理想情况下会带来很高的回报和意义，但成为父母也可能会带来压力和压力。围绕母性的情感体验的复杂性反映了荷尔蒙、神经生物学、社会、以及在向母亲过渡期间发生的内在心理过程，以及在这段时间里，母亲重新审视自己的记忆和为人父母的表征：(1) 内化新生儿，(2) 解决早期冲突，以及 (3) ) 确定可用于新的护理任务的可用资源（Pines，1972；Priel & Besser，2001；Von Mohr 等，2017）与 Blatt (1991a) 的模型一致，母亲和她们的孩子的内部世界——无论是在和怀孕后——对于了解母性至关重要（Blum，2017 年）。客体关系是动态系统或“内部工作模型”，可指导行为、态度和期望，并帮助个人理解自己、他人和关系（奥尔巴赫和戴蒙德，2017 年）。甚至在出生之前，准妈妈可能持有新生儿的心理表征，并伴随着一系列有意识和无意识的幻想。例如，一些母亲可能对未出生的孩子抱有理想化的幻想（例如，“各方面都很完美”、“我生活的充实”，Sorenson & Schuelke，1999），其他人可能会谈论共生或融合的幻想（例如，设想自己包含胎儿，Blum，2017 年），或者对被迫害的幻想更加焦虑和担忧（例如，寄生胎儿或耗竭，Raphael-Leff，1996 年）。考虑到这些表征指导行为和态度，一些母亲可能比其他人更愿意承担照顾任务。与此一致，研究表明，内部表征的内容会对母子互动产生相当大的影响。例如，对分娩的幻想会影响初产母亲关于是否要求剖腹产的决定 人格和母性成瘾 6——对于更倾向于投射消极或不想要的想法、感受、幻想和动机的母亲来说尤其如此（Handelzalts、Fisher、Sadan 和 Goldzweig，2017 年）。同样，其他研究报告称，母乳喂养的心理表征和喂养互动（例如，安慰、拒绝、哭泣等）也可能影响母亲对待母乳喂养的方式，甚至影响改用奶瓶喂养的决定（Kronborg 等，2016）。 ，2015 年；Sayre 等人，2001 年）。影响育儿行为的心理表征超出婴儿期，包括在游戏互动期间和与父母控制实践有关的心理表征（Crawford & Benoit，2009；Soenens 等人，2010 年）。内部表征的质量（即连贯性、灵活性和丰富性）也可能影响母亲理解和调整自己的行为以敏感和适当地回应孩子的言语前需求和心理状态的能力（Alvarez-Monjaras、McMahon &suchman ，2017；Fonagy、Gergely 和 Target，2007；Fonagy、Steele、Steele、Moran 和 Higgitt，1991）。例如，在成人依恋访谈 (George, Kaplan, & Main, 1985) 中，表达脱离的母亲往往不那么敏感、更被动、更不鼓励，而那些表达更连贯的母亲则较少消极（例如，攻击性或侵入性）和更积极（例如，温暖或舒缓）的育儿做法（Slade、Belsky、Aber 和 Phelps，1999 年；Sokolowsky、Hans、Bernstein 和 Cox，2007 年）。因此，心理表征的整体质量允许母亲更敏感地与孩子互动。母体关系和儿童的内部世界 最近的研究表明，这些物体表征不仅会影响母体行为，而且还可能通过母亲思考和解释自己和婴儿行为的能力而代代相传心理状态和意图（称为反思功能；Fonagy 等，2007）。照顾者的反思性人格和母性成瘾 7 功能——与心理表征固有相关（Alvarez-Monjaras 等，2017）——被认为是众所周知的依恋模式和关系知识的代际传递中缺失的环节（Fonagy & Allison， 2014）。通过对婴儿自动行为表达（即父母敏感性）的这些显着、明示和偶然的反馈反应，看护者慢慢地使孩子对自己和他人的主要和次要心理状态和意图敏感（Fonagy & Bateman，2008 年；Fonagy 等等，2007）。这种“自然教学法”（Csibra & Gergely，2009 年）通过允许