Parenting styles in borderline personality disorder: A pilot study

Apoorva Shrivastava; M Manjula; K John Vijaysagar; Harish Thippeswamy

doi:10.4103/ijsp.ijsp_54_20

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Year : 2022 | Volume : 38 | Issue : 1 | Page : 99-102

Parenting styles in borderline personality disorder: A pilot study

Apoorva Shrivastava¹, M Manjula¹, K John Vijaysagar², Harish Thippeswamy³
¹ Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
² Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
³ Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission	30-Mar-2020
Date of Acceptance	13-Oct-2020
Date of Web Publication	17-Feb-2022

Correspondence Address:
Ms. Apoorva Shrivastava
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijsp.ijsp_54_20

Abstract

Background: Personality disorders (PDs) are often influenced by early circumstances such as parenting. Parenting remains a subjective experience which has not been well studied in the context of PDs from the perspectives of parents and their children. Aims: This study examined the parenting styles in the form of perceived parenting in youth with borderline PD (BPD) and parenting experiences of their parents. Settings and Design: We employed a mixed-methods cross-sectional study design to assess youth aged between 16 and 24 years diagnosed with BPD and their parents, who sought treatment at a tertiary care psychiatric hospital. Methods: Youth (n = 5) and their parents (n = 8) were assessed on the Structured Clinical Interview for DSM 5 for PD, MINI International Neuropsychiatric Interview 7.0.2, and the Parenting Styles and Dimensions Questionnaire – Short Form. Two youth and two parents from the primary sample were selected for a semi-structured interview on parenting. Statistical Analysis: Parenting style scores were analyzed through descriptive statistics. Thematic analysis was used to interpret the interview data. Results: Youth with BPD perceived parenting as authoritarian and scored their parents lowest on the autonomy-granting dimension of authoritative parenting style. Verbal hostility was scored highest for parents. Parents of youth with BPD perceived their parenting style as authoritative, viewing themselves as warm and supportive. In the interviews, youth reported high criticality; they expressed dissatisfaction with parenting styles and need for support. The parents reported the negative influence of marital discord on parenting styles, and the need for open communication. Conclusions: Parenting styles are perceived differently by youth with BPD and their parents. Presence of psychopathology and individual personality traits of both youth and parents seem to play an important role in determining parenting,which needs further exploration.

Keywords: Borderline personality disorder, parenting styles, perceived parenting, youth

How to cite this article:
Shrivastava A, Manjula M, Vijaysagar K J, Thippeswamy H. Parenting styles in borderline personality disorder: A pilot study. Indian J Soc Psychiatry 2022;38:99-102

How to cite this URL:
Shrivastava A, Manjula M, Vijaysagar K J, Thippeswamy H. Parenting styles in borderline personality disorder: A pilot study. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Jun 30];38:99-102. Available from: https://www.indjsp.org/text.asp?2022/38/1/99/337870

Introduction

Studies suggest an association between personality disorders (PD) and parenting.^[1],[2],[3] Higher occurence of PD is associated with parental rejection, overprotection, and conflict in parenting. Strong association is found between the personality disorders in parents with the PD in children.^[2] Development of PD in early adulthood is more likely in children who experience low parental affection and aversive parenting.^[3],[4]

Individuals with Borderline PD (BPD) have reported low parental care, high overprotection, and inconsistency in parenting.^[5] Avon Longitudinal Study of Parents and Children reported that children who were exposed to maladaptive parenting and higher levels of family adversity were at heightened risk of developing BPD symptoms.^[6] Suboptimal parenting, parental conflict,^[6] growing up in a dysfunctional family, early childhood adversities,^[7],[8] and parental rearing styles, are related to the development of BPD traits.^[5]

Parenting remains a subjective experience, which essentially is a transaction that involves at least two parties: a parent and a child.^[9] Parenting styles can be understood as attitudes toward the child that are communicated to them and create an emotional climate in which parents' behavior is expressed.^[10] Indian parenting styles are likely to be different from those of Western countries.^[11] Maladaptive parenting is reported to be a psychosocial risk factor for the development of BPD across Western studies.^[12] Although there are attempts to understand cultural factors in PDs, there is a paucity of research on the association of parenting styles and PD in India.^[13] Additionally, fathers have not been participants in most studies on parenting and PDs worldwide.

BPD is known to cause significant distress because it significantly burdens patients and their families.^[14] Learning about the relationship of parenting styles with BPD symptoms would help in better tailoring of interventions for the patients and their families. This paper is an attempt in the form of a pilot study (part of doctoral research) to address the above-mentioned gap in the literature. We examined parenting styles in the form of perceived parenting from the youth's perspective and as parenting experiences from the parents' perspective. This is done using both qualitative and quantitative methods, and significant results have been presented briefly.

Methods

A cross-sectional, mixed-methods (concurrent embedded) design was used. In this design, the secondary method (qualitative in this case) is embedded, or nested, within the predominant quantitative method.^[15]

Participants

Youth aged between 16 and 24 years, diagnosed with BPD, seeking treatment at a tertiary care psychiatric hospital and their parents, all with a minimum education level of 10^th standard, were included in the study. Youth with major medical illness, neurological disorders, head injury, psychosis, severe depression, intellectual disability, and Cluster A PD and youth living away from parents were excluded from the study. Parents with any neurological disorders, head injury, psychosis, severe depression (current episode), and intellectual disability were excluded from the study. Furthermore, parents who have stayed away from their children for >5 years before their children attaining 16 years of age were excluded from the study. Five youth, four fathers, and four mothers were assessed. Two youth and their parents (three) from the main sample consented to participate in the semi-structured interview. The participants were recruited from the outpatient and inpatient facilities. Written informed consent was obtained from the youth and their parents for their participation. The study was approved by the institute's ethics committee.

Measures

Structured Clinical Interview for DSM 5 for PD was used for screening the youth and to assess PDs in parents.^[16]

MINI-International Neuropsychiatric Interview (MINI 7.0.2), a short, semi-structured diagnostic inventory for DSM-IV, and International Classification of Diseases 10^th Revision was used to explore Axis I psychiatric disorders.^[17]

The Parenting Styles and Dimensions Questionnaire – Short Form (PSDQ-SF), a 32-item self-rated inventory, is devised to assess authoritative, authoritarian, and permissive parenting styles, as well as specific parenting practices within each of these styles. The questionnaire is intended for use by both parents and children. Items are rated on a 5-point Likert scale ranging from 1 (never) to 5 (always), with scores based on the primary subscales and their respective parenting factors. PSDQ was used to assess perceived parenting in youth and parenting experiences in their parents.^[18]

A semi-structured interview was developed by the researcher to assess perceived parenting in youth and parenting experiences in parents. It was developed after reviewing literature and was validated by four experts belonging to the departments of clinical psychology and psychiatry of the institute. The parenting experiences' interview broadly explored family and home atmosphere, expectations of parenting and methods of parenting, expectations from children, help-seeking, and support for parenting, whereas the perceived parenting interview with youth explored the relationship with parents, family environment, emotion regulation, and experiences of abuse.

Data analysis

Because the sample size was small, only mean was calculated for the scores of PSDQ for youth and their parents. Thematic analysis was used to interpret data from interviews.^[19] The themes identified were independently verified by the second author. The main themes have been discussed in this article.

Results

The mean age of the youth was 19.2 years (SD= 2.68) years, and that of mothers was 46 years (SD = 2.70) and fathers was 49 years (SD= 2.94). All families belonged to middle socioeconomic status, and the education level of youth was 12^th standard and above.

The youth were all females diagnosed with BPD. Depression was the most common Axis 1 diagnosis, with active suicidality in one youth. One mother was diagnosed with dependent PD and another mother reported a past episode of depression. Two fathers had obsessive-compulsive personality traits, however no Axis 1 disorders were found on MINI.

The youth with BPD perceived the parenting styles of their parents as authoritarian, with the highest scores for both parents on verbal hostility dimension. Parents were scored lowest on the autonomy-granting dimension, showing youth perception of inadequate freedom and autonomy [Table 1]. In the interview for perceived parenting, the youth reported low satisfaction with the parenting styles of their parents, lack of support, and high criticality from them. They emphasized the need for understanding and open communication with parents. The youth also reported emotional and physical abuse in the family. Presence of conflict between parents greatly distressed them, making the youth deem it as “emotionally scarring experiences.”

Table 1: Mean scores on Parenting Styles and Dimensions Questionnaire

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On the other hand, parents perceived their parenting style as authoritative and viewed themselves as warm, supportive, and open to reasoning and discussions with their children [Table 1]. They did not perceive themselves as punitive and unreasonable like their children did. The parenting experience interview revealed the presence of an unhealthy home atmosphere, poor conflict resolution in family, marital discord between parents, lack of open communication, dissatisfaction with spouse's parenting style, and lack of support from spouse majorly. They reported being unhappy with the current relationship with children, and a feeling that they could have managed things differently. Parents felt that marital conflicts had affected their relationship with children and also children's mental health.

Discussion

Since parenting is a transaction between parents and their children, it can be argued that both parties' personality traits and psychopathology may also impact it. Some parents had reported Cluster C personality traits and these may be affecting their parenting style as would the presence of psychopathology. Previously also, it has been seen that mothers of adolescents with BPD reported more parenting stress, general psychopathology, and Cluster C personality traits compared to the control group.^[4]

BPD traits of youth and the presence of psychopathology may impact their perception of parenting and their response to it, eventually influencing their parents' behavior. While it is also seen that BPD patients perceive and portray the parenting received unfavorably,^[20] often describing their parents as neglectful, invalidating, overinvolved, and indifferent.^{[2],[21],[22]} Problematic parenting has been related to elevated risk for a wide range of offspring PDs.^[3],[4]

Youth and parental personality traits affect the transaction of parenting, leading to different perceptions and experiences for both, which may also reciprocally affect each other. This is an important area to be explored so that better management programs can be developed for the families of patients with PDs. As this was a pilot study, the results cannot be taken as conclusive; however, they do emphasize a link between parenting, psychopathology in parents, and BPD. This also highlights the importance of studying this topic, especially in India, where there is a lack of relevant literature.

Conclusion

Youth and their parents' perception of parenting differ from each other. Mental health status and personality of both parents and their children seem to play a role in determining the nature and perception of parenting.The study adds to building a case to explore areas of personality disorders, parenting, the reciprocal interactions and interventions involving families.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Batool N, Shehzadi H, Riaz MN, Riaz MA. Paternal malparenting and offspring personality disorders: Mediating effect of early maladaptive schemas. J Pak Med Assoc 2017;67:556-60.
2.	Cheng HG, Huang Y, Liu Z, Liu B. Associations linking parenting styles and offspring personality disorder are moderated by parental personality disorder, evidence from China. Psychiatry Res 2011;189:105-9.
3.	Johnson JG, Cohen P, Chen H, Kasen S, Brook JS. Parenting behaviors associated with risk for offspring personality disorder during adulthood. Arch Gen Psychiatry 2006;63:579-87.
4.	Schuppert HM, Albers CJ, Minderaa RB, Emmelkamp PM, Nauta MH. Parental rearing and psychopathology in mothers of adolescents with and without borderline personality symptoms. Child Adolesc Psychiatry Ment Health 2012;6:29.
5.	Boucher MÈ, Pugliese J, Allard-Chapais C, Lecours S, Ahoundova L, Chouinard R, et al. Parent-child relationship associated with the development of borderline personality disorder: A systematic review. Personal Ment Health 2017;11:229-55.
6.	Winsper C, Zanarini M, Wolke D. Prospective study of family adversity and maladaptive parenting in childhood and borderline personality disorder symptoms in a non-clinical population at 11 years. Psychol Med 2012;42:2405-20.
7.	Afifi TO, Mather A, Boman J, Fleisher W, Enns MW, Macmillan H, et al. Childhood adversity and personality disorders: Results from a nationally representative population-based study. J Psychiatr Res 2011;45:814-22.
8.	Temes CM, Magni LR, Fitzmaurice GM, Aguirre BA, Goodman M, Zanarini MC. Prevalence and severity of childhood adversity in adolescents with BPD, psychiatrically healthy adolescents, and adults with BPD. Personal Ment Health 2017;11:171-8.
9.	de la Iglesia G, Stover JB, Freiberg Hoffmann A, Fernandez Liporace MM. Perceived parenting styles and parental inconsistency scale: Construct validity in young adults. Int J Humanit Soc Sci 2014;4:61-9.
10.	Darling N, Steinberg L. Parenting style as context: An integrative model. Psychol Bull 1993;113:487.
11.	Sahithya BR, Manohari SM, Vijaya R. Parenting styles and its impact on children – A cross cultural review with a focus on India. Ment Health Relig Cult 2019;22:357-83.
12.	Steele KR, Townsend ML, Grenyer BFS. Parenting and personality disorder: An overview and meta-synthesis of systematic reviews. PLoS One 2019;14:e0223038.
13.	Sharan P. An overview of Indian research in personality disorders. Indian J Psychiatry 2010;52:S250-4. [PUBMED] [Full text]
14.	Bailey RC, Grenyer BF. Burden and support needs of carers of persons with borderline personality disorder: A systematic review. Harv Rev Psychiatry 2013;21:248-58.
15.	Creswell J. Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Research. 4^th ed. Boston: Pearson; 2012. p. 534-75.
16.	First MB, Williams JB, Benjamin LS, Spitzer RL. User's guide for the SCID-5-PD (Structured Clinical Interview for DSM-5 Personality Disorder). Arlington: American Psychiatric Association; 2015.
17.	Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59 Suppl 20:22-33.
18.	Robinson CC, Mandleco B, Olsen SF, Hart CH. Authoritative, authoritarian, and permissive parenting practices: Development of a new measure. Psychol Rep 1995;77:819-30.
19.	Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101.
20.	Sansone RA, Sansone LA. The families of borderline patients: The psychological environment revisited. Psychiatry (Edgmont) 2009;6:19-24.
21.	Gunderson JG, Lyoo IK. Family problems and relationships for adults with borderline personality disorder. Harv Rev Psychiatry 1997;4:272-8.
22.	Stepp SD, Whalen DJ, Scott LN, Zalewski M, Loeber R, Hipwell AE. Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. Dev Psychopathol 2014;26:361-78.