The mental health of preschoolers in a Norwegian population-based study when their parents have symptoms of borderline, antisocial, and narcissistic personality disorders: at the mercy of unpredictability

Chinese Medicine

Lars Wichström²  Turid Suzanne Berg-Nielsen¹ 

[1] Regional Centre for Child and Adolescent Mental Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Child and Adolescent Psychiatric Clinic, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway

关键词: Generation;    Parent;    Child;    Psychopathology;    Psychiatry;    Personality disorder;   

Others  :  791380
DOI  :  10.1186/1753-2000-6-19

 received in 2012-02-08, accepted in 2012-05-20,  发布年份 2012

【 摘 要 】

Background

Clinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is whether the risk to children’s mental health extends to the normal population of parents who have subclinical symptomlevels of these disorders.

Methods

This inquiry used data from a Trondheim, Norway community sample of 922 preschoolers and one parent for each child. The mean age of the children was 53 months (SD 2.1). Parents reported symptoms of Borderline, Antisocial and Narcissistic Personality Disorders on the DSM-IV ICD-10 Personality Questionnaire, and the children’s symptoms of DSM-IV behavioral and emotional diagnoses were measured with the Preschool Age Psychiatric Assessment, a comprehensive interview. Multigroup Structural Equation Modeling was used to assess the effect of parents’ symptoms on their preschoolers’ behavioral and emotional problems.

Results

The analyses yielded strongly significant values for the effect of parents’ Personality Disorder symptoms on child problems, explaining 13.2% of the variance of the children’s behavioral symptoms and 2.9% of the variance of internalizing symptoms. Biological parents’ cohabitation status, i.e., whether they were living together, emerged as a strong moderator on the associations between parental variables and child emotional symptoms; when parents were not cohabiting, the variance of the children’s emotional problems explained by the parents’ Personality Disorder symptoms increased from 2.9% to 19.1%.

Conclusions

For the first time, it is documented that parents’ self-reported symptoms of Borderline, Antisocial, and Narcissistic Personality Disorders at a predominantly subclinical level had a strong effect on their children’s psychiatric symptoms, especially when the biological parents were not living together. Child service providers need to be aware of these specific symptoms of parental Personality Disorders, which may represent a possible risk to children.

【 授权许可】

   
2012 Berg-Nielsen and Wichstrom; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Kringlen E, Torgersen S, Cramer V: Mental illness in a rural area - a Norwegian psychiatric epidemiological study. Soc Psychiatry Psychiatr Epidemiol 2006, 41(9):713-719.
• [2]Kringlen E, Torgersen S, Cramer V: A Norwegian psychiatric epidemiological study. Am J Psychiatry 2001, 158(7):1091-1098.
• [3]Torvik FA, Rognmo K: Children of parents with mental disorders or alcohol abuse: prevalence and consequences. Report - Norwegian Institute of Public Health 2011, 4:20-21.
• [4]Vidair HB, Reyes JA, Shen S, Parrilla-Escobar MA, Heleniak CM, Hollin IL, Woodruff S, Turner JB, Rynn MA: Screening parents during child evaluations: exploring parent and child psychopathology in the same clinic. J Am Acad Child Adolesc Psychiatry 2011, 50(5):441-450.
• [5]Göpfert M, Webster J, Seeman MV (Eds): Parental psychiatric disorder. Distressed parents and their families. Cambridge University Press, New York; 1996.
• [6]Rutter M, Quinton D: Parental psychiatric disorder - effects on children. Psychol Med 1984, 14(4):853-880.
• [7]Westen D, Shedler J, Durrett C, Glass S, Martens A: Personality diagnoses in adolescence: DSM-IV Axis II diagnoses and an empirically derived alternative. Am J Psychiatry 2003, 150(5):952-966.
• [8]Adshead G: Dangerous and severe parenting disorder? Personality disorder, parenting and new legal proposals. Child Abuse Rev 2003, 12:227-237.
• [9]American Psychiatric Association: Diagnostic and statistical manual of mental disorders. in., 4th, text revision. 2000 edition. Washington DC: American Psychiatric Association, Washington; 2000:685-717. 2000
• [10]Chmielewski M, Bagby RM, Quilty LC, Paxton R, McGee Ng SA: A (re)-evaluation of the symptom structure of borderline personality disorder. Can J Psychiatry 2011, 56:9.
• [11]Markon KE: Modeling psychopathology structure: a symptom-level analysis of axis I and II disorders. Psychol Med 2010, 40:273-288.
• [12]Krueger RF: Continuity of axes I and II: Toward a unified model of personality, personality disorders, and clinical disorders. J Pers Disord 2005, 19(3):233-261.
• [13]Yudofsky SC: Fatal flaws: navigating destructive relationships with people with disorders of personality and character. American Psychiatric Publishing, Inc, Arlington; 2005.
• [14]Weiss M, Zelkowitz P, Feldman RB, Vogel J, Heyman M, Paris J: Psychopathology in offspring of mothers with borderline personality disorder: a pilot study. Can J Psychiatry 1996, 41(5):285-290.
• [15]Eaton NR, Krueger RF, Keyes KM, Skodol AE, Markon KE, Grant BF, Hasin DS: Borderline personality disorder co-morbidity: relationship to the internalizing-externalizing structure of common mental disorders. Psychol Med 2011, 41(5):1041-1050.
• [16]Barnow S, Spitzer C, Grabe HJ, Kessler C, Freyberger HJ: Individual characteristics, familial experience, and psychopathology in children of mothers with borderline personality disorder. J Am Acad Child Adolesc Psychiatry 2006, 45(8):965-972.
• [17]Abela JRZ, Skitch SA, Auerbach RP, Adams P: The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents. J Pers Disord 2005, 19(1):68-83.
• [18]Duniz M, Scheer PJ, Trojovsky A, Kaschnitz W, Kvas E, Macari S: Changes in psychopathology of parents of NOFT (non-organic failure to thrive) infants during treatment. Eur Child Adolesc Psychiatry 1996, 5(2):93-100.
• [19]Foley DL, Pickles A, Simonoff E, Maes HH, Silberg JL, Hewitt JK, Eaves LJ: Parental concordance and comorbidity for psychiatric disorder and associate risks for current psychiatric symptoms and disorders in a community sample of juvenile twins. J Child Psychol Psychiatry 2001, 42:381-394.
• [20]Herndon RW, Iacono WG: Psychiatric disorder in the children of antisocial parents. Psychol Med 2005, 35(12):1815-1824.
• [21]Kendler KS, Davis CG, Kessler RC: The familial aggregation of psychiatric and substance use disorders in the National Comorbidity Survey: a family histroy study. Br J Psychiatry 1997, 170:541-548.
• [22]Shears J, Robinson J, Emde RN: Fathering relationships and their associations with juvenile delinquency. Infant Ment Health J 2002, 23:79-87.
• [23]Rutter M, Moffitt TE, Caspi A: Gene-environment interplay and psychopathology: multiple varieties but real effects. J Child Psychol Psychiatry 2006, 47(3–4):226-261.
• [24]Plomin R: Commentary: why are children in the same family so different? Non-shared environment three decades later. Int J Epidemiol 2011, 40(3):582-592.
• [25]Beaulieu DA, Bugental D: Contingent parental investment: an evolutionary framework for understanding early interaction between mothers and children. Evol Hum Behav 2008, 29:249-255.
• [26]Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, et al.: Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008, 69(4):533-545.
• [27]Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF: Prevalence, correlates, and comorbidity of dsm-iv antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2005, 66(6):677-685.
• [28]Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, Ruan WJ, Pulay AJ, Saha TD, Pickering RP, et al.: Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008, 69(7):1033-1045.
• [29]Widiger TA, Frances AJ: Toward a dimensional model for the personality disorders. In Personality disorders and the five-factor model of personality. vol. 2 edition. Edited by Costa PT, Widiger TA. American Psychological Association, Washington DC; 2002:23-44.
• [30]Van Leeuwen KG, Mervielde I, De Clercq B, De Fruyt F: Extending the spectrum idea: child personality, parenting and psychopathology. Eur J Pers 2007, 21:63-89.
• [31]Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ: Personality disorder types proposed for DSM-5. J Pers Disord 2011, 25(2):136-169.
• [32]Johnson JG, Cohen P, Kasen S, Smailes E, Brook JS: Association of maladaptive parental behavior with psychiatric disorder among parents and their offspring. Arch Gen Psychiatry 2001, 58:453-460.
• [33]Whaley SE, Pinto A, Sigman M: Characterizing interactions between anxious mothers and their children. J Consult Clin Psychol 1999, 67(6):826-836.
• [34]Ehrensaft MK, Wasserman GA, Verdelli L, Greenwald S, Miller L, Davies M: Maternal antisocial behavior, parenting practices, and behavior problems in boys at risk for antisocial behavior. J Child Fam Studies 2003, 12(1):27-40.
• [35]Belsky J, Jaffee S: The multiple determinants of parenting. In Developmental Psychopathology. vol. 3, 2 edition. Edited by Cicchetti D, Cohen DJ. Wiley, New Jersey; 2006:38-85.
• [36]Kochanska G, Clark LA, Goldman MS: Implications of mothers' personality for their parenting and their young children's developmental outcomes. J Pers 1997, 65:387-420.
• [37]Lahey BB, Russo MF, Walker JL, Piacentini JC: Personality characteristics of the mothers of children with disruptive behavior disorders. J Consult Clin Psychol 1998, 57(4):512-515.
• [38]Nigg JT, Hinshaw SP: Parent personality traits and psychopatholgy associated with antisocial behavors in childhood Attention-Deficit Hyperactivity Disorder. J Child Psychol Psychiatry 1998, 39(2):145-159.
• [39]Berg-Nielsen TS, Vikan A, Dahl AA: Parenting related to child and parental psychopathology. Clin Child Psychol Psychiatry 2002, 7:529-552.
• [40]Newman LK, Stevenson CS, Bergman LR, Boyce P: Borderline personality disorder, mother-infant interaction and parenting perceptions: preliminary findings. Aust N Z J Psychiatry 2007, 41(7):598-605.
• [41]Macfie J, Swan SA: Representations of the caregiver-child relationship and of the self, and emotion regulation in the narratives of young children whose mothers have borderline personality disorder. Dev Psychopathol 2009, 21(3):993-1011.
• [42]Crandell LE, Patrick MPH, Hobson RP: 'Still-face' interactions between mothers with borderline personality disorder and their 2-month-old infants. Br J Psychiatry 2003, 183:239-247.
• [43]Johnson JG, Cohen P, Kasen S, Ehrensaft MK, Crawford TN: Associations of parental personality disorders and axis I disorders with childrearing behavior. Psychiatry 2006, 69(4):336-350.
• [44]Stanley N, Penhale B: The mental health problems of mothers experiencing the child protection system. Child Abuse Rev 1999, 8:34-45.
• [45]Bools C, Neale B, Meadow R: Munchausen-syndrome by proxy - A study of psychopathology. Child Abuse Negl 1994, 18(9):773-788.
• [46]Cassidy B, Zoccolillo M, Hughes S: Psychopathology in adolescent mothers and its effects on mother-infant interactions: a pilot study. Can J Psychiatry 1996, 41(6):379-384.
• [47]Hobson PR, Patrick M, Crandell L, Garcia-Perez R, Lee A: Personal relatedness and attachment in infants of mothers with borderline personality disorder. Dev Psychopathol 2005, 17:329-347.
• [48]Hobson RP, Patrick MPH, Hobson JA, Crandell L, Bronfman E, Lyons-Ruth K: How mothers with borderline personality disorder relate to their year-old infants. Br J Psychiatry 2009, 195(4):325-330.
• [49]Coley RL, Carrano J, Lewin-Bizan S: Unpacking Links between fathers' antisocial behaviors and children's behavior problems: direct, indirect, and interactive effects. J Abnorm Child Psychol 2011, 39(6):791-804.
• [50]Moffitt TE, Caspi A, Harrington H, Milne BJ: Males on the life-course persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Dev Psychopathol 2002, 14:179-207.
• [51]Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH, Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH: Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 2011.
• [52]Byrne BM: Structural Equation Modeling with Mplus. Routledge, Taylor & Francis Group, New York; 2012.
• [53]Statistics Norway: Figures on Trondheim Municipality. Statistics Norway, ; 2010.
• [54]Goodman R: The Strengths and Difficulties Questionnaire: A research note. J Child Psychol Psychiatry 1997, 38(5):581-586.
• [55]Crone MR, Vogels AG, Hoekstra F, Treffers PD, Reijneveld SA: A comparison of four scoring methods based on the parent-rated Strengths and Difficulties Questionnaire as used in the Dutch preventive child health care system. BMC Publ Health 2008, 8:106. BioMed Central Full Text
• [56]Egger HL, Erkanli A, Keeler G, Potts E, Walter BK, Angold A: Test-Retest Reliability of the Preschool Age Psychiatric Assessment (PAPA). J Am Acad Child Adolesc Psychiatry 2006, 45(5):538-549.
• [57]First MB, Spitzer RL, Gibbon M, Williams JBW: The structured clinical interview for DSM III_R personality disorders (SCID II). Part I: description. J Pers Disord 1995, 9:83-91.
• [58]Bodlund O, Grann M, Ottosson H, Svanborg C: Validation of the self-report questionnaire DIP-Q in diagnosing DSM-IV personality disorders: a comparison of three psychiatric samples. Acta Psychiatr Scand 1998, 97(6):433-439.
• [59]Grann M, Bodlund O, Ottosson H, Svanborg C: Personality disorders according to DIP-Q self-report and relation to axis I disorders. Nord J Psychiatry 1998, 52:170-170.
• [60]Ottosson H, Bodlund O, Ekselius L, Grann M, von Knorring L, Kullgren G, Lindstrom E, Soderberg S: DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview. Eur Psychiatry 1998, 13(5):246-253.
• [61]Ottosson H, Bodlund O, Ekselius L, von Knorring L, Kullgren G, Lindstrom E, Soderberg S: The DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) - Construction and preliminary validation. Nord J Psychiatry 1995, 49(4):285-291.
• [62]Ottosson H, Grann M, Kullgren G: Test-retest reliability of a self-report questionnaire for DSM-IV and ICD-10 personality disorders. Eur J Psychol Assess 2000, 16(1):53-58.
• [63]Armor DJ: Theta reliability and factor scaling. Edited by Costner H. Jossey-Bass, San Francisco; 1974.
• [64]Huber PJ: The behavior of maximum likelihood estimates under nonstandard conditions. University of California Press, Berkeley, CA; 1967:221-233.
• [65]White H: A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 1980, 48:817-830.
• [66]Muthén LK, Muthén BO: Mplus User's Guide. Fifth Edition edition. Muthén & Muthén, Los Angeles, CA; 1998–2007.
• [67]Yu C-Y: Evaluating Cutoff criteria of model Fit Indices for Latent Variable Models with Binary and Continuous Outcomes. University of California, Los Angeles; 2002.
• [68]Brown TA: Confirmatory Factor Analysis for Applied Research. The Guilford Press, New York; 2006.
• [69]Satorra A: Scaled and adjusted restricted tests in multi-sample analysis of moment structures In: Innovations in multivariate statistical analysis A Festschrift for Heinz Neudecker. Edited by Heijmans RDH, Pollock DSG, Satorra A. Kluwer Academic Publishers, London; 2000:233-247.
• [70]De Los Reyes A, Goodman KL, Kliewer W, Reid-Quiñones K: Whose depression relates to discrepancies? Testing relations between informant characteristics and informant discrepancies from both informants’ perspectives. Psychol Assess 2008, 20:139-149.
• [71]Chi TC, Hinshaw SP: Mother-child relationships of children with ADHD: the role of maternal depressive symptoms and depression-related distortions. J Abnorm Child Psychol 2002, 30:387-400.
• [72]Berg-Nielsen TS, Vika A, Dahl AA: When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem. Child Care Health Dev 2003, 29(3):207-213.
• [73]Berg-Nielsen TS, Solheim E, Belsky J, Wichstrom L: Preschoolers' psychosocial problems: In the eyes of the beholder? Adding teacher characteristics as determinants of discrepant parent-teacher reports. Child Psychiatry & Human Development 2012, 43(3):393-413.