Introduction A personality disorder is a sustainable pattern of perception, cognition and relationship with the environment and one’s person, pervasive, maladaptive and inflexible, affecting important areas of the individual’s life functioning. Specialized studies in the field describe a high rate of heritability of the personality disorders and the importance of these parent personality disorders in the development of the child, includind the development of psychopathology.
The purpose of this study was to assess the frequency and type of personality disorder in parents of children with psychiatric pathology and to identify a relationship between personality disorders in parents and internalizing and outsourcing problems in children.
Materials and methods The study was conducted on two groups of 30 children and their parents, the first batch of children with internalizing problems and the second with children with outsourcing problems, hospitalized in the Pediatric Psychiatry Clinic from Cluj-Napoca during April 2011-October 2011. We used as instruments for assessment the psychiatric interview, SCID-II and CBCL. Data processing was done with SPSS version 17.
Results We revealed a relationship between avoidant, obsessive-compulsive, schizoid and depressive personality traits of parents and psychiatric disorders in children.
Conclusions Personality disorders are relatively common among parents of children with psychiatric diagnosis. For these reasons therapeutic relationship and plan for children should be made taking into account the presence of personality disorder of the parent.
Personality disorders are characterized by maladaptive and enduring behavioral patterns, affecting personal functioning and interpersonal contact. Clinical studies highlighted the high degree of heritability of mental disorders and the existence of ineffective parenting styles associated with behavioral disorders in children and adolescents (Calvo et al., 2009; Latzman et al., 2009).
Although parent-child interaction has been extensively studied and correlations have been obtained between certain styles of parenting and psychiatric pathology in children (Coplan et al., 2009, Johnson et al., 2006; Huver et al., 2010), addressing the child pathology from the parent’s point of view, remains a current issue. The study addresses how parent’s personality disorders determines the parenting style.
Objectives: The aim of this study was to assess the frequency and type of personality disorders in parents of children with psychiatric pathology and to identify a relationship between the parent’s type of personality disorder and internalizing /externalizing children problems.
Participants: 60 biological parents (male and female) of children with a psychiatric disorder were included in the study. The children were hospitalized in the Pediatric Psychiatry Department of the Clinical Emergency Hospital for Children in Cluj-Napoca, Romania, from April to September 2011. We established two groups, the first group of children, diagnosed according to DSM IV criteria, with an internalizing (anxiety, depression) psychiatric disorder and the second group of children with an externalizing (ADHD, conduct disorder) psychiatric disorder. Parents who had a DSM axis I Disorder were excluded from the study, also children who had adoptive parents, who came from foster care centers and who had a diagnosis that could not be classified into one of the categories set above .
Measures and procedure: After obtaining informed consent and privacy of data, the SCID-II, structured clinical interview for axis II disorders on the DSM IV was applied to the parents. The interview can be used to provide both categorical and dimensional diagnosis. Studies in the field have demonstrated good reliability and validity of the SCID-II in the research and clinical field (Lobbestael et al., 2010).
Table I Demographics Parents
C. INT. = Clinical Internalizing Disorder / C. EXT. = Clinical Externalizing Disorder
Parents were asked to complete the children behavioral checklist (CBCL 1.5-5 years and 6-18 years), the questionnaire evaluates different competencies (school, social activities), and internalizing/externalizing problems of children (test retest loyalty of 0.91 for internalizing problems and 0.92 for externalizing problems; agreement between informants was 0.72 for internalizing problems and 0.92 for externalizing problems). (Ang et al., 2012).
The children diagnosis was taken from the clinical observation records, demographic data was gathered: children and parent’s gender, occupation, educational level, socioeconomic, marital status, number of children, the brothers’ psychiatric pathology.
There were 60 children included in the study, divided into two groups, a first group of 30 children with an internalization diagnosis and a second group of 30 children diagnosed with an externalizing disorder. The average age for children was 9.5 ± 4.81 years, there were 37 boys and 23 girls, 17 girls and 13 boys with internalizing disorders, 6 girls and 24 boys with externalizing disorders.
Table II Parent’s personality disorders frequency and type
In Table II we present the frequency and the personality type disorders, identified in parents. We have identified an increased frequency of C cluster personality disorders in parents of male children and parents of children with internalizing disorder; an increased frequency of A cluster personality disorders in parents of children diagnosed with externalizing problems.
In order to identify a relationship between parents personality disorder and children internalizing and externalizing psychiatric disorders, we have applied chi-square test for independent samples. Statistical analysis revealed a relationship between the parents personality disorder and the psychiatric diagnosis in children (avoidant PD χ ² = 4.286, p = 0.038; obsessive-compulsive PD χ ² = 4.0.43, p = 0.04; depressive PD χ ² = 4.286, p =0.038).
To analyze to what extent parents personality disorder may be predictive for the development of internalizing/externalizing disorders in children (diagnosed clinically and identified using CBCL) we applied multiple linear regression analysis. We established parent’s personality disorder as a predictor for the internalization/externalization disorders in children and behavioral disturbance in children as the criterion variable. The best predictor for clinically diagnosed internalizing and externalizing disorders in children was the obsessive-compulsive personality disorder (beta =0.252, p =0.46). The best predictors for internalizing/externalizing disorders identified by the CBCL were: depressive personality disorder (beta =0.528 p =0.000), schizoid (beta =0.268, p =0.016) and antisocial (beta =0.261, p =0.018) in parents.
From the group of 60 parents, 55 were women, married, with low socioeconomic status, with a medium educational level, with an almost equal distribution by age and occupation.
We have identified an increased frequency of C cluster personality disorders in the parents of male children and parents of children with internalizing disorder; an increased frequency of A cluster personality disorders in parents of children diagnosed with externalizing disorders .
We revealed a relationship between the parent’s avoidant, obsessive-compulsive, depressive personality disorder and internalizing and externalizing disorders in children, clinically diagnosed.
The best predictor for clinically diagnosed internalizing and externalizing disorders in children was the parent obsessive-compulsive personality disorder.
The best predictors for internalizing /externalizing disorders in children, identified by the CBCL, were parent’s depressive, schizoid and antisocial personality disorder.
Limitations and Discussions
The study took into account only one parent, not focusing on the children personality traits, or onto the child-parent interaction. The parent’s personality disorder was categorically assessed. As future research directions we intend to assess the dimensional personality traits of the parents at the same time with children personality traits, based upon specific cognitive schemes. Research directions are consistent with the DSM V.
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