Skip to main content Accessibility help
×
Home

Parenting and personality disorder: clinical and child protection implications

  • Gwen Adshead

Summary

I review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Parenting and personality disorder: clinical and child protection implications
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Parenting and personality disorder: clinical and child protection implications
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Parenting and personality disorder: clinical and child protection implications
      Available formats
      ×

Copyright

Corresponding author

Dr Gwen Adshead, Locum Consultant Forensic Psychiatrist, Southern Health NHS Foundation Trust, Ravenswood House, The Knowle, Fareham PO17 5NA, UK. Email: gwen.adshead@southernhealth.nhs.uk

Footnotes

Hide All

Learning Objectives

Be better able to consider whether any parents assessed have a personality dysfunction Understand how parental personality dysfunction may influence child development Be better prepared to make referrals of parents to psychological therapy services

Declaration of Interest

None

Footnotes

References

Hide All
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Bakermans-Kranenburg, MJ, van IJzendoorn, MH (2008) Oxytocin receptor (OXTR) and serotonin transporter (5-HTT) genes associated with observed parenting. Social Cognitive and Affective Neuroscience, 3: 128–34.
Bambrough, S, Shaw, M, Kershaw, S (2014) The Family Drug and Alcohol Court service in London: a new way of doing Care Proceedings. Journal of Social Work Practice, 28: 357–70.
Bateman, A, Fonagy, P (2013) Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder. British Journal of Psychiatry, 203: 221–7.
Beckett, C, Dickens, J, Bailey, S (2014) Concluding Care Proceedings Within 26 Weeks: Messages from the Evaluation of the Tri-borough Care Proceedings Pilot. Centre for Research on Children & Families/University of East Anglia.
Belsky, J (1984) The determinants of parenting: a process model. Child Development, 55: 8396.
Berg-Nielsen, TS, Vikan, A, Dahl, AA et al (2002) Parenting related to child and parental psychopathology: a descriptive review of the literature. Clinical Child Psychology and Psychiatry, 7: 529–52.
Berg-Nielsen, TS, Wichström, L (2012) 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. Child and Adolescent Psychiatry and Mental Health, 6: 113.
Bools, C, Neale, B, Meadow, R (1994) Munchausen's syndrome by proxy: a study of psychopathology. Child Abuse and Neglect, 18: 773–88.
Bornstein, RF, Gold, SH (2008) Comorbidity of personality disorders and somatization disorder: a meta-analytic review. Journal of Psychopathology and Behavioral Assessment, 30: 154–61.
Cooklin, A (2013) Promoting children's resilience to parental mental illness: engaging the child's thinking. Advances in Psychiatric Treatment, 19: 229–40.
Craig, TKJ, Cox, AD, Klein, K (2002) Intergenerational transmission of somatization behaviour: a study of chronic somatizers and their children. Psychological Medicine, 32: 805–16.
Craig, TKJ, Bialas, I, Hodson, S et al (2004) Intergenerational transmission of somatization behaviour: 2. Observations of joint attention and bids for attention. Psychological Medicine, 34: 199209.
Department for Communities and Local Government (2012) The Troubled Families Programme: Financial Framework for the Troubled Families Programme's Payment-by-Results Scheme for Local Authorities. TSO (The Stationery Office).
Department for Education (2011) Multisystemic Therapy (MST). DfE (http://www.education.gov.uk/commissioning-toolkit/Content/PDF/Multisystemic%20Therapy.pdf).
Department for Education and Skills, Department for Constitutional Affairs (2006) Review of the Child Care Proceedings System in England and Wales. DfES/DCA.
Dinwiddie, S, Bucholz, K (1993) Psychiatric diagnoses of self-reported child abusers. Child Abuse and Neglect, 17: 465–76.
Ellis, BJ, Boyce, WT (2008) Biological sensitivity to context. Current Directions in Psychological Science, 17: 183–7.
Famularo, R, Kinscherff, R, Fenton, T (1992) Psychiatric diagnoses of abusive mothers: a preliminary report. Journal of Nervous and Mental Disease, 180: 658–61.
Foley, DL, Eaves, LJ, Wormley, B et al (2004) Childhood adversity, monoamine oxidase a genotype, and risk for conduct disorder. Archives of General Psychiatry, 61: 738–44.
Frick, PJ, Lahey, BB, Loeber, R et al (1992) Familial risk factors to oppositional defiant disorder and conduct disorder: parental psychopathology and maternal parenting. Journal of Consulting and Clinical Psychology, 60: 4955.
Frigerio, A, Costantino, E, Ceppi, E et al (2013) Adult attachment interviews of women from low-risk, poverty, and maltreatment risk samples: comparisons between the hostile/helpless and traditional AAI coding systems. Attachment and Human Development, 15: 424–42.
Galbally, M, Lewis, AJ, IJzendoorn, MV et al (2011) The role of oxytocin in mother-infant relations: a systematic review of human studies. Harvard Review of Psychiatry, 19: 114.
Hobson, R P., Patrick, MPH, Hobson, JA et al (2009) How mothers with borderline personality disorder relate to their year-old infants. British Journal of Psychiatry, 195: 325–30.
Johnson, JG, Cohen, P, Kasen, S et al (2001) Association of maladaptive parental behavior with psychiatric disorder among parents and their offspring. Archives of General Psychiatry, 58: 453–60.
Johnson, JG, Cohen, P, Kasen, S et al (2006) Maternal psychiatric disorders, parenting, and maternal behavior in the home during the child rearing years. Journal of Child and Family Studies, 15: 97114.
Kim-Cohen, J, Caspi, A, Rutter, M et al (2006) The caregiving environments provided to children by depressed mothers with or without an antisocial history. American Journal of Psychiatry, 163: 1009–18.
Lahey, BB, Piacentini, JC, McBurnett, K et al (1988) Psychopathology in the parents of children with conduct disorder and hyperactivity. Journal of the American Academy of Child & Adolescent Psychiatry, 27: 163–70.
Lahey, BB, Russo, MF, Walker, JL et al (1989) Personality characteristics of the mothers of children with disruptive behavior disorders. Journal of Consulting and Clinical Psychology, 57: 512–5.
Livesley, WJ (2007) A framework for integrating dimensional and categorical classifications of personality disorder. Journal of Personality Disorders, 21: 199224.
Loranger, AW, Sartorius, N, Andreoli, A et al (1994) The International Personality Disorder Examination: the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry, 51: 215–24.
Loranger, AW, Janca, A, Sartorius, N (eds) (1997) Assessment and diagnosis of personality disorders: The ICD-10 International Personality Disorder Examination (IPDE). Cambridge University Press.
Lyons-Ruth, K, Yellin, C, Melnick, S et al (2005) Expanding the concept of unresolved mental states: hostile/helpless states of mind on the Adult Attachment Interview are associated with disrupted mother– infant communication and infant disorganization. Development and Psychopathology, 17: 123.
Lyons-Ruth, K, Melnick, S, Patrick, M et al (2007) A controlled study of Hostile-Helpless states of mind among borderline and dysthymic women. Attachment and Human Development, 9: 116.
Marshall, T, Jones, DPH, Ramchandani, PG et al (2007) Intergenerational transmission of health beliefs in somatoform disorders: exploratory study. British Journal of Psychiatry, 191: 449–50.
McCrone, P, Dhanasiri, S, Patel, A et al (2008) Paying the Price: The Cost of Mental Health Care in England to 2026. King's Fund.
Moran, P, Leese, M, Lee, T et al (2003) Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder. British Journal of Psychiatry, 183: 228–32.
National Institute for Health and Clinical Excellence (2009a) Antisocial Personality Disorder: Treatment, Management and Prevention (NICE Clinical Guideline 77) (September 2013). NICE.
National Institute for Health and Clinical Excellence (2009b) Borderline Personality Disorder: Treatment and Management (NICE Clinical Guideline 78). NICE.
National Institute for Mental Health in England (2003) Personality Disorder: No Longer a Diagnosis of Exclusion. Policy Implementation Guidance for the Development of Services for People with Personality Disorder. Department of Health/NIMHE.
National Offender Management Service, Department of Health (2012) A Guide to Psychologically Informed Planned Environments. National Offender Management Service/Department of Health.
National Scientific Council on the Developing Child (2010) Early Experiences Can Alter Gene Expression and Affect Long-Term Development (Working Paper No. 10). Center on the Developing Child, Harvard University.
Nigg, JT, Hinshaw, SP (1998) Parent personality traits and psychopathology associated with antisocial behaviors in childhood attentiondeficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 39: 145–59.
Nijssens, L, Luyten, P, Bales, DL (2013) Mentalization-based treatment for parents (MBT-P) with borderline personality disorder and their infants. In Minding the Child: Mentalization-Based Interventions with Children, Young People and Their Families (eds Midgley, N, Vrouva, I) 7997. Routledge.
Office for National Statistics (2014) Births in England and Wales, 2013 (Statistical Bulletin). ONS (http://www.ons.gov.uk/ons/dcp171778_371129.pdf).
Ofsted (2013) What about the Children? Joint Working between Adult and Children's Services when Parents or Carers have Mental Ill Health and/or Drug and Alcohol Problems. Ofsted.
Perroud, N, Dayer, A, Piguet, C et al (2014) Childhood maltreatment and methylation of the glucocorticoid receptor gene NR3C1 in bipolar disorder. British Journal of Psychiatry, 204: 30–5.
Royal College of Psychiatrists (2011) Parents as Patients: Supporting the Needs of Patients who are Parents and Their Children (College Report CR164). Royal College of Psychiatrists.
Rutter, M, Quinton, D (1984) Parental psychiatric disorder: effects on children. Psychological Medicine, 14: 853–80.
Sarkar, J, Adshead, G (2012) Clinical Topics in Personality Disorder. RCPsych Publications.
Shonin, E, van Gordon, W, Slade, K et al (2013) Mindfulness and other Buddhist-derived interventions in correctional settings: a systematic review. Aggression and Violent Behavior, 18: 365–72.
Stanley, N, Penhale, B (1999) The mental health problems of mothers experiencing the child protection system. Child Abuse Review, 8: 3445.
Stein, A, Woolley, H, McPherson, K (1999) Conflict between mothers with eating disorders and their infants during mealtimes. British Journal of Psychiatry, 175: 455–61.
Stern, J, Murphy, M, Bass, C (1993) Personality disorders in patients with somatisation disorder. A controlled study. British Journal of Psychiatry, 163: 785–9.
Stoffers, JM, Völlm, BA, Rücker, G et al (2012) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 8: CD005652.
Tavistock and Portman NHS Foundation Trust (2014) Family drug and alcohol court. Tavistock and Portman (http://www.tavistockandportman.nhs.uk/care-and-treatment/information-parents-and-carers/our-clinical-services/family-drug-and-alcohol). Accessed 8 Nov 2014.
Taylor, CG, Norman, DK, Murphy, JM et al (1991) Diagnosed intellectual and emotional impairment among parents who seriously mistreat their children: prevalence, type, and outcome in a court sample. Child Abuse and Neglect, 15: 389401.
Tunnard, J (2004) Parental Mental Health Problems: Messages from Research, Policy and Practice. Research in Practice.
van IJzendoorn, M (1995) Adult attachment representations, predictive responsiveness and infant attachment: a meta-analysis of the predictive validity of the Adult Attachment Interview. Psychological Bulletin, 117: 387403.
van IJzendoorn, M, Schuengel, CS, Bakermans-Kranenburg, MJ (1999) Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11: 225–49.
van Ijzendoorn, MH, Bakermans-Kranenburg, MJ, Ebstein, RP (2011) Methylation matters in child development: toward developmental behavioral epigenetics. Child Development Perspectives, 5: 305–10.
Vanyukov, MM, Moss, HB, Plail, JA et al (1993) Antisocial symptoms in preadolescent boys and in their parents: associations with cortisol. Psychiatry Research, 46: 917.
Weiss, M, Zelkowitz, P, Feldman, RB et al (1996) Psychopathology in offspring of mothers with borderline personality disorder: a pilot study. Canadian Journal of Psychiatry/La Revue Canadienne de Psychiatrie, 41: 285–90.
Wolff, S, Acton, WP (1968) Characteristics of parents of disturbed children. British Journal of Psychiatry, 114: 593601.
Yates, TM, Egeland, B, Sroufe, A (2003) Rethinking resilience: a developmental process perspective. In Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities (ed Luthar, SS) 243–66. Cambridge University Press.

Related content

Powered by UNSILO

Parenting and personality disorder: clinical and child protection implications

  • Gwen Adshead

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Parenting and personality disorder: clinical and child protection implications

  • Gwen Adshead
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *