Parental bonding style and suicidality

Many clinical factors associated with suicide in youth are well known, such as depression, substance abuse, conduct disorder, and poor social support. Less well-known risk factors include childhood and family adversity, such as witnessing domestic violence, and experiencing parental separation or divorce, and childhood physical and/or sexual abuse.

Psychiatrists and other mental health professionals should consider an additional factor when working with young patients in crisis: parental bonding style. In these families with a history of mental illness, children are at particular risk for psychopathology.

Parental bonding is a construct developed in the 1970s and 1980s by Australian psychiatrist Gordon Parker and his colleagues (Brit. J. Med. Psychology 1979;52:1-10). The concept is dichotomous, including level of care and level of control, or protection. It is not surprising that high-care parenting is considered optimal, while low-care, or neglectful parenting, is detrimental.

What might be more surprising is the overwhelming finding that high levels of control, or overprotection, are associated with higher levels of psychopathology than appropriate or under protection. Specifically, studies show that high levels of maternal overprotection are associated with generally higher levels of psychopathology in children and adolescents (Child Psychiatry Hum. Dev. 2012;43:102-12 and Behav. Ther. 2007;38:402-11), while overprotection in both parents is associated with anxiety disorders (Behav. Cogn. Psychother. 2012;40:287-96), social phobia (J. Anxiety Disord. 2012;26:608-16), eating disorders (J. Psychiatr. Ment. Health Nurs. 2011;18:728-35), and depression (Depress. Anxiety 2010;27:1149-57).

Furthermore, the combination of low care and overprotective parenting styles appears to be particularly detrimental. Not only is this parenting style associated with psychopathology. Studies agree, nearly unanimously, that parental affectionless control is associated with suicidality later in life, according to an analysis of 12 papers by Dr. Simona A. Goschin of Beth Israel Medical Center, New York; Jessica Briggs of the Family Center for Bipolar at Beth Israel; and their colleagues (J. Affect. Disord. 2013 June 29 [doi:10.1016/j.jad.2013.05.096]) This finding holds true with regard to maternal parental style in all cases.

However, the studies reviewed showed slightly more disagreement when it came to the effect of paternal style on suicidality. Some studies showed an association between paternal affectionless control and suicidality; others simply found no association between paternal style and suicidality.

Not unexpectedly, this difference could be related to the historically more dominant role of mothers relative to fathers within families.

A few years ago, a team of researchers examined the possible connections between perceived family problems and suicide ideation in a sample of Chinese adolescents in Hong Kong. Some studies have characterized Chinese parenting as "relatively controlling and even hostile," the researchers wrote (Int. J. Psychology 2001;36:81-7). The investigators in this study defined an authoritarian parenting style as one that emphasizes "control, maturity, obedience, and conformity" in children. Furthermore, the investigators examined the perceived lower role of fathers in the care and discipline of adolescents in Hong Kong. In Chinese families, "fathers tend to be perceived as more strict and disciplining and more concerned with the demands of propriety and necessity than with feelings, while mothers tend to be viewed as more kind, warm affectionate, and lenient," the authors wrote.

After getting students in the study to complete numerous questionnaires, including the Scale of Suicide Ideation, the investigators concluded that suicide ideation was significantly tied to "perceived authoritarian parenting, low parental warmth, high maternal over control, negative child-rearing practices, and a negative family climate."

It is difficult to ascertain from the research why deficient parental bonding in the form of affectionless control has such a strong association with suicidality. Several studies have attempted to answer this question by using nonsuicidal psychiatric patients as control subjects, most recently an investigation in Israel led by Ornit Freudenstein, Ph.D., and his colleagues (Eur. Psychiatry 2011;26:504-7). Dr. Freudenstein found that adolescents who exhibited severe suicidal behavior were more likely to perceive their mothers are less caring and more overprotective than their counterparts with either mild or no suicidal behavior. He and his colleagues concluded that maternal bonding might be an "important correlate of suicidal behavior in adolescents" and might in fact guide strategies we develop while working with these patients.

It is also worth noting that affectionless control has proven to be a significant risk factor for suicidality in both adolescents and adults. All of the studies using adolescent subjects only showed affectionless control to be a risk factor for suicidality, and the studies using adult populations were nearly as uniform. This suggests that poor parenting style has long lasting, possibly lifelong consequences. Again, the relationship between affectionless and controlling upbringing and age in suicide attempters deserves further study, as does the question of whether its pernicious effects ever dissipate.

Children are affected most by the style of the parent who has the greatest involvement in raising them. Higher levels of overprotection during childhood associate with higher levels of pathology in adolescence and adulthood, particularly in parents who also are less caring. We clinicians should use these findings to guide our adult patients toward an optimal parenting style, and to recognize and intervene when we see signs of low care, overprotection, or both – particularly in families with a history of affective disorders.

Recognizing affectionless control as a risk factor for suicide might help us identify at-risk patients, so that we might better focus our treatment plans and/or intervene before the suicidal behavior occurs.

Dr. Galynker is founder and director of the Family Center for Bipolar, New York. He also is associate chairman of the department of psychiatry and behavioral sciences at the Beth Israel Medical Center, New York, and is director of the division of biological psychiatry at the medical center. Ms. Briggs serves as program assistant at the Family Center for Bipolar.

Many clinical factors associated with suicide in youth are well known, such as depression, substance abuse, conduct disorder, and poor social support. Less well-known risk factors include childhood and family adversity, such as witnessing domestic violence, and experiencing parental separation or divorce, and childhood physical and/or sexual abuse.

Psychiatrists and other mental health professionals should consider an additional factor when working with young patients in crisis: parental bonding style. In these families with a history of mental illness, children are at particular risk for psychopathology.

Parental bonding is a construct developed in the 1970s and 1980s by Australian psychiatrist Gordon Parker and his colleagues (Brit. J. Med. Psychology 1979;52:1-10). The concept is dichotomous, including level of care and level of control, or protection. It is not surprising that high-care parenting is considered optimal, while low-care, or neglectful parenting, is detrimental.

What might be more surprising is the overwhelming finding that high levels of control, or overprotection, are associated with higher levels of psychopathology than appropriate or under protection. Specifically, studies show that high levels of maternal overprotection are associated with generally higher levels of psychopathology in children and adolescents (Child Psychiatry Hum. Dev. 2012;43:102-12 and Behav. Ther. 2007;38:402-11), while overprotection in both parents is associated with anxiety disorders (Behav. Cogn. Psychother. 2012;40:287-96), social phobia (J. Anxiety Disord. 2012;26:608-16), eating disorders (J. Psychiatr. Ment. Health Nurs. 2011;18:728-35), and depression (Depress. Anxiety 2010;27:1149-57).

Furthermore, the combination of low care and overprotective parenting styles appears to be particularly detrimental. Not only is this parenting style associated with psychopathology. Studies agree, nearly unanimously, that parental affectionless control is associated with suicidality later in life, according to an analysis of 12 papers by Dr. Simona A. Goschin of Beth Israel Medical Center, New York; Jessica Briggs of the Family Center for Bipolar at Beth Israel; and their colleagues (J. Affect. Disord. 2013 June 29 [doi:10.1016/j.jad.2013.05.096]) This finding holds true with regard to maternal parental style in all cases.

However, the studies reviewed showed slightly more disagreement when it came to the effect of paternal style on suicidality. Some studies showed an association between paternal affectionless control and suicidality; others simply found no association between paternal style and suicidality.

Not unexpectedly, this difference could be related to the historically more dominant role of mothers relative to fathers within families.

A few years ago, a team of researchers examined the possible connections between perceived family problems and suicide ideation in a sample of Chinese adolescents in Hong Kong. Some studies have characterized Chinese parenting as "relatively controlling and even hostile," the researchers wrote (Int. J. Psychology 2001;36:81-7). The investigators in this study defined an authoritarian parenting style as one that emphasizes "control, maturity, obedience, and conformity" in children. Furthermore, the investigators examined the perceived lower role of fathers in the care and discipline of adolescents in Hong Kong. In Chinese families, "fathers tend to be perceived as more strict and disciplining and more concerned with the demands of propriety and necessity than with feelings, while mothers tend to be viewed as more kind, warm affectionate, and lenient," the authors wrote.

After getting students in the study to complete numerous questionnaires, including the Scale of Suicide Ideation, the investigators concluded that suicide ideation was significantly tied to "perceived authoritarian parenting, low parental warmth, high maternal over control, negative child-rearing practices, and a negative family climate."

It is difficult to ascertain from the research why deficient parental bonding in the form of affectionless control has such a strong association with suicidality. Several studies have attempted to answer this question by using nonsuicidal psychiatric patients as control subjects, most recently an investigation in Israel led by Ornit Freudenstein, Ph.D., and his colleagues (Eur. Psychiatry 2011;26:504-7). Dr. Freudenstein found that adolescents who exhibited severe suicidal behavior were more likely to perceive their mothers are less caring and more overprotective than their counterparts with either mild or no suicidal behavior. He and his colleagues concluded that maternal bonding might be an "important correlate of suicidal behavior in adolescents" and might in fact guide strategies we develop while working with these patients.

It is also worth noting that affectionless control has proven to be a significant risk factor for suicidality in both adolescents and adults. All of the studies using adolescent subjects only showed affectionless control to be a risk factor for suicidality, and the studies using adult populations were nearly as uniform. This suggests that poor parenting style has long lasting, possibly lifelong consequences. Again, the relationship between affectionless and controlling upbringing and age in suicide attempters deserves further study, as does the question of whether its pernicious effects ever dissipate.

Children are affected most by the style of the parent who has the greatest involvement in raising them. Higher levels of overprotection during childhood associate with higher levels of pathology in adolescence and adulthood, particularly in parents who also are less caring. We clinicians should use these findings to guide our adult patients toward an optimal parenting style, and to recognize and intervene when we see signs of low care, overprotection, or both – particularly in families with a history of affective disorders.

Recognizing affectionless control as a risk factor for suicide might help us identify at-risk patients, so that we might better focus our treatment plans and/or intervene before the suicidal behavior occurs.

Dr. Galynker is founder and director of the Family Center for Bipolar, New York. He also is associate chairman of the department of psychiatry and behavioral sciences at the Beth Israel Medical Center, New York, and is director of the division of biological psychiatry at the medical center. Ms. Briggs serves as program assistant at the Family Center for Bipolar.

Many clinical factors associated with suicide in youth are well known, such as depression, substance abuse, conduct disorder, and poor social support. Less well-known risk factors include childhood and family adversity, such as witnessing domestic violence, and experiencing parental separation or divorce, and childhood physical and/or sexual abuse.

Psychiatrists and other mental health professionals should consider an additional factor when working with young patients in crisis: parental bonding style. In these families with a history of mental illness, children are at particular risk for psychopathology.

Parental bonding is a construct developed in the 1970s and 1980s by Australian psychiatrist Gordon Parker and his colleagues (Brit. J. Med. Psychology 1979;52:1-10). The concept is dichotomous, including level of care and level of control, or protection. It is not surprising that high-care parenting is considered optimal, while low-care, or neglectful parenting, is detrimental.

What might be more surprising is the overwhelming finding that high levels of control, or overprotection, are associated with higher levels of psychopathology than appropriate or under protection. Specifically, studies show that high levels of maternal overprotection are associated with generally higher levels of psychopathology in children and adolescents (Child Psychiatry Hum. Dev. 2012;43:102-12 and Behav. Ther. 2007;38:402-11), while overprotection in both parents is associated with anxiety disorders (Behav. Cogn. Psychother. 2012;40:287-96), social phobia (J. Anxiety Disord. 2012;26:608-16), eating disorders (J. Psychiatr. Ment. Health Nurs. 2011;18:728-35), and depression (Depress. Anxiety 2010;27:1149-57).

Furthermore, the combination of low care and overprotective parenting styles appears to be particularly detrimental. Not only is this parenting style associated with psychopathology. Studies agree, nearly unanimously, that parental affectionless control is associated with suicidality later in life, according to an analysis of 12 papers by Dr. Simona A. Goschin of Beth Israel Medical Center, New York; Jessica Briggs of the Family Center for Bipolar at Beth Israel; and their colleagues (J. Affect. Disord. 2013 June 29 [doi:10.1016/j.jad.2013.05.096]) This finding holds true with regard to maternal parental style in all cases.

However, the studies reviewed showed slightly more disagreement when it came to the effect of paternal style on suicidality. Some studies showed an association between paternal affectionless control and suicidality; others simply found no association between paternal style and suicidality.

Not unexpectedly, this difference could be related to the historically more dominant role of mothers relative to fathers within families.

A few years ago, a team of researchers examined the possible connections between perceived family problems and suicide ideation in a sample of Chinese adolescents in Hong Kong. Some studies have characterized Chinese parenting as "relatively controlling and even hostile," the researchers wrote (Int. J. Psychology 2001;36:81-7). The investigators in this study defined an authoritarian parenting style as one that emphasizes "control, maturity, obedience, and conformity" in children. Furthermore, the investigators examined the perceived lower role of fathers in the care and discipline of adolescents in Hong Kong. In Chinese families, "fathers tend to be perceived as more strict and disciplining and more concerned with the demands of propriety and necessity than with feelings, while mothers tend to be viewed as more kind, warm affectionate, and lenient," the authors wrote.

After getting students in the study to complete numerous questionnaires, including the Scale of Suicide Ideation, the investigators concluded that suicide ideation was significantly tied to "perceived authoritarian parenting, low parental warmth, high maternal over control, negative child-rearing practices, and a negative family climate."

It is difficult to ascertain from the research why deficient parental bonding in the form of affectionless control has such a strong association with suicidality. Several studies have attempted to answer this question by using nonsuicidal psychiatric patients as control subjects, most recently an investigation in Israel led by Ornit Freudenstein, Ph.D., and his colleagues (Eur. Psychiatry 2011;26:504-7). Dr. Freudenstein found that adolescents who exhibited severe suicidal behavior were more likely to perceive their mothers are less caring and more overprotective than their counterparts with either mild or no suicidal behavior. He and his colleagues concluded that maternal bonding might be an "important correlate of suicidal behavior in adolescents" and might in fact guide strategies we develop while working with these patients.

It is also worth noting that affectionless control has proven to be a significant risk factor for suicidality in both adolescents and adults. All of the studies using adolescent subjects only showed affectionless control to be a risk factor for suicidality, and the studies using adult populations were nearly as uniform. This suggests that poor parenting style has long lasting, possibly lifelong consequences. Again, the relationship between affectionless and controlling upbringing and age in suicide attempters deserves further study, as does the question of whether its pernicious effects ever dissipate.

Children are affected most by the style of the parent who has the greatest involvement in raising them. Higher levels of overprotection during childhood associate with higher levels of pathology in adolescence and adulthood, particularly in parents who also are less caring. We clinicians should use these findings to guide our adult patients toward an optimal parenting style, and to recognize and intervene when we see signs of low care, overprotection, or both – particularly in families with a history of affective disorders.

Recognizing affectionless control as a risk factor for suicide might help us identify at-risk patients, so that we might better focus our treatment plans and/or intervene before the suicidal behavior occurs.

Dr. Galynker is founder and director of the Family Center for Bipolar, New York. He also is associate chairman of the department of psychiatry and behavioral sciences at the Beth Israel Medical Center, New York, and is director of the division of biological psychiatry at the medical center. Ms. Briggs serves as program assistant at the Family Center for Bipolar.