Parental Burden Associated with Borderline Personality Disorder in Female Offspring

Abstract

To identify aspects of parental burden associated with borderline personality disorder (BPD), an anonymous internet survey linked to BPD support websites was developed for parents to complete on their BPD offspring and unaffected siblings. The questions cover aspects of the child's life from pregnancy through young adulthood, and query about the impact of the child's BPD on six domains of the parent's life, including physical and emotional health, marriage, job, standard of living, social life, and career trajectory. Additionally, financial burden was assessed with questions pertaining to insurance and out-of pocket costs associated with the BPD disorder. BPD offspring were identified by meeting diagnostic criteria embedded within the survey and having been given a diagnosis of BPD by a professional at some point in their life. We report on 233 female offspring meeting strict criteria for BPD. Parents of daughters with BPD endorsed varying levels of impact on the six domains comprising burden with the largest impact on emotional health which was impacted in over 88% of the respondents. Over 50% of parents endorsed four or greater of the six burden items. Particular aspects of the offspring's BPD symptom profile correlated with intensity of parental burden included including problems in adolescence with acting out behavior (p < .000), property destruction (.003), delusional symptoms (.007), and hallucinatory symptoms (.008). A subgroup of respondents provided data on specific financial expenses. The average and median out-of-pocket expense was $60,087, and $10,000. Insurance costs totaled an average of $108,251 with a mean of $20,000. The average cost per year after diagnosis was $14,606 out-of-pocket and $45,573 billed to insurance. The median cost per year after diagnosis was $3,667 out-of-pocket, and $12,500 billed to insurance. After adjusting for household income, a female proband who had been raped incurred roughly $40,000 more in BPD-related costs, while a diagnosis of conduct disorder led to about $50,000 in additional costs. Parents of female offspring with BPD experience burden in multiple domains of their life and many have incurred substantial financial expense. Increasing awareness of co-morbid conditions in the BPD proband that significantly increase parental burden may be indicators for the provision of increased family support.

Supporting a Person With Personality Disorder: A Study of Carer Burden and Well-Being

“…Qualitative information in the present study, visually represented in the concept map, suggests that caring for a person with personality disorder significantly affects relationships, including conflict and concern between family members and isolation from friends, consistent with findings from previous qualitative research (Ekdahl et al, 2011;Giffin, 2008;Goodman et al, 2011). Future research and the development of new guidelines may benefit from empirically ex- ploring the interpersonal experience of caregiving to understand the relational dynamics potentially contributing to the experience of burden and mental health problems (Grenyer, 2013).…”

“…A cut-off score of 7 or more items has shown good sensitivity and specificity for the DSM-IV diagnosis of BPD (Zanarini et al, 2003). The MSI-BPD has been adapted in previous research for carers to endorse observed symptoms of the person with personality disorder (Goodman et al, 2011). For the 283 participants with complete data on this measure, the MSI-BPD-C had weak internal consistency (Cronbach's α = 0.46).…”

“…An online questionnaire exploring the burden associated with caring for a daughter with BPD showed that the largest impact was on emotional health, physical strain, marital satisfaction, and social life (Goodman et al, 2011). A further study found that both biologically related and unrelated Dutch carers of a person with BPD scored higher than the general Dutch population on the Symptom Checklist 90 (a measure of mental health problems; Scheirs & Bok, 2007).…”

Prevention and early intervention for borderline personality disorder: a novel public health priority

“…Fourth, when BPD is compared with other mental disorders, it is among the leading causes of disability-adjusted life years (DALYs) in young people 9 . BPD is also a substantial financial burden for the families of young people, with estimated average costs per annum in the US of $14,606 out-ofpocket, plus $45,573 billed to insurance 10 . Fifth, the "first wave" of evidence-based treatments has demonstrated that structured treatments for BPD in young people are effective 4 .…”

Improving the Recognition of Borderline Personality Disorder in a Bipolar World

“…To reduce the likelihood of overlooking potentially relevant studies, I conducted a second search using the terms "personality disorder(s)" and "economic" or "cost(s)" and found one other study, also from the Netherlands (Soeteman et al, 2008). One study has examined the economic costs of BPD in the United States (Goodman et al, 2010), in contrast to the 15 studies that have examined the cost of bipolar disorder (Kleine-Budde et al, 2014).…”