Why Are Mental Health Problems a Problem for Child Custody? Part 1

Psychological assessments are a tool that the court can use, but they are not generally a regular occurrence. Parents who can't agree on matters for custody are almost invariably sent to mediation and then co parenting classes. I have the impression that sometimes people might feel like the only time you would need a psychological evaluation and psychiatric assessment in a child custody case is because one parent shows up in court disheveled and rambling about how the aliens gave them a message for the president. I think the perception is that mental health problems would rarely interfere the care of the children and the ability of a couple to work together. But the reality of mental health, divorce and custody is very different.

According to the National Institute of Mental Health, 9.1 percent of the population has a personality disorder https://www.nimh.nih.gov/health/statistics/personality-disorders So in a group of ten people, about one will have a personality disorder-- meaning these are not rare conditions that you will never see. The traits associated with these disorders make relationships very difficult. From the Journal of Family Psychology: "Relationship instability is expected when personality pathology is present, as PDs are interpersonal in nature and are associated with social impairment. "  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569846/

So people with personality disorders are going to have more unstable relationships and when relationships are unstable, they frequently end up in divorce or a break up. Which means family courts are MORE likely to see these individuals than, say an average employer. With the fact that personality disorders are fairly prevalent and the relationships with these individuals are highly likely to dissolve, family courts should understand that encountering mentally unstable individuals in custody cases on a regular is a certainty, not a possibility. And nothing in the medical literature about these disorders says that parenting and co parenting will be exempt from the instability of these disorders. And yet, family courts have not established any way to respond to these cases based on this reality. Again, courts are commonly using co parenting classes as an intervention in "high conflict divorces". They do not acknowledge the role that mental health issues are playing.

What do personality disorders entail? Here is what the American Psychiatric Association says: 

• Antisocial personality disorder: a pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie or deceive others, or may act impulsively. More on antisocial personality disorder in the APA blog.
• Avoidant personality disorder: a pattern of extreme shyness, feelings of inadequacy, and extreme sensitivity to criticism. People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.
• Borderline personality disorder: a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger, or have ongoing feelings of emptiness.
• Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behavior. People with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.
• Histrionic personality disorder: a pattern of excessive emotion and attention-seeking. People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions.
• Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.
• Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfection and control. A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively, not allowing time for leisure or friends, or may be inflexible in their morality and values. (This is NOT the same as obsessive-compulsive disorder.)
• Paranoid personality disorder: a pattern of being suspicious of others and seeing them as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them.
• Schizoid personality disorder: being detached from social relationships and expressing little emotion. A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others.
• Schizotypal personality disorder: a pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety. https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

Take a look at that list: violating the rights of others, instability in personal relationships, frequent suicide attempts, repeatedly lying and deceiving others, lack of empathy, excessive attention seeking. Do these traits sound like they are conducive to a cooperative relationship or the ability to be effective in being the sole caretaker for children. The answer, of course, is no. These traits associated with personality disorders are actually counterproductive to effective parenting and co parenting. Yet our family courts don't do anything to acknowledge this fact. An abundance of scholarly literature shows that children who are raised by parents with personality disorders have a significantly higher risk of problems:

Stepp et al. (2011) state: "Children of mothers with BPD should be considered a high-risk group given the wide array of poor psychosocial outcomes that have been found in these children." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268672/

Macfie (2010) states: "...children aged 4-18 whose mothers have BPD are more likely than are children of mothers with other personality disorders to experience changes in household composition and schools attended, removal from the home, and exposure to parent drug or alcohol abuse and mother's suicide attempts (Feldman et al., 1995). Second, these children are diagnosed with more attention and disruptive behavior disorders than are comparisons (Weiss et al., 1996). Third, children aged 11-18 whose mothers have BPD exhibit more problems with attention, delinquency, and aggression than do children whose mothers have no psychiatric disorders; they also have more anxiety, depression, and low self-esteem than do children of depressed mothers, children of mothers with other personality disorders, and children of mothers with no disorder (Barnow, Spitzer, Grabe, Kessler, & Freyberger, 2006)."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819472/

Dutton (2011) states: "Matthew K. Denny-Keys

Joanna R. Sells

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Abstract

A review is made of research connecting personality disorder in parents to child maltreatment and/or child mental health problems. Research studies indicate that certain personality disorders, notably Antisocial Personality Disorder and Borderline and Narcissistic personality disorders in parents show relationships to both parental behavior and ensuing childhood problems. However, parental personality disorders can also affect children's behavior through genetic transmission, hence while parental personality disorders are risk flags in custody assessments, parental behavior toward the child remains an essential target of assessment.

https://www.researchgate.net/publication/241745610_Parental_Personality_Disorder_and_Its_Effects_on_Children_A_Review_of_Current_Literature

Jabeen et al, 2021: When children are overvalued or indicated to have superiority over others, they tend to develop narcissism [6]. Moreover, when it comes to the self-protection of a highly narcissistic parent, (s)he leaves his/her children abandoned and often treat them with aggression/abuse [7]. The victims of unhappy behaviors or narcissistic abuse can only survive if they are able to cope with such situations [8, 9].

And "While discussing the darker side of narcissistic parenting, a child can be affected badly during childhood [20]. It leads to low-esteem or a diminished sense of self [21]. They experience trauma and may go towards anxiety and isolation [8] or even may think of suicide [9]. Constant anxiety and stressful situations can lead a person to mental sickness and psychological alterations [22]. However, researchers also proposed a few strategies to live a healthy life which is only possible with the passage of time, or when a child is able to learn and to apply them [9]."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925789/

Adshead (2018) stated: "Studies going back almost 50 years (

Reference Wolff and ActonWolff 1968; Reference Rutter and QuintonRutter 1984) found evidence that parental personality disorder is associated with hostility towards children, which in turn increases the risk of mental disorders in the child. Later studies of parents of children referred to child and adolescent mental health services (CAMHS) continue to find high levels of parental personality pathology. High levels of antisocial personality disorder in both mothers and fathers have been found in studies of parents of children diagnosed with conduct disorder or oppositional defiant disorder (Reference Lahey, Piacentini and McBurnettLahey 1988, Reference Lahey, Russo and Walker1989; Reference Frick, Lahey and LoeberFrick 1992; Reference Nigg and HinshawNigg 1998). Reference Weiss, Zelkowitz and FeldmanWeiss et al (1996) found that children of mothers with borderline personality disorder had more psychiatric diagnoses and poorer impulse control than children of mothers without such disorders; and similarly, children of mothers with both antisocial traits and depression had more problems than children of mothers who had either antisocial traits or depression (Reference Kim-Cohen, Caspi and RutterKim-Cohen 2006). Reference Berg-Nielsen and WichströmBerg-Nielsen & Wichström (2012) report that self-reported personality disorder traits in parents are associated with externalising behaviour in their children. Finally, follow-up studies of children in ‘high-risk families’ found that parental personality disorder predicted adolescent personality disorder, a relationship mediated by maladaptive parenting behaviours (Reference Johnson, Cohen and KasenJohnson 2001)... Although the majority of people with personality disorder pose no risk of harm to others, some types of personality disorder (especially antisocial and narcissistic) may be associated with risk of harm to vulnerable or dependent others. Retrospective cohort studies of maltreating parents often find high prevalence (60–70%) of personality disorder (Reference Taylor, Norman and MurphyTaylor 1991; Reference Famularo, Kinscherff and FentonFamularo 1992; Reference Dinwiddie and BucholzDinwiddie 1993; Reference Stanley and PenhaleStanley 1999). Although some of these studies may suffer from a degree of sampling bias and post hoc reasoning, their findings mirror evidence from the forensic literature that suggests that parental personality disorder is a risk factor for family violence and child maltreatment in certain circumstances: usually when parental cluster B disorders (Box 2) occur in combination with substance misuse and environmental stress. In particular, fathers with antisocial personality disorder may become involved with mothers who have borderline personality disorder; these couples are more likely to be involved in domestic violence, which increases the risk of all forms of child maltreatment within the home... Mothers with personality disorder may display a variety of abnormal behaviours that affect their children’s development. For example, there is a close association between personality disorder and somatising disorder (

Reference Stern, Murphy and BassStern 1993; Reference Bornstein and GoldBornstein 2008); and there is evidence that somatising mothers struggle to respond to their children’s needs, and may increase the risk of somatising behaviours in their children (Reference Craig, Cox and KleinCraig 2002, Reference Craig, Bialas and Hodson2004; Reference Marshall, Jones and RamchandaniMarshall 2007). A subgroup of mothers with personality disorder also have symptoms of eating disorders, which can give rise to dysfunctional control over their children’s food and influence the children’s eating patterns (Reference Stein, Woolley and McPhersonStein 1999).

There are particular concerns about the relationship between maternal personality disorder and highly abnormal illness behaviour that involves deceptions and claiming children are ill when they are not. One study of mothers who demonstrated such highly abnormal and risky illness behaviour involving their children found that over 50% of these women had either somatising disorder or personality disorder (especially borderline personality disorder) (Reference Bools, Neale and MeadowBools 1994)." https://www.cambridge.org/core/journals/bjpsych-advances/article/parenting-and-personality-disorder-clinical-and-child-protection-implications/688CAD3F786DDA983982860333AF4A6B

People with these disorders get sent to co parenting classes all the time in hopes that a co parenting class will solve the custody conflict. The assumption behind this is that when the court sees problems related to custody and co parenting, those issues are just related to custody and co parenting and nothing more. But the co parenting and custody conflict is often just another manifestation of a series of mental health problems that are permeating every other aspect of the parent's life. The courts just happen to see the co parenting and custody conflict. According to the American Psychiatric Association, these disorders can be treated with:

• Psychoanalytic/psychodynamic/transference-focused therapy
• Dialectical behavior therapy
• Cognitive behavioral therapy
• Group therapy
• Psychoeducation (teaching the individual and family members about the diagnosis, treatment and ways of coping)

So a co parenting class alone is not enough to make these issues go away. 

Mood disorders

Mood disorders also carry a higher risk of divorce https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846331/, with bipolar disorder and depressive disorder having some of the highest associations with divorce. So there is a high likelihood of encountering individuals with these conditions in a family court scenario. Bipolar disorder in particular presents a certain set of problems for parenting and custody. Being raised by a parent with bipolar disorder is associated with more negative outcomes for the child https://digitalcommons.nl.edu/cgi/viewcontent.cgi?article=1736&context=diss

Vasquez (2022) states: "The inconsistencies, conflict, and lack of safety can influence the child’s attachment to the parent (Chang et al., 2001). Research has demonstrated negative effects in children of parents with bipolar I disorder, such as poor interpersonal functioning within different settings including work, school, and intimate relationships; an impaired sense of self or identity; and mood disorders (Chang et al., 2001; Cook et al., 2005; Madey & Rodgers, 2009; Schore & Schore, 2008; Simeon et al., 2003)". 

Again, we are dealing with a situation that poses higher risk to the child, has an increased likelihood of showing up in family court, but is not recognized as a problem for parenting or co parenting by family law courts. When a couple can't agree on custody, they are sent to child custody recommending counseling and then if they can't agree there, the court goes straight to trial. 

Divorce trials present an ineffective solution to custody disputes. The judge essentially encounters the couple only in a situation that is completely devoid of the parents actually engaging with the children and rests largely on testimony of the individuals. Even when medical documentation is present, a judge may still place testimony of a parent over or another individual over medical documentation or admissions of failures to care for the children. And the idea behind a trial is to convince one person in a place of power (t that you are the best parent. Individuals with certain types of personality disorders actually love this. Court is one of the few places where a very important and powerful person will listen to everything they have to say. Also of note are that people who suffer from paranoid delusions may use litigation as a response to those delusions (source). These are likely the individuals who claim they hate court and just want to co parent but file a lot of motions or orders, especially over things that do not require a judge's consideration.

parents with bipolar: https://digitalcommons.nl.edu/cgi/viewcontent.cgi?article=1736&context=diss

mental disorders and divorce: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846331/

personality disorders and divorce: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569846/

delusions: https://www.ncbi.nlm.nih.gov/books/NBK539855/#:~:text=The%20diagnosis%20of%20a%20delusional,before%20coming%20to%20the%20diagnosis.

NIMH personality disorders: https://www.nimh.nih.gov/health/statistics/personality-disorders