Modeling Personality Disorder Symptoms Based on Parenting Styles, Temperament, and Childhood Emotional Abuse: The Mediating Roles of Ego Strength and Impulse Control in Patients with Hypertension
Keywords:
Personality Disorders; Parenting Styles; Temperament; Childhood Emotional Abuse; Ego Strength; Impulse Control; Hypertension.Abstract
Purpose: This study aimed to develop and test a structural model of personality disorder symptoms based on parenting styles, temperament, and childhood emotional abuse, considering the mediating roles of ego strength and impulse control among patients with hypertension.
Methods and Materials: This descriptive-correlational study employed structural equation modeling. The statistical population comprised patients with hypertension who attended hospitals and healthcare centers in Tehran during the second half of 2023. A total of 250 patients were selected through purposive sampling. Data were collected using the Personality Styles and Disorders Inventory, Baumrind Parenting Styles Questionnaire, Cloninger Temperament and Character Inventory, Bernstein Childhood Trauma Questionnaire, Markstrom Ego Strength Inventory, and Barratt Impulsiveness Scale. The hypothesized structural model and direct and indirect relationships among the variables were examined using SPSS and AMOS software.
Findings: The proposed structural model demonstrated an acceptable fit to the observed data. Parenting styles had significant direct effects on impulse control and personality disorder symptoms. Temperament significantly predicted ego strength, while childhood emotional abuse exerted significant direct effects on both ego strength and personality disorder symptoms. Ego strength had a significant negative direct effect on personality disorder symptoms, whereas impaired impulse control had a significant positive direct effect on these symptoms. Bootstrap analyses confirmed that ego strength significantly mediated the relationships of temperament and childhood emotional abuse with personality disorder symptoms. Impulse control also significantly mediated the relationship between parenting styles and personality disorder symptoms. Collectively, the predictor and mediator variables accounted for 71% of the variance in personality disorder symptoms.
Conclusion: Personality disorder symptoms in patients with hypertension appear to arise from the interaction of family-related experiences, dispositional characteristics, and adverse childhood emotional experiences. Ego strength and impulse control constitute important psychological mechanisms through which these distal factors influence personality pathology.
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References
Aghili, S. M., & Seyedi, S. A. (2024). The Effectiveness of Mindfulness on Defense Mechanisms, Behavioral Brain Systems, and Impulsivity in Patients with Hypertension. Journal of Health Psychology.
Bafandeh, H., Ahmadi, A., & Dadashi, S. (2023). Comparing Cognitive Flexibility, Impulsivity, and Qualitative Academic Performance in Students with Borderline Personality Traits and Normal Students. Quarterly Journal of Modern Psychological Research, 18(69), 43-49.
Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., & Priebe, K. (2020). Dialectical Behavior Therapy for Posttraumatic Stress Disorder Compared with Cognitive Processing Therapy in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry, 77(12), 1235-1245. https://doi.org/10.1001/jamapsychiatry.2020.2148
Dai, Y., Yang, P., Ji, W., Diao, L., & Lu, H. (2025). The Correlation Between Non-Suicidal Self-Injury in Adolescents, Parenting Styles, and Borderline Personality Traits. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1620872
Do, N. M., Clauss, F., Schmitt, M., & Manière, M. C. (2023). Influence of a Child's Temperament on Behaviour Management Problems in the Dental Office: A Literature Review. Children, 10, 90. https://doi.org/10.3390/children10010090
Enayati, M., Khanzadeh, M., Raeisi, Z., & Dehghani, A. (2025). The Mediating Role of Authoritative Parenting Style in Predicting Risky Behaviors Based on the Dark Triad of Personality with the Mediation of Distress Tolerance in Adolescents. Journal of Psychological Science, 24(151), 223-244.
Euler, S., Nolte, T., Constantinou, M., Griem, J., Montague, P. R., Fonagy, P., Personality, & Mood Disorders Research, N. (2021). Interpersonal Problems in Borderline Personality Disorder: Associations with Mentalizing, Emotion Regulation, and Impulsiveness. Journal of personality disorders, 35(2), 177-193. https://doi.org/10.1521/pedi_2019_33_427
Jarareh, J., Seifouri, A., & Amiri, M. (2022). Predicting Personality Disorders Based on Complex Trauma with the Mediating Role of Ego Strength. Clinical Psychology Studies, 12(46), 1-23.
Kaur, M., & Sanches, M. (2023). Parenting Role in the Development of Borderline Personality Disorder. Psychopathology, 56(1-2), 109-116. https://doi.org/10.1159/000524802
Kaya, T., & Demir, N. (2024). Evaluation of Patients Diagnosed with Essential Hypertension in Terms of Mental and Personality Disorders. Alpha Psychiatry, 25(1), 54-62. https://doi.org/10.5152/alphapsychiatry.2024.231363
Kharamin, M., & Dehestani, M. (2021). Predicting Personality Disorders Based on Childhood Emotional Neglect and Exploitation with the Mediating Role of Anger in Individuals with Hypertension. Clinical Psychology Studies, 11(44), 142-177.
Kiaei, S., Golshani, F., Emamipour, S., Baghdasarians, A., & Badiei, M. M. (2021). A Structural Model of Borderline Personality Disorder Based on Childhood Abuse Experiences, Schema Modes, and Perceived Maternal Parenting with the Mediating Role of Emotion-Regulation Difficulties. Family and Health, 11(1), 105-122.
Kolahi, P., Salehi, M., Maddahi, M., & Sepah Mansour, M. (2022). The Effectiveness of Mindfulness-Based Stress Reduction on Trait Anxiety, State Anxiety, and Blood Pressure in Coronary Heart Disease Patients with Hypertension. Advances in Cognitive Sciences, 24(1), 147-159.
Koudys, J. W., Cane, C., Nikolova, Y. S., & Ruocco, A. C. (2023). Transdiagnostic Impulsivity-Relevant Phenotypes and the Comorbidity of Personality Disorders with Substance and Alcohol Use Disorders. Current Addiction Reports, 1-9. https://doi.org/10.1007/s40429-023-00483-6
Liu, B., Yang, Y., Geng, J., Cai, T., Zhu, M., & Chen, T. (2022). Harsh Parenting and Children's Aggressive Behavior: A Moderated Mediation Model. International journal of environmental research and public health, 19(4), 2403. https://doi.org/10.3390/ijerph19042403
Malhi, G. S., Bell, E., Boyce, P., Bassett, D., Berk, M., Bryant, R., & Murray, G. (2020). The 2020 Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for Mood Disorders: Bipolar Disorder Summary. Bipolar Disorders, 22(8), 805-821. https://doi.org/10.1111/bdi.13036
Martin, S., Zabala, C., Del-Monte, J., Graziani, P., Aizpurua, E., Barry, T. J., & Ricarte, J. (2019). Examining the Relationships between Impulsivity, Aggression, and Recidivism for Prisoners with Antisocial Personality Disorder. Aggression and Violent Behavior, 49, 101314. https://doi.org/10.1016/j.avb.2019.07.009
McGowan, N. M., Goodwin, G. M., Bilderbeck, A. C., & Saunders, K. E. (2020). Actigraphic Patterns, Impulsivity, and Mood Instability in Bipolar Disorder, Borderline Personality Disorder, and Healthy Controls. Acta Psychiatrica Scandinavica, 141(4), 374-384. https://doi.org/10.1111/acps.13148
Mohammadi, A. (2021). The Role of Parenting Styles in Predicting Antisocial Personality Disorder. Journal of Psychology and Educational Sciences Studies, 4(21).
Nasirpour, N., Abbasian, M., & Pouraghajan, A. (2022). Presenting an Audit-Quality Model Based on Personality Organization, Occupational Stress, and Ego Strength. Iranian Journal of Psychiatry and Clinical Psychology, 28(1), 62-75.
Normandin, L., Weiner, A., & Ensink, K. (2023). An Integrated Developmental Approach to Personality Disorders in Adolescence: Expanding Kernberg's Object Relations Theory. American Journal of Psychotherapy, 76(1), 9-14. https://doi.org/10.1176/appi.psychotherapy.20220023
Pourmaveddat, K., & Dehghan Manshadi, Z. (2022). Investigating the Predictive Role of Parenting Styles and the Parent-Child Relationship in Disruptive Mood Dysregulation Disorder. Research in Behavioral Sciences, 20(1), 184-195. https://doi.org/10.52547/rbs.20.1.184
Ravi, S., Havewala, M., Kircanski, K., Brotman, M. A., Schneider, L., Degnan, K., Almas, A., Fox, N., Pine, D. S., Leibenluft, E., & Filippi, C. (2022). Parenting and Childhood Irritability: Negative Emotion Socialization and Parental Control Moderate the Development of Irritability. Development and Psychopathology, 1. https://doi.org/10.1017/S0954579421001346
Roininen, S. M., Cheetham, M., Mueller, B. U., & Battegay, E. (2024). Unmet Challenges in Treating Hypertension in Patients with Borderline Personality Disorder: A Systematic Review [Systematic review and meta-analysis].
Sahithya, B. R., & Raman, V. (2021). Parenting Style, Parental Personality, and Child Temperament in Children with Anxiety Disorders: A Clinical Study from India. Indian Journal of Psychological Medicine, 43(5), 382-391. https://doi.org/10.1177/0253717620973376
Shao, X., & Zhu, G. (2020). Associations among Monoamine Neurotransmitter Pathways, Personality Traits, and Major Depressive Disorder. Frontiers in Psychiatry, 11, 381. https://doi.org/10.3389/fpsyt.2020.00381
Stülb, K., Messerli-Bürgy, N., Kakebeeke, T. H., Arhab, A., Zysset, A. E., Leeger-Aschmann, C. S., Schmutz, E. A., Meyer, A. H., Kriemler, S., Jenni, O. G., & Puder, J. J. (2019). Prevalence and Predictors of Behavioral Problems in Healthy Swiss Preschool Children over a One-Year Period. Child Psychiatry & Human Development, 50(3), 439-448. https://doi.org/10.1007/s10578-018-0849-x
Vahedi Moghadam, N., Khademi, A., Hosseinzadeh Taghvaei, M., & Zeinali, A. (2024). Comparing the Effectiveness of Metacognitive Therapy and Positive Psychotherapy on Emotion Regulation in Patients with Chronic Hypertension. Journal of Nursing Research, 19(3).
Winsper, C., Bilgin, A., Thompson, A., Marwaha, S., Chanen, A. M., Singh, S. P., & Furtado, V. (2020). The Prevalence of Personality Disorders in the Community: A Global Systematic Review and Meta-Analysis. British Journal of Psychiatry, 216(2), 69-78. https://doi.org/10.1192/bjp.2019.166
Yan, W., Wang, X., Kuang, H., Chen, Y., Baktash, M. B., Eskenazi, B., & Xia, Y. (2020). Physical Activity and Blood Pressure during Pregnancy: Mediation by Anxiety Symptoms. Journal of affective disorders, 264, 376-382. https://doi.org/10.1016/j.jad.2019.11.056
Yen, S., Peters, J. R., Nishar, S., Grilo, C. M., Sanislow, C. A., Shea, M. T., & Skodol, A. E. (2021). Association of Borderline Personality Disorder Criteria with Suicide Attempts: Findings from the Collaborative Longitudinal Study of Personality Disorders over 10 Years of Follow-Up. JAMA Psychiatry, 78(2), 187-194. https://doi.org/10.1001/jamapsychiatry.2020.3598
Zashchirinskaia, O., & Isagulova, E. (2023). Childhood Trauma as a Risk Factor for High-Risk Behaviors in Adolescents with Borderline Personality Disorder. Iranian Journal of Psychiatry, 18(1), 65. https://doi.org/10.18502/ijps.v18i1.11414
Zena, Y. M., & Heeralal, P. J. H. (2021). The Relationship between Parenting Style and Preschool Children's Social-Emotional Development. Universal Journal of Educational Research, 9(8), 1581-1588. https://doi.org/10.13189/ujer.2021.090810
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