The effects of parental rearing styles and early maladaptive schemas in the development of personality: a systematic review

Introdução: O objetivo do presente artigo é identificar e caracterizar estudos que avaliem a repercussão dos estilos parentais na formação de sintomas psicopatológicos e verificar uma possível relação dos padrões parentais com o desenvolvimento dos esquemas iniciais desadaptativos (EIDs). Método: Uma busca sistemática foi realizada nas seguintes bases de dados: PsychNet, BVS, Scopus, Web of Science e PubMed. Foram buscados estudos empíricos publicados até 2018, escritos em português, inglês ou espanhol, que investigassem e caracterizassem os efeitos dos estilos parentais. Resultados: A busca eletrônica identificou 321 artigos nas diferentes bases de dados, dentre os quais apenas 22 preencheram os critérios de seleção e foram lidos na íntegra. Os estudos demonstraram que há correlação entre EIDs, rejeição materna, estilos parentais e depressão. Também foi encontrada a participação dos EIDs como mediadores na relação entre estilos parentais e/ou educação e sintomas disfuncionais na formação da personalidade. Conclusão: Nos estudos selecionados, estilos parentais se destacaram entre as variáveis envolvidas na formação da personalidade e ativação dos padrões esquemáticos. Portanto, frisa-se a importância de estudos na área, a fim de aprofundar conhecimentos para promover saúde e melhores estratégias de prevenção em crianças. Descritores: Esquemas iniciais desadaptativos, estilos parentais, personalidade. Abstract


Introduction
From the moment a baby is born, his/her parents, or caregivers, are the main source of nurturance, protection and education. The parents' behaviors with regard to discipline, hierarchy and emotional support are what we call parental rearing style, or behavior. 1 Jeffrey Young, founder of Schema Therapy, suggests that in order to become psychologically healthy adults, it is important that our core psychological needs are adequately met by our parents/caregivers during childhood. In cases of parental neglect these needs are

Methods
In

Article selection
The electronic search identified 321 articles in the different databases. Of these, six (1.86%) were excluded because they were not scientific articles and 238 (74.1%) duplicates were also excluded. After reading the titles and abstracts of 77 ( A flowchart illustrating the manuscript selection process is presented below (Figure 1).   -In the first cluster, VUL in children correlated with VUL and DS schemas in mother. The child's ED schema correlated perfectly with ED in father; -In the second cluster, VUL in children correlated with AB, DS, FA, EM and VUL in mother. The child's ED schema correlated perfectly with father's ED schema; -In the third cluster, the VUL in the child correlated with mother's VUL, AB, MA, ISC and DS significantly. The ED schema correlated perfectly with ED in the father; -MA schema in the father were predictors of developing third cluster in the child. SI schema in the mother was a predictor of developing third cluster in the child. SUB and VUL schemas in the child predict the third cluster of personality disorders.
-The cross-sectional design does not allow causal attributions to be made; -Limited sample size; -Self-report method. -Negative recollections of paternal rearing behaviors, and higher levels of several core beliefs were related to eating symptomatology; -AB, DS and VUL schema were found to mediate the influence of aspects of paternal rearing behaviors on eating psychopathology; -Paternal rearing behaviors were predictive of eating psychopathology; -Perception of paternal overprotection is predictive of drive for thinness; -Perceived paternal rejection can lead to the development of a combination of fear that significant others will not be able to continue providing emotional support and to underlying feelings of shame and inferiority. -No associations were found between eating psychopathology and perceptions of parenting or core beliefs within the non-clinical group -Self-report measures; -Retrospective measure of parental rearing; -The women were a self-selected group. -Pessimistic/fearful mother, overprotective/worrywart father and emotionally divesting father perceptions meaningfully predicted depression and anxiety; -Pessimistic/fearful mother and belittling/captious mother perceptions meaningfully predicted negative-self symptoms; -Pessimistic/fearful mother, overprotective/worrywart father and belittling/captious mother meaningfully predicted somatization; -Caring/controlling behaviors of the father and protecting behaviors of the mother meaningfully predicted depression in the negative direction; -Caring/controlling behaviors of the mother and protecting behaviors of the father meaningfully predicted anxiety in the negative direction. -Caring/controlling behaviors of the mother and protecting, and caring/ controlling behaviors of the father meaningfully predicted negative-self symptoms and hostility in the negative direction.
-Did not report limitations. and parenting origins than non-opioid abusers and parenting origins were related to their corresponding schemas.
-All participants were male. -The study was crosssectional in nature; -Sample of non-clinical adolescents who were predominantly Caucasian, with relatively high educational levels; -The sample was rather small (N=173) and as a result it was not possible to perform factor analysis on the items of the YSQ-A; -Self-report measures; -Unclear whether a questionnaire like the YSQ-A truly measures maladaptive schemas.   In seven studies, relations were found between depression and poor parenting styles, such as authoritarian parenting 7 ; emotional deprivation and excessive parental control 11 ; maternal pessimism, paternal overprotection and emotional alienation 16 ; low parental care and overprotection 24 ; emotional neglect, alcoholic parents and income 28 ; and maternal rejection. 27 Additionally, Lumley et al. 19 found an association between low levels of parental responsiveness, symptoms of major depression and high levels of psychological control. The structural organization of both tightly-interconnected negative schemas and loosely-interconnected positive schemas were significantly associated with depressive symptoms.
It should be noted that the studies also revealed that dysfunctional parenting is related to development of pathological symptoms of depressive personality, 7 A, B and C clusters of personality disorders 8,27 and, more specifically, of antisocial personality disorder. 22 As observed by Beigi et al., 8  In parallel, the results also showed that MF transsexuals were more likely to develop psychiatric symptoms and described their mothers as less caring, less affective and more controlling during their childhood, when compared with controls. In turn, MF transsexuals saw their mothers as abusive and unreliable and with insufficient autonomy and achievement. MF transsexuals described their fathers as less caring, less available, less reliable and more critical and depreciative. 25 EMS mediated the relationship between parental rearing styles and/or parental education and dysfunctional symptoms over the course of personality development in 66.6% of the studies. Among the symptoms investigated, we highlight personality disorder symptoms, 7,27 depression, 11,14,18,24 eating psychopathologies, 13 and, finally, we found mediation of EMS in the relationship between negligent and abusive parental rearing styles -which were also identified as predictors -and dissociative, anxiety and/or depressive symptoms. 28 Moreover, compliant surrender mode was found to mediate negative parenting and restrictive and compensatory behaviors in an Australian sample with eating disorder. 9 In terms of specific EMS, the most prevalent EMS in the studies were vulnerability, 8,12,20,24,25,27 dependence/ incompetence, 20,24,27 and failure, 20,25,27 from the second domain (impaired autonomy and performance), as well as abandonment 13,14,20,22 and emotional deprivation, 8,20,25 related to the first domain (disconnection/rejection).

Discussion
During personality development, environmental, social and biological variables interfere with the construction and activation of schematic patterns of functioning. 2 Amongst these variables, the present study focused on parental rearing style.
Maladaptive personality patterns start to be formed the moment a child begins to interact with the world and are shaped by life experiences throughout the child's development. 2  of these studies show a significant presence of EMS as potential mediators between the two variables. 7,11,13,14,18,28 In agreement with what has been reported in other manuscripts, parental neglect is considered a relevant variable for development of depression, 29  In the present study, when mentioning the act of trying to preserve, or protect, oneself, the authors do not refer to any ability that the child might have to prevent these adverse experiences from contributing to development of EMS. Considering that children have the right to have their basic needs met and that is parents' duty to meet them, 2 what the authors are referring to when discussing preservation are behaviors that can minimize the distress and suffering caused by these needs not being met. In other words, these behaviors represent an adaptation to the harmful elements of the remote environment. When observing child behavior, one can perceive that children strive to find ways of having at least part of their needs met, and, normally through trial and error, they, very intuitively, work out how to do this with their parents. This movement can be seen as an adaptation to their parents, as the children's reaction, with the tools they have, to the parents' rearing styles, so they can soften the way the parents' behaviors reverberate in their inner world, or at least make it more bearable.
Analyzing the importance of parental rearing styles in personality development, one could hypothesize that, in evolutionary terms, even with a certain amount of deprivation and suffering, it would be more advantageous for children (in terms of survival) to adapt to their parents' style (to whom they are attached, and who are normally attached to them) rather than not to do so. This does not mean, however, that this adaptation is a matter of choice or that there are necessarily any alternatives to it, but it considers that maybe children tend to behave, intuitively, in a way that maximizes meeting of their needs and preserves the bond with caregivers .
Drawing from clinical experience, the authors noted that, even after repeated abuse and/or neglect situations, children's attitudes towards their parents are likely to remain mostly positive, forgiving and obedient (especially at an early age). There seems to be a special need for reconciliation between absolutely distinct, and oftentimes dichotomic, images a child has of his/her mother or father, who, depending on the emotional state the parent is in (depressed, irritated, detached X euthymic, calm, connected, etc.), the child can love or hate. Thus, for instance, seeing himself/herself as someone who deserves punishment or neglect could serve as a powerful tool for reduction of an incredibly distressing cognitive dissonance: seeing the person who your life depends on as incapable or not sufficiently emotionally connected to you to want or be able to meet your most basic emotional needs.
In their study about vulnerability and depression, Ingram & Ritter 33 found evidence that children raised in a household where they are neglected by the mother are more prone to develop depression when adults and to have negative emotions and cognitions about themselves. These authors also found that these children are likely to have a predominantly negative self-image, and that this way of looking at themselves may have been developed as a reaction to parental rearing stylefrom the mother's side. In this study, Ingram & Ritter 33 suggest that, if a child is being raised by a neglectful mother, he/she may begin to internalize what he/she sees as being a maternal view (of the child) that would be coherent with the attitude of not taking good care of this child, who thus starts to develop representations of himself/herself that are coherent with the perception of not being worthy of care and nurturance -which is in agreement with the description of EMS from the first domain, Disconnection and Rejection. 2 Two studies reported specific social and cultural variables that could have contributed to schema construction. In the study with transsexuals, the feeling of social exclusion and the need to be accepted by members of the same sex were considered factors relevant 25 to development of EMS. In the opposite direction, interesting but isolated data suggested that an overprotective/anxious parenting style, hypothetically dysfunctional, 2 was perceived as functional and could lead to an expected and positive interpersonal cycle in Turkey's collectivistic society. 26 Notwithstanding, this speculative interpretation about the role, influence and impact of culture and social experiences in the development of EMS or adaptive behavior, which has been emerging spontaneously, should be investigated in new studies assessing this relationship.
With regard to limitations, 59% of the studies referred to the characteristics of the samples investigated and the fact that the results could not be generalized. 7,8,10,11,[13][14][15]17,21,27,28 Small sample sizes may have limited their ability to detect further differences and larger sample sizes might therefore enable future studies to contribute more, allowing for more finegrained analyses. Furthermore, half of the studies presented limitations related to the use of self-reporting tools, which may contribute to biased responses and may increase the likelihood of association between the measures used. 8,9,[11][12][13]15,19,21,22,26,27 Use of instruments of retrospective analysis was considered a limitation in 31.8% of the studies, since participants may recall their most recent parenting experiences, be influenced by schemas currently in operation, facilitate distortions and allow inferences about perceived parenting behaviors. 10,11,13,23,25,27,28 One alternative would be to conduct longitudinal studies, which could minimize this effect if they evaluated the present moment -although memory distortions may still occur anyway, considering that the participant would not be answering questions about the present moment.
Other limitations reported were the cross-sectional study designs, 8,9,[21][22][23] since no conclusions can be drawn on cause-effect relations between the variables investigated. An appropriate research study design would ideally include a prospective cohort study or multi-method approach, for example. Finally, just three manuscripts did not mention limitations. 16,20,24 Not many articles were found that met the inclusion criteria for the present study, which goes to show the scarcity of published research in this area, despite the relevance of the topic. It is important to note that the data obtained from the manuscripts in this systematic review are the fruit of studies conducted on several continents, hence allowing a general mapping of what is being investigated, even considering the small samples.
Comparative studies would be extremely relevant, since cultural, social and demographic aspects could broaden understanding of the phenomena. In conclusion, it is suggested that future research be conducted to broaden and deepen knowledge about the formation of personality structures, with the objective of providing information that can promote care and prevention strategies in early childhood.

Disclosure
No conflicts of interest declared concerning the publication of this article.