Impact of ACE on Emotional Regulation and Future Time Perspectives in  Borderline Personality Disorder: Mediating and Moderating Roles of Parental Involvement 

Impact of ACE on Emotional Regulation and Future Time Perspectives in Borderline Personality Disorder: Mediating and Moderating Roles of Parental Involvement | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of ACE on Emotional Regulation and Future Time Perspectives in Borderline Personality Disorder: Mediating and Moderating Roles of Parental Involvement Sonakshi Nayar, Angeline Miriam George, Dr. Suvarna Jyothi K This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5361958/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Adverse Childhood Experiences (ACEs) are known to have significant psychological and physiological impacts on various aspects of adult life. This study aimed to examine the influence of ACEs on Emotional Regulation (ER) and Future Time Perspective (FTP) in young adults diagnosed with Borderline Personality Disorder (BPD) within an Indian context. Method: The study explored the mediating and moderating roles of Parental Involvement in these relationships. A sample of 40 young adults, both male and female, from the Inpatient and Outpatient Departments of Psychiatry and Clinical Psychology from SRMC hospital, diagnosed with BPD, were assessed. Result: The findings challenge established theoretical frameworks by showing that whereas ACEs strongly predict PI, neither ACEs nor PI were significant predictors of ER or FTP in this group. These results imply that the cultural setting, particularly the collectivist character of Indian society, may be a significant moderator of the psychological effects of early adversity in borderline personality disorder. Conclusion : The paper also identifies other constraints that might have affected the results, such as a small sample size, gender imbalance, and cultural heterogeneity. Given the diversity in BPD symptomatology and the impact of culture, the study emphasizes the need for more research and interventions that are specifically suited to cultural differences. Adverse Childhood Experiences Emotional Regulation Future Time Perspectives Parental Involvement Young Adults Borderline Personality Disorder Figures Figure 1 Figure 2 Background "Borderline personality disorder is characterized by a severe disruption in emotional regulation that can impair all aspects of an individual's life, as compellingly stated by Linehan (1993).". This loss of emotional control can make an individual more impulsive, have an adverse effect on their self-esteem, and damage their relationships with other people (National Institute of Mental Health, Borderline Personality Disorder 2022). Borderline personality disorder (BPD) affects 0.7% to 1.4% of the adult population overall and is the most prevalent and severe personality disorder (PD) in clinical treatment. Although the adult result for BPD is symptomatically better than anticipated, it indicates significant rates of morbidity and death, severe and ongoing disability across a wide range of functional domains, and a substantial consumption of mental health resources. These findings provide strong support for the creation of prevention and early intervention strategies that have undergone empirical testing (Chanen et al., 2008). Models of Borderline Personality Disorder i) Biosocial Model of Emotional Dysregulation The exact nature of emotional dysfunction is still unknown, despite the fact that theory and research consistently identify it as a central disturbance in BPD (Crowell, Beauchaine, & Linehan, 2009; Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004; Trull, Tomko, Brown, & Scheiderer, 2010). According to the biosocial theory as shown in Figure 1 (Linehan, 1993), a well-known model of BPD, the disorder develops as a result of the intricate interaction between a child's biologically rooted emotional fragility and contextual factors that are perceived as trivializing, invalidating, or diminishing the child's negative affect. People with BPD experience widespread dysregulation of emotions. According to this perspective, a lot of the issues linked to BPD, like impulsivity and poor social functioning, are caused by an individual's strong emotional sensitivity or by their attempts to flee or avoid uncomfortable situations. According to the biosocial theory (Fig 1), there are three broad generalizations about the nature of emotional responding in people with BPD: (1) people with BPD have lower thresholds for recognising or responding to emotionally-relevant cues; (2) people with BPD have larger emotional reactions to emotional stimuli; and (3) people with BPD have slow return to baseline, which means that it takes longer for an emotional response to pass, suggesting that these people have few effective coping mechanisms (Linehan, 1993). Linehan's Process model highlights dysfunction in terms of the bottom-up processes, such as automatic emotional response, although emotion research has concentrated on the roles of both "bottom-up" and "top-down" emotional processes (Ochsner & Gross, 2005; Ochsner et al., 2004). On the other hand, emotional reactivity can be controlled by top-down emotion regulation processes by using techniques like distancing, reappraisal, and distraction. However, the outcomes of research studies assessing emotional responding in BPD have been inconsistent, pointing to a more complex picture of emotional functioning in BPD (Rosenthal et al., 2008). Figure 1 The biosocial developmental model of emotional dysregulation in BPD. Adapted from Linehan (1993) Adverse Childhood Experiences Role of childhood adversity and its impact on personality disorders has been a plausible risk factor in the etiology for personality disorders.A growing body of prospective studies have laid their focus on the conjoint impact of early environmental factors, individualistic traits and its comorbid impact on the diagnosis of BPD (Winsper, 2018).The present study can be related to Bronfenbrenner's Ecological Systems Theory. The theory states that the development of a child is not merely impacted by the environment but by the interaction with the various aspects of the environment (Guy-Evans, 2020).Children's physical and cognitive development interacts with changing societal expectations as they get older and explore new areas. The individual's response to real life transition periods solely depends on the social support the child receives during their growing years.Adverse Childhood Experiences can be linked to this theory as it focuses on the adverse experiences a child faces based on his environmental interactions (Olofson, 2017).Adverse childhood experiences (ACEs) are traumatic events that occur during childhood. As per the Center for Disease and Control Kaiser study, ACEs can have a significant impact on a person’s physical health, mental health and future opportunity all through their life (Center for Disease Control and Prevention, 2019). The Kaiser study conducted in the year 1998 concluded that Adverse Childhood Experiences impact adult health in several ways and are a huge risk to adult life. The study concluded that people who experienced zero ACE’s during their lifetime have a low risky adult mental health. On the contrary, the adult health of those individuals who suffered from four or more ACE’s during their lifetime was poor. The study also identified ten prominent ACE’s that an individual can suffer during the course of their life span. The ten ACE’s can be, neglect which can be physical or emotional; abuse which can be physical, sexual or emotional and household dysfunctions that can include mental illness, divorce, mother being treated violently, substance abuse or incarcerated relative. Studies have suggested that childhood adversity, parental patterns and an uncongenial family environment cumulatively are found to play a role in Borderline Personality Disorder (Ludolph et al., 1990). Abuse in families and dysfunctional family environments could be a causal factor for Borderline Personality Disorder (Bleiberg, 1994; Haugaard, 2004; Paris, 2000; Stepp, Olino, Klein, Seeley, & Lewinsohn, 2013; Wilkins & Warner, 2001; Zanarini & Frankenburg, 1997). However, the specific role of childhood maltreatment and its impact on BPD is still in question (Bradley, Jenei, & Westen, 2005) as certain risk factors, such as childhood adversity, parental involvement, and uncongenial familial environment, could all contribute to the development of BPD and are more likely to be interrelated (Ludolph et al., 1990). The BPD symptomatology is significantly impacted by poor family environments and childhood traumas, shedding its light on the parental influence on the symptoms of BPD (Weaver & Clum, 1993). Parental Involvement Parental involvement is defined as the parental interaction and the active participation of the parent with their child and their active role in their child’s schooling.This entails assessing the quantity and caliber of real participation, keeping an eye on teenage activities, and creating efficient communication plans (Baig et al., 2021). Studies suggest that the role of parenting plays a crucial role as one of the causal factors in BPD as poor parental styles, parental pathology and non-adaptive behavior patterns could all significantly lead to a diagnosis of BPD (Kaur & Sanches, 2022). Maladaptive parenting patterns such as parental conflict, abuse and neglect, exposure to domestic violence, high expressed emotions, invalidation and interpersonal hypersensitivity have all been identified as major psychosocial risk factors for the development of borderline personality disorder (BPD) in children and adolescents (Kaur & Sanches, 2022). Apart from maladaptive parenting, parental styles such as authoritative and permissive parenting styles were commonly found in parenting of children who had BPD. Parental pathology was another significant causal factor in the diagnosis of BPD (Kaur & Sanches, 2022). An Oman based study using the cross sectional design having 3468 adolescents answered questions relating to their parents involvement in their lives as children, analyzing if their parents checked up on their homework, understood their problems, knew what they did in their spare time and their overall relationship with their parents, on a 20 point likert scale. The collected data was matched with nutritious food intake, working out, self care, bodily harm, bullying, substance usage, tobacco usage and overall mental health. (Baig et al., 2021). The results indicated that higher the parental involvement the more likely the child to perform better academically and have a higher future orientation. Model of Parental Involvement i) The Hoover-Dempsey and Sandler Model It provides a thorough foundation for comprehending the reasons and means by which parents get involved in the education of their children. The model states that parental engagement is determined by their attitudes and beliefs regarding their role in their child's education as well as their perceived ability to make a positive contribution. Through an understanding of these interactions, the model assists researchers and educators in creating strategies to increase parental involvement, which eventually improves children's educational outcomes (Whitaker, 2018). The model clarifies how parental engagement, whether in the home or school context, may act as a protective factor or, conversely, be limited in its effectiveness in mitigating the negative effects of childhood adversity by emphasizing the significance of parental beliefs, attitudes, and perceived efficacy in determining their involvement. Comprehending the dynamics of parental engagement may be crucial in creating interventions that specifically target the areas of emotional regulation and future orientation that are frequently disturbed in the context of borderline personality disorder (BPD). Emotional Regulation Attempts to control our own or other people's emotions are known as emotion regulation (ER). Studies confirm a clear link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that in the BPD subgroup, there is a relationship between self-reported emotional abuse and acute symptomatology that is influenced by issues with emotion regulation. One mechanism by which early life stress, especially emotional abuse, raises the chance of developing BPD symptomatology could be issues regulating emotions (Carvalho Fernando et al., 2014). Poor Emotional Regulation of an individual diagnosed with BPD could be another factor that could be impacted by childhood traumas.The symptoms of borderline personality disorder include emotional absorption, low self-efficacy, negative appraisal patterns, and deficiencies in behavioral control when adversely stimulated. These factors significantly impede adaptive goal-directed activities when distressed (Gaher et al., 2013). A study conducted in the USA on 456 participants with BPD analyzed the impact of BPD on emotional regulation, relationship among negative affect and other aspects of BPD. Results indicated that participants with BPD displayed poorer emotional regulation and did not have enough access to emotional regulation strategies (Salsman & Linehan, 2012). Models of Emotional Regulation i) Extended Process Model of Emotional Regulation According to this enlarged model, there are three valuation systems that are engaged in emotion regulation, each of which develops through a process of perception, valuation, and action. These systems are identified by the stage at which they occur in the emotion regulation process. The first step, identification, entails identifying an emotion (perception), assessing it as an experience that has to be regulated (value), and deciding whether or not to start regulating it (activity). The second step, selection, entails determining which emotion regulation strategies are available (perception), assessing the likelihood that a given strategy will work or not based on contextual factors both internal and external (valuation), and deciding which strategy to employ (action). Implementation, the third and last stage, entails converting a general emotion regulation strategy into particular behaviors that would be most appropriate for that particular situation (perception), assessing the likelihood that a particular emotion regulation strategy will be effective or ineffective (valuation), and actually selecting and putting into practice a particular emotion regulation strategy (action) (McRae & Gross, 2020, Tull & Kimbrel, 2020). In reaction to a particular situational setting, which creates a feedback loop, an emotional response is formed in four stages. Every stage of the emotion generation process is where maladaptive versions of regulation methods are used by people with BPD (Demchenko, 2018). Future Time Perspectives Future Orientation (FO) plays an important role in the identity development of oneself. An individual with a high future orientation has a stronger focus on their future goals, plans their future better and organizes their life better. Studies have showcased that children who undergo ACE’s have lower future opportunities because of a lower future orientation, thereby impacting their planning, employment and future goals (Metzler et al., 2016). Based on studies conducted, a high future orientation reduces the chances of sexual behavior, violence, addictions and improved outcomes in relation to education (Johnson et al., 2016). All these factors are also caused due to Adverse Childhood Experiences, as per the CDC Kaiser study. Hence, having a high future orientation could be useful in the prevention of problems that Adverse Childhood Experiences could cause. Future orientation can be defined in a variety of ways but this study defines it as a process through which future related behaviors are influenced by both cognitive and motivational/emotional factors. (Johnson et al.,2016). Future time Perspectives can be defined based on the lifelong theory of motivation known as socioemotional selectivity theory that believes in the perspective that people's objectives change as time horizons get shorter, favoring future-oriented goals for those with more time and present-oriented goals for those with less time (Henry et al., 2017). The integration of the expected future into the psychological present is referred to as FTP. It consists of two main aspects: Content (showing what one expects to happen in the future) and Extension (showcasing how far into the chronological future an individual's psychological future spans) (Seginer & Lens, 2014). It is not known to what extent the future orientation of patients with BPD is impacted but research states that the poor coping techniques, negatively biased thinking and difficulty in processing emotions could impact the thinking pertaining to the future in BPD individuals (Liu et al., 2024). Need for the Study The goal of this study is to explore the psychological risk factors associated with Borderline Personality Disorder (BPD) in young adults, to better understand how these factors impact their future as they transition into adulthood. Most existing research has focused on the physical effects of Adverse Childhood Experiences (ACEs) on BPD. This study, however, is concentrated on the psychological aspects of ACEs and how they relate to emotional regulation and future orientation in young adults with BPD.Addressing problems from childhood early on can help individuals grow into healthier adults, both physically and mentally. It is important to understand how ACEs and parental involvement affect emotional regulation and future outlook in this population.The study focuses on young adults because BPD is easier to diagnose early on, and this age is crucial for intervention. Evidence shows that early treatment can significantly improve BPD in young people.This research was conducted in India to address a gap in studies that have mostly focused on Western populations. Indian cultural perspectives, which emphasize the relational and holistic view of individuals, are important for understanding and treating personality disorders. Traditional Western views on personality disorders often contrast with the Indian perspective, which sees the self as shaped by relationships and societal contexts. Therefore, it is important to consider these cultural differences when planning interventions for personality disorders in India. Review of Literature Adverse childhood experiences (ACEs) and early developmental problems are common causes of Borderline Personality Disorder (BPD), a complex and multidimensional mental health disease. This research review examines the important role that adverse childhood experiences (ACEs), including emotional and physical abuse, neglect, and difficult parent-child relationships, have in the development of borderline personality disorder (BPD) symptoms, especially in young adults. The review also looks at how parenting methods, parental psychopathology, and emotional support affect a child's psychological development.. Furthermore, the impact of Future Time Perspective (FTP) and emotion dysregulation on the presentation of BPD is examined, emphasizing the ways in which these variables interact within the Indian community, where there is a dearth of studies on these variables. Prodromal symptoms frequently appear early in life, particularly in early adolescence, and there are predisposing factors for BPD that are already present in childhood (Miller et al., 2008; Kaess et al., 2014; Stepp and Lazarus, 2018). Borderline personality disorder is a Personality Disorder (PD) that has been strongly linked to childhood traumas (Hasya, 2023) According to Bozetello's study, high-risk individuals have a positive history of traumatic experiences, such as early emotional and/or physical abuse and neglect at the hands of caregivers (Johonson et al., 2000, 2001; Carlson et al., 2009; Belsky et al., 2012; Bornovalova et al., 2013); bullying by peers (Crowell et al., 2009; Kaess et al., 2014; Haltigan et al., 2015; Antila et al., 2017); persistent abnormalities in familial behaviors and parent-child relationships (Lyons-Ruth et al., 2015; Vanwoerden et al., 2017) and severe maternal psychopathology (Barnow et al., 2013; Stepp et al., 2015; Mahan et al., 2018). Similar to this, early psychopathology including depression, oppositional-defiant disorder, eating disorders, ADHD, and substance use disorders interact with negative childhood and adolescent experiences (ACE’s) as well as temperamental and personality traits to raise the risk of borderline personality disorder (BPD) in early life (Vaillancourt et al., 2014; Ha et al., 2014; Hallquist et al., 2015; Sharp et al., 2015; Conway et al., 2015; Stepp et al., 2019; Milijkovitch et al., 2018; Mahan et al., 2018; Bornovalova et al., 2018). The link between ACE’s, parenting, and child psychopathology is gaining attention in the ACE literature because of the intergenerational impact of ACE’s. Due to their prominence in early life and ability to shape a child's behavior later on, emotional availability and discipline techniques are two parenting facets that can deepen our understanding of the connections between ACEs, parenting, and child psychopathology from an attachment framework. A study conducted using PRISMA indicated a clear correlation between parental emotional support and punitive methods and ACEs. Dissociation and depression were found to be possible mediators. There was evidence to suggest the direct link between internalizing and externalizing problems in children and parental ACEs. Possible mediators were emotional availability, attachment, children's experiences of abuse, and maternal anxiety and depressive symptoms (Rowell & Neal-Barnett, 2021). Studies on parental involvement in BPD have focused mainly on three main aspects of parenting which could be a risk factor for BPD, they include: maladaptive parenting , poor parental styles and the parents psychopathology (Kaur & Sanches, 2022). A meta-analysis of ten research involving adult and pediatric populations found that those who experienced verbal abuse or hostility from their mothers were around three times more likely to develop borderline personality disorder (BPD). A prospective longitudinal study involving a sizable sample of 6,050 moms and their kids looked into the relationship between poor parenting practices, parent conflict throughout childhood, and symptoms of borderline personality disorder in later life. An ongoing study called the Children in the Community (CIC) Study examines how personality disorders (PDs) and other psychiatric problems develop in an epidemiological sample of over 800 young people. The CIC Study has used prospective data to track developmental trajectories over 20 years from adolescence into adulthood. It has also looked into the implications of comorbidity with Axis I disorders, early risks for Axis II disorders and symptoms (including both environmental factors such as parental involvement and early characteristics), and the associated negative prognostic risk of adolescent PDs into adulthood Parental personality issues have been linked to problematic parenting and symptoms and disorders in their offspring, according to recent articles that used data from the CIC study. Additional proof that dysfunctional parenting is associated with a higher likelihood of BPD symptoms in children has been presented by the studies.(Cohen et al., 2005). A study that looked at the reciprocal effects of negative emotionality, self-control, and harsh parenting between the ages of 5 and 14 predicted the onset of borderline personality disorder (BPD) symptoms in teenage girls between the ages of 14 and 17 and discovered a positive correlation between them . The study made clear that emotional issues that impede the development of emotion regulation may be made worse by a lack of self-control (Keenan et al., 2010). According to Linehan, parental invalidation has a significant role in the development of borderline personality disorder. According to this theory, BPD arises from a childhood spent in an environment that invalidates emotional expression (e.g., parents who minimize or punish their children) (Parshall, 1995). Stress during early life is thought to be a major factor in the development of borderline personality disorder (BPD) and could lead to emotional dysregulation in the patient. A study included 63 healthy control volunteers and a sample of 49 BPD patients in order to look into the relationships between self-reported childhood trauma, difficulties regulating emotions, and these factors. The effect of self-reported childhood trauma, both in terms of quality and severity, on self-reported emotion regulation was assessed using multiple regression analysis. The findings confirmed a link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that the relationship between self-reported emotional abuse and acute symptomatology in the BPD subgroup is influenced by more challenges with emotion control. The exact nature of emotional dysfunction is still unknown, despite the fact that theory and research consistently identify it as a central disturbance in BPD. (Crowell, Beauchaine, & Linehan, 2009; Lieb, Zanarini, Schmahl, Linehan, & Bohus, 2004; Trull, Tomko, Brown, & Scheiderer, 2010). Emotion dysregulation is known to be one of the main causes behind borderline personality disorder (BPD) and related pathologies, according to theory and research. However, many concerns concerning the precise role of emotion dysregulation in the development and treatment of BPD and its related challenges remain unsolved, despite the substantial studies demonstrating a link between emotion dysregulation and BPD (Park et al., 2020). A study conducted on the effect of self-reported childhood trauma, both in terms of quality and severity, on self-reported emotion regulation was assessed using multiple regression analysis.The findings confirmed a link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that the relationship between self-reported emotional abuse and acute symptomatology in the BPD subgroup is influenced by more challenges with emotion control. A person's ability to control affect and emotions is closely correlated with how they view the past, present, and future in relation to time, as well as how they perceive time is passing.Seventeen BPD patients between the ages of 18 and 52 participated in the study, and 17 control participants who were matched for gender, age, and educational attainment were also included. Foreseeing, anticipating, and making plans for future desirable outcomes are essential for motivation, behavior, and overall well-being. As a result, research on FTP is fragmented and focuses on different parts of the construct, employs different metrics, and evaluates various antecedents and consequences (Kooij et al., 2018). It is not known to what extent the future orientation of patients with BPD is impacted but research states that the poor coping techniques, negatively biased thinking and difficulty in processing emotions could impact the thinking pertaining to the future in BPD individuals (Liu et al., 2024). Individuals diagnosed with borderline personality disorder (BPD) exhibit inappropriate emotion-regulation techniques and increased negative affect. According to the Zimbardo Time Perspective Inventory (ZTPI), patients with BPD exhibit aberrations in almost every temporal orientation. Specifically, they scored higher on the present-fatalistic and past-negative dimensions and lower on the future and past-positive dimensions. From the standpoint of balanced time, BPD patients deviate more than controls (BTP). Patients with BPD experience a general expansion of time in the present, but not the past, when it comes to the STQ. When combined, our findings demonstrate how a significant imbalance in each person's time orientations and a likely unfavorable perception of an increase in subjective time in daily life can be linked to borderline personality disorder (BPD) (Mioni et al., 2020). Further studies suggest that BPD patients give more importance to short term relief of emotions over long term relief due to their impulsive tendencies and a poor future orientation Chapman & Gratz (2007). Although these studies have not been conducted in an Indian context it becomes essential to include this variable in the study as a reduced future orientation could harm the treatment outcomes devised for the patient Zanarini et al. (2011). Methodology Aim To study the impact of Childhood Traumas on Emotional Regulation and Future Orientation among young adults with BPD while factoring in the Mediating and Moderating effects of Parental Involvement. Objectives To study the level of Adverse Childhood Experiences, Parental Involvement, Future Time Perspectives and Emotional regulation among young adult, BPD patients. Hypothesis H 1 1 : Childhood traumas will be negatively associated with emotional regulation among young adults with Borderline Personality Disorder (BPD). H1 2 : Childhood traumas will be negatively associated with future orientation among young adults with BPD. H1 3 : Higher levels of Adverse Childhood Experiences (ACEs) will be associated with lower levels of perceived Parental Involvement (PI) among young adults with Borderline Personality Disorder (BPD). H1 4 : Parental involvement will moderate the relationship between childhood traumas and emotional regulation, such that the negative effects of childhood traumas on emotional regulation will be stronger when parental involvement is low. H 1 5 : Parental involvement will moderate the relationship between childhood traumas and future orientation, such that the negative effects of childhood traumas on future orientation will be stronger when parental involvement is low. H1 6 : Parental involvement will mediate the relationship between childhood traumas and emotional regulation in young adults with BPD, such that higher levels of parental involvement will weaken the negative impact of childhood traumas on emotional regulation. H1 7 : Parental involvement will mediate the relationship between childhood traumas and future orientation in young adults with BPD, such that higher levels of parental involvement will weaken the negative impact of childhood traumas on future orientation. Variables Adverse Childhood Experiences Parental Involvement Future Time Perspective Emotional Regulation Site of Study The study was conducted offline at (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai. Period of Study The study went on for a period of 7 months from February 2023- August 2024 Sample A sample size of 40 participants, young adults diagnosed with BPD, ranging between 18-40 years were chosen as the sample for the study. The participants were recruited from the Inpatient Psychiatry and Outpatient Psychiatry and Clinical Psychology department at the SRMC hospital. They were diagnosed by Psychiatrists and Clinical Psychologists at SRMC, using (International Personality Diagnostic Examination) IPDE and clinical interview methods. Further, the participants were re-screened using the McLean Screening Instrument for BPD (MSI-BPD) and only those who score <7 on a 10 item scale were recruited for the study. Sample Size Calculation The sample size for the study was based on (Ball and Links 2009), who reported the proportion of subjects with AED as 93% The sample size was calculated according to the formula given by Lemeshow et al, 1990¹: Sample size N = z1-/22× p × 1-pδ² Proportion of subjects with AED: p= 0.93 (93%) Precision : δ = 0.075 (7.5%) Type I error : α = 0.05 (5%), z1-α/2 = 1.96; Beta = 20%, Power: 80% Based on the formula and values given above: Sample size required N = [1.96² x 0.93 x (1-0.93)] / 0.075² = 44.46 ≈ 45 Thus, 95% confidence interval, the proposed sample size for the study is 45. Inclusion criteria Participants diagnosed with Borderline Personality Disorder by a Psychiatrist/ Clinical Psychologists from SRIHER, Chennai . Participants ranging between 18-40 years of age. Have not started taking therapy (1-2 sessions in exceptional cases). Individuals who have attained a minimum of 10 years of formal education. Exclusion criteria Participants with intellectual disability (ID) or active psychosis. Participants residing outside of India. Data Collections Methods Primary sources were used to get the data for this study. This technique of data collecting minimizes the impact of the researcher's personal opinions on the findings and helps to lower the potential of errors in the study. Offline survey questions were used and given to participants who visited the SRMC Psychiatry IP and OP as well as the Clinical Psychology OP in order to measure the adverse childhood traumas of patients with BPP and its impact on the FTP and ER: mediating and moderating effect of parental involvement. Utilizing an offline survey approach offers a productive means of gathering information from a healthcare group. Based on the study characteristics and pertinent information, the questionnaires were chosen.The main technique of gathering data, which were the questionnaires, guarantees the validity, consistency, and reliability of the information gathered. Research Design The study is a non experimental design using the ex post facto method. An ex post facto research design is a method in which groups with qualities that already exist are compared on some dependent variable. Also known as "after the fact" research, an ex post facto design is considered quasi-experimental because the subjects are not randomly assigned - they are grouped based on a particular characteristic or trait. Tools Socio-demographic Details: Socio-demographic data sheet is a semi-structured socio-demographic data sheet prepared by the Investigator, which includes information regarding name/initials, age/date of birth, gender, birth order, number of siblings, education, occupation, and area of residence to procure basic information from the individual partaking in the study. Scale 1: McLean Screening Instrument for BPD (MSI-BPD) It is a 10 item self report screening tool used to confirm the BPD diagnosis used in a population above the age 15 years of age (Zanarini et al.,2003). Reliability and Validity: Cronbach alpha of 0.78, the MSI-BPD states acceptable validity and reliability (Zanarini et al., 2003).In a sample of students and community members, Gardner and Qualter (2009) discovered that the MSI-BPD had a strong correlation with existing BPD screening instruments. They also stated that confirmatory factor analysis indicated that the MSI-BPD is a suitable measure for evaluating BPD as a global construct. Scale 2: Adverse Childhood Experiences International Questionnaire It is a 44 item screening questionnaire that is used to measure the various types of emotional and physical abuse, household dysfunction and various other kinds of trauma that lead to childhood adversity. It was formulated by the World Health Organization (WHO, 2018). Scale 3: Parenting Involvement Rating Scale The scale was developed to measure parental involvement in their children's education.It measures parental acceptance, aspirations, attention, encouragement, guidance, influence, decision making, parental provision of physical facilities and parental care to the physical fitness of the child.It is an Indian tool developed in Kochi, India. Reliability and validity: The reliability of the scale and its components and the internal consistency has been determined by the test retest method. (Naseems & Gafoor, 2001). Scale 4 : The Interpersonal Emotion Regulation Questionnaire (IERQ) The Interpersonal Emotion Regulation Questionnaire (IERQ) is a tool designed to evaluate how well people manage their emotions when they don't actively try to do so. Reliability and validity: The IERQ and its four subscales: Enhancing positive affect; Perspective taking; Soothing and Social modeling all have excellent internal consistency and reliability. (Hofmann et al., 2016) Scale 5 : Future Time Perspective Survey The Future Time Perspective (FTP) scale measures a person’s perception of their future as being time-limited. Example of an item: How does your future look to you? Reliability and validity: Future Time Perspective Scale for Adolescents and Young Adults. between each factor and the total scale fall between 0.60 and 0.78 and are greater than the correlations between each factor, indicating that FTPS- AYA has good construct validity. (Lyu, 2016). Procedure The study was conducted purely in an offline setting. Upon being chosen by the clinicians to be a part of the study, the participants were contacted Inclusion criteria included participants who were young adults aged between 18-40 years and had been given a formal diagnosis of BPD by Psychiatrists and Clinical Psychologists from the Out-patient and In-patient Department of Psychiatry and the Out-patient Department of Clinical Psychology in Sri Ramachandra Institute of Higher Education and Research. Further, they had no prior history of taking psychotherapy. Individuals who have attained a minimum of 10 years of formal education. Additionally, another screening tool, McLean Screening Instrument for BPD, was used to re-confirm the diagnosis of BPD. A physical form containing a brief of the study and consent to take part was handed over to the participants. Upon their agreement to participate in the study, the consent form was signed duly by each of the participants. Next, a demographic sheet containing all the details of the participant was filled in by all the participants. The participants were then screened using the screening tool, ACE International questionnaire. Once the consent, demographic sheet and screening is complete the questionnaire was filled by all the participants for the study. Post the collection of data, analysis using path analysis was initiated. Result The empirical results of a study examining the intricate interactions among young adults with Borderline Personality Disorder (BPD) and adverse childhood experiences (ACEs), future time perspectives (FTP), emotional regulation (ER), and the moderating and mediating effect of parental involvement are presented in this section.The results are organized into two main sections: first, an analysis of the relationships between ACEs PI, FTP and ER outcomes; and second, a look at the potential moderating and mediating effect of parental involvement on these relationships. Table 1 Association between Total ACE Score and Parameters Parameters Total ACE Score p value Total PIRS*** Correlation Coefficient (rho) = -0.33 0.036 1 Total FTP Correlation Coefficient (rho) = 0.1 0.548 1 Total ER Correlation Coefficient (rho) = -0.03 0.863 1 Note : The following variables were significantly associated (p<0.05) with the variable Total ACE Score , Total PIRS ***Significant at p<0.05, 1: Spearman Correlation, 2: Wilcoxon-Mann-Whitney U Test There is a statistically significant negative correlation between the total ACE score and parental involvement as shown in Table1.As the total ACE score increases, indicating more adverse childhood experiences, the perceived level of parental involvement decreases. There is a weak positive correlation between total ACE score and future time perspective, which suggests that ACEs do not have a significant impact on future time perspective in this sample. There is a very weak negative correlation between total ACE score and emotional regulation,suggesting that ACEs do not have a significant impact on emotional regulation in this sample. Based on this The null hypothesis is not rejected for H1 and H2 and therefore, H1 and H2 is not supported by the data. H3 is supported by the data and hence the null hypothesis is rejected. (Table 1) Moderation Analysis Moderation Analysis for Parental Involvement between Adverse Childhood Experiences (ACE) and both Emotional Regulation (ER) and Future Orientation (FTP) (i) For Emotional Regulation: Table 2 Moderation: Model Summary for ACE, ER and PIRS _____________________________________________________________________________ Model R R 2 Adjusted R 2 MSE Change Statistics R 2 Change F Change Sig. 1 .274 .075 -.002 18.017 .075 .974 .416 P Predictors: (Constant), Interaction, Parental Involvement, Mean of ACE Dependent Variable: Emotional Regulation From the above Table 2, we simplify that the correlation between these two variable groups is 0.274 which is a strong positive correlation , and the R 2 value is 0.075 which implies that 7.5% of the values in these two separate groups and the ACE is influenced with respect to parental involvement. To estimate the linear relationship between the variables we will discuss further. The model explains a small proportion of the variance in Emotional Regulations. The interaction term does not significantly improve the model, albeit weakly. (ii) For Future Orientation: Table 3 Moderation: Model Summary for ACE, FTP and PIRS ____________________________________________________________________________ Model R R 2 Adjusted R 2 MSE Change Statistics R 2 Change F Change Sig. 1 .123 .015 -.067 16.271 .015 .185 .906 Predictors: (Constant), Interaction, Parental Involvement, Mean of ACE Dependent Variable: Future Orientation From the above Table 3, we simplify that the correlation between these two variable groups is 0.123 which is positive correlation, and the R 2 value is 0.015 which implies that only1.5% of the values in these two separate groups and the ACE is influenced with respect to parental involvement. To estimate the linear relationship between the variables we will discuss further. The model explains a small proportion of the variance in Future Orientation. The interaction term does not significantly improve the model, albeit weakly. The moderation model postulated that parental involvement modifies the ways in which childhood adversity affects emotional regulation or future time perspective in young adults diagnosed with borderline personality disorder (BPD). However, the data refuted this theory. Put another way, while the involvement of parents is influenced by childhood adversity, it does not appear to have an effect on the way in which childhood adversity affects young adults capacity for emotion regulation or future orientation This implies that other variables may have a greater influence on these result Mediation Analysis Mediation analysis for Parental Involvement on the Adverse Childhood Experiences (ACE) and both Emotional Regulation (ER) and Future Orientation (FTP). Table 4 Regression Coefficients for Predicting ER and FTP from PI and ACE __________________________________________________________________________ Model Unstandardized Coefficients Standardized Coefficients t Sig. B SE Beta 1 (Constant) 41.370 14.613 2.831 .007 Parental Involvement .167 .107 .267 1.569 .125 ACE .388 1.317 .050 .295 .770 2 (Constant) 42.345 13.123 3.227 .003 Parental Involvement -.042 .096 -.077 -.442 .661 ACE .478 1.183 .071 .404 .688 Dependent Variable: Emotional Regulation andFuture Orientation As shown in Table 4, we can depict that the PI of the patients on the emotional regulation and future orientation is not a significant mediator because both of its significance is greater than 0.05. So, we do not reject our null hypothesis H 06 and H 07 . The hypothesized mediation model was not supported by the data. While ACE significantly predicts Parental Involvement, neither ACE nor Parental Involvement significantly predicts ER or FTP. These findings suggest that other factors may be more influential in determining Emotional Regulation and Future orientation among young adults with BPD. Figure 2 Mediation and Moderation Model Note : X: Independent Variable (ACE), M: Mediator/Moderator (Parental Involvement), Y: Dependent Variables (ER and FTP) Discussion The results imply that negative childhood experiences are linked to modifications in parental participation, which is in line with other research, as shown in table 1 (Smith et al., 2020; Johnson & Lee, 2018). This can be related to a 2007 study, Zanarini, M. C., Williams, A. A., Lewis, R. E., Bradford Reich, R., & Frankenburg, F. R. investigated the connection between parental participation, early adversity, and the intensity of BPD symptoms in adulthood. Their research showed that, even in the face of strong ACEs, BPD patients who reported higher levels of positive parental involvement as children showed less severe BPD symptoms as adults. This shows that parental participation can affect a person with BPD's emotional and psychological results in a long-lasting way. In a clinical sample, Barnow, Spitzer, Kessler, H. J., Grabe, H. J., & Freyberger, H. J. (2006) investigated the moderating effect of parental participation in the link between ACEs and BPD. According to their research, having an attentive and supportive parent when growing up was linked to improved emotional regulation and a lower incidence of borderline personality disorder symptoms as an adult. This study emphasizes how crucial it is to take parental participation into account when evaluating the long-term impacts of ACEs on people with BPD. These findings can be linked to the current study showcasing the interaction between ACE and PI, in a BPD population. However in the study, emotional regulation improves with better parental involvement, this was not showcased in the present study as PI did not have any affect on the ER of the sample size. In contrast to certain theoretical frameworks (Khokhar & Kumari, 2024), this engagement had no discernible impact on our sample of young adults with BPD's future time perspectives or emotional regulation. This implies that although ACEs may have an effect on parental involvement, these particular psychological consequences in this population may not be strongly or directly predicted by it. These findings could be due to ample number of factors which include: Cultural Differences In Asian cultures, especially in India, where cultural influences greatly impact symptom expression, there is a dearth of diagnosis and research on borderline personality disorder (BPD) (Hwang et al., 2008; Ziegenbein et al., 2008). Research shows that social norms and cultural expectations influence interpersonal functioning, emotions, and self-perception, which in turn influences BPD diagnosis and presentation (Jani et al., 2016 ). Although parental participation is essential for reducing BPD symptoms, its effects may differ depending on the culture. Strong familial ties and emotional self-control are examples of traditional Indian practices that may serve as protective factors, lowering the overt manifestation of BPD symptoms (Paris, 1996 ). This shows that parental participation may not attenuate or moderate the effects of early trauma on emotional regulation and future direction in Indian communities, which could be explained by cultural differences. Self and Cultural Aspects The environment in which a person is raised and engages with others shapes their mental image of themselves. According to Markus and Kitayama (1991), people's sense of self varies depending on their cultural context and how it relates to important people. Asians have been noted by Lalonde et al. (2004) to develop an interdependent self, which is a more flexible and fluid vision that is bound to others. According to Cheung (1998), identity in Eastern cultures is shaped by interpersonal notions and is inextricably linked to significant persons. Identity creation and spread are influenced by culture and social structures since identity development occurs within a social setting. Once more, the family plays a very small part in helping people transcend their sense of self and identity; instead, people's identities are mostly dependent on their significant others and are typically examined in the context of interpersonal interactions. In this respect, parental involvement could be “not a very important factor” mediating or moderating the relationship between Trauma, FTP and ER, in a BPD population. Classificatory systems and Cross-Cultural Bias Studies address the prevalence of Borderline Personality Disorder (BPD) worldwide and highlights differences in how it is classified in the DSM-5, CCMD, and ICD-10 systems. Cultural influences impact the symptoms of Borderline Personality Disorder (BPD), despite its stable genetic and neurobiological markers. Studies on borderline personality disorder (BPD) in various nations, particularly among immigrant groups, reveal cultural variations in the frequency of symptoms. These results underline the necessity of a single, dimension-based classification of BPD in order to reduce cross-cultural bias and enhance diagnosis precision. This could be another limitation as most studies on BPD have been done on a western population using the western classificatory systems such as DSM, which could make it harder to generalize or obtain the same results on an Indian population. Heterogeneity of the condition Studies suggest that the heterogeneity of BPD, as a disorder in itself, poses a challenge in both clinical and research work (Cavelti et al., 2021 ). Cavelti et al. ( 2021 ) have highlighted that the variety of BPD poses a substantial difficulty in clinical and research settings. There is a great deal of variation in the symptoms and behavioral patterns associated with BPD, which causes individuals to experience and manage their condition differently. The non-significant results for parental involvement in predicting future time perspectives and emotional regulation in our sample were probably influenced by this variability. Because BPD can present in a variety of ways, parental involvement may be important for some people but not for others, depending on a variety of reasons. As a result, the overall value of these interactions in our study may have been diminished. Subgroup analyses should be taken into account in future studies in order to account for this diversity and to investigate more specialized therapies that cater to the particular requirements of various BPD profiles. Conclusion While ACE significantly predicts Parental Involvement, neither ACE nor Parental Involvement significantly predicts ER or FTP.These findings suggest that other factors may be more influential in determining Emotional Regulation and Future orientation among young adults with BPD. While studies conducted in a normal population have shown an impact of ACE of ER and FTP, the same variables on a BPD population did not yield the same results (Nayar, 2022 ). Significance and Implication By exposing the nuanced association between ACEs and psychological consequences in Indian individuals with Borderline Personality Disorder (BPD), this research challenges Western-centric presumptions. Although ACEs have a substantial impact on parental participation, they are not a reliable indicator of emotional regulation (ER) or future time perspective (FTP) in this situation, highlighting the importance of cultural influences. Since Indian collectivist beliefs could alleviate some of the psychological effects seen in Western civilizations, the study highlights the necessity for culturally appropriate treatment practices. Public health policies in India should prioritize early intervention for populations at risk, and future research should investigate other cultural modifiers. Limitations The lack of homogeneity in the sample, which includes a range of age ranges, comorbid conditions, and cultural backgrounds, in addition to the small sample size and gender imbalance (31 females, 9 men), could have an impact on the study's findings. Future Research The results may not be as broadly applicable as they could be due to this gender gap, especially considering the variations in BPD symptoms between the sexes. Furthermore, as BPD is underdiagnosed in Asian cultures like India, where emotional expression is frequently restricted, cultural considerations may also be important. Future studies should examine the effects of culture and gender on BPD outcomes. Declarations Department of Health Research (DHR) / INDIAN COUNCIL OF MEDICAL RESEARCH (ICMR) Approved this study. Registration No: EC/NEW/INST/2023/TN/0321 Ethics approval and consent to participate The study was approved by Consent for publication I provide consent for publication and I would produce documents required for the same. Availability of data and materials Data is available for viewership, as physical forms- data was entered into the google forms and then excel, I have copies of all the above. Competing interests The authors declare that there are no competing interests. Funding No funds were obtained for the study. Authors' contributions Sonakshi Nayar (corresponding author) was the main contributor to the study. All the three authors worked on the manuscript collective in the result, discussions and planning phase. Acknowledgements We would like to express our heartfelt appreciation to our Head of Department, Dr. Neeradha Chandramohan, whose leadership and dedication have greatly influenced us and whose wisdom and encouragement have been a source of inspiration. We are sincerely grateful to all the authorities and departments at Sri Ramachandra Institute of Higher Education and Research, whose timely assistance made this paper possible. Special thanks are due to the faculty members and support staff of the Department of Clinical Psychology and Psychiatry for their consistent support. We also wish to extend our deepest gratitude to the participants of this study for their willingness to share their personal experiences. Without their trust and openness, this research would not have been possible. Lastly, we are profoundly thankful to our friends, family, and God, who have been my constant pillars of support. 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Parenting stress and competence in borderline personality disorder is associated with mental health, trauma history, attachment and reflective capacity. Borderline Personality Disorder and Emotion Dysregulation , 7 (1). https://doi.org/10.1186/s40479-020-00124-8 Stepp, S. D., Olino, T. M., Klein, D. N., Seeley, J. R., & Lewinsohn, P. M. (2013). Unique influences of adolescent antecedents on adult borderline personality disorder features. Personality Disorders: Theory, Research, and Treatment , 4 (3), 223–229. https://doi.org/10.1037/per0000015 Stepp, S. D., Scott, L. N., Jones, N. P., Whalen, D. J., & Hipwell, A. E. (2015). Negative emotional reactivity as a marker of vulnerability in the development of borderline personality disorder symptoms. Development and Psychopathology , 28 (1), 213–224. https://doi.org/10.1017/s0954579415000395 Stepp, S. D., Whalen, D. J., Scott, L. N., Zalewski, M., Loeber, R., & Hipwell, A. E. (2014). Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. Development and Psychopathology , 26 (2), 361–378. https://doi.org/10.1017/s0954579413001041 Trull, T. J., Tomko, R. L., Brown, W. C., & Scheiderer, E. M. (2010). Borderline personality disorder in 3-D: Dimensions, symptoms, and measurement challenges. Social and Personality Psychology Compass , 4 (11), 1057–1069. https://doi.org/10.1111/j.1751-9004.2010.00312.x Tull, M. T., & Kimbrel, N. A. (2020). Emotion in posttraumatic stress disorder: Etiology, assessment, Neurobiology, and treatment . Academic Press is an imprint of Elsevier. U.S. Department of Health and Human Services. (n.d.). Borderline Personality Disorder . National Institute of Mental Health. https://www.nimh.nih.gov/site-info/policies#part_2718 Vaillancourt, T., Brittain, H. L., McDougall, P., Krygsman, A., Boylan, K., Duku, E., & Hymel, S. (2014). 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5361958","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381916678,"identity":"3beba719-35cf-4b12-b699-35f14c7da604","order_by":0,"name":"Sonakshi Nayar","email":"data:image/png;base64,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","orcid":"","institution":"Sri Ramachandra Institute of Higher Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Sonakshi","middleName":"","lastName":"Nayar","suffix":""},{"id":381916679,"identity":"9dbdbfd3-ac83-4820-bb54-0017530cbd23","order_by":1,"name":"Angeline Miriam George","email":"","orcid":"","institution":"Sri Ramachandra Institute of Higher Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Angeline","middleName":"Miriam","lastName":"George","suffix":""},{"id":381916680,"identity":"0d560485-e191-4fcc-a4fb-4f7479727bdc","order_by":2,"name":"Dr. Suvarna Jyothi K","email":"","orcid":"","institution":"Sri Ramachandra Institute of Higher Education and Research","correspondingAuthor":false,"prefix":"Dr.","firstName":"Suvarna","middleName":"Jyothi","lastName":"K","suffix":""}],"badges":[],"createdAt":"2024-10-30 15:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5361958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5361958/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69966664,"identity":"31324b70-48fd-428c-96d3-7de51b820ffd","added_by":"auto","created_at":"2024-11-27 05:36:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":89844,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe biosocial developmental model of emotional dysregulation in BPD. Adapted from Linehan (1993)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5361958/v1/e0275987e03e9df3bdffd710.png"},{"id":69966227,"identity":"deb2d931-3a7e-488a-a159-fde78ded13fc","added_by":"auto","created_at":"2024-11-27 05:28:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMediation and Moderation Model\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: X: Independent Variable (ACE), M: Mediator/Moderator (Parental Involvement), Y: Dependent Variables (ER and FTP)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5361958/v1/8d0d37bdc61f481fe1e7e8a5.png"},{"id":71636734,"identity":"c9a1bbfa-5b6c-4923-a90b-629649ee12b4","added_by":"auto","created_at":"2024-12-17 10:17:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1083368,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5361958/v1/8bd100b6-3469-4e89-938a-77ba99260a49.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of ACE on Emotional Regulation and Future Time Perspectives in Borderline Personality Disorder: Mediating and Moderating Roles of Parental Involvement ","fulltext":[{"header":"Background","content":"\u003cp\u003e\u0026quot;Borderline personality disorder is characterized by a severe disruption in emotional regulation that can impair all aspects of an individual\u0026apos;s life, as compellingly stated by Linehan (1993).\u0026quot;. This loss of emotional control can make an individual more impulsive, have an adverse effect on their self-esteem, and damage their relationships with other people (National Institute of Mental Health, \u003cem\u003eBorderline Personality Disorder\u0026nbsp;\u003c/em\u003e2022). Borderline personality disorder (BPD) affects 0.7% to 1.4% of the adult population overall and is the most prevalent and severe personality disorder (PD) in clinical treatment. Although the adult result for BPD is symptomatically better than anticipated, it indicates significant rates of morbidity and death, severe and ongoing disability across a wide range of functional domains, and a substantial consumption of mental health resources. These findings provide strong support for the creation of prevention and early intervention strategies that have undergone empirical testing (Chanen et al., 2008).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModels of Borderline Personality Disorder\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ei) Biosocial Model of Emotional Dysregulation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; The exact nature of emotional dysfunction is still unknown, despite the fact that theory and research consistently identify it as a central disturbance in BPD (Crowell, Beauchaine, \u0026amp; Linehan, 2009; Lieb, Zanarini, Schmahl, Linehan, \u0026amp; Bohus, 2004; Trull, Tomko, Brown, \u0026amp; Scheiderer, 2010). According to the biosocial theory as shown in Figure 1 (Linehan, 1993), a well-known model of BPD, the disorder develops as a result of the intricate interaction between a child\u0026apos;s biologically rooted emotional fragility and contextual factors that are perceived as trivializing, invalidating, or diminishing the child\u0026apos;s negative affect. People with BPD experience widespread dysregulation of emotions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;According to this perspective, a lot of the issues linked to BPD, like impulsivity and poor social functioning, are caused by an individual\u0026apos;s strong emotional sensitivity or by their attempts to flee or avoid uncomfortable situations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;According to the biosocial theory (Fig 1), there are three broad generalizations about the nature of emotional responding in people with BPD: (1) people with BPD have lower thresholds for recognising or responding to emotionally-relevant cues; (2) people with BPD have larger emotional reactions to emotional stimuli; and (3) people with BPD have slow return to baseline, which means that it takes longer for an emotional response to pass, suggesting that these people have few effective coping mechanisms (Linehan, 1993).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Linehan\u0026apos;s Process model highlights dysfunction in terms of the bottom-up processes, such as automatic emotional response, although emotion research has concentrated on the roles of both \u0026quot;bottom-up\u0026quot; and \u0026quot;top-down\u0026quot; emotional processes (Ochsner \u0026amp; Gross, 2005; Ochsner et al., 2004). On the other hand, emotional reactivity can be controlled by top-down emotion regulation processes by using techniques like distancing, reappraisal, and distraction. However, the outcomes of research studies assessing emotional responding in BPD have been inconsistent, pointing to a more complex picture of emotional functioning in BPD (Rosenthal et al., 2008).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe biosocial developmental model of emotional dysregulation in BPD. Adapted from Linehan (1993)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse Childhood Experiences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Role of childhood adversity and its impact on personality disorders has been a plausible risk factor \u0026nbsp;in \u0026nbsp;the etiology for personality disorders.A growing body of prospective studies have laid their focus on the conjoint impact of early environmental factors, individualistic traits and its comorbid impact on the diagnosis of BPD (Winsper, 2018).The present study can be related to Bronfenbrenner\u0026apos;s Ecological Systems Theory. The theory states that the development of a child is not merely impacted by the environment but by the interaction with the various aspects of the environment (Guy-Evans, 2020).Children\u0026apos;s physical and cognitive development interacts with changing societal expectations as they get older and explore new areas. The individual\u0026apos;s response to real life transition periods solely depends on the social support the child receives during their growing years.Adverse Childhood Experiences can be linked to this theory as it focuses on the adverse experiences a child faces based on his environmental interactions (Olofson, 2017).Adverse childhood experiences (ACEs) are traumatic events that occur during childhood. As per the Center for Disease and Control Kaiser study, ACEs can have a significant impact on a person\u0026rsquo;s physical health, mental health and future opportunity all through their life (Center for Disease Control and Prevention, 2019). The Kaiser study conducted in the year 1998 concluded that Adverse Childhood Experiences impact adult health in several ways and are a huge risk to adult life. The study concluded that people who experienced zero ACE\u0026rsquo;s during their lifetime have a low risky adult mental health. On the contrary, the adult health of those individuals who suffered from four or more ACE\u0026rsquo;s during their lifetime was poor. The study also identified ten prominent ACE\u0026rsquo;s that an individual can suffer during the course of their life span. The ten ACE\u0026rsquo;s can be, neglect which can be physical or emotional; abuse which can be physical, sexual or emotional and household dysfunctions that can include mental illness, divorce, mother being treated violently, substance abuse or incarcerated relative.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Studies have suggested that childhood adversity, parental patterns and an uncongenial family environment cumulatively are found to play a role in Borderline Personality Disorder \u0026nbsp;(Ludolph et al., 1990).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAbuse in families and dysfunctional family environments could be a causal factor for Borderline Personality Disorder (Bleiberg, 1994; Haugaard, 2004; Paris, 2000; Stepp, Olino, Klein, Seeley, \u0026amp; Lewinsohn, 2013; Wilkins \u0026amp; Warner, 2001; Zanarini \u0026amp; Frankenburg, 1997). However, the specific role of childhood maltreatment and its impact on BPD is still in question (Bradley, Jenei, \u0026amp; Westen, 2005) as certain risk factors, such as childhood adversity, parental involvement, and uncongenial familial environment, could all contribute to the development of BPD and are more likely to be interrelated (Ludolph et al., 1990). The BPD symptomatology is significantly impacted by poor family environments and childhood traumas, shedding its light on the parental influence on the symptoms of BPD (Weaver \u0026amp; Clum, 1993).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParental Involvement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParental involvement is defined as the parental interaction and the active participation of the parent with their child and their active role in their child\u0026rsquo;s schooling.This entails assessing the quantity and caliber of real participation, keeping an eye on teenage activities, and creating efficient communication plans (Baig et al., 2021). \u0026nbsp;Studies suggest that the role of parenting plays a crucial role as one of the causal factors in BPD as poor parental styles, parental pathology and non-adaptive behavior patterns could all significantly lead to a diagnosis of BPD (Kaur \u0026amp; Sanches, 2022). Maladaptive parenting patterns such as parental conflict, abuse and neglect, exposure to domestic violence, high expressed emotions, invalidation and interpersonal hypersensitivity have all been identified as major psychosocial risk factors for the development of borderline personality disorder (BPD) in children and adolescents (Kaur \u0026amp; Sanches, 2022). Apart from maladaptive parenting, parental styles such as authoritative and permissive parenting styles were commonly found in parenting of children who had BPD. Parental pathology was another significant causal factor in the diagnosis of BPD (Kaur \u0026amp; Sanches, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;An Oman based \u0026nbsp;study using the cross sectional design having 3468 adolescents answered questions relating to their parents involvement in their lives as children, \u0026nbsp;analyzing if their parents checked up on their homework, understood their problems, knew what they did in their spare time and their overall relationship with their parents, on a 20 point likert scale. The collected data was matched with nutritious food intake, working out, self care, bodily harm, bullying, substance usage, tobacco usage and overall mental health. \u0026nbsp;(Baig et al., 2021). The results indicated that \u0026nbsp;higher the parental involvement the more likely the child to perform better academically and have a higher future orientation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel of Parental Involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ei) The Hoover-Dempsey and Sandler Model\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;It provides a thorough foundation for comprehending the reasons and means by which parents get involved in the education of their children. The model states that parental engagement is determined by their attitudes and beliefs regarding their role in their child\u0026apos;s education as well as their perceived ability to make a positive contribution. Through an understanding of these interactions, the model assists researchers and educators in creating strategies to increase parental involvement, which eventually improves children\u0026apos;s educational outcomes (Whitaker, 2018). The model clarifies how parental engagement, whether in the home or school context, may act as a protective factor or, conversely, be limited in its effectiveness in mitigating the negative effects of childhood adversity by emphasizing the significance of parental beliefs, attitudes, and perceived efficacy in determining their involvement. Comprehending the dynamics of parental engagement may be crucial in creating interventions that specifically target the areas of emotional regulation and future orientation that are frequently disturbed in the context of borderline personality disorder (BPD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmotional Regulation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; Attempts to control our own or other people\u0026apos;s emotions are known as emotion regulation (ER).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies confirm a clear \u0026nbsp;link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that in the BPD subgroup, there is a relationship between self-reported emotional abuse and acute symptomatology that is influenced by issues with emotion regulation. One mechanism by which early life stress, especially emotional abuse, raises the chance of developing BPD symptomatology could be issues regulating emotions (Carvalho Fernando et al., 2014).\u0026nbsp;Poor Emotional Regulation of an individual diagnosed \u0026nbsp; with BPD could be another factor that could be impacted by childhood traumas.The symptoms of borderline personality disorder include emotional absorption, low self-efficacy, negative appraisal patterns, and deficiencies in behavioral control when adversely stimulated. These factors significantly impede adaptive goal-directed activities when distressed (Gaher et al., 2013). A study conducted in the USA on 456 participants with BPD analyzed the impact of BPD on emotional regulation, relationship among negative affect and other aspects of BPD. Results indicated that participants with BPD displayed poorer emotional regulation and did not have enough access to emotional regulation strategies (Salsman \u0026amp; Linehan, 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModels of Emotional Regulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ei) Extended Process Model of Emotional Regulation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; According to this enlarged model, there are three valuation systems that are engaged in emotion regulation, each of which develops through a process of perception, valuation, and action. These systems are identified by the stage at which they occur in the emotion regulation process. The first step, identification, entails identifying an emotion (perception), assessing it as an experience that has to be regulated (value), and deciding whether or not to start regulating it (activity). The second step, selection, entails determining which emotion regulation strategies are available (perception), assessing the likelihood that a given strategy will work or not based on contextual factors both internal and external (valuation), and deciding which strategy to employ (action). Implementation, the third and last stage, entails converting a general emotion regulation strategy into particular behaviors that would be most appropriate for that particular situation (perception), assessing the likelihood that a particular emotion regulation strategy will be effective or ineffective (valuation), and actually selecting and putting into practice a particular emotion regulation strategy (action) (McRae \u0026amp; Gross, 2020, Tull \u0026amp; Kimbrel, 2020).\u0026nbsp;In reaction to a particular situational setting, which creates a feedback loop, an emotional response is formed in four stages. Every stage of the emotion generation process is where maladaptive versions of regulation methods are used by people with BPD (Demchenko, 2018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Time Perspectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Future Orientation (FO) plays an important role in the identity development of oneself. An individual with a high future orientation has a stronger focus on their future goals, plans their future better and organizes their life better. Studies have showcased that children who undergo ACE\u0026rsquo;s have lower future opportunities because of a lower future orientation, thereby impacting their planning, employment and future goals (Metzler et al., 2016). Based on studies conducted, a high future orientation reduces the chances of sexual behavior, violence, addictions and improved outcomes in relation to education (Johnson et al., 2016). All these factors are also caused due to Adverse Childhood Experiences, as per the CDC Kaiser study. Hence, having a high future orientation could be useful in the prevention of problems that Adverse Childhood Experiences could cause. Future orientation can be defined in a variety of ways but this study defines it as a process through which future related behaviors are \u0026nbsp;influenced by both cognitive and motivational/emotional factors. (Johnson et al.,2016). Future time Perspectives can be defined based on the \u0026nbsp;lifelong theory of motivation known as socioemotional selectivity theory that believes in the perspective that \u0026nbsp;people\u0026apos;s objectives change as time horizons get shorter, favoring future-oriented goals for those with more time and present-oriented goals for those with less time (Henry et al., 2017). The integration of the expected future into the psychological present is referred to as FTP. It consists of two main aspects: Content (showing what one expects to happen in the future) and Extension (showcasing how far into the chronological future an individual\u0026apos;s psychological future spans) (Seginer \u0026amp; Lens, 2014).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; It is not known to what extent the future orientation of patients with BPD is impacted but research states that the poor coping techniques, negatively biased thinking and difficulty in processing emotions could impact the thinking pertaining to the future in BPD individuals (Liu et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeed for the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; The goal of this study is to explore the psychological risk factors associated with Borderline Personality Disorder (BPD) in young adults, to better understand how these factors impact their future as they transition into adulthood. Most existing research has focused on the physical effects of Adverse Childhood Experiences (ACEs) on BPD. This study, however, is concentrated on the psychological aspects of ACEs and how they relate to emotional regulation and future orientation in young adults with BPD.Addressing problems from childhood early on can help individuals grow into healthier adults, both physically and mentally. It is important to understand how ACEs and parental involvement affect emotional regulation and future outlook in this population.The study focuses on young adults because BPD is easier to diagnose early on, and this age is crucial for intervention. Evidence shows that early treatment can significantly improve BPD in young people.This research was conducted in India to address a gap in studies that have mostly focused on Western populations. Indian cultural perspectives, which emphasize the relational and holistic view of individuals, are important for understanding and treating personality disorders. Traditional Western views on personality disorders often contrast with the Indian perspective, which sees the self as shaped by relationships and societal contexts. Therefore, it is important to consider these cultural differences when planning interventions for personality disorders in India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Review of Literature","content":"\u003cp\u003e\u0026nbsp; \u0026nbsp; Adverse childhood experiences (ACEs) and early developmental problems are common causes of Borderline Personality Disorder (BPD), a complex and multidimensional mental health disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;This research review examines the important role that adverse childhood experiences (ACEs), including emotional and physical abuse, neglect, and difficult parent-child relationships, have in the development of borderline personality disorder (BPD) symptoms, especially in young adults. The review also looks at how parenting methods, parental psychopathology, and emotional support affect a child\u0026apos;s psychological development.. Furthermore, the impact of Future Time Perspective (FTP) and emotion dysregulation on the presentation of BPD is examined, emphasizing the ways in which these variables interact within the Indian community, where there is a dearth of studies on these variables.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Prodromal symptoms frequently appear early in life, particularly in early adolescence, and there are predisposing factors for BPD that are already present in childhood (Miller et al., 2008; Kaess et al., 2014; Stepp and Lazarus, 2018). Borderline personality disorder is a \u0026nbsp;Personality Disorder (PD) that has been strongly linked to childhood traumas (Hasya, 2023) According to Bozetello\u0026apos;s study, high-risk individuals have a positive history of traumatic experiences, such as early emotional and/or physical abuse and neglect at the hands of caregivers (Johonson et al., 2000, 2001; Carlson et al., 2009; Belsky et al., 2012; Bornovalova et al., 2013); bullying by peers (Crowell et al., 2009; Kaess et al., 2014; Haltigan et al., 2015; Antila et al., 2017); persistent abnormalities in familial behaviors and parent-child relationships (Lyons-Ruth et al., 2015; Vanwoerden et al., 2017) and severe maternal psychopathology (Barnow et al., 2013; Stepp et al., 2015; Mahan et al., 2018). \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Similar to this, early psychopathology including depression, oppositional-defiant disorder, eating disorders, ADHD, and substance use disorders interact with negative childhood and adolescent experiences (ACE\u0026rsquo;s) as well as temperamental and personality traits to raise the risk of borderline personality disorder (BPD) in early life (Vaillancourt et al., 2014; Ha et al., 2014; Hallquist et al., 2015; Sharp et al., 2015; Conway et al., 2015; Stepp et al., 2019; Milijkovitch et al., 2018; Mahan et al., 2018; Bornovalova et al., 2018). \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; The link between ACE\u0026rsquo;s, parenting, and child psychopathology is gaining attention in the ACE literature because of the intergenerational impact of ACE\u0026rsquo;s. Due to their prominence in early life and ability to shape a child\u0026apos;s behavior later on, emotional availability and discipline techniques are two parenting facets that can deepen our understanding of the connections between ACEs, parenting, and child psychopathology from an attachment framework. A study conducted using PRISMA indicated a clear correlation between parental emotional support and punitive methods and ACEs. Dissociation and depression were found to be possible mediators. There was evidence to suggest the direct link between internalizing and externalizing problems in children and parental ACEs. Possible mediators were emotional availability, attachment, children\u0026apos;s experiences of abuse, and maternal anxiety and depressive symptoms\u0026nbsp;(Rowell \u0026amp; Neal-Barnett, 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Studies on parental involvement in BPD have focused mainly on three main aspects of parenting which could be a risk factor for BPD, they include: maladaptive parenting , poor parental styles and the parents \u0026nbsp;psychopathology\u0026nbsp; (Kaur \u0026amp; Sanches, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; A meta-analysis of ten research involving adult and pediatric populations found that those who experienced verbal abuse or hostility from their mothers were around three times more likely to develop borderline personality disorder (BPD). A prospective longitudinal study involving a sizable sample of 6,050 moms and their kids looked into the relationship between poor parenting practices, parent conflict throughout childhood, and symptoms of borderline personality disorder in later life. An ongoing study called the Children in the Community (CIC) Study examines how personality disorders (PDs) and other psychiatric problems develop in an epidemiological sample of over 800 young people. The CIC Study has used prospective data to track developmental trajectories over 20 years from adolescence into adulthood. It has also looked into the implications of comorbidity with Axis I disorders, early risks for Axis II disorders and symptoms (including both environmental factors such as parental involvement and early characteristics), and the associated negative prognostic risk of adolescent PDs into adulthood Parental personality issues have been linked to problematic parenting and symptoms and disorders in their offspring, according to recent articles that used data from the CIC study. Additional proof that dysfunctional parenting is associated with a higher likelihood of BPD symptoms in children has been presented by the studies.(Cohen et al., 2005). A study that looked at the reciprocal effects of negative emotionality, self-control, and harsh parenting between the ages of 5 and 14 predicted the onset of borderline personality disorder (BPD) symptoms in teenage girls between the ages of 14 and 17 and discovered a positive correlation between them . The study made clear that emotional issues that impede the development of emotion regulation may be made worse by a lack of self-control (Keenan et al., 2010). \u0026nbsp;According to Linehan, parental invalidation has a significant role in the development of borderline personality disorder. According to this theory, BPD arises from a childhood spent in an environment that invalidates emotional expression (e.g., parents who minimize or punish their children) (Parshall, 1995).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Stress during early life is thought to be a major factor in the development of borderline personality disorder (BPD) and could lead to emotional dysregulation in the patient. \u0026nbsp; A study included 63 healthy control volunteers and a sample of 49 BPD patients in order to look into the relationships between self-reported childhood trauma, difficulties regulating emotions, and these factors. The effect of self-reported childhood trauma, both in terms of quality and severity, on self-reported emotion regulation was assessed using multiple regression analysis. The findings confirmed a link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that the relationship between self-reported emotional abuse and acute symptomatology in the BPD subgroup is influenced by more challenges with emotion control. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;The exact nature of emotional dysfunction is still unknown, despite the fact that theory and research consistently identify it as a central disturbance in BPD. \u0026nbsp;(Crowell, Beauchaine, \u0026amp; Linehan, 2009; Lieb, Zanarini, Schmahl, Linehan, \u0026amp; Bohus, 2004; Trull, Tomko, Brown, \u0026amp; Scheiderer, 2010). Emotion dysregulation is known to be one of the main causes behind borderline personality disorder (BPD) and related pathologies, according to theory and research. However, many concerns concerning the precise role of emotion dysregulation in the development and treatment of BPD and its related challenges remain unsolved, despite the substantial studies demonstrating a link between emotion dysregulation and BPD (Park et al., 2020). A study conducted on the effect of self-reported childhood trauma, both in terms of quality and severity, on self-reported emotion regulation was assessed using multiple regression analysis.The findings confirmed a link between emotional regulation issues and self-reported maltreatment experiences, particularly emotional abuse and neglect. Further examination revealed that the relationship between self-reported emotional abuse and acute symptomatology in the BPD subgroup is influenced by more challenges with emotion control.\u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;A person\u0026apos;s ability to control affect and emotions is closely correlated with how they view the past, present, and future in relation to time, as well as how they perceive time is passing.Seventeen BPD patients between the ages of 18 and 52 participated in the study, and 17 control participants who were matched for gender, age, and educational attainment were also included.\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Foreseeing, anticipating, and making plans for future desirable outcomes are essential for motivation, behavior, and overall well-being. As a result, research on FTP is fragmented and focuses on different parts of the construct, employs different metrics, and evaluates various antecedents and consequences (Kooij et al., 2018). It is not known to what extent the future orientation of patients with BPD is impacted but research states that the poor coping techniques, negatively biased thinking and difficulty in processing emotions could impact the thinking pertaining to the future in BPD individuals (Liu et al., 2024). Individuals diagnosed with borderline personality disorder (BPD) exhibit inappropriate emotion-regulation techniques and increased negative affect. \u0026nbsp; According to the Zimbardo Time Perspective Inventory (ZTPI), patients with BPD exhibit aberrations in almost every temporal orientation. Specifically, they scored higher on the present-fatalistic and past-negative dimensions and lower on the future and past-positive dimensions. From the standpoint of balanced time, BPD patients deviate more than controls (BTP). Patients with BPD experience a general expansion of time in the present, but not the past, when it comes to the STQ. When combined, our findings demonstrate how a significant imbalance in each person\u0026apos;s time orientations and a likely unfavorable perception of an increase in subjective time in daily life can be linked to borderline personality disorder (BPD) (Mioni et al., 2020). Further studies suggest that BPD patients give more importance to short term relief of emotions over long term relief due to their impulsive tendencies and a poor future orientation \u0026nbsp;Chapman \u0026amp; Gratz (2007). Although these studies have not been conducted in an Indian context it becomes essential \u0026nbsp;to include this variable in the study as a reduced future orientation could harm the treatment outcomes devised for the patient Zanarini et al. (2011).\u0026nbsp;\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Methodology ","content":"\u003cp\u003e\u003cstrong\u003eAim\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; To study the impact of Childhood Traumas on Emotional Regulation and Future Orientation among young adults with BPD while factoring in the Mediating and Moderating effects of Parental Involvement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; To study the level of Adverse Childhood Experiences, Parental Involvement, Future Time Perspectives and Emotional regulation among young adult, BPD patients. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eH 1\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e: Childhood traumas will be negatively associated with emotional regulation among young adults with Borderline Personality Disorder (BPD).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e: Childhood traumas will be negatively associated with future orientation among young adults with BPD.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e: Higher levels of Adverse Childhood Experiences (ACEs) will be associated with lower levels of perceived Parental Involvement (PI) among young adults with Borderline Personality Disorder (BPD).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e:\u0026nbsp;Parental involvement will moderate the relationship between childhood traumas and emotional regulation, such that the negative effects of childhood traumas on emotional regulation will be stronger when parental involvement is low.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH 1\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e: Parental involvement will moderate the relationship between childhood traumas and future orientation, such that the negative effects of childhood traumas on future orientation will be stronger when parental involvement is low.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e: Parental involvement will mediate the relationship between childhood traumas and emotional regulation in young adults with BPD, such that higher levels of parental involvement will weaken the negative impact of childhood traumas on emotional regulation.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eH1\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Parental involvement will mediate the relationship between childhood traumas and future orientation in young adults with BPD, such that higher levels of parental involvement will weaken the negative impact of childhood traumas on future orientation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAdverse Childhood Experiences\u003c/li\u003e\n \u003cli\u003eParental Involvement\u003c/li\u003e\n \u003cli\u003eFuture Time Perspective\u003c/li\u003e\n \u003cli\u003eEmotional Regulation\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSite of Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;The study was conducted offline at (SRIHER) Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Period of Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;The study went on for a period of 7 months from February 2023- August 2024\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;A sample size of 40 participants, young adults diagnosed with BPD, \u0026nbsp;ranging between 18-40 years were chosen as the sample for the study. The participants were recruited from the Inpatient Psychiatry and Outpatient Psychiatry and Clinical Psychology department at the SRMC hospital. They were diagnosed by Psychiatrists and Clinical Psychologists at SRMC, using (International Personality Diagnostic Examination) IPDE and clinical interview methods.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurther, the participants were re-screened using the McLean Screening Instrument for BPD (MSI-BPD) \u0026nbsp;and only those who score \u0026lt;7 on a 10 item scale were recruited for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sample size for the study was based on (Ball and Links 2009), who reported the proportion of subjects with AED as 93%\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated according to the formula given by Lemeshow et al, 1990\u0026sup1;:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample size N\u003c/em\u003e\u003c/strong\u003e = \u0026nbsp; z1-/22\u0026times; p \u0026times; 1-p\u0026delta;\u0026sup2;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eProportion of subjects with AED:\u003c/em\u003e\u003c/strong\u003ep= 0.93 (93%)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePrecision\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u0026delta; = 0.075 (7.5%)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eType I error\u003c/em\u003e\u003c/strong\u003e: \u0026alpha; = 0.05 (5%), z1-\u0026alpha;/2 = 1.96; Beta = 20%, Power: 80%\u003c/p\u003e\n\u003cp\u003eBased on the formula and values given above:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample size required N\u003c/em\u003e\u003c/strong\u003e = [1.96\u0026sup2; x 0.93 x (1-0.93)] \u003cstrong\u003e/\u003c/strong\u003e 0.075\u0026sup2; \u0026nbsp;= 44.46 \u0026asymp; 45\u003c/p\u003e\n\u003cp\u003eThus, 95% confidence interval, the proposed sample size for the study is 45.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eParticipants diagnosed with Borderline Personality Disorder by a Psychiatrist/ Clinical Psychologists from SRIHER, Chennai . \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eParticipants ranging between 18-40 years of age.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHave not started taking therapy (1-2 sessions in exceptional cases).\u003c/li\u003e\n \u003cli\u003eIndividuals who have attained a minimum of 10 years of formal education.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eParticipants with intellectual disability (ID) or active psychosis.\u003c/li\u003e\n \u003cli\u003eParticipants residing outside of India.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collections Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Primary sources were used to get the data for this study. This technique of data collecting minimizes the impact of the researcher\u0026apos;s personal opinions on the findings and helps to lower the potential of errors in the study. Offline survey questions were used and given to participants who visited the SRMC Psychiatry IP and OP as well as the Clinical Psychology OP in order to measure the adverse childhood traumas of patients with BPP and its impact on the FTP and ER: mediating and moderating effect of parental involvement. Utilizing an offline survey approach offers a productive means of gathering information from a healthcare group. Based on the study characteristics and pertinent information, the questionnaires were chosen.The main technique of gathering data, which were the questionnaires, guarantees the validity, consistency, and reliability of the information gathered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Design\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;The study is a non experimental design using the ex post facto method. \u0026nbsp;An\u003cstrong\u003e\u003cem\u003e\u0026nbsp;ex post facto research\u003c/em\u003e\u003c/strong\u003e design is a method in which groups with qualities that already exist are compared on some dependent variable. Also known as \u0026quot;after the fact\u0026quot; research, an ex post facto design is considered quasi-experimental because the subjects are not randomly assigned - they are grouped based on a particular characteristic or trait.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSocio-demographic Details:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;Socio-demographic data sheet is a semi-structured socio-demographic data sheet prepared by the Investigator, which includes information regarding name/initials, age/date of birth, gender, birth order, number of siblings, education, occupation, and area of residence to procure basic information from the individual partaking in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScale 1: McLean Screening Instrument for BPD (MSI-BPD)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is a 10 item self report screening tool used to confirm the BPD diagnosis used in a population above the age 15 years of age (Zanarini et al.,2003).\u003c/p\u003e\n\u003cp\u003eReliability and Validity: Cronbach alpha of 0.78, the MSI-BPD states acceptable validity and reliability (Zanarini et al., 2003).In a sample\u0026nbsp;of students and community members, Gardner and Qualter (2009) discovered that the MSI-BPD had a strong\u0026nbsp;correlation with existing\u0026nbsp;BPD screening instruments. They also stated that\u0026nbsp;confirmatory factor analysis indicated that\u0026nbsp;the MSI-BPD is a suitable measure\u0026nbsp;for evaluating\u0026nbsp;BPD as a global construct.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScale 2: Adverse Childhood Experiences International Questionnaire\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;It is a 44 item screening questionnaire that is used to measure the various types of emotional and physical abuse, household dysfunction and various other kinds of trauma that lead to childhood adversity. It was formulated by the World Health Organization (WHO, 2018). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScale 3: Parenting Involvement Rating Scale\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scale was developed to measure parental involvement in their children\u0026apos;s education.It measures parental acceptance, aspirations, attention, encouragement, guidance, influence, decision making, parental provision of physical facilities and parental care to the physical fitness of the child.It is an Indian tool developed in Kochi, India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReliability and validity:\u003c/em\u003e\u003c/strong\u003e The reliability of the scale and its components and the internal consistency has been determined by the \u0026nbsp;test retest method. (Naseems \u0026amp; Gafoor, 2001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScale 4 : The Interpersonal Emotion Regulation Questionnaire (IERQ)\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Interpersonal Emotion Regulation Questionnaire (IERQ) is a tool designed to evaluate how well people manage their emotions when they don\u0026apos;t actively try to do so.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReliability and validity:\u003c/em\u003e\u003c/strong\u003e The IERQ and its four subscales: Enhancing positive affect; Perspective taking; Soothing and Social modeling all have excellent internal consistency and reliability. (Hofmann et al., 2016)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eScale 5 : Future Time Perspective Survey\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Future Time Perspective (FTP) scale measures a person\u0026rsquo;s perception of their future as being time-limited. Example of an item: How does your future look to you?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eReliability and validity:\u003c/em\u003e\u003c/strong\u003e Future Time Perspective Scale for Adolescents and Young Adults. between each factor and the total scale fall between 0.60 and 0.78 and are greater than the correlations between each factor, indicating that FTPS- AYA has good construct validity. (Lyu, 2016).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe study was conducted purely in an offline setting.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUpon being chosen by the clinicians to be a part of the study, the participants were contacted\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Inclusion criteria included participants who were young adults aged between 18-40 years and had been given a formal diagnosis of \u0026nbsp;BPD by Psychiatrists and Clinical Psychologists \u0026nbsp;from the Out-patient and In-patient Department of Psychiatry and the Out-patient Department of Clinical Psychology in Sri Ramachandra Institute of Higher Education and Research. Further, they had no prior history of taking psychotherapy. Individuals who have attained a minimum of 10 years of formal education.\u003c/li\u003e\n \u003cli\u003eAdditionally, another screening tool, McLean Screening Instrument for BPD, was used to re-confirm the diagnosis of BPD.\u003c/li\u003e\n \u003cli\u003eA physical form containing a brief of the study and consent to take part was handed over to the participants.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eUpon their agreement to participate in the study, the consent form was signed duly by each of the participants.\u003c/li\u003e\n \u003cli\u003eNext, a demographic sheet containing all the details of the participant was filled in by all the participants.\u003c/li\u003e\n \u003cli\u003eThe participants were then screened using the screening tool, ACE International questionnaire.\u003c/li\u003e\n \u003cli\u003eOnce the consent, demographic sheet and screening is complete the questionnaire was filled by all the participants for the study.\u003c/li\u003e\n \u003cli\u003ePost the collection of data, analysis using path analysis was initiated.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Result ","content":"\u003cp\u003eThe empirical results of a study examining the intricate interactions among young adults with Borderline Personality Disorder (BPD) and adverse childhood experiences (ACEs), future time perspectives (FTP), emotional regulation (ER), and the moderating and mediating effect of parental involvement are presented in this section.The results are organized into two main sections: first, an analysis of the relationships between ACEs PI, FTP and ER outcomes; and second, a look at the potential moderating and mediating effect of parental involvement on these relationships.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eAssociation between Total ACE Score and Parameters\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"629\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2782%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.4849%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal ACE Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2369%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2782%;\"\u003e\n \u003cp\u003eTotal PIRS***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.4849%;\"\u003e\n \u003cp\u003eCorrelation Coefficient (rho) = -0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2369%;\"\u003e\n \u003cp\u003e0.036\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2782%;\"\u003e\n \u003cp\u003eTotal FTP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.4849%;\"\u003e\n \u003cp\u003eCorrelation Coefficient (rho) = 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2369%;\"\u003e\n \u003cp\u003e0.548\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25.2782%;\"\u003e\n \u003cp\u003eTotal ER\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55.4849%;\"\u003e\n \u003cp\u003eCorrelation Coefficient (rho) = -0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2369%;\"\u003e\n \u003cp\u003e0.863\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe following variables were significantly associated (p\u0026lt;0.05) with the variable Total ACE Score , Total PIRS\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e***Significant at p\u0026lt;0.05, 1: Spearman Correlation, 2: Wilcoxon-Mann-Whitney U Test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;There is a statistically significant negative correlation between the total ACE score and parental involvement as shown in Table1.As the total ACE score increases, indicating more adverse childhood experiences, the perceived level of parental involvement decreases. There is a weak positive correlation between total ACE score and future time perspective, which suggests that ACEs do not have a significant impact on future time perspective in this sample. There is a very weak negative correlation between total ACE score and emotional regulation,suggesting that ACEs do not have a significant impact on emotional regulation in this sample. Based on this\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe null hypothesis is not rejected for H1 and H2 and therefore, H1 and H2 is not supported by the data. H3 is supported by the data and hence the null hypothesis is rejected. (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModeration Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eModeration Analysis for Parental Involvement between Adverse Childhood Experiences (ACE) and both Emotional Regulation (ER) and Future Orientation (FTP)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(i) For Emotional Regulation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eModeration: Model Summary for ACE, ER and PIRS\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e_____________________________________________________________________________\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"634\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 271px;\"\u003e\n \u003cp\u003eChange Statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eF Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e-.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e18.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e.416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 634px;\"\u003e\n \u003cp\u003eP \u0026nbsp; \u0026nbsp; Predictors: (Constant), Interaction, Parental Involvement, Mean of ACE\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 634px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dependent Variable: Emotional Regulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; From the above Table 2, we simplify that the correlation between these two variable groups is 0.274 which is a\u003cem\u003e\u0026nbsp;strong positive correlation\u003c/em\u003e\u003cstrong\u003e,\u003c/strong\u003e and the R\u003csup\u003e2\u003c/sup\u003e value is 0.075 which implies that \u003cem\u003e7.5% of the values in these two separate groups and the ACE is influenced with respect to parental involvement.\u0026nbsp;\u003c/em\u003eTo estimate \u0026nbsp;the linear relationship between the variables we will discuss further.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; The model explains a small proportion of the variance in Emotional Regulations.\u003c/em\u003e \u003cem\u003eThe interaction term does not significantly improve the model, albeit weakly.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;(ii) For Future Orientation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u0026nbsp;3\u0026nbsp;\u003c/strong\u003e\u003cem\u003eModeration: Model Summary for ACE, FTP and PIRS\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e____________________________________________________________________________\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 269px;\"\u003e\n \u003cp\u003eChange Statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eF Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e-.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e16.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e.906\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 631px;\"\u003e\n \u003cp\u003ePredictors: (Constant), Interaction, Parental Involvement, Mean of ACE\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 631px;\"\u003e\n \u003cp\u003eDependent Variable: Future Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;From the above Table 3, \u0026nbsp;we simplify that the correlation between these two variable groups is 0.123 which is positive correlation, and the R\u003csup\u003e2\u003c/sup\u003e value is 0.015 which implies that only1.5% of the values in these two separate groups and the \u003cem\u003eACE is influenced with respect to parental involvement.\u0026nbsp;\u003c/em\u003eTo estimate the linear relationship between the variables we will discuss further.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp;The model explains a small proportion of the variance in Future Orientation. The interaction term does not significantly improve the model, albeit weakly. \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; The moderation model postulated that parental involvement modifies the ways in which childhood adversity affects emotional regulation \u0026nbsp;or future time perspective in young adults diagnosed with borderline personality disorder (BPD). However, the data refuted this theory. Put another way, while the involvement of parents is influenced by childhood adversity, it does not appear to have an effect on the way in which childhood adversity affects young adults capacity for emotion regulation or future orientation This implies that other variables may have a greater influence on these result\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMediation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMediation analysis for Parental Involvement on the Adverse Childhood Experiences (ACE) and both Emotional Regulation (ER) and Future Orientation (FTP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable \u0026nbsp;4\u0026nbsp;\u003c/strong\u003e\u003cem\u003eRegression Coefficients for Predicting ER and FTP from PI and ACE\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e__________________________________________________________________________\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"634\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 16.7404%;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20.2695%;\"\u003e\n \u003cp\u003eUnstandardized \u0026nbsp;Coefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003eStandardized\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Coefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 4.9769%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e41.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e14.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e2.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003eParental\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003eACE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e1.317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 4.9769%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e42.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e13.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e3.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003eParental\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eInvolvement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e-.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e-.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e-.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.7635%;\"\u003e\n \u003cp\u003eACE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0257%;\"\u003e\n \u003cp\u003e.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6.1532%;\"\u003e\n \u003cp\u003e1.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.0489%;\"\u003e\n \u003cp\u003e.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 5.4293%;\"\u003e\n \u003cp\u003e.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 4.253%;\"\u003e\n \u003cp\u003e.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 57.2793%;\"\u003e\n \u003cp\u003eDependent Variable: Emotional Regulation andFuture Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; As shown in Table 4, we can depict that the PI of the patients on the emotional regulation and future orientation is not a significant mediator because both of its significance is\u003cem\u003e\u0026nbsp;greater than 0.05. So, we do not reject our null hypothesis H\u003csub\u003e06\u0026nbsp;\u003c/sub\u003eand H\u003csub\u003e07\u003c/sub\u003e.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;The hypothesized mediation model was not supported by the data.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eWhile ACE significantly predicts Parental Involvement, neither ACE nor Parental Involvement significantly predicts ER or FTP.\u0026nbsp;\u003c/em\u003eThese findings suggest that other factors may be more influential in determining Emotional Regulation and Future orientation among young adults with BPD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure\u003cem\u003e\u0026nbsp;\u003c/em\u003e2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eMediation and Moderation Model\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: X: Independent Variable (ACE), M: Mediator/Moderator (Parental Involvement), Y: Dependent Variables (ER and FTP)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results imply that negative childhood experiences are linked to modifications in parental participation, which is in line with other research, as shown in table 1 (Smith et al., 2020; Johnson \u0026amp; Lee, 2018). This can be related to a 2007 study, Zanarini, M. C., Williams, A. A., Lewis, R. E., Bradford Reich, R., \u0026amp; Frankenburg, F. R. investigated the connection between parental participation, early adversity, and the intensity of BPD symptoms in adulthood. Their research showed that, even in the face of strong ACEs, BPD patients who reported higher levels of positive parental involvement as children showed less severe BPD symptoms as adults. This shows that parental participation can affect a person with BPD's emotional and psychological results in a long-lasting way. In a clinical sample, Barnow, Spitzer, Kessler, H. J., Grabe, H. J., \u0026amp; Freyberger, H. J. (2006) investigated the moderating effect of parental participation in the link between ACEs and BPD. According to their research, having an attentive and supportive parent when growing up was linked to improved emotional regulation and a lower incidence of borderline personality disorder symptoms as an adult. This study emphasizes how crucial it is to take parental participation into account when evaluating the long-term impacts of ACEs on people with BPD. These findings can be linked to the current study showcasing the interaction between ACE and PI, in a BPD population. However in the study, emotional regulation improves with better parental involvement, this was not showcased in the present study as PI did not have any affect on the ER of the sample size. In contrast to certain theoretical frameworks (Khokhar \u0026amp; Kumari, 2024), this engagement had no discernible impact on our sample of young adults with BPD's future time perspectives or emotional regulation. This implies that although ACEs may have an effect on parental involvement, these particular psychological consequences in this population may not be strongly or directly predicted by it. These findings could be due to ample number of factors which include:\u003c/p\u003e \u003cp\u003e \u003cb\u003eCultural Differences\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn Asian cultures, especially in India, where cultural influences greatly impact symptom expression, there is a dearth of diagnosis and research on borderline personality disorder (BPD) (Hwang et al., 2008; Ziegenbein et al., 2008). Research shows that social norms and cultural expectations influence interpersonal functioning, emotions, and self-perception, which in turn influences BPD diagnosis and presentation (Jani et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Although parental participation is essential for reducing BPD symptoms, its effects may differ depending on the culture. Strong familial ties and emotional self-control are examples of traditional Indian practices that may serve as protective factors, lowering the overt manifestation of BPD symptoms (Paris, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). This shows that parental participation may not attenuate or moderate the effects of early trauma on emotional regulation and future direction in Indian communities, which could be explained by cultural differences.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSelf and Cultural Aspects\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe environment in which a person is raised and engages with others shapes their mental image of themselves. According to Markus and Kitayama (1991), people's sense of self varies depending on their cultural context and how it relates to important people. Asians have been noted by Lalonde et al. (2004) to develop an interdependent self, which is a more flexible and fluid vision that is bound to others. According to Cheung (1998), identity in Eastern cultures is shaped by interpersonal notions and is inextricably linked to significant persons. Identity creation and spread are influenced by culture and social structures since identity development occurs within a social setting. Once more, the family plays a very small part in helping people transcend their sense of self and identity; instead, people's identities are mostly dependent on their significant others and are typically examined in the context of interpersonal interactions. In this respect, parental involvement could be \u0026ldquo;not a very important factor\u0026rdquo; mediating or moderating the relationship between Trauma, FTP and ER, in a BPD population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClassificatory systems and Cross-Cultural Bias\u003c/b\u003e \u003c/p\u003e \u003cp\u003eStudies address the prevalence of Borderline Personality Disorder (BPD) worldwide and highlights differences in how it is classified in the DSM-5, CCMD, and ICD-10 systems. Cultural influences impact the symptoms of Borderline Personality Disorder (BPD), despite its stable genetic and neurobiological markers. Studies on borderline personality disorder (BPD) in various nations, particularly among immigrant groups, reveal cultural variations in the frequency of symptoms. These results underline the necessity of a single, dimension-based classification of BPD in order to reduce cross-cultural bias and enhance diagnosis precision. This could be another limitation as most studies on BPD have been done on a western population using the western classificatory systems such as DSM, which could make it harder to generalize or obtain the same results on an Indian population.\u003c/p\u003e \u003cp\u003e \u003cb\u003eHeterogeneity of the condition\u003c/b\u003e \u003c/p\u003e \u003cp\u003eStudies suggest that the heterogeneity of BPD, as a disorder in itself, poses a challenge in both clinical and research work (Cavelti et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Cavelti et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) have highlighted that the variety of BPD poses a substantial difficulty in clinical and research settings. There is a great deal of variation in the symptoms and behavioral patterns associated with BPD, which causes individuals to experience and manage their condition differently. The non-significant results for parental involvement in predicting future time perspectives and emotional regulation in our sample were probably influenced by this variability. Because BPD can present in a variety of ways, parental involvement may be important for some people but not for others, depending on a variety of reasons. As a result, the overall value of these interactions in our study may have been diminished. Subgroup analyses should be taken into account in future studies in order to account for this diversity and to investigate more specialized therapies that cater to the particular requirements of various BPD profiles.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWhile ACE significantly predicts Parental Involvement, neither ACE nor Parental Involvement significantly predicts ER or \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eFTP.These\u003c/span\u003e\u003c/span\u003e findings suggest that other factors may be more influential in determining Emotional Regulation and Future orientation among young adults with BPD. While studies conducted in a normal population have shown an impact of ACE of ER and FTP, the same variables on a BPD population did not yield the same results (Nayar, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eSignificance and Implication\u003c/h3\u003e\n\u003cp\u003eBy exposing the nuanced association between ACEs and psychological consequences in Indian individuals with Borderline Personality Disorder (BPD), this research challenges Western-centric presumptions. Although ACEs have a substantial impact on parental participation, they are not a reliable indicator of emotional regulation (ER) or future time perspective (FTP) in this situation, highlighting the importance of cultural influences. Since Indian collectivist beliefs could alleviate some of the psychological effects seen in Western civilizations, the study highlights the necessity for culturally appropriate treatment practices. Public health policies in India should prioritize early intervention for populations at risk, and future research should investigate other cultural modifiers.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe lack of homogeneity in the sample, which includes a range of age ranges, comorbid conditions, and cultural backgrounds, in addition to the small sample size and gender imbalance (31 females, 9 men), could have an impact on the study\u0026apos;s findings.\u003c/p\u003e\n\u003ch3\u003eFuture Research\u003c/h3\u003e\n\u003cp\u003eThe results may not be as broadly applicable as they could be due to this gender gap, especially considering the variations in BPD symptoms between the sexes. Furthermore, as BPD is underdiagnosed in Asian cultures like India, where emotional expression is frequently restricted, cultural considerations may also be important. Future studies should examine the effects of culture and gender on BPD outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDepartment of Health Research (DHR) / INDIAN COUNCIL OF MEDICAL RESEARCH (ICMR) Approved this study. Registration No: EC/NEW/INST/2023/TN/0321\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study was approved by\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eI provide consent for publication and I would produce documents required for the same.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eData is available for viewership, as physical forms- data was entered into the google forms and then excel, I have copies of all the above. \u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe authors declare that there are no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNo funds were obtained for the study.\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eSonakshi Nayar (corresponding author) was the main contributor to the study. All the three authors worked on the manuscript collective in the result, discussions and planning phase.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWe would like to express our heartfelt appreciation to our Head of Department, Dr. Neeradha Chandramohan, whose leadership and dedication have greatly influenced us and whose wisdom and encouragement have been a source of inspiration.\u003c/p\u003e\n\u003cp\u003eWe \u0026nbsp; are sincerely grateful to all the authorities and departments at Sri Ramachandra Institute of Higher Education and Research, whose timely assistance made this paper possible. Special thanks are due to the faculty members and support staff of the Department of Clinical Psychology and Psychiatry for their consistent support.\u003c/p\u003e\n\u003cp\u003eWe also wish to extend our deepest gratitude to the participants of this study for their willingness to share their personal experiences. Without their trust and openness, this research would not have been possible.\u003c/p\u003e\n\u003cp\u003eLastly, we are profoundly thankful to our friends, family, and God, who have been my constant pillars of support. Their encouragement and presence have been essential in bringing this paper to completion.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAntila, H., Arola, R., Hakko, H., Riala, K., Riipinen, P., \u0026amp; Kantoj\u0026auml;rvi, L. (2017). 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Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. \u003cem\u003eDevelopment and Psychopathology\u003c/em\u003e, \u003cem\u003e26\u003c/em\u003e(2), 361\u0026ndash;378. https://doi.org/10.1017/s0954579413001041\u003c/li\u003e\n \u003cli\u003eTrull, T. J., Tomko, R. L., Brown, W. C., \u0026amp; Scheiderer, E. M. (2010). Borderline personality disorder in 3-D: Dimensions, symptoms, and measurement challenges. \u003cem\u003eSocial and Personality Psychology Compass\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(11), 1057\u0026ndash;1069. https://doi.org/10.1111/j.1751-9004.2010.00312.x\u003c/li\u003e\n \u003cli\u003eTull, M. T., \u0026amp; Kimbrel, N. A. (2020). \u003cem\u003eEmotion in posttraumatic stress disorder: Etiology, assessment, Neurobiology, and treatment\u003c/em\u003e. Academic Press is an imprint of Elsevier.\u003c/li\u003e\n \u003cli\u003eU.S. Department of Health and Human Services. 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Impulsivity, defensive functioning, and borderline personality disorder. \u003cem\u003eThe Canadian Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(2), 81\u0026ndash;84. https://doi.org/10.1177/070674379604100204\u003c/li\u003e\n \u003cli\u003eVanwoerden, S., Kalpakci, A., \u0026amp; Sharp, C. (2017). The relations between inadequate parent-child boundaries and borderline personality disorder in adolescence. \u003cem\u003ePsychiatry Research\u003c/em\u003e, \u003cem\u003e257\u003c/em\u003e, 462\u0026ndash;471. https://doi.org/10.1016/j.psychres.2017.08.015\u003c/li\u003e\n \u003cli\u003eWeaver, T. L., \u0026amp; Clum, G. A. (1993). Early family environments and traumatic experiences associated with borderline personality disorder. \u003cem\u003eJournal of Consulting and Clinical Psychology\u003c/em\u003e, \u003cem\u003e61\u003c/em\u003e(6), 1068\u0026ndash;1075. https://doi.org/10.1037//0022-006x.61.6.1068\u003c/li\u003e\n \u003cli\u003eWhitaker, M. C. (2018). 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Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults. \u003cem\u003eJournal of Personality Disorders\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(5), 607\u0026ndash;619. https://doi.org/10.1521/pedi.2011.25.5.607\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adverse Childhood Experiences, Emotional Regulation, Future Time Perspectives, Parental Involvement, Young Adults, Borderline Personality Disorder","lastPublishedDoi":"10.21203/rs.3.rs-5361958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5361958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAdverse Childhood Experiences (ACEs) are known to have significant psychological and physiological impacts on various aspects of adult life. This study aimed to examine the influence of ACEs on Emotional Regulation (ER) and Future Time Perspective (FTP) in young adults diagnosed with Borderline Personality Disorder (BPD) within an Indian context.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThe study explored the mediating and moderating roles of Parental Involvement in these relationships. A sample of 40 young adults, both male and female, from the Inpatient and Outpatient Departments of Psychiatry and Clinical Psychology from SRMC hospital, diagnosed with BPD, were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe findings challenge established theoretical frameworks by showing that whereas ACEs strongly predict PI, neither ACEs nor PI were significant predictors of ER or FTP in this group. These results imply that the cultural setting, particularly the collectivist character of Indian society, may be a significant moderator of the psychological effects of early adversity in borderline personality disorder.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The paper also identifies other constraints that might have affected the results, such as a small sample size, gender imbalance, and cultural heterogeneity. Given the diversity in BPD symptomatology and the impact of culture, the study emphasizes the need for more research and interventions that are specifically suited to cultural differences.\u003c/p\u003e","manuscriptTitle":"Impact of ACE on Emotional Regulation and Future Time Perspectives in Borderline Personality Disorder: Mediating and Moderating Roles of Parental Involvement ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-27 05:28:43","doi":"10.21203/rs.3.rs-5361958/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe23f740-0abc-4229-ad1c-93cac28f0e12","owner":[],"postedDate":"November 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-17T10:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-27 05:28:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5361958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5361958","identity":"rs-5361958","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}