Associations between four types of childhood neglect and personality disorder symptoms during adolescence and early adulthood: findings of a community-based longitudinal study

Data from a community-based longitudinal study were used to investigate the association between childhood neglect and personality disorder (PD) symptom levels during adolescence and early adulthood. Psychosocial and psychiatric interviews were administered to a representative sample of 738 youths and their mothers from upstate New York in 1975, 1983, 1985-1986, and 1991-1993. Evidence of childhood cognitive, emotional, physical, and supervision neglect was obtained from the maternal interviews that were conducted in 1975, 1983, and 1985-1986, and from New York State records. PDs were assessed among the youths in 1985-1986, when they were adolescents, and in 1991-1993, when they were young adults. Findings indicated that childhood emotional, physical, and supervision neglect were associated with increased risk for PDs and with elevated PD symptom levels during adolescence and early adulthood, after age, sex, childhood physical or sexual abuse, other types of childhood neglect, and cooccurring PD symptoms were controlled statistically. Childhood emotional neglect was associated with increased risk for avoidant PD and with paranoid and Cluster A PD symptom levels during adolescence and early adulthood. Childhood physical neglect was associated with increased risk for schizotypal PD and with Cluster A PD symptom levels during adolescence and early adulthood. Childhood supervision neglect was associated with increased risk for passive-aggressive and Cluster B PDs and with borderline, paranoid, and passive-aggressive PD symptom levels during adolescence and early adulthood. The present findings suggest that childhood emotional, physical, and supervision neglect may play a role in the etiology of some PDs.     

The children in the community study of developmental course of personality disorder

The Children in the Community (CIC) Study is an ongoing investigation of the course of psychiatric disorders including personality disorders (PDs) in an epidemiological sample of about 800 youths. In addition to tracking developmental trajectories over 20 years from adolescence into adulthood, the CIC Study has used prospective data to investigate early risks for Axis II disorders and symptoms (including both environmental factors and early characteristics), implications of comorbidity with Axis I disorders, and associated negative prognostic risk of adolescent PDs into adulthood. The substantial independent impact of PD on subsequent Axis I disorders, suicide attempts, violent and criminal behavior, interpersonal conflict, and other problematic adult outcomes confirms the importance of attention to these problems when they manifest in early adolescence. The implications of study findings for potential changes in the DSM are discussed.     

Genetic and environmental contributions to the co-occurrence of depressive personality disorder and DSM-IV personality disorders

One of the main controversies with regard to depressive personality disorder (DPD) concerns the co-occurrence with the established DSM-IV personality disorders (PDs). The main aim of this study was to examine to what extent DPD and the DSM-IV PDs share genetic and environmental risk factors, using multivariate twin modeling. The DSM-IV Structured Interview for Personality was applied to 2,794 young adult twins. Paranoid PD from Cluster A, borderline PD from Cluster B, and all three PDs from Cluster C were independently and significantly associated with DPD in multiple regression analysis. The genetic correlations between DPD and the other PDs were strong (.53-.83), while the environmental correlations were moderate (.36-.40). Close to 50% of the total variance in DPD was disorder specific. However, only 5% was due to disorder-specific genetic factors, indicating that a substantial part of the genetic vulnerability to DPD also increases the vulnerability to other PDs.     

Relative impact of young adult personality disorders on subsequent quality of life: findings of a community-based longitudinal study

Little is known about long-term prognostic implications of personality disorder (PD) for quality of life (QOL) in the young adult population not selected for psychiatric treatment. The purpose of this study was to determine the association of PDs with QOL assessed after an 11-year interval. PDs were assessed in 1991-1994 at mean age 22, and indicators of QOL were assessed in 2001-2004 at mean age 33 based on a community sample of 588 young adults. Findings indicated that any PD, or a cluster A, B, or C PD each were independently associated with elevated impairment in overall QOL after adjusting for demographic variables, co-occurring Axis I disorder, and physical illness, and PDs in other clusters. Cluster B PD had a greatest adverse impact on QOL. Symptoms of antisocial, borderline, and schizotypal PD symptoms were independently associated with significant reductions in QOL; avoidant, paranoid, and dependent PD symptoms were associated with smaller reductions, not reaching statistical significance. Symptoms of other individual PDs were not associated with reduced QOL. PDs in young adults in the community have an enduring and adverse impact on subsequent QOL that cannot be attributed to physical illness or Axis I psychiatric disorder.     

The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence

This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.     

Development of personality disorder symptoms and the risk for partner violence

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men.     

Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.     

The structure of axis II disorders in adolescents: a cluster- and factor-analytic investigation of DSM-IV categories and criteria

The aim of this study was to ascertain whether the structure of personality disorder (PD) symptoms in adolescents assessed using DSM-IV diagnoses and diagnostic criteria resembles the structure intended for the diagnosis of PDs in adults. A national sample of clinicians rated DSM-IV Axis II criteria on 294 adolescent patients in treatment for enduring maladaptive personality patterns. Cluster analysis replicating procedures used in an adult sample by Morey (1988) identified considerable similarity between adult and adolescent PDs, as did exploratory factor analysis of ratings of diagnostic criteria, which yielded ten empirically derived factors that resembled the ten DSM-IV PDs. Cluster analysis and confirmatory factor analysis with indicators of Axis II symptoms produced mixed results in replicating the DSM-IV hierarchical structure of PDs (Clusters A, B, and C), although hierarchical models generally fared better than models specifying only first-order factors or clusters. The structure of personality pathology as assessed by Axis II criteria in adolescents resembles that outlined in DSM-IV Axis II for adults, suggesting that PDs can be assessed in adolescents as in adults. Whether this is an optimal way of diagnosing personality pathology in adolescence, however, requires further investigation.     

Severity of childhood attention-deficit hyperactivity disorder--a risk factor for personality disorders in adult life?

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.     

Predicting individual change in personality disorder features by simultaneous individual change in personality dimensions linked to neurobehavioral systems: the longitudinal study of personality disorders

Personality disorders (PDs), long thought to be immutable over time, show considerable evidence of individual change and malleability in modern prospective longitudinal studies. The factors responsible for the evident individual change in PDs over time, however, remain essentially unknown. A neurobehavioral model that posits negative emotion (NEM), nonaffective constraint (CON), communal positive emotion (PEM-C), and agentic positive emotion (PEM-A) as important systems underlying PD provides a theoretical basis for investigating predictors of change in PD features over time. Thus, in this study, the authors investigated how individual change in NEM, CON, PEM-C, and PEM-A over time predicted individual change in PD features over time, using longitudinal data on PD assessed by the International Personality Disorders Examination (A. W. Loranger, 1999), as well as data on normal personality features gathered within a 4-year prospective multiwave longitudinal study (N = 250). The authors used the method of latent growth modeling to conduct their analyses. Lower initial levels of PEM-C predicted initial levels of the growth trajectories for those with elevated Cluster A PD features. Elevated NEM, lower CON, and elevated PEM-A initial levels were found to characterize the initial levels of growth trajectories for those with increased Cluster B PD features. Interestingly, subjects with higher initial levels of PEM-A revealed a more rapid rate of change (declining) in Cluster B PD features over time. Elevated NEM and decreased PEM-C initial levels were found to characterize the growth trajectories for subjects with increased Cluster C PD features. The substantive meaning of these results is discussed, and the methodological advantages offered by this statistical approach are also highlighted.     

Confirmatory factor analyses of DSM-IV Cluster C personality disorder criteria

Notwithstanding its research and clinical relevance, the dimensionality and validity of the DSM-IV avoidant, dependent, and obsessive-compulsive personality disorders (PDs) criteria is still a largely unexplored topic. The aim of this study was to test the factor structure for DSM-IV Cluster C PD criteria in a sample of 641 consecutively admitted outpatients. Factor analysis results suggested that avoidant, dependent, and obsessive-compulsive PDs share a common latent dimension, and supported the three-factor structure of both observer and self-report ratings of DSM-IV Cluster C PD criteria. The pattern of factor loadings, however, was different from the one expected according to the DSM-IV classification.     

Personality disorders in patients with burning mouth syndrome

Burning Mouth Syndrome (BMS) presents high rates of comorbid Axis I disorders while no controlled studies have addressed the question of Axis II comorbidities. The aim of the present study was to examine DSM-IV (APA, 1994) Axis II comorbidity in BMS patients and to control for the specificity of this association. Seventy BMS patients were compared to a nonpsychiatric population sample and to patients with other Somatoform Disorders for the presence of personality disorders (assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders [SCID-II; First, Gibbon, Spitzer, & Williams, 1997). Prevalence rates were compared using the Pearson's chi square test. At least one personality disorder (PD) was found in 85.7%, 24.3%, and 88.6% of subjects in the three groups, respectively. When examining PD subgroups, significant differences emerged even between the BMS and the somatoform disorder group, with BMS patients showing more Cluster A and fewer Cluster B PDs. Our results suggest that BMS is associated with a specific pattern of Axis II comorbidity.     

Personality disorders and personality dimensions in anorexia nervosa

Information on the relationship between anorexia nervosa (AN) and personality disorders (PDs) and dimensions of temperament and character (measured by the Temperament and Character Inventory [TCI; Cloninger, Przybeck Svrakic, & Wetzel, 1994]) is limited. This study examines the predictive validity of the TCI for PD diagnoses assessed by the International Personality Disorder Examination-ICD-10 (IPDE-ICD-10; Loranger, Janca, & Sartorius, 1997) interviews of 46 women with DSM-IV-defined AN. Patients with a PD reported higher levels of harm-avoidance and lower levels of self-directedness than those without a PD. Scores on the TCI were predictive of the number of PD features present, particularly for those PDs in the anankastic, anxious, and dependent groups accounting for 40% to 51% of the variance. Cluster analysis based on scores on the TCI identified a subgroup of patients characterized by low levels of novelty seeking, self-directedness, and cooperativeness and high levels of harm avoidance. This cluster included the majority of those with avoidant, anxious, or dependent PDs. Assessment of particular personality dimensions was able to predict PDs in an anorexic sample. Since normal personality dimensions have greater validity than the categorical PDs, a consideration of normal temperament and character may assist in clinical decisionmaking and considerations concerning treatment.     

Predicting conflict within romantic relationships during the transition to adulthood

We conducted a retrospective study between 1997 and 2000 with 200 participants in the Children in the Community Study at their mean age of 29 (range: 27–31 years). Participants completed detailed narrative interviews about their transition to adulthood and described monthly levels of partner conflict that had occurred between ages 17 and 27. Data from these interviews were used to investigate the developmental trajectory and predictors of conflict in romantic relationships. Multilevel growth models showed that partner conflict increased between ages 19 and 25 and then declined slightly. Parental divorce, low parental socioeconomic status, being an only child, being divorced, being married, cohabiting, and having biological offspring were associated with elevated partner conflict. Different patterns of association between these variables and partner conflict were observed in men and women.     

Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults

Anxious and avoidant attachment were assessed in the Children in the Community (CIC) Study during adolescence and adulthood using self-report scales developed for this prospective study. The convergent and discriminant validity of the new CIC attachment scales were evaluated and their stability was assessed across a 17-year interval. Attachment scales predicted DSM-IV personality disorders in theoretically coherent and clinically meaningful ways, especially when supplemented with a separate measure of interpersonal aggression. Cluster B and C personality disorder symptoms were associated with elevated anxious attachment. Avoidant attachment was positively associated with Cluster A symptoms and inversely associated with Cluster B and C symptoms. Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters.     

Drinking motives as mediators in the relation between personality disorder symptoms and alcohol use disorder

Research shows high comorbidity between Cluster B Personality Disorders (PDs) and Alcohol Use Disorders (AUDs). Studies of personality traits and alcohol use have identified coping and enhancement drinking motives as mediators of the relation among impulsivity, negative affectivity or affectivity instability, and alcohol use. To the extent that certain PDs reflect extreme expression of these traits, drinking motives were hypothesized to mediate the relation between PD symptoms and presence/absence of an alcohol use disorder (AUD). This hypothesis was tested using a series of cross-sectional and prospective path models estimating the extent that coping and enhancement drinking motives mediated the relation between cluster A, B, and C PD symptom counts and AUD diagnosis among a sample of 168 young adults between ages 18 and 21. Enhancement motives mediated the cross-sectional relation between Cluster B symptoms and AUD. Prospectively, enhancement motives partially mediated the relation between Cluster B personality symptoms and AUD through the stability of Year 1 AUD to Year 3 AUD. Results suggest that enhancement motives may be especially important in understanding the relation between Cluster B personality disorders and AUDs.     

Dimensions of Normal and Abnormal Personality: Elucidating DSM‐IV Personality Disorder Symptoms in Adolescents

ABSTRACT The present study aimed to elucidate dimensions of normal and abnormal personality underlying DSM‐IV personality disorder (PD) symptoms in 168 adolescents referred to mental health services. Dimensions derived from the Big Five of normal personality and from Livesley's (2006) conceptualization of personality pathology were regressed on interview‐based DSM‐IV PD symptom counts. When examined independently, both models demonstrated significant levels of predictive power at the higher order level. However, when added to the higher order Big Five dimensions, Livesley's higher and lower order dimensions afforded a supplementary contribution to the understanding of dysfunctional characteristics of adolescent PDs. In addition, they contributed to a better differentiation between adolescent PDs. The present findings suggest that adolescent PDs are more than extreme, maladaptive variants of higher order normal personality traits. Adolescent PDs seem to encompass characteristics that may be more completely covered by dimensions of abnormal personality. Developmental issues and implications of the findings are discussed.     

The association of affiliation and achievement personality styles with DSM-IV personality disorders

Investigators from theoretically diverse backgrounds have long described two personality styles associated with depression. The affiliation style describes individuals with interpersonal concerns; the achievement style describes individuals who have concerns with personal failure. Although primarily related to risk for depression, there has also been recognition that extreme forms of these styles are related to personality disorders (PDs). The current study examines the relation between the DSM-IV PDs and the two personality styles, assessing the latter using two approaches: (a) dependency/self-criticism (Blatt, 1974) and (b) sociotropy/autonomy (Beck, 1983). Results show that whereas the achievement style is associated with most PDs (except for the histrionic and dependent PDs), the affiliation style is associated only with histrionic, dependent, and depressive PDs. Controlling for shared PD variance leaves only two associations, affiliation with dependent PD and achievement with narcissistic PD. Results are discussed in the context of current efforts to capture personality psychopathology within a comprehensive dimensional framework.     

Early maladaptive schemas in personality disordered individuals

The present study aimed to examine the specificity of schema domains in three personality disorder (PD) groups, namely borderline (BPD), obsessive-compulsive (OCPD), and avoidant PD (AvPD), and to correctly identify the three PD groups on the basis of these schemas. The sample consisted of 48 clinical participants diagnosed with PDs and assigned to 1 of 3 groups on the basis of their Axis II diagnoses (BPD: n = 13; OCPD: n = 13; AvPD: n = 22). High scores on Dependence/Incompetence, Defectiveness/ Shame and Abandonment were found for the BPD group. Such pattern appears to be most consistent with Young's theory of BPD. Consistent with the theory and empirical findings of Beck et al. (1990, 2001), OCPD was associated with elevations on the Unrelenting Standards schema domain, but not on Emotional Inhibition, which was found to be elevated for AvPD. In conclusion, the present study suggests that there are different patterns of schema domains across different PDs and that the Schema Questionnaire (SQ) is potentially useful in differentiating between these PDs.     

Distinguishing general and specific personality disorder features and implications for substance dependence comorbidity

Clinical and population-based samples show high comorbidity between Substance Use Disorders (SUDs) and Axis II Personality Disorders (PDs). However, Axis II disorders are frequently comorbid with each other, and existing research has generally failed to distinguish the extent to which SUD/PD comorbidity is general or specific with respect to both specific types of PDs and specific types of SUDs. We sought to determine whether ostensibly specific comorbid substance dependence-Axis II diagnoses (e.g., alcohol use dependence and borderline personality disorder) are reflective of more pervasive or general personality pathology or whether the comorbidity is specific to individual PDs. Face-to-face interview data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Participants included 34,653 adults living in households in the United States. We used hierarchical factor models to statistically partition general and specific personality disorder dimensions while simultaneously testing for specific PD-substance dependence relations. Results indicated that substance dependence-Axis II comorbidity is characterized by general (pervasive) pathology and by Cluster B PD pathology over and above the relationship to the general PD factor. Further, these relations between PD factors and substance dependence diagnoses appeared to largely account for the comorbidity among substance dependence diagnoses in the younger but not older participants. Our findings suggest that a failure to consider the general PD factor, which we interpret as reflecting interpersonal dysfunction, can lead to potential mischaracterizations of the nature of certain PD and SUD comorbidities.