Part III - Etiology
Child Development and Personality Disorder

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The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder—antisocial PD—in a minority of those with the adolescent disorder.

Section snippets

What is “personality” and how does it develop?

Actual empirical studies of the development of PD covering more than a limited section of the period from birth or very early life to adulthood are sparse. Nevertheless, the last decade has been a very fertile one for increasing convergence on models of personality development, arising in particular from evolving conceptions of the origins and role of personality. These newer models present personality as arising from the combination of basic and universal emotions and emotion-related

Assessment of personality disorder or components of personality disorder in childhood: current status

An examination of the published empirical literature on developmental aspects of PD shows that most of this work focuses either on borderline or antisocial PD.

Assessment of personality disorder in children and adolescents

Several measures of most or all PD disorders or symptoms in children or adolescents have been developed and employed. The Schedler-Westen Assessment Procedure-200 for Adolescents [39] is a Q-sort instrument designed for clinicians to use for adolescent patients. An assessment based on a checklist of the DSM criteria has also been shown to relate to other variables comparably to a structured diagnostic interview and thus provides a reasonable substitute. In addition, this research team obtained

Demographic Risks for Pre-Adult Personality Disorder

Analyses undertaken for somewhat different purposes showed a series of risks reported in early childhood to predict an aggregate measure of PD symptoms in both late adolescence and early adulthood. These risks include low socioeconomic status (SES) of family, being raised in a single-parent family, welfare support of family, parental death, and social isolation [46]. In aggregate, the early adolescent risks predicted 28% of the variance in PD symptoms 9 years later in adulthood. Related

Childhood abuse and neglect as predictors of personality disorder

A recent literature review has provided a detailed summary of published research findings regarding the empirically demonstrated associations of childhood physical, sexual, and emotional abuse, and childhood neglect with PD during adolescence or adulthood [56]. These different forms of abuse or neglect often occur together and reflect general severely inadequate or even malevolent parenting, but sexual abuse in particular may often not involve parents except as inadequate supervisors and

Other specific early signs of personality disorder

Although data on neurobiological correlates of childhood PD is yet to be widely explored, two indicators of problematic executive function, the Wisconsin Card Sorting Test and the Continuous Performance Test have been shown to be abnormal in school-age day treatment children with borderline pathology [59].

Early social inhibition has been shown to be associated with avoidant disorder in young offspring of parents with panic disorder, major depression, both, and neither [60]. Self-mutilation in

Stability of personality disorder from childhood to adulthood

Chronicity of adult personality disorder is associated with early onset as retrospectively reported in clinical populations [66]. Early adolescent clinical cases of disruptive behavior disorders were more likely to have Cluster B disorders at mean age 43, and adolescent girls with emotional disorders had elevated rates of Cluster C PD [67]. Nevertheless, early symptoms of PD are not necessarily followed by adult disorder. Most of the current data on the course of personality disorder in

Predictive relationships and comorbidity of childhood/adolescent Axis I disorders and personality disorders

Comorbidity among the PDs in adolescence was high in the CIC cohort, with about half of those with any PD also meeting diagnostic criteria for one or more other PDs [69]. An effort to understand this relationship was examined in a study of potential reciprocal effects of longitudinal courses of borderline and narcissistic PD symptoms from adolescence to adulthood [72]. Both sets of symptoms are highest in the early adolescent period, and correlated throughout. When narcissistic PD symptoms are

Prognostic implications of early personality disorder and elevated personality disorder symptoms

Findings are beginning to accumulate regarding the long-term functional prognosis associated with PD assessed in adolescence. Several studies of the CIC cohort investigated prognostic implications of adolescent PD for young adult problems (mean age 22). Crawford and colleagues [81] showed a prediction by adolescent Cluster B PD of low intimacy and well-being that increased as young people entered adulthood. Conflict with family members was high during the transition to adulthood (ages 17 to 27)

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