School climate and continuity of adolescent personality disorder symptoms.

BACKGROUND: Schools are key social contexts for shaping development and behavior in youths; yet, little is known of their influence on adolescent personality disturbance. METHOD: A community-based sample of 592 adolescents was assessed for family and school experiences, Axis I psychiatric disorders, and Axis II personality disorder (PD) symptoms, and followed into young adulthood. Multiple regression analysis was used to estimate associations between adolescent-reported school climate and young adult PD symptoms independent of age, sex, family socioeconomic status; childhood maltreatment; Axis I disorder, PD symptoms, academic grades, and parental punishment in adolescence; and four dimensions of school climate. RESULTS: Schools characterized as high in learning focus were related to cluster B (antisocial, borderline, histrionic, and narcissistic PD) symptom declines, whereas schools characterized as high in opportunities for student autonomy were related to cluster A (paranoid, schizoid, and schizotypal PD) symptom declines. In contrast, schools characterized as conflictual or supporting interpersonal informality/familiarity among students and teachers were related to increases in cluster A symptoms and cluster C (avoidant, dependent, and obsessive-compulsive PD) symptoms. CONCLUSIONS: Schools may exert both positive and negative influences on continuity of adolescent personality disturbance. The role of the school in guiding young people toward more favorable developmental pathways and alleviating personality disturbance is discussed.

Early maternal separation and the trajectory of borderline personality disorder symptoms.

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

Comorbid Axis I and Axis II disorders in early adolescence: outcomes 20 years later.

CONTEXT: Although Axis II personality disorders in adolescence have been linked to psychopathology and psychosocial impairment in early adulthood, little is known about their effects over longer periods. OBJECTIVES: To evaluate and compare long-term prognoses of adolescent personality disorders and co-occurring Axis I disorders. DESIGN: Population-based longitudinal study. SETTING: Upstate New York. PARTICIPANTS: A community sample of 629 adolescents interviewed at a mean age of 13.8 years and again at a mean age of 33.2 years. MAIN OUTCOME MEASURES: Clinically assessed psychiatric disorders and self-reported attainment and function. RESULTS: Axis I (mood, anxiety, disruptive behavior, and substance use disorders) and Axis II disorders in adolescence showed risks for negative prognoses lasting 20 years. Co-occurring Axis I and Axis II disorders consistently presented the highest risk, often approximating the sum of the axis-associated risk or even several times the risk of disorders in either axis alone. CONCLUSIONS: Long-term prognoses of Axis I and Axis II disorders are of comparable magnitude and often additive when comorbid. These findings are highly relevant to the current debate over how personality disorders should be handled in DSM-V.

How affect regulation moderates the association between anxious attachment and neuroticism.

Correlations between anxious attachment and neuroticism (usually about .40 to .50) prompt questions about whether self-reported anxious attachment captures a key construct in attachment theory or if it reflects a more general personality trait instead. A college sample of late adolescents and young adults (N = 287) was used to show that questionnaire measures of neuroticism and anxious attachment do not have a simple linear association; instead, neuroticism and anxious attachment have a more complex dynamic relationship that is moderated by avoidant attachment, an attachment style that reflects an interpersonally derived strategy for affect regulation. The association between neuroticism and anxious attachment is further moderated by conscientiousness, a personality trait that may reflect a more biologically mediated system of affect regulation. These separate moderating effects and the different affect regulation systems they reflect are discussed in the context of longstanding debates about how personality traits and attachment styles influence each other.

Personality disorder and impaired functioning from adolescence to adulthood.

BACKGROUND: Little is currently known about functioning and impairment during adulthood associated with the course of personality disorders. AIMS: To investigate the association of personality disorder stability from adolescence through middle adulthood with measures of global functioning and impairment, using prospective epidemiological data. METHOD: A community-based sample of 658 individuals was interviewed at mean ages 14, 16, 22 and 33 years. RESULTS: Individuals with persistent personality disorder had markedly poorer functioning and greater impairment at mean age 33 years than did those who had never been identified as having such disorder or who had a personality disorder that was in remission, after co-occurring Axis I disorders at age 33 years were taken into account. Remitted disorder was associated with mild long-term impairment. Adult-onset personality disorders, however, were also associated with significant impairment. CONCLUSIONS: Persistent and adult-onset personality disorders are associated with functional impairment among adults in the community. These effects are independent of co-occurring Axis I disorders.

Personality disorders in early adolescence and the development of later substance use disorders in the general population.

Assessments of personality disorder (PD) and conduct disorder (CD) in a random community sample at mean age 13 were employed to predict subsequent substance abuse disorder (SUD), trajectories of symptoms of abuse or dependence on alcohol, marijuana, or other illicit substances, and hazard of initiating marijuana use over the subsequent decade. Personality disorders and conduct disorder were associated with diagnoses and symptoms of SUDs in every model and their effects were independent of correlated family risks, participant sex, and other Axis I disorders. Specific elevated PD symptoms in early adolescence were also associated with differential trajectories of already initiated SUD symptoms as well as elevated risk for future onset of SUD symptoms. For several models the greatest of these effects were shown for borderline PD and for conduct disorder, the predecessor of adult antisocial PD. Passive-aggressive PD also showed independent elevation effects on substance use symptoms for alcohol and marijuana. Analyses over 30 years suggest that Cluster B PD (borderline, histrionic, narcissistic) are independent risks for development of SUD and warrant clinical attention.

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.

Gender differences in the age-changing relationship between instrumentality and family contact in emerging adulthood.

Data from the Children in the Community Transitions Study were used to examine gender differences in the impact of family contact on the development of finance and romance instrumentality from ages 17 to 27 years. Family contact decreased among both men and women across emerging adulthood, although it decreased more rapidly in men than in women. Both finance and romance instrumentality increased for men and women across emerging adulthood. The growth rate did not differ between men and women in either domain, although men tended to be characterized by higher levels of instrumentality than women. There were noteworthy gender differences in the impact of family contact on the development of instrumentality. At age 17, family contact was negatively associated with instrumentality for both men and women; at age 27, the impact of family contact on instrumentality was less negative for women and was positive for men.

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.

Associations of parental personality disorders and axis I disorders with childrearing behavior.

Data from the Children in the Community Study, a community-based longitudinal investigation, were used to investigate the associations of parental anxiety, depressive, substance use, and personality disorders with parental child rearing behavior. Comprehensive psychosocial interviews, including assessments of child rearing, were conducted with 224 women and 153 men (mean age = 33 years; mean off- spring age = 8 years). Findings indicated that parental personality disorders were associated with parental possessiveness, inconsistent parental discipline, low parental communication, and low parental praise and encouragement. These associations remained significant when parental gender, offspring gender, and co-occurring parental disorders were controlled statistically. Parental anxiety disorders were independently associated with parental possessiveness. Parents with personality disorders were substantially more likely than parents without personality disorders to report engaging in multiple problematic child rearing behaviors. This association was not moderated by co-occurring parental disorders. These findings suggest that the presence of a parental personality disorder may be associated with an elevated likelihood of problematic parenting behavior during the child rearing years.

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.

Self-reported personality disorder in the children in the community sample: convergent and prospective validity in late adolescence and adulthood.

Approximately 800 youths from the Children in the Community Study (Cohen & Cohen, 1996) have been assessed prospectively for over 20 years to study personality disorders (PDs) in adolescents and young adults. In this article we evaluate the Children in the Community Self-Report (CIC-SR) Scales, which were designed to assess DSM-IV PDs using self-reported prospective data from this longitudinal sample. To evaluate convergent validity, we assessed concordance between the CIC-SR Scales and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1995) in 644 participants at mean age 33. To assess predictive validity, we used CIC-SR Scales at mean age 22 to predict subsequent CIC-SR and SCID-II Personality Questionnaire scores at mean age 33. In these analyses the CIC-SR Scales matched or exceeded benchmarks established in previous comparisons between self-report instruments and structured clinical interviews. Unlike other self-report scales, the CIC-SR did not appear to overestimate diagnoses when compared with SCID-II clinical diagnoses.

Adolescent personality disorders and conflict with romantic partners during the transition to adulthood.

Longitudinal data were used to investigate the association of adolescent personality disorders with conflict between romantic partners during the transition to adulthood (i.e., age 17 to 27). Findings indicated that adolescent personality disorders (PDs) assessed at mean age 16 were associated with subsequent elevated partner conflict. Cluster B PD was associated with sustained elevations in partner conflict throughout the transition to adulthood. Cluster A and C PDs were associated with elevated partner conflict before age 23. Paranoid, schizoid, schizotypal, borderline, narcissistic, and obsessive-compulsive PD symptoms were independently associated with sustained elevations in partner conflict.