Integrating a developmental perspective in dimensional models of personality disorders

Maladaptive Self- and Interpersonal Functioning Increments General Psychiatric Severity in the Association with Adolescent Personality Pathology

Dimensionalized diagnostic systems, especially the entry criterion of maladaptive self and interpersonal functioning, hold particular advantages for the downward extension of personality pathology to young persons, but require conceptual clarification. The current study evaluated the distinctiveness of maladaptive self and interpersonal functioning by examining its incremental value over and above general psychiatric severity in the association with personality pathology. A community sample of N = 419 youth (50.4% female; M_age = 11.91, SD = 1.19) between the ages of 10 and 14 completed measures of maladaptive self- and interpersonal functioning, general psychiatric severity (internalizing-externalizing spectrum), and personality pathology. Results showed that, as expected, maladaptive self- and interpersonal functioning incremented general psychiatric severity in the association with personality pathology in adolescents. Results contribute to the literature base illustrating the value of the entry criterion of the ICD-11 and AMPD diagnostic system.

Towards a better understanding of adolescent obsessive-compulsive personality traits and obsessive-compulsive symptoms from growth trajectories of perfectionism

Although there is increasing attention for the interrelationship between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD), their shared characteristics in terms of childhood trait antecedents remain understudied. Perfectionism may be a viable candidate trait antecedent, given its role in the clinical manifestation of both OCPD and OCD in adulthood, and the evidence that perfectionism reflects a dispositional tendency observable from childhood onwards. However, little is known about childhood trajectories of perfectionism with prospective links to later OCPD versus OCD. Using latent growth curve modeling, this study explored the baseline and growth of childhood perfectionism in 485 community and referred children (55.5% girls, 7.17-14.78 years old, Mage = 10.74, SD = 1.50) across three waves. Adolescent OCPD traits and OCD symptoms were measured in Wave 4. An overall decreasing trend of perfectionism from childhood through adolescence appeared, without inter-individual differences in growth. Individual differences in baseline levels of childhood perfectionism were significant, and equally predicting adolescent OCPD and OCD outcomes. At a more specific level, childhood perfectionism predicted most strongly the rigid perfectionism component of OCPD, and the orderliness/cleanliness/perfectionism and obsession domain of OCD. This demonstrates the value of childhood perfectionism for understanding differential outcomes of adolescent OCPD traits and OCD symptoms.

Leisure Satisfaction, Personality, and Psychosexual Adjustment Among College Students: A Latent Profile Analysis

Although the factors influencing sexual health have been explored by researchers, the impact of leisure and personality on psychosexual adjustment and the interaction of these two factors remain unknown. This study investigated the relationship between leisure satisfaction and psychosexual adjustment based on the compensation theory and the social learning theory. The differences in psychosexual adjustment across different personality types were also explored. Finally, we examined the interaction between personality and leisure satisfaction based on the personal-environment fit models. The participants in this study were 1,161 college students. The results supported all the hypotheses proposed. There was a significant positive correlation between leisure satisfaction and psychosexual adjustment. Participants of four personality types (the overcontrolled, high-moderate, low-moderate, and resilient groups) had different performance in psychosexual adjustment. The resilient group had the highest scores, while the overcontrolled group had the lowest scores. The results suggest that there is an interaction between personality and leisure satisfaction. Our research could enrich the research contents of leisure and personality and provide a practical basis for the improvement of college students in psychosexual adjustment.

Personality Disorders in Childhood: Validity of the Coolidge Personality and Neuropsychological Inventory for Children (CPNI)

BACKGROUND

A growing body of evidence has shown that maladaptive traits and emerging patterns of personality can be traced to an early stage of development and may be assessed in childhood. The goal of present study was to provide preliminary data on the validity of the Coolidge Personality and Neuropsychological Inventory for Children (CPNI), an instrument designed to assess personality pathologies and other clinical conditions in childhood.

METHOD

A sample of 146 clinicians completed the CPNI, as well as the Child Behavior Checklist (CBCL) to evaluate the behavioral problems and social competencies, regarding a child (aged 6-11 years) who had been in their care between 2 and 12 months. The clinicians also filled out a clinical questionnaire to provide information on the children, their families, and psychotherapies.

RESULTS

There were significant and clinically consistent associations between the CPNI and CBCL. They confirmed the good concurrent (convergent and discriminant) validity of the CPNI.

CONCLUSIONS

The findings seem to support the validity of the CPNI as diagnostic instrument, taking children's PDs and behavioral problems into account. Despite some limitations, the CPNI represents a helpful measure to evaluate the children's personality configurations according to the DSM model. It may be employed along with other tools based on other diagnostic frameworks within the context of a multi-method and multi-informant assessment to provide an accurate and comprehensive formulation of children's overall functioning.

Thin slice derived personality types predict longitudinal symptom trajectories

Resilient, undercontrolled, and overcontrolled personality types have been identified across the life span and are associated with psychiatric symptoms and functioning. However, it is unknown whether these types are identifiable in preschool-aged children using observational indices or whether they predict longitudinal outcomes. The current study used observationally coded five-factor model (FFM) traits in a sample of preschoolers to identify whether personality traits cluster into types, whether types predict psychiatric symptoms and impairment across development, and whether types better predict outcomes than trait dimensions. Using a validated "thin slice" approach, preschool personality was observationally coded in a clinically enriched sample oversampled for depression (N = 299). Latent class analysis tested how FFM dimensions organized into types, identifying resilient, undercontrolled, and overcontrolled preschoolers. Types demonstrated baseline diagnostic differences and multilevel models indicated above baseline diagnoses, undercontrolled children exhibited elevated externalizing symptoms and worse functioning across development, whereas overcontrolled and resilient children did not differ. Personality types and dimensions both provided similar predictive utility. Resilient, undercontrolled, and overcontrolled personality types are identifiable using FFM observational coding in clinically heterogeneous preschoolers and undercontrolled children demonstrated the most severe trajectories. Findings highlight that personality types are detectable at early ages and have unique predictive power for psychiatric outcomes across development compared with dimensions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A meta‐analysis of psychopathy‐, antisocial PD‐ and FFM associations

This research meta‐analytically summarizes the relationships of the Five‐Factor Model (FFM) with psychopathy and Antisocial Personality Disorder (APD). Effect sizes of the associations between psychopathy, APD and the FFM were compiled from 26 independent samples (N = 6913) for psychopathy and 57 independent samples (N = 16 424) for APD. The results revealed predominantly points of similarity and some differences in the FFM associations of both disorders. Symptoms of psychopathy and APD were negatively associated with Conscientiousness and Agreeableness facets and positively with scores on Angry–Hostility (N2), Impulsiveness (N5), Excitement Seeking (E5) and negatively with Warmth (E1). Only psychopathy had a small negative association with Anxiety (N1) and was characterized by stronger negative associations with Agreeableness and Straightforwardness (A2), Compliance (A4) and Modesty (A5) compared to APD. The moderator analyses showed that sample type, use of the NEO‐PI‐R and APD instrument moderated the APD FFM associations, while psychopathy instrument and age group were moderators in the psychopathy MA. Implications of this research for the assessment of APD and psychopathy relying on dimensional models of personality pathology are discussed. Copyright © 2009 John Wiley & Sons, Ltd.

Developmental Course of Personality Disorder Traits in Childhood and Adolescence

Developmental patterns of personality pathology traits are not well delineated from childhood through late adolescence. In the present study, participants (N = 675, 56% female) were recruited to create three cohorts of third (n = 205), sixth (n = 248), and ninth (n = 222) graders to form an accelerated longitudinal cohort design. We assessed six PD (avoidant, dependent, histrionic, narcissistic, borderline, schizotypal) traits based on DSM-IV trait diagnostic conceptualizations via parent report at baseline, 18 months, and 36 months. According to parent report, mean levels of avoidant, dependent, histrionic, narcissistic, borderline, and schizotypal traits all declined for both boys and girls. The changes in dependent and histrionic traits were of medium effect size, and the changes in avoidant, narcissistic, borderline, and schizotypal traits were of small effect size. Over the 3 years of the study, the traits of each PD also demonstrated moderate to high rank-order stability.

Relational Aggression and Narcissistic Traits: How Youth Personality Pathology Informs Aggressive Behavior

Low agreeableness features centrally in personality profiles of Cluster B personality disorder (PD) diagnoses, and it has been associated with relational aggression (RAgg; intentionally damaging others' social relationships). Researchers have hypothesized that RAgg may be a potential developmental precursor for Cluster B PDs. However, a dimensional approach to personality dysfunction is preferable to the categorical system found in the current diagnostic manual. To build a bridge between two disjointed literatures (categorical PDs and RAgg), the aim of this project is to detail how RAgg in youth is situated in the trait space represented by disagreeableness in a dimensional model of personality pathology. Caregivers of 911 youth (ages 6-18) reported on youth's RAgg and disagreeableness. We found that RAgg was most strongly related to three facets: Narcissistic traits, Hyperexpressive traits, and Dominance-Egocentrism traits. Overall, these findings provide support for RAgg as an early manifestation of personality pathology, particularly for narcissistic traits.

The p factor and dimensional structural models of youth personality pathology and psychopathology

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a developing dimensional nosology which provides a joint framework for study of psychopathology and personality pathology. Dimensional structural models of psychopathology often include an overarching dimension of psychopathology (p factor) representing covariation among all forms of psychopathology. The p factor can be recovered in youth and adult samples, and has been found to relate to personality traits in similar ways in youth and adults. However, placement of personality pathology in an overarching psychopathology structure has almost exclusively been investigated in adults. We review evidence for the relationships between normal-range and pathological personality traits and psychopathology in adults and youth, ultimately making the case for study of a joint personality - psychopathology framework in youth.

Adolescent Personality Pathology and the Alternative Model for Personality Disorders: Self Development as Nexus

This paper reviews maladaptive trait development (DSM-5 Section III Criterion B), the development of DSM-5 Section II borderline personality disorder, and research on the development of identity, self-direction, empathy/mentalizing, and intimacy (DSM-5 Section III Criterion A). Combined, these previously disparate literatures begin to point to an integrated developmental theory of personality pathology, which suggests that Criterion A concepts (identity, self-direction, empathy, and intimacy) coalesce around the development of self, marking a discontinuous (qualitative) developmental shift. This developmental shift is a function of the demands placed on individuals to take on independent adult role function, combined with biologically-based maturational cognitive and emotional advances during adolescence. Section II personality disorder ensues when an integrated and coherent sense of self fails to develop, resulting in nonfulfilment of adult role function. In this sense, Criterion A self function can account for the onset of Section II personality disorder in adolescence, while Criterion B provides a useful descriptive account of continuous aspects of personality function over time.

Observed Personality in Preschool: Associations with Current and Longitudinal Symptoms

Personality is consistently associated with psychopathology across the lifespan. However, little is known of how observed personality dimensions in preschoolers are associated with concurrent or longitudinal symptoms across development. Spectrum, vulnerability, and pathopolasty models theorize how child personality and psychopathology are related across development. The current study tests these three models using observationally coded personality dimensions in a longitudinal sample of preschoolers. A validated 'thin slice' technique was used to code observed Five Factor Model (FFM) personality dimensions of extraversion, agreeableness, conscientiousness, neuroticism, and openness to experience in a clinically enriched preschool sample oversampled for depression (N = 299). Children were followed longitudinally for 9 years while assessing dimensional psychological symptoms and global functioning. Longitudinal multilevel models testing the spectrum, or shared underlying factor model, indicated depressive symptoms in adolescence were predicted by higher preschool extraversion and lower agreeableness and conscientiousness, externalizing symptoms were predicted by lower agreeableness and higher neuroticism, and worse global functioning was predicted by higher extraversion and neuroticism, and lower agreeableness and conscientiousness. Some associations held after accounting for the influence of baseline psychological symptoms, indicating support for a vulnerability relationship between personality and later psychopathology. No support was demonstrated for pathoplasty models such that personality did not influence the developmental course or change of psychopathology over time. Findings indicate personality dimensions measured as early as the preschool period prospectively impact psychopathology and functioning across child development, demonstrating support for both a spectrum and vulnerability relationship between youth personality and psychopathology.

The assessment of personality disorder: methodological, developmental, and contextual considerations

The reliable and valid assessment of personality disorders (PDs) faces several challenges in different domains. In particular, the variety of methods, settings, and informants relevant for PD assessment raises questions about best practices. Additionally, issues surrounding assessment across the lifespan, including youth and the elderly, further complicate PD assessment. We review these issues here and point toward future directions in PD assessment, with an emphasis on the utility of dimensional PD assessment.

Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships

BACKGROUND

As borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention. Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. Relational factors such as adverse childhood experiences and current relational problems can be considered important in adolescents who are at-risk for BPD. Nonsuicidal self-injury (NSSI) is a key precursor for adolescent BPD and one of the most promising targets for early detection and intervention of BPD.

METHODS

In a clinical sample of 152 adolescents engaging in nonsuicidal self-injury (NSSI) disorder referred to mental healthcare in Germany, this study investigated whether we can differentiate who has BPD from 1) adverse childhood experiences; and 2) the quality of current relationships, both with parents and peers. BPD was assessed both categorically as a dichotomized score and dimensionally as a continuous score.

RESULTS

More adverse childhood experiences, but not low quality of current social relationships, were related to more BPD symptoms and an increased risk for meeting full criteria for BPD. In the dimensional model, current social relationship quality with parents and peers did not show a moderating (protecting or aggravating) effect on the association between adverse childhood experiences and BPD. Using a categorical approach, however, the association between childhood adversity and meeting full criteria for BPD was higher in individuals reporting higher quality of current parent-child relationship.

CONCLUSIONS

These results highlight adverse childhood experiences as risk factors of BPD, while the role of current social relationships seems more complex.

Understanding adolescent personality pathology from growth trajectories of childhood oddity

Research on developmental trajectories of early maladaptive features for understanding later personality disorders (PDs) is increasingly recognized as an important study area. The course of early odd features is highly relevant in this regard, as only a few researchers have addressed childhood oddity in the context of emerging PDs. Using latent growth modeling, the current study explores growth parameters of odd features in a mixed sample of Flemish community and referred children (N = 485) across three measurement waves with 1-year time intervals. Personality pathology was assessed at a fourth assessment point in adolescence. Beyond a general declining trend in oddity characteristics, the results demonstrated that both an early onset and an increasing trend of oddity-related characteristics over time are independent predictors of adolescent PDs. Childhood oddity tends to be the most manifest precursor for PDs with a core oddity feature (i.e., the schizotypal and borderline PD), but also appears to predict most of the other DSM-5 PDs. Results are discussed from an overarching developmental framework on PDs (Cicchetti, 2014), specifically focusing on the principle of multifinality. From a clinical perspective, the significance of increasing or steady-high childhood oddity trajectories for adolescent PDs highlights the relevance of systematic screening processes across time.

Exploring the complexity of the childhood trait–psychopathology association: Continuity, pathoplasty, and complication effects

Four different models have been generally proposed as plausible etiological explanations for the relation between personality and psychopathology, namely, the vulnerability, complication, pathoplasty, and spectrum or continuity model. The current study entails a joint investigation of the continuity, pathoplasty, and complication models to explain the nature of the associations between early maladaptive traits and psychopathology over time in 717 referred and community children (54.4% girls), aged from 8 to 14 years. Across a 2-year time span, maladaptive traits and psychopathology were measured at three different time points, thereby relying on comprehensive and age-specific dimensional operationalizations of both personality symptoms and psychopathology. The results demonstrate overall compelling evidence for the continuity model, finding more focused support for pathoplasty and complication effects for particular combinations of personality symptoms and psychopathology dimensions. As expected, the continuity associations were found to be more robust for those personality–psychopathology associations that are conceptually closer, such as the emotional instability/introversion–internalizing problems association and the disagreeableness–externalizing problems association. Continuity associations were also stronger when personality was considered from a maladaptive rather than from a general trait perspective. The implication of the findings for the treatment of psychopathology and personality symptoms are briefly discussed.

The relationship between hippocampal asymmetry and temperament in adolescent borderline and antisocial personality pathology

Investigating etiological processes early in the life span represents an important step toward a better understanding of the development of personality pathology. The current study evaluated the interaction between an individual difference risk factor (i.e., temperament) and a biological risk factor for aggressive behavior (i.e., atypical [larger] rightward hippocampal asymmetry) in predicting the emergence of borderline personality disorder (BPD) and antisocial personality disorder symptoms during early adolescence. The sample consisted of 153 healthy adolescents (M = 12.6 years, SD = 0.4, range = 11.4–13.7) who were selected from a larger sample to maximize variation in temperament. Interactions between four temperament factors (effortful control, negative affectivity, surgency, and affiliativeness), based on the Early Adolescent Temperament Questionnaire—Revised, and volumetric measures of hippocampal asymmetry were examined as cross-sectional predictors of BPD and antisocial personality disorder symptoms. Boys were more likely to have elevated BPD symptoms if they were high on affiliation and had larger rightward hippocampal asymmetry. In boys, low affiliation was a significant predictor of BPD symptoms in the presence of low rightward hippocampal asymmetry. For girls, low effortful control was associated with elevated BPD symptoms in the presence of atypical rightward hippocampal asymmetry. This study builds on previous work reporting significant associations between atypical hippocampal asymmetry and poor behavioral regulation.

Traits in transition: the structure of parent-reported personality traits from early childhood to early adulthood

The present research was conducted to map the hierarchical structure of youths' personality traits, to identify the foundational level of this structure, and to test whether the meanings of some youth personality dimensions shift with age. We addressed these issues by analyzing personality parent reports describing a cross-sectional sample of 16,000 children, adolescents, and young adults (ages 3 to 20). These parent reports were made using a broadband measure of youths' personal characteristics, the common-language California Child Q-Set. Analyses of the full sample and comparisons of 16 age groups supported three main conclusions. First, the hierarchical structure of youths' personality traits both resembles and differs from the adult personality hierarchy in important ways. Second, a set of six dimensions--Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness to Experience, and Activity--may constitute the foundational level of the youth personality hierarchy from middle childhood through adolescence. This "Little Six" structure represents a union of the most prominent personality and temperament dimensions. Third, the meanings of some youth personality dimensions (e.g., Activity, Conscientiousness) shift systematically with age. These findings advance our understanding of when and how personality structure develops during the first two decades of life.

The child behavior checklist dysregulation profile predicts adolescent DSM-5 pathological personality traits 4 years later

Emotional dysregulation in childhood has been associated with various forms of later psychopathology, although no studies have investigated the personality related adolescent outcomes associated with early emotional dysregulation. The present study uses a typological approach to examine how the child behavior checklist-dysregulation profile (CBCL-DP) predicts DSM-5 pathological personality traits (as measured with the personality inventory for the diagnostic and statistical manual of mental disorders 5 or PID-5 by Krueger et al. (Psychol Med 2012)) across a time span of 4 years in a sample of 243 children aged 8-14 years (57.2 % girls). The results showed that children assigned to the CBCL-DP class are at risk for elevated scores on a wide range of DSM-5 personality pathology features, including higher scores on hostility, risk taking, deceitfulness, callousness, grandiosity, irresponsibility, impulsivity and manipulativeness. These results are discussed in the context of identifying early manifestations of persistent regulation problems, because of their enduring impact on a child's personality development.

A Five-Factor Model framework for understanding childhood personality disorder antecedents

The present contribution reviews evidence that supports the relevance of childhood antecedents of personality disorders, and advocates that the validity of a Five-Factor Model framework for describing general trait differences in childhood can be extended towards the field of developmental personality difficulties. In addition, we suggest that several traditional childhood Axis I conditions include a substantial trait component that may be responsible for the recurring finding that childhood Axis I disorders are predictive for adult Axis II disorders. Given the valuable information provided by a trait assessment, we further propose to integrate dimensional personality and personality pathology measures as standard tools in mental health assessments at a young age.

Cluster B maladaptive personality traits in Spanish adolescents

INTRODUCCTION

The prevalence and expression of Cluster B personality disorders during adolescence have been poorly analyzed. The main aim of this research was to analyze the rate of Cluster B maladaptive personality traits in Spanish adolescents. We also examined dimensional structure underlying the influence of sex and age in its phenotypic expression, was also examined.

METHOD

The sample consisted of a total of 1440 participants (Mean=15.9 years, SD=1.2). The self-reporting questionnaire used was the Personality Diagnostic Questionnaire-4 + (PDQ-4 +).

RESULTS

Maladaptative «dramatic» or «erratic» personality traits are common among adolescents, particularly antisocial and borderline facets. Using the PDQ-4+ cut-off points, 20.3% of the sample submitted had a Cluster B personality disorder. The analysis of the internal structure of the Cluster B items of the PDQ-4 + yielded a factorial solution centred on three interrelated factors, including: Antisocial, Borderline and Histrionic/Narcissistic. There were differences by gender in the subscales of Cluster B, but not in function of age.

CONCLUSIONS

These data yield new insights that improve the understanding of the Cluster B personality disorders and traits in this sector of the population. Future studies should use measurement tools that take into account the concern, conviction and distress associated with such experiences.

Behavioral problems in children with motor and intellectual disabilities: prevalence and associations with maladaptive personality and marital relationship

Prevalence rates of behavioral problems in children with motor disabilities are commonly based on questionnaires developed for a general population (e.g., Child Behavior CheckList). These questionnaires do not take into account lower levels of intellectual functioning. The first aim of this study was to examine the prevalence of parent-reported and daily caretaker-reported behavioral problems in children with motor and intellectual disabilities (MID) using the Developmental Behavior Checklist. Second, we investigated whether behavioral problems were related to sex and age. Our third and fourth aim were to determine whether behavioral problems are related to maladaptive personality traits and to marital stress and conflict. Participants were 101 Flemish children with MID (mean age=14 years 6 months). For total behavioral problems, we found prevalence rates of 18% and 8% based on parent and daily caretaker reports, respectively. Based on parent reports, twenty seven percent of the children with MID exhibited anxiety problems. Behavioral problems were not related to sex. Older children showed fewer behavioral problems than younger children. Multiple hierarchical regression analyses revealed that lower scores on Compulsivity and higher scores on Emotional Instability and Disagreeableness were related to behavioral problems. In addition to personality traits, stress and conflict in the marital relationship was also positively associated with behavioral problems. Given the importance of behavioral problems in children with MID, this study is of theoretical and clinical interest and has the potential to inform targeted clinical interventions.

Childhood personality types: vulnerability and adaptation over time

BACKGROUND

  Substantial evidence suggests that a Five-Factor Model personality assessment generates a valid description of childhood individual differences and relates to a range of psychological outcomes. Less is known, however, about naturally occurring profiles of personality and their links to psychopathology. The current study explores whether childhood personality characteristics tend to cluster in particular personality profiles that show unique associations with psychopathology and quality of life across time.

METHODS

  Latent class analysis was conducted on maternal rated general personality of a Flemish childhood community sample (N = 477; mean age 10.6 years). The associations of latent class membership probability with psychopathology and quality of life 2 years later were examined, using a multi-informant perspective.

RESULTS

  Four distinguishable latent classes were found, representing a Moderate, a Protected, an Undercontrolled and a Vulnerable childhood personality type. Each of these types showed unique associations with childhood outcomes across raters.

CONCLUSIONS

  Four different personality types can be delineated at young age and have a significant value in understanding vulnerability and adaptation over time.

Schizotypy, emotional-behavioural problems and personality disorder traits in a non-clinical adolescent population

The main goal of the present study was to examine the relationship between the schizotypy dimensions, emotional-behavioural problems and personality disorder traits in non-clinical general adolescent population. A total of 1455 participants (M=15.9years; S.D.=1.2) were administered the Oviedo Schizotypy Assessment Questionnaire (ESQUIZO-Q), the Strengths and Difficulties Questionnaire (SDQ) and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Correlation analyses revealed significant associations between the schizotypy and emotional-behavioural problems self-reported by adolescents. Participants with high scores in schizotypy dimensions, reported higher rates of affective and behavioural problems than those with low scores. Also, schizotypy dimensions and personality disorder traits were closely related in adolescent population. These data indicate, as occurs in clinical samples, the high overlap between schizotypy and personality disorder traits. Affective dysregulation and behavioural problems are present at the subclinical level in non-clinical adolescent population. These results have implications for the integration of schizotypy studies within the paradigms of developmental psychology and dimensional models of personality.

Personality disorders and retention in a therapeutic community for substance dependence

Although therapeutic community (TC) treatment is a promising intervention for substance use disorders, a primary obstacle to successful treatment is premature attrition. Because of their prevalence within substance use treatment facilities, personality disorder (PD) diagnoses have been examined as predictors of treatment completion. Prior research on TC outcomes has focused almost exclusively on antisocial personality disorder (ASPD), and the results have been mixed. This study extends previous research by examining the impact of the 10 Axis II PDs on early (first 30 days) attrition as well as overall time to dropout in a 9-month residential TC. Survival analyses indicated that borderline was the only PD negatively related to overall program retention. In contrast, ASPD, as well as histrionic PD, were related to very early attrition, but not to overall program retention. Early assessment and identification of at-risk individuals may improve treatment retention and outcome for TC treatment.

General and maladaptive personality dimensions in pediatric obsessive-compulsive symptoms

Obsessive-compulsive disorder (OCD) is a chronic and impairing clinical disorder in childhood, often characterized by a heterogeneous symptomatic profile and high co-occurrence with other disorders. The present study introduces a new perspective on the description of OCD symptoms in youth, and empirically examines the value of a personality framework (e.g. Five Factor of Personality; FFM) for understanding early OCD symptomatology in a referred sample of 274 children and adolescents, relying on age-specific measures of general and maladaptive personality. Differences in general and maladaptive personality traits for high versus low-scoring children and adolescents on the Obsessive-Compulsive Scale of the Child Behavior Checklist (CBCL-OCS) were explored. The discriminant validity of both higher-and lower-order personality traits was supported, showing that high CBCL-OCS scorers are characterized by specific personality features ranging from adaptive to pathological, especially in terms of Conscientiousness. In addition, personality traits contributed to the accurate classification of high- versus low-scorers on the CBCL-OCS. Implications for clinical practice and recommendations for future research are discussed.

Personality pathology comorbidity in adult females with eating disorders

Personality pathology is examined in 100 female in-patients diagnosed with eating disorders. The Eating Disorder Inventory-II and the NEO-PI-R were self-administered and personality pathology was assessed using a structured interview. Clinicians additionally evaluated patients' global functioning. The results indicated sizeable personality disorder comorbidity, and two dimensions of personality pathology, for example, an internalizing and an externalizing factor, could be identified. Patients' global functioning was primarily associated with dimensions of personality pathology, but not with eating disorder symptoms. Assessment and therapeutic interventions should focus on this co-occurring pathology in order to improve patients' functioning.

Pathological narcissism and narcissistic personality disorder

We review the literature on pathological narcissism and narcissistic personality disorder (NPD) and describe a significant criterion problem related to four inconsistencies in phenotypic descriptions and taxonomic models across clinical theory, research, and practice; psychiatric diagnosis; and social/personality psychology. This impedes scientific synthesis, weakens narcissism's nomological net, and contributes to a discrepancy between low prevalence rates of NPD and higher rates of practitioner-diagnosed pathological narcissism, along with an enormous clinical literature on narcissistic disturbances. Criterion issues must be resolved, including clarification of the nature of normal and pathological narcissism, incorporation of the two broad phenotypic themes of narcissistic grandiosity and narcissistic vulnerability into revised diagnostic criteria and assessment instruments, elimination of references to overt and covert narcissism that reify these modes of expression as distinct narcissistic types, and determination of the appropriate structure for pathological narcissism. Implications for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the science of personality disorders are presented.

Research Review: 'Ain't misbehavin': Towards a developmentally-specified nosology for preschool disruptive behavior

There is increasing consensus that disruptive behavior disorders and syndromes (DBDs) are identifiable in preschool children. There is also concomitant recognition of the limitations of the current DBD nosology for distinguishing disruptive behavior symptoms from the normative misbehavior of early childhood. In particular, there appears to be substantial insensitivity to heterotypic manifestations of this developmental period and problems in identifying meaningful heterogeneity. As a result, the developmental basis for much of the current nosology may be called into question. To address these and other critical issues, this paper reviews the foundational elements of clinical and developmental science pertinent to developmental differentiation of disruptive behavior in the preschool period as paradigmatic for developmental specification across the lifespan and generates an agenda for future research. We begin by reviewing evidence of the validity of DBDs in preschool children. This is followed by an outline of key developmental concepts and a review of the corollary evidence from developmental science. These provide a basis for conceptualizing disruptive behavior in reference to developmental deviation in four core dimensions hypothesized to mark the core features of disruptive behavior syndromes. Finally, we propose a program of research to establish an empirical basis for determining the incremental utility of a developmentally specified nosology. Central to this approach is a contention that the benefits of developmental specification are extensive and outweigh any disadvantages. This is because a developmentally specified approach holds substantial promise for increasing sensitivity and specificity for differentiating disruptive behavior from normative misbehavior and from other related syndromes as well as for improving prediction. Further, more precisely defined, developmentally based phenotypes are likely to elucidate distinct mechanisms within translational studies and to serve as a catalyst for the generation of novel treatments.

A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.

Childhood personality pathology: dimensional stability and change

Studies on the developmental course of personality disorders have suggested that adult personality disorders enclose both features with a natural plasticity over time, as well as stable components represented by underlying trait dimensions. The current study broadens this dimensional stability perspective toward an earlier developmental stage, and describes with different indices of stability the longitudinal behavior of basic childhood maladaptive trait dimensions in a community sample of 477 Flemish children. The results underscore structural, rank-order, and within-person stability for the disagreeableness, emotional instability, introversion, and compulsivity dimensions and suggest a similar maturation principle as has been proposed for adults. Individual growth curve analyses indicate that children's maladaptive trait scores generally decrease as they grow older, with a smaller decline for high-scoring individuals. Childhood maladaptive traits and general psychopathology dimensions show similar longitudinal patterns in terms of shape and change over time, supporting a spectrum conceptualization of Axis I related pathology and personality disorder precursors at young age. The implications of these findings for a developmental perspective on dimensional conceptualizations of personality disorders are discussed.

Conscientiousness and externalizing psychopathology: Overlap, developmental patterns, and etiology of two related constructs

The present paper focuses on the trait domain of conscientiousness, its development, and its relation to psychopathology. The definition of conscientiousness and its interface with specific forms of psychopathology, such as externalizing psychopathology, are discussed first. Then an overview of the known developmental changes in conscientiousness across the life course is provided, as well as the potential shared developmental etiology of conscientiousness and externalizing psychopathology. Given the lack of data, testing etiological factors that may contribute to the development of both conscientiousness and externalizing disorders, we report on three studies examining the childhood experiences associated with both conscientiousness and externalizing behaviors. Last, future directions are discussed.