Understanding adolescent personality pathology from growth trajectories of childhood oddity

Paternal Borderline Symptoms and Offspring Outcomes in Young Adulthood

Borderline personality disorder symptoms (BPDsx) in mothers have been linked to psychopathology in their offspring. However, it is still unclear whether BPDsx in fathers influences offspring psychopathology and, if so, how this risk transmission may occur. A total of 448 father-mother-offspring triads completed a longitudinal study following children from birth until age 20 and included self-report questionnaires and clinical interviews when children were 15 and 20 years old. Results revealed that paternal BPDsx were predictive of youth BPDsx and internalizing symptoms, even after controlling for maternal BPDsx. Chronic family stress was a significant mediator of the relationship between paternal BPDsx and offspring BPDsx, internalizing symptoms, and externalizing symptoms. Fathers' expressed emotion and child temperament were not significant mediators. Although offspring sex predicted youth outcomes, it was not a significant moderator of the association between paternal BPDsx and offspring symptoms. Finally, controlling for comorbid paternal disorders weakened the association between paternal BPDsx and youth psychopathology.

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.

Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents

The recent development of a dimensional view toward personality disorder opens up the field of personality research based on the constructs of personality functioning (Criterion A) and maladaptive personality traits (Criterion B) as core components of personality pathology. However, little is known about the roles of these aspects in relation to borderline personality features during adolescence. The current study aimed at exploring the associations of Criterion A and B and their contribution in predicting borderline personality features in adolescence. A sample of 568 adolescents aged 11-17 (M = 14.38, SD = 1.57; 42.4% males) from different backgrounds (community-based, psychiatric inpatients, and youth forensic care) completed a set of questionnaires among which were measures of personality functioning, maladaptive personality traits, and borderline personality features. The findings reveal that Criterion A and B are strongly interrelated and both are significant in predicting borderline personality features in adolescents. Further, the results showed the incremental value of Criterion A beyond the level of underlying psychopathology and maladaptive personality traits suggesting the distinctive function of Criterion A to capture the features of borderline personality. These findings extend the knowledge about the dimensional aspects of personality pathology in adolescence. The implications in relation to the new personality disorder model in the ICD-11 are highlighted.

Childhood Personality Assessment Q-Sort (CPAP-Q): A Clinically and Empirically Procedure for Assessing Traits and Emerging Patterns of Personality in Childhood

BACKGROUND

Despite increasing research confirming the existence of childhood personalities, which are recognizable from a developmental perspective, controversies over the possibility to assess personality in childhood have continued. The purpose of this study was to provide initial data on the validation of the Childhood Personality Assessment Q-Sort (CPAP-Q), a clinician report instrument that can be employed to evaluate children's personalities and address the gap in the field of emerging personality in children classification.

METHOD

A sample of 135 clinicians completed the CPAP-Q to assess the personality features of 135 children (ages 4-11) who had been in their care between two and 12 months. The clinicians completed a clinical questionnaire to collect information on them, the children, and their families, as well as the Child Behavior Checklist (CBCL), to evaluate the children's behavioral problems and social competencies.

RESULTS

Q-factor analysis identified seven specific emerging personality patterns: psychological health, borderline/impulsive, borderline/dysregulated, schizoid, inhibited/self-critical, obsessive, and dysphoric/dependent. These patterns revealed good levels of validity and reliability.

CONCLUSIONS

These findings are preliminary, but seem to support the possibility of evaluating emerging personality patterns in childhood and their developmental pathways that may lead to personality disorders in adolescence and adulthood. The CPAP-Q promises to significantly contribute to less explored research areas and encourage systematic studies of children assessment, promoting best practices for individualized diagnoses.

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.

Childhood schizotypal features vs. high-functioning autism spectrum disorder: Developmental overlaps and phenomenological differences

Although autism spectrum disorder and schizophrenia have allegedly different onset timelines (e.g. in early years of life vs adolescence/early adulthood), there is nonetheless a diagnostic grey-zone along developmental stages, in which overlapping clinical features related to social impairment and oddity could impact on the differential diagnosis between childhood schizotypal features and high-functioning autism spectrum disorder. A phenomenological perspective may be helpful for the purpose of timely differential diagnosis also in developmental years.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis-related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

Exposure to interparental intimate partner violence and the development of borderline features in adolescents

BACKGROUND

Due to associated trauma, exposure to intimate partner violence (IPV) is considered a form of child maltreatment, and is associated with heightened risk for mental health problems.

OBJECTIVE

To evaluate associations between exposure to interparental IPV and the prospective development of borderline features in adolescents.

PARTICIPANTS AND SETTING

A diverse sample of 1,042 adolescents were recruited from public high schools throughout southeastern United States and followed annually for 5 years. Baseline mean age was 15.09 (SD = .79; range 13-18), and 56 % of the sample was female; 31.4 % (n = 327) were Hispanic, 29.4 % (n = 306) were White/not Hispanic, 27.9 % (n = 291) were African American, 3.6 % (n = 38) were Asian or Pacific Islander, and 7.7 % (n = 80) were mixed or another race.

METHODS

Exposure to interparental IPV and the quality of the parent-child relationship were assessed at baseline. Borderline features were assessed annually for the each of the five follow-up timepoints. Latent growth curve modeling was used to estimate the course of change of BPD features over time.

RESULTS

Consistent with expectations, and controlling for quality of parent-child relationships and sociodemographic confounds, findings demonstrated that IPV exposure related to both cross-sectional association between interparental IPV and adolescents' borderline features and change in borderline features over a 5-year period.

CONCLUSION

Adolescents who had witnessed interparental IPV were more likely to have higher levels of BPD features at baseline and to deviate from the typically observed normative decline in BPD features over the 4-year follow-up period.

Integrating developmental aspects in current thinking about personality pathology

The current review outlines some recent highlights from the developmental literature on personality pathology with regard to its conceptualization, development, assessment and clinical utility. Notable parallels with adult evidence are described, but also unique and age-specific issues are discussed. Finally, suggestions for future research that may stimulate a life-span and integrative perspective on personality pathology from childhood onwards are proposed.