Adverse Childhood Experiences Are Associated With Personality Disorder: A Prospective, Longitudinal Study
Abstract
There is a lack of studies that have prospectively examined adverse childhood experiences (ACEs) in association with a personality disorder (PD). Data from a sample of 8,199 adolescents first assessed for ACEs were linked with subsequent data from the Norwegian Patient Register in order to obtain diagnoses of a PD in adulthood (after a 14-year follow-up). We used logistic regression analysis. Any type of ACE gave a 3.8-fold higher risk of developing a PD. Abuse, more specifically emotional abuse, came out as one of the strongest predictors. Of the adolescents who developed a PD, approximately 90% had a history of ACE. The results of this study support the importance of assessing ACEs, such as abuse, neglect, and household dysfunction, in the diagnostic procedure and treatment for PD.
REFERENCES
- 2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45(6), 814–822. https://doi.org/10.1016/j.jpsychires.2010.11.008 Crossref Medline, Google Scholar (
- 2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. British Journal of Psychiatry, 204, 335–340. https://doi.org/10.1192/bjp.bp.113.131227 Crossref Medline, Google Scholar (
American Psychiatric Association . (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Author. Google Scholar- 2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4 Crossref Medline, Google Scholar (
- 2013). Mentalization-based treatment. Psychoanalytic Inquiry, 33(6), 595–613. https://doi.org/10.1080/07351690.2013.835170 Crossref Medline, Google Scholar (
- 2004). Childhood maltreatment associated with adult personality disorders: Findings from the Collaborative Longitudinal Personality Disorders Study. Journal of Personality Disorders, 18(2), 193–211. https://doi.org/10.1521/pedi.18.2.193.32777 Link, Google Scholar (
- 2017). Association between childhood adversity and a diagnosis of personality disorder in young adulthood: A cohort study of 107,287 individuals in Stockholm County. European Journal of Epidemiology, 32(8), 721–731. https://doi.org/10.1007/s10654-017-0264-9 Crossref Medline, Google Scholar (
- 2019). A research programme to evaluate DBT-PTSD, a modular treatment approach for Complex PTSD after childhood abuse. Borderline Personal Disorder and Emotion Dysregulation, 6, 7. https://doi.org/10.1186/s40479-019-0099-y Crossref Medline, Google Scholar (
- 1988). A secure base: Parent-child attachment and healthy human development. Basic Books. Google Scholar (
- 2022). Prevalence of adverse childhood experiences and their co-occurrence in a large population of adolescents: A Young HUNT 3 study. Social Psychiatry and Psychiatroc Epidemiology, 57(12), 2359–2366. https://doi.org/10.1007/s00127-022-02277-z Crossref Medline, Google Scholar (
- 2013). The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. Journal of Nervous and Mental Disease, 201(12), 1007–1020. https://doi.org/10.1097/nmd.0000000000000049 Crossref Medline, Google Scholar (
- 2013). Prevention and early intervention for borderline personality disorder: Current status and recent evidence. British Journal of Psychiatry Supplement, 54, s24–s29. https://doi.org/10.1192/bjp.bp.112.119180 Crossref Medline, Google Scholar (
- 2017). Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind. Personality and Mental Health, 11 (2), 77–90. https://doi.org/10.1002/pmh.1365 Crossref Medline, Google Scholar (
- 2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. Euro-pean Journal of Psychotraumatology, 4. https://doi.org/10.3402/ejpt.v4i0.20706 Google Scholar (
- 2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398. https://doi.org/10.3928/00485713-20050501-05 Crossref, Google Scholar (
- 2018). Borderline personality disorder and sexual abuse: A systematic review. Psychiatry Research, 262, 70–77. https://doi.org/10.1016/j.psychres.2018.01.043 Crossref Medline, Google Scholar (
- 2019). The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive Psychiatry, 92, 1–6. https://doi.org/10.1016/j.comppsych.2019.04.001 Crossref Medline, Google Scholar (
- 2020). Is emotional abuse as harmful as physical and/or sexual abuse? Journal of Child and Adolescent Trauma, 13(4), 399–407. https://doi.org/10.1007/s40653-019-00292-y Crossref Medline, Google Scholar (
- 2015). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLoS One, 10(3), e0122846. https://doi.org/10.1371/journal.pone.0122846 Crossref Medline, Google Scholar (
- 1998). Parental socialization of emotion. Psychoanalytic Inquiry, 9(4), 241–273. https://doi.org/10.1207/s15327965pli0904_1 Crossref, Google Scholar (
- 1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8 Crossref Medline, Google Scholar (
- 2020). Unresolved attachment mediates the relationship between childhood trauma and impaired personality functioning in adolescence. Journal of Personality Disorders, 34(Suppl. B), 84–103. https://doi.org/10.1521/pedi_2020_34_468 Link, Google Scholar (
- 2015). Association between childhood maltreatment and normal adult personality traits: Exploration of an understudied field. Journal of Personality Disorders, 29(1), 1–14. https://doi.org/10.1521/pedi_2014_28_143 Link, Google Scholar (
- 1992). Trauma and recovery. Basic Books. Google Scholar (
- 2014). Cohort profile of the Young-HUNT Study, Norway: A population-based study of adolescents. International Journal of Epidemiology, 43(2), 536–544. https://doi.org/10.1093/ije/dys232 Crossref Medline, Google Scholar (
- 2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4 Crossref Medline, Google Scholar (
- 1999). Childhood maltreatment increases risk for personality disorders during early adulthood. Archives of General Psychiatry, 56(7), 600–606. https://doi.org/10.1001/archpsyc.56.7.600 Crossref Medline, Google Scholar (
- 2017). Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ). Journal of Affective Disorders, 207, 181–187. https://doi.org/10.1016/j.jad.2016.09.032 Crossref Medline, Google Scholar (
- 2019). Self-reported impulsivity in women with borderline personality disorder: The role of childhood maltreatment severity and emotion regulation difficulties. Borderline Personality Disorder and Emotion Dysregulation, 6, 6. https://doi.org/10.1186/s40479-019-0101-8 Crossref Medline, Google Scholar (
- 2010). Disentangling the relationship between different types of childhood maltreatment and personality disorders. Journal of Personality Disorders, 24(3), 285–295. https://doi.org/10.1521/pedi.2010.24.3.285 Link, Google Scholar (
- 2020). Early adversity and critical periods: Neurodevelopmental consequences of violating the expectable environment. Trends in Neuroscience, 43(3), 133–143. https://doi.org/10.1016/j.tins.2020.01.002 Crossref Medline, Google Scholar (
- 2022). Childhood trauma and amygdala nuclei volumes in youth at risk for mental illness. Psychological Medicine, 52(6), 1192–1199. https://doi.org/10.1017/s0033291720003177 Crossref Medline, Google Scholar (
- 2014). Sensitive periods of amygdala development: The role of maltreatment in preadolescence. Neuroimage, 97, 236–244. https://doi.org/10.1016/j.neuroimage.2014.04.025 Crossref Medline, Google Scholar (
- 2020). Childhood adversity and borderline personality disorder: A meta-analysis. Acta Psychiatrica Scandinavica, 141(1), 6–20. https://doi.org/10.1111/acps.13118 Crossref Medline, Google Scholar (
- 2017). Childhood abuse and neglect and insecure attachment states of mind in adulthood: Prospective, longitudinal evidence from a high-risk sample. Developmental Psychopathology, 29(2), 347–363. https://doi.org/10.1017/s0954579417000037 Crossref Medline, Google Scholar (
- 2016). Is there a link between childhood adversity, attachment style and Scotland's excess mortality? Evidence, challenges and potential research. BMC Public Health, 16, 655. https://doi.org/10.1186/s12889-016-3201-z Crossref Medline, Google Scholar (
- 2010). Stability of borderline personality disorder features in girls. Journal of Personality Disorders, 24(4), 460–472. https://doi.org/10.1521/pedi.2010.24.4.460 Link, Google Scholar (
- 2002). Scars that won't heal: The neurobiology of child abuse. Scientific American, 286(3), 68–75. Crossref Medline, Google Scholar (
- 2003). The neurobiological consequences of early stress and childhood maltreatment. Neuroscience and Biobehavorial Reviews, 27(1-2), 33–44. https://doi.org/10.1016/s0149-7634(03)00007-1 Crossref Medline, Google Scholar (
- 2013). Childhood maltreatment and psychopathology: A case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. American Journal of Psychiatry, 170(10), 1114–1133. https://doi.org/10.1176/appi.ajp.2013.12070957 Crossref Medline, Google Scholar (
- 2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews Neuroscience, 17(10), 652–666. https://doi.org/10.1038/nrn.2016.111 Crossref Medline, Google Scholar (
- 2017). Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population. Child Abuse and Neglect, 70, 255–263. https://doi.org/10.1016/j.chiabu.2017.06.001 Crossref Medline, Google Scholar (
- 2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, 21(7), 51. https://doi.org/10.1007/s11920-019-1040-1 Crossref Medline, Google Scholar (
- 2009). A prospective investigation of borderline personality disorder in abused and neglected children followed up into adulthood. Journal of Personality Disorders, 23(5), 433–446. https://doi.org/10.1521/pedi.2009.23.5.433 Link, Google Scholar (
- 2020). The prevalence of personality disorders in the community: A global systematic review and meta-analysis. British Journal of Psychiatry, 216(2), 69–78. https://doi.org/10.1192/bjp.2019.166 Crossref Medline, Google Scholar (
- 2012). Prospective study of family adversity and maladaptive parenting in childhood and borderline personality disorder symptoms in a non-clinical population at 11 years. Psychological Medicine, 42(11), 2405–2420. https://doi.org/10.1017/s0033291712000542 Crossref Medline, Google Scholar (
World Health Organization . (1993). The ICD-10 classification of mental and behavioural disorders. Author. Google Scholar- 2001). Treatment histories of borderline inpatients. Comprehensive Psychiatry, 42(2), 144–150. https://doi.org/10.1053/comp.2001.19749 Crossref Medline, Google Scholar (