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Early threat exposure is a transdiagnostic risk factor for psychopathology, and evidence suggests that genetic variation in the oxytocin receptor (OXTR) moderates this association. However, it is unclear if this gene-by-environment (G×E) interaction is tied to unique risk for disorder-specific outcomes or instead increases shared risk for general psychopathology. Moreover, little is known about how this G×E interaction increases risk. The current study utilized a prospective, longitudinal sample of females (n = 2,020) to examine: (a) whether the interaction between early threat exposure and OXTR variation (rs53576, rs2254298) confers risk for disorder-specific outcomes (depression, anxiety, borderline and antisocial personality disorders) and/or general psychopathology in early adulthood; and (b) whether social–emotional deficits (emotion dysregulation, callousness, attachment quality) during adolescence constitute mediating mechanisms. Consistent with hypotheses, the interactive effects of early threat exposure and OXTR variation (rs53576) predicted general psychopathology, with threat-exposed women carrying at least one copy of the rs53576 A-allele at greatest risk. This interaction was mediated via emotional dysregulation in adolescence, with threat-exposed A-allele carriers demonstrating greater emotion dysregulation, and greater emotion dysregulation predicting general psychopathology in early adulthood. Findings suggest that this G×E places women at risk for a broad range of psychopathology via effects on emotion dysregulation.
Differential susceptibility theory (DST) posits that individuals differ in their developmental plasticity: some children are highly responsive to both environmental adversity and support, while others are less affected. According to this theory, “plasticity” genes that confer risk for psychopathology in adverse environments may promote superior functioning in supportive environments. We tested DST using a broad measure of child genetic liability (based on birth parent psychopathology), adoptive home environmental variables (e.g., marital warmth, parenting stress, and internalizing symptoms), and measures of child externalizing problems (n = 337) and social competence (n = 330) in 54-month-old adopted children from the Early Growth and Development Study. This adoption design is useful for examining DST because children are placed at birth or shortly thereafter with nongenetically related adoptive parents, naturally disentangling heritable and postnatal environmental effects. We conducted a series of multivariable regression analyses that included Gene × Environment interaction terms and found little evidence of DST; rather, interactions varied depending on the environmental factor of interest, in both significance and shape. Our mixed findings suggest further investigation of DST is warranted before tailoring screening and intervention recommendations to children based on their genetic liability or “sensitivity.”
A number of genomic conditions caused by copy number variants (CNVs) are associated with a high risk of neurodevelopmental and psychiatric disorders (ND-CNVs). Although these patients also tend to have cognitive impairments, few studies have investigated the range of emotion and behaviour problems in young people with ND-CNVs using measures that are suitable for those with learning difficulties.
A total of 322 young people with 13 ND-CNVs across eight loci (mean age: 9.79 years, range: 6.02–17.91, 66.5% male) took part in the study. Primary carers completed the Developmental Behaviour Checklist (DBC).
Of the total, 69% of individuals with an ND-CNV screened positive for clinically significant difficulties. Young people from families with higher incomes (OR = 0.71, CI = 0.55–0.91, p = .008) were less likely to screen positive. The rate of difficulties differed depending on ND-CNV genotype (χ2 = 39.99, p < 0.001), with the lowest rate in young people with 22q11.2 deletion (45.7%) and the highest in those with 1q21.1 deletion (93.8%). Specific patterns of strengths and weaknesses were found for different ND-CNV genotypes. However, ND-CNV genotype explained no more than 9–16% of the variance, depending on DBC subdomain.
Emotion and behaviour problems are common in young people with ND-CNVs. The ND-CNV specific patterns we find can provide a basis for more tailored support. More research is needed to better understand the variation in emotion and behaviour problems not accounted for by genotype.
Maltreatment by parents can be conceptualized as pathogenic escalations of a disturbed parent–child relationship that have devastating consequences for children's development and mental health. Although parental psychopathology has been shown to be a risk factor both for maltreatment and insecure attachment representations, these factors` joint contribution to child psychopathology has not been investigated. In a sample of Burundian refugee families living in refugee camps in Western Tanzania, the associations between attachment representations, maltreatment, and psychopathology were examined by conducting structured interviews with 226 children aged 7 to 15 and both their parents. Structural equation modeling revealed that children's insecure attachment representations and maltreatment by mothers fully mediated the relation between maternal and child psychopathology [model fit: comparative fit index (CFI) = 0.96; root mean square error of approximation (RMSEA) = 0.05]. A direct association between paternal and child psychopathology was observed (model fit: CFI = 0.96; RMSEA = 0.05). The findings suggest a vicious cycle, wherein an insecure attachment to a mother suffering from psychopathology may be linked to children's risk to be maltreated, which may reinforce insecure representations and perpetuate the pathogenic relational experience. Interventions targeting the attachment relationship and parental mental health may prevent negative child outcomes.
Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach.
Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients.
Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders.
Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
Prior research has shown that sipping of alcohol begins to emerge during childhood and is potentially etiologically significant for later substance use problems. Using a large, community sample of 9- and 10-year-olds (N = 11,872; 53% female), we examined individual differences in precocious alcohol use in the form of alcohol sipping. We focused explicitly on features that are robust and well-demonstrated correlates of, and antecedents to, alcohol excess and related problems later in the lifespan, including youth- and parent-reported externalizing traits (i.e., impulsivity, behavioral inhibition and activation) and psychopathology. Seventeen percent of the sample reported sipping alcohol outside of a religiously sanctioned activity by age 9 or 10. Several aspects of psychopathology and personality emerged as small but reliable correlates of sipping. Nonreligious sipping was related to youth-reported impulsigenic traits, aspects of behavioral activation, prodromal psychotic-like symptoms, and mood disorder diagnoses, as well as parent-reported externalizing disorder diagnoses. Religious sipping was unexpectedly associated with certain aspects of impulsivity. Together, our findings point to the potential importance of impulsivity and other transdiagnostic indicators of psychopathology (e.g., emotion dysregulation, novelty seeking) in the earliest forms of drinking behavior.
Abnormal body mass index (BMI) has been associated with development of psychopathology. This association in children is well documented, for both overweight and underweight children. However, the association between change in BMI and the development of psychopathology has been less investigated.
To investigate the association between change in BMI between childhood and adolescence and psychopathology in adolescence.
Data from the Growing Up in Ireland cohort were used. We investigated the ’98 cohort (also known as the child cohort) at age 9/13. BMI, defined using internationally recognised definitions as underweight, healthy or overweight, was used as the exposure, and abnormal Strength and Difficulties Questionnaire scores were used as the outcome. Logistic regression was undertaken for the analysis. All analyses were adjusted for confounders.
A change to overweight from healthy BMI was significantly associated with increased risk of psychopathology (adjusted OR 1.66; 95% CI 1.19–2.32). Both change from underweight to healthy (adjusted OR 0.12; 95% CI 0.03–0.43) or from overweight to healthy (adjusted OR 0.47; 95% CI 0.79–0.8) was associated with a significantly reduced risk of developing psychopathology.
As a child’s BMI returns to within the healthy range, their risk of adolescent psychopathology is reduced. Interventions to restore healthy BMI, in both underweight and overweight, children may reduce their risk of adolescent psychopathology.
There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.
Teenage childbearing (age 15–19 years) represents a significant public health issue that can generate considerable deleterious, multigenerational consequences for teen-childbearing mothers and their offspring. However, few studies have examined the potential mediating mechanisms that may explain if and how teen childbearing is associated with the development of offspring psychopathology. The current study used a developmental model to test the mediating role of chronic child maltreatment in the relationship between teen childbearing and offspring internalizing symptoms in childhood and emerging adulthood. The study participants were 384 individuals from socioeconomically disadvantaged, ethnically diverse backgrounds, assessed across two longitudinal waves of data (i.e., ages 10–12 and 18–20). The sample included maltreated and nonmaltreated children, all of whom were comparable in terms of family income. Structural equation modeling was conducted to test direct and indirect pathways from teen childbearing to offspring psychopathology. A multigenerational developmental cascade was found such that individuals born to mothers who began their childbearing in adolescence were more likely to experience chronic maltreatment during childhood, which in turn predicted greater internalizing symptoms throughout childhood and emerging adulthood. Using a developmental psychopathology framework, the results are discussed with regard to implications for prevention and early intervention.
Parents’ comparisons of siblings have been understudied among sibling research, especially in Chinese societies where the government recently relaxed its one-child policy. This study, using a two-wave longitudinal design, explored how parents’ comparisons of siblings were associated with adolescents’ internalizing and externalizing problems. Study participants were 260 Chinese adolescents who had siblings and completed questionnaires that assessed their internalizing and externalizing problems, as well as their perceptions of parents’ critical comparisons of siblings. Cross-lagged modeling analysis showed that parents’ comparisons of siblings predicted more internalizing and externalizing problems in adolescents 6 months later. Moreover, adolescents’ externalizing problems but not internalizing problems predicted more parents’ comparisons of siblings over time. These findings underscore the importance of reciprocal relations between parents’ comparisons of siblings and adolescents’ externalizing problems and the implication of cultural context in understanding associations between parental practices and adolescents’ adjustment.
We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology.
Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic).
Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men.
Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
The following commentary on Jang and Choi’s chapter Issues and New Directions in Personality Disorder (PD) Genetics (This Volume) echoes their call to harness advances in PD assessment rather than rely on politically derived "top down" nosologies. We first discuss how recent work in the joint hierarchical structure of PD traits and psychopathology, as well as, personality dynamics (i.e., how personality manifests in different situations) likely offer fruitful avenues for exploring the more nuanced role of genetics in the development and maintenance of PD. Second, we highlight the need to better understand the role of environment in PD genetics and discuss emerging models (e.g., common pathway model). Third, we stress the need for more research and larger samples in order to arrive at stronger conclusions. Fourth, we consider how advances in gene-environment research can help to determine targets for PD prevention and treatment.
In acknowledgment of the continued tension between the need to dimensionalize personality pathology in youth, and the reality of a categorical nosology in clinical settings, the goal of the present chapter is to review research on child and adolescent personality pathology from both these perspectives. While the review highlights several differences in constructs, methodology, and clinical implications of the two approaches, it also highlights significant commonalities in conclusions drawn from the traditions underlying categorical versus dimensional approaches. In particular, both categorical and dimensional approaches seem to support the idea that adolescence presents a unique developmental period for the crystallization of personality pathology.
Traditionally, studies of personality disorder development have focused on (1) whether adult symptoms are expressed among children and adolescents, and if so (2) ages of onset at which full syndrome criteria are met. Although such studies are necessary and important, they provide limited understanding of etiopathophysiology—the complex and interactive biological and social determinants of PDs across the lifespan. This commentary presents a brief update to our conceptual model of antisocial (ASPD) and borderline (BPD) development among boys and girls. It focuses on (1) complexity of genetic, environmental, and neurohormonal influences on subcortical vulnerability to impulsivity; (2) increasing contributions of cortically mediated emotion dysregulation in adolescence and adulthood; and (3) moderation of common genetic and neural vulnerabilities to ASPD and BPD by sex. Importantly, neural correlates of ASPD and BPD are already observed among teens who are at risk for the disorders. Implications for prevention are discussed.
Over the past twenty years, several taxonomies of personality and psychopathology have been developed. More recently, many studies have compared dimensional models of personality pathology to categorical diagnoses of personality disorders. Altogether, this proliferation of research suggests the value of articulating the desirable properties of a good taxonomic system. Here, the authors extend basic research in cognitive science on the limitations of representational capacity, which suggests that humans need to compress complex clinical presentations to make good judgments. With this in mind, the authors propose that information compression and information fidelity are two principles that are essential to good taxonomy. The principle of information compression is that taxonomies should prune the complexities of a detailed clinical presentation to focus on important sources of covariation. The principle of information fidelity is that a good taxonomy should maintain essential features that reasonably approximate the structure of an individual or the population. They conclude with the claim that the overarching goal of taxonomic science in classifying personality pathology is to provide clinicians and researchers with empirically based informative priors that help to bias thinking toward useful clinical distinctions.
This commentary on Sharp and De Clerq’s chapter (this volume) describes potential benefits of integrating and synthesizing research conducted primarily predominantly with adults from a personality pathology perspective with the increasingly robust body of research conducted with children and adolescents from a developmental psychopathology perspective. Both perspectives view psychopathology as emerging from an interplay of biologically-based vulnerabilities and risk and protective factors at multiple levels of social ecological systems (e.g., individual, family, community, and culture). Both attempt to understand developmental pathways and trajectories that may evolve into more durable and distinctive patterns of thoughts, emotions, and behaviors that may be categorized as a personality disorder or other mental disorder. Both perspectives hope to identify effective interventions that may prevent more severe and chronic disorders among at-risk individuals. The authors argue that the integration of personality pathology and developmental psychopathology perspectives may contribute to the development of more sophisticated transdiagnostic approaches that inform clinical case formulation and treatment planning for children and adolescents.
The authors offer their appreciation of the astute commentaries by Scott and Pilkonis and Niedtfeld, Paret, and Schmahl regarding their chapter on borderline personality disorder. Scott and Pilkonis address some very important big picture themes regarding the conceptualization, etiology, and treatment of BPD, and Niedtfeld et al. more specifically comment on innovative research highlighting the interplay of neuroscience and psychotherapy. In this rejoinder, the authors comment on these and other issues and suggest that a developmental psychopathology framework for theory and research has promise for illuminating the nature and etiology of BPD and highlighting important directions for prevention and treatment.
This chapter reviews how personality disorder assessment, conceptualization, and treatment can be enhanced by considering interpersonal models. Contemporary Integrative Interpersonal Theory (CIIT) provides conceptual grounding to interpersonal models, which are often constructed around the two dimensions of agency and communion. Agency captures the theme of achievement, status, control, and differentiation, whereas communion captures the theme of connectedness, union, solidarity, and friendship. The authors discuss how personality disorder patients often struggle with agency and communion, and review research articulating how personality disorders are associated with specific impairments in agency and communion in cross-sectional and longitudinal research designs. They also propose a fifth assumption to CIIT to integrate emerging literature on pathological interpersonal patterns in personality disorders. This assumption emphasizes the importance of context in characterizing non-normative social exchanges beyond simple deviations from complementarity. They conclude by discussing how concepts in interpersonal models can be used to inform and implement therapy for patients with a personality disorder.
This comment concurs with Miller and Widiger’s review on the five-factor model’s potential to describe personality pathology. Remaining challenges are the definition of the domain that one wants to cover and how to separate personality description from dysfunction.
Categorical rubrics are the prevailing approach to personality disorder (PD) assessment and diagnosis. Diagnostic manuals, funding bodies, and training programs tend to follow this categorical model. Yet there is now abundant evidence that PD categories are impeding research progress on personality pathology. This chapter describes an emerging dimensional perspective on personality problems, the Hierarchical Taxonomy of Psychopathology (HiTOP). The HiTOP framework encapsulates factor analytically derived higher- and lower-order dimensions of personality pathology, ranging from an overarching general factor of psychopathology at the hierarchy’s apex to homogeneous maladaptive personality traits and acute symptoms at the base. This multi-level system bypasses aspects of categorical PD diagnoses that researchers find problematic (e.g., comorbidity, within-diagnosis heterogeneity, and insufficient coverage of personality problems encountered in the clinic). HiTOP has the potential to renew field-wide interest in PD and streamline social, psychological, and biological research on personality pathology.