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University of Southampton Research Repository Eprints Soton University of Southampton Research Repository ePrints Soton Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. AUTHOR (year of submission) "Full thesis title", University of Southampton, name of the University School or Department, PhD Thesis, pagination http://eprints.soton.ac.uk UNIVERSITY OF SOUTHAMPTON FACULTY OF SOCIAL AND HUMAN SCIENCES Psychology Childhood Predictors of Personality Disorders by Johanna Koerting Supervisors: Edmund Sonuga-Barke, Roelie Hempel, Thomas Lynch Thesis for the degree of Doctor of Philosophy February 2015 UNIVERSITY OF SOUTHAMPTON ABSTRACT Personality disorders (PDs) are characterised by enduring patterns of inner experience and behaviour that deviate markedly from the expectation of the individual's culture, have their onset in adolescence or early adulthood, are pervasive, inflexible and stable over time, and can lead to serious distress and impairment in daily life and functioning (APA, 2013). Even though empirical research in this area is mostly lacking, prominent theoretical models of PD argue that individual child characteristics such as difficult temperament, and adverse environmental factors such as negative parenting behaviours, interact to increase a child’s risk of developing personality pathology later in life. This thesis examined childhood predictors of Personality Disorders (PDs). The aim was to investigate (1) Whether externalising and/or internalising childhood problems were predictive of personality pathology in early adulthood; (2) Whether the associations between childhood problems and personality pathology were moderated or mediated by negative parenting; and (3) Whether continuities in child psychopathology explained the associations between childhood problems and PDs. In Chapter 1, an overview about what is currently known about the developmental pathways to PD was provided. Applying an interactive model, biological and environmental risk factors, as well as evidence looking at the interplay between these factors, was reviewed. Further, an overview about the risk markers for the development of PD, in the form of common childhood disorders (EXT and INT problems) was given. In Chapter 2, all published prospective longitudinal studies about the predictive validity of childhood externalising and internalising problems regarding PDs were collated and meta- analysed. Chapter 3 outlined and justified the methodology applied across studies. In addition, the methodological challenges encountered when conducting this research were discussed, as well as the methods applied to overcome these challenges. In Chapter 4, using a prospective longitudinal design, childhood problems were investigated as predictors of personality pathology in early adulthood. Childhood data was collected in 1990/1991, of three- year-old children and their families, where children were assessed for emotional and behavioural problems, namely hyperactivity, emotional problems, shyness and conduct problems. Both additive and interactive effects of baseline variables were assessed in relation to personality pathology in early adulthood, controlling for age, sex and socio-economic status (SES) at baseline. The results showed that externalising but not internalising problems were significantly predictive of personality pathology at follow-up. Only one additive effect and no interactive effects were found. In Chapter 5, the effects of adverse parenting on the associations between childhood problems and PD were investigated. Specifically, we explored whether maternal and/or paternal lack of warmth and/or overcontrol as assessed by retrospective reports by the young persons, significantly influenced the relationship between childhood disorders and personality pathology. We found that paternal indifference and maternal overcontrol were predictive of adult PD; these negative parenting dimensions added to the effects of childhood problems detected in Chapter 4 in the prediction of PD. No moderation effects and few partial mediation effects were detected. In Chapter 6, the effects of continuities of childhood psychopathology on PD were assessed. Specifically, it was investigated whether the effects of childhood problems on PD were mediated by homotypic or heterotypic continuities in psychopathology (i.e. continuity within the same (homotypic) or different (heterotypic) ‘class’ of disorder) which were assessed in early adulthood. Only homotypic continuities were found: hyperactivity at age 3 was associated with adult Attention- Deficit Hyperactivity Disorder (ADHD), and conduct problems at age 3 were associated with later Oppositional Defiant Disorder (ODD). ADHD did not mediate the relationship between hyperactivity and adult PD, and ODD partially mediated the association between conduct problems and adult PD. In Chapter 7, the results of all previous chapters were summarised and discussed. In sum, we found strong and robust associations between childhood externalising problems and PD; these were not influenced by negative parenting, and they were not mediated by continuation of symptoms into adulthood. Negative parenting, especially paternal indifference, additionally increased the risk for a PD, but parenting did not interact with childhood problems in the prediction of PD. Specifically, the following risk patterns were found: (1) childhood hyperactivity, conduct problems and paternal indifference predicted Borderline PD; (2) childhood conduct problems and maternal overcontrol predicted Antisocial PD; and (3) childhood hyperactivity predicted Avoidant PD. These results are in contrast to the consensus that child characteristics and environmental factors interact in the development of PD. Rather, the results would support a model of separate pathways leading to PD. Our findings have several implications for early intervention and prevention strategies. The findings were discussed in relation to current developmental theories of PD, as well as their implication for our understanding of developmental pathways for PD. FACULTY OF SOCIAL AND HUMAN SCIENCES Psychology Thesis for the degree of Doctor of Philosophy CHILDHOOD PREDICTORS OF PERSONALITY DISORDERS Johanna Luise Koerting Table of Contents i ABSTRACT ................................................................................................................................ i Table of Contents ................................................................................................................ i List of tables ........................................................................................................................ix List of figures ......................................................................................................................xi DECLARATION OF AUTHORSHIP ............................................................................. xii Acknowledgements ....................................................................................................... xiii Definitions and Abbreviations ............................................................................... xiv Chapter 1: Literature Review – Childhood Predictors Of Personality Disorders............................................................................................................... 1 1.1 Introduction ........................................................................................................... 1 1.1.1 Assessment of Personality Disorders ..................................... 2 1.1.2 Temperament......................................................................................... 8 1.1.3 Developmental Pathways to Personality Disorder .......... 9 1.2 Biological Risk Factors .................................................................................. 11 1.2.1 Genetic Risk/Heritability of Specific Personality Disorders ............................................................................................... 12 1.2.2 Genetic Risk/Heritability of Vulnerability to Personality Pathology .............................................................................................. 13 1.3 Environmental risk factors for PD ......................................................... 15 1.3.1 Prenatal, Perinatal and Early Postnatal Risk Factors ... 15 1.3.2 Child Maltreatment .......................................................................... 18 1.3.3 Parent Risk Factors.......................................................................... 23 1.3.4 Family and Socioeconomic Adversity ................................... 35 1.4 Interaction between Genetic and Environmental Influences . 37 1.5 Protective factors ............................................................................................. 39 1.6 Risk markers....................................................................................................... 42 1.6.1 Externalising childhood problems ......................................... 42 1.6.2 Internalising childhood problems
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