Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults

Do insecure adult attachment styles mediate the relationship between childhood maltreatment and violent behavior?

Attachment theory has played an important role in attempts to understand the "cycle of violence," where maltreated children are at increased risk for perpetrating violence later in life. However, little is known empirically about whether adult attachment insecurity in close relationships may partly explain the link between childhood maltreatment and violent behavior. This study aimed to address this gap using data from a prospective longitudinal study of documented childhood abuse and neglect cases and demographically matched controls (ages 0-11 years), who were followed into adulthood and interviewed (N = 892). Participants completed the Relationship Scales Questionnaire assessing adult attachment styles at mean age 39.54. Criminal arrest data were used to determine arrests for violence after the assessment of attachment through mean age 50.54. There were significant direct paths from childhood maltreatment and adult attachment insecurity to violent arrests after attachment measurement. Attachment insecurity partly explained the higher levels of violence in individuals with maltreatment histories. Analyses of maltreatment subtypes and attachment styles revealed that attachment anxiety appeared to mediate paths between neglect and physical abuse and later violence. There were no significant indirect paths from neglect or physical abuse to violence via attachment avoidance. Implications and future directions are discussed.

Perception Over Personality in Lethal Force: Aggression, Impulsivity, and Big Five Traits in Threat Assessments and Behavioral Responses due to Weapon Presence and Posture

The use of lethal force is a combination of threat perception and individual judgment that sometimes warrants a behavioral response. This simplified description implicates perceptual factors and individual differences in lethal force decision making, which ongoing research continues to address. However, personality-based factors have been less explored as to how they might affect either threat perception or behavioral responses in a lethal force decision. The current investigation examined multiple personality traits with the potential to influence lethal force decision making, including aggression, impulsivity, and the Big Five traits. These measures were compared to threat perception and behavioral responses made to a variety of lethal force stimuli broadly categorized as clear threats, ambiguous threats, and clear nonthreats. Samples were recruited from combat-trained infantry, military recruits, and the civilian community to control for prior lethal force training. Although there was a strong omnibus relationship between threat perception and the likelihood of a behavioral response, neither military training nor personality differences had any impact on threat perception or a binary (e.g., shoot/don't-shoot) behavioral response. Therefore, we conclude that perception dominates personality in lethal force decision making when the threat assessment decision is limited to factors such as weapon presence or posture rather than emotion.

Insecure attachment and personality disorder: a twin study of adults

This study used 239 twin pairs from a volunteer community sample to investigate how anxious and avoidant attachment are related to personality disorder (PD). Factor analysis showed that self‐reported anxious attachment and 11 PD scales from the Dimensional Assessment of Personality Problems loaded onto one factor (emotional dysregulation), and avoidant attachment and four PD scales loaded onto a second factor (inhibitedness). Biometric models indicated that 40% of the variance in anxious attachment was heritable, and 63% of its association with corresponding PD dimensions was attributable to common genetic effects. Avoidant attachment was influenced by the shared environment instead of genes. Correlations between avoidance and corresponding PD dimensions were attributable to experiences in the nonshared environment that influenced both variables. Copyright © 2006 John Wiley & Sons, Ltd.

Development and change in attachment: A multiwave assessment of attachment and its correlates across childhood and adolescence

This research examines the contextual factors that facilitate development and change in attachment during later childhood, adolescence, and early adulthood using a longitudinal cohort design involving 690 children (7-19 years old) and their parents. At each wave, a variety of interpersonal variables (e.g., parent-child stress) were measured. We examined alternative developmental processes (i.e., long-term, catalytic, and short-term processes) that have not been previously distinguished in attachment research. Preregistered analyses revealed that nondevelopmental processes can explain the associations between almost all of the interpersonal variables of interest and attachment security, suggesting that previous research using traditional longitudinal methods may have misattributed nondevelopmental processes for developmental ones. For example, we found that friendship quality, although prospectively associated with attachment both in prior work and in the current study, was not developmentally associated with attachment. However, after controlling for nondevelopmental sources of covariation, we identified a number of developmental processes that may help explain change in attachment. For example, we found that initial levels of parental depression, as well as growth in parent-child stress, were related to growth in adolescent insecurity over 3 years. We also examined 12 genetic variants studied in previous research and found that they were not related to average levels or changes in attachment. These results highlight how distinguishing unique kinds of developmental processes allows for a more comprehensive understanding of attachment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Pathways from Father Engagement during Infancy to Child Aggression in Late Childhood

Child aggression and its dire consequences cause social problems. Informed by family systems theory and parenting stress theory, this study specifically examined the mediating pathways from father engagement to child aggression through maternal parenting stress, child resistant attachment, and maternal physical abuse. We conducted a secondary data analysis on 2016 mother-child dyads from the Fragile Families and Child Wellbeing Study by building structural equation models. We found indirect effects of father engagement on child aggression through influencing mothers' parenting stress. Children's attachment and mothers' physical abuse mediated the effects of mothers' stress on child behavior-based aggression and verbal- and mood-based aggression. Interventions should target fostering fathers' engagement, alleviating mothers' parenting stress and changing mothers' abusive parenting, and improving mother-child attachment.

Developmental trajectories of attachment and depressive symptoms in children and adolescents

Previous research has found that insecure attachment is associated with depression. In the present study, we use an accelerated longitudinal cohort design to examine how the association between attachment and depression develops during childhood and adolescence. Specifically, 690 children from 3 distinct cohorts (grades 3, 6, and 9) completed self-report measures of attachment and depressive symptoms 3 times over 3 years. Growth curve analyses indicated that attachment anxiety and attachment avoidance were uniquely related to depressive symptoms. Higher levels of attachment anxiety and avoidance predicted higher levels of depressive symptoms over time. Additionally, changes in attachment security were associated with changes in depressive symptoms. The analyses suggest that insecure attachment and depressive symptoms co-vary and that these dynamics are evident in childhood and adolescence.

Avoidant personality disorder: current insights

Avoidant personality disorder (AVPD) is a relatively common disorder that is associated with significant distress, impairment, and disability. It is a chronic disorder with an early age at onset and a lifelong impact. Yet it is underrecognized and poorly studied. Little is known regarding the most effective treatment. The impetus for research into this condition has waxed and waned, possibly due to concerns regarding its distinctiveness from other disorders, especially social anxiety disorder (SAD), schizoid personality disorder, and dependent personality disorder. The prevailing paradigm subscribes to the "severity continuum hypothesis", in which AVPD is viewed essentially as a severe variant of SAD. However, areas of discontinuity have been described, and there is support for retaining AVPD as a distinct diagnostic category. Recent research has focused on the phenomenology of AVPD, factors of possible etiological significance such as early parenting experiences, attachment style, temperament, and cognitive processing. Self-concept, avoidant behavior, early attachments, and attachment style may represent points of difference from SAD that also have relevance to treatment. Additional areas of research not focused specifically on AVPD, including the literature on social cognition as it relates to attachment and personality style, report findings that are promising for future research aimed at better delineating AVPD and informing treatment.

Attachment Security Priming as a Potential Intervention for Depressive Symptoms

Numerous studies have demonstrated that people high on attachment insecurity are more likely to report depressive symptoms as compared to those low on insecurity (secures). These findings suggest that enhancing one's sense of attachment security could help relieve depressive symptoms. One promising technique for increasing attachment security that has received relatively little attention as a therapeutic intervention is attachment security priming. Compared with other interventions, security priming is easier and takes less time to administer. The current studies examined if priming techniques used to increase attachment security could reduce depressive symptoms in an adolescent and emerging adults samples. In Study 1, depressive symptoms were assessed before exposure to either attachment security or neutral primes and then re-assessed one week later. Results revealed that participants who were exposed to the security primes reported a greater decrease in depressive symptoms than the control group. In Study 2, adolescents who were repeatedly exposed over two weeks to security primes showed lower depression symptoms than participants exposed to neutral primes. Overall, our findings provide initial support to the idea that attachment security priming can be a useful method to help decrease depressive symptoms.

Autonomy-connectedness mediates sex differences in symptoms of psychopathology

OBJECTIVES

This study aimed to examine if autonomy-connectedness, capacity for self-governance under the condition of connectedness, would mediate sex differences in symptoms of various mental disorders (depression, anxiety, eating disorders, antisocial personality disorder).

METHOD

Participants (N = 5,525) from a representative community sample in the Netherlands filled out questionnaires regarding the variables under study.

RESULTS

Autonomy-connectedness (self-awareness, SA; sensitivity to others, SO; capacity for managing new situations, CMNS) fully mediated the sex differences in depression and anxiety, and partly in eating disorder -(drive for thinness, bulimia, and body dissatisfaction) and anti-social personality disorder characteristics. The mediations followed the expected sex-specific patterns. SO related positively to the internalizing disorder indices, and negatively to the anti-social personality disorder. SA related negatively to all disorder indices; and CMNS to all internalizing disorder indices, but positively to the anti-social personality disorder.

CONCLUSION

Treatment of depression, anxiety, but also eating disorders and the antisocial personality disorder may benefit from a stronger focus on autonomy strengthening.

Experiences in Close Relationships – Psychometric properties among patients with personality disorders

Patients with personality disorders represent maladaptive attachment strategies, influencing the quality of their interpersonal relationships. Within these patient populations, it is important to have a measure, easily applied, to assess such strategies. A widely used instrument is Experiences in Close Relationships (ECR), assessing two constructs called avoidance and anxiety. Lately, two short forms of ECR have been proposed, called ECR-S and ECR-N12. The aim of this study is to investigate the psychometric properties of the Norwegian @version of ECR and its two short forms in a sample of patients with mainly personality disorders. An internal consistency and confirmatory factor analysis of ECR, ECR-S and ECR-N12 from 495 patients was conducted, as well as an exploratory factor analysis of ECR. The internal consistency of ECR was found questionable. Confirmatory factor analysis revealed a poor model fit based on ECR and ECR-S. The ECR-N12 revealed a mediocre fit, indicating a potential for improvement. Exploratory factor analysis indicated two different aspects of avoidance and three aspects of anxiety. This five-factor solution was called ECR-FF. Inferences from scores based on ECR should be derived with care. A revision of ECR and ECR-N12 is warranted, and further studies are needed to investigate the validity of ECR-FF.

Comparison of patterns and strength of adult attachment in patients with Axis I, Axis I+II disorders and a community sample

BACKGROUND

Adult attachment patterns influence the quality of close relationships, and they are therefore important for treatment planning in psychiatry.

AIM

This study compares the patterns and strength of adult attachment in patients with Axis I, Axis I+II disorders and individuals of a general population sample.

METHODS

Patients were recruited from a psychiatric outpatient clinic, 72 with Axis I disorders and 72 with Axis I+II disorders. The patients and a normative community sample (n = 437) filled in the Experiences in Close Relationships questionnaire.

RESULTS

The proportion of insecure attachment differed significantly between all groups: 40% in the community sample, 64% in the Axis I group and 90% in the Axis I+II group. On the dimensional anxiety and avoidance subscales, a similar significant gradient was observed related to the strength of attachment.

CONCLUSION

A definite gradient was observed concerning patterns and strength of attachment in relation to the severity of psychopathology.

An empirically derived classification of adolescent personality disorders

OBJECTIVE

This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded.

METHOD

A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires.

RESULTS

We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings.

CONCLUSION

The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.

Personality constellations of adolescents with histories of traumatic parental separations

Consistent with attachment theory and a developmental psychopathology framework, a growing body of research suggests that traumatic parental separations may lead to unique pathways of personality adaptation and maladaptation. The present study both examined personality characteristics and identified personality subtypes of adolescents with histories of traumatic separations. Randomly selected psychologists and psychiatrists provided data on 236 adolescents with histories of traumatic separations using a personality pathology instrument designed for use by clinically experienced observers, the Shedler-Westen Assessment Procedure. Using a Q factor analysis, five distinct personality subtypes were identified as follows: internalizing/avoidant, psychopathic, resilient, impulsive dysregulated, and immature dysregulated. Initial support for the validity of the subtypes was established on the basis of axis I and axis II pathology, adaptive functioning, developmental history, and family history variables. The personality subtypes demonstrated substantial incremental validity in predicting adaptive functioning, above and beyond demographic variables and histories of other traumatic experiences.

Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients

BACKGROUND

As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients.

METHODS

We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD).

RESULTS

Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%.

LIMITATIONS

Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report.

CONCLUSIONS

Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.

The role of co-morbid personality pathology in predicting self-reported aggression in patients with schizophrenia

BACKGROUND

Personality pathology affects behavioral patterns in patients with schizophrenia notwithstanding psychotic symptomatology. An investigation of the role of co-morbid personality pathology in the occurrence of aggression in schizophrenia is explored using both categorical and dimensional approaches to personality pathology.

METHODS

In a cross-sectional study we evaluate, in 97 patients diagnosed with schizophrenia, the effect of personality pathology on the occurrence of aggression in schizophrenia using both a categorical approach, as described in DSM-IV-TR Axis II, and a dimensional approach, as operationalized in the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). We also employ mediation analyses to explore the extent to which dimensions within the DAPP mediate the relationship between co-morbid personality disorders and aggression.

RESULTS

Personality pathology accounts for aggression in schizophrenia. Both the categorical and the dimensional approaches equally well account for the occurrence of aggression, with each model accounting for 60% of the variance. Interestingly, the mediation analysis reveals that the association between categorically defined personality pathology and aggression is substantially mediated by the higher-order-trait dissocial behavior of the DAPP-BQ, accounting for 50.6 % of the total effect size.

CONCLUSION

Personality pathology can be a significant predictor of aggression in patients with schizophrenia. While both the categorical and the dimensional trait models of personality disorders equally explain the aggression data, much of the relationship between the categorically defined personality disorders and the occurrence of aggression in schizophrenia can be explained by the presence of dissocial behavior as operationalized in the DAPP-BQ dimensional model.

The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study

Attachment theory categorically assesses how a person perceives and experiences interpersonal relationships. Attachment style is linked to numerous physical and psychological phenomena; however, there is a paucity of research examining its relationship to suicide ideation and attempt in adults. Our study addresses this and investigates the relationship of adult attachment style and mental disorders in a nationally representative sample. Using data from the National Comorbidity Survey Replication (N = 5692, aged >18 years), multiple logistic regression analyses were conducted to examine these relationships. After adjusting for confounding variables, insecure attachment styles were associated with greater reporting of suicidal ideation, attempt, and all mental disorder categories analyzed (adjusted odds ratio range, 1.13-1.81). Secure attachment styles were associated with a decreased likelihood of reporting suicidal ideation, attempt, and any anxiety disorder (adjusted odds ratio range, 0.67-0.91). Clinicians should be aware of attachment issues in their patients to ensure better health outcomes and more effective physician-patient relationships.

Subtypes of aggression in patients with schizophrenia: the role of personality disorders

BACKGROUND

Research has repeatedly demonstrated that schizophrenia has a small but significant association with violence. It is further recognised that a subgroup of people with such links also have personality disorders, but the extent to which type of violence or aggression varies according to subgroup is less clear.

AIM

This study aimed to investigate, among co-morbid cases, if the number or type of personality disorders predicts type of aggression.

METHODS

In a cross-sectional study, 108 patients with schizophrenia were assessed for personality disorder, Axis-I diagnosis, verbal IQ, social functioning and type of aggression.

RESULTS

Logistic regression revealed that the more personality disorders identified (Cluster B personality disorders compared with Clusters A and C) and anti-social personality disorder compared with other Cluster B disorders significantly predicted premeditated aggression.

CONCLUSIONS

These findings suggest that detailed personality assessment should be a routine part of comprehensive assessment of patients with schizophrenia. Improved knowledge of the presence and type of personality disorders may help detect and manage the risk of some types of aggression.

Differentiating adolescent self-injury from adolescent depression: possible implications for borderline personality development

Self-inflicted injury (SII) in adolescence marks heightened risk for suicide attempts, completed suicide, and adult psychopathology. Although several studies have revealed elevated rates of depression among adolescents who self injure, no one has compared adolescent self injury with adolescent depression on biological, self-, and informant-report markers of vulnerability and risk. Such a comparison may have important implications for treatment, prevention, and developmental models of self injury and borderline personality disorder. We used a multi-method, multi-informant approach to examine how adolescent SII differs from adolescent depression. Self-injuring, depressed, and typical adolescent females (n = 25 per group) and their mothers completed measures of psychopathology and emotion regulation, among others. In addition, we assessed electrodermal responding (EDR), a peripheral biomarker of trait impulsivity. Participants in the SII group (a) scored higher than depressed adolescents on measures of both externalizing psychopathology and emotion dysregulation, and (b) exhibited attenuated EDR, similar to patterns observed among impulsive, externalizing males. Self-injuring adolescents also scored higher on measures of borderline pathology. These findings reveal a coherent pattern of differences between self-injuring and depressed adolescent girls, consistent with theories that SII differs from depression in etiology and developmental course.

Distinct but overlapping neural networks subserve depression and insecure attachment

Insecure attachment has been linked to depression and to outcome in psychotherapy. The neural mechanisms subserving the relationship between attachment security and depression are not well understood. We have developed a method to examine attachment-related brain activity in depression. Twenty-eight women, half depressed, viewed images of their mother, a female friend, and female strangers during fMRI scanning. The effects of depression and insecure attachment were determined with whole-brain multiple linear regression of blood-oxygen-level-dependent response against subjects' Beck Depression Inventory and Adult Attachment Interview (AAI) coherence of mind scores. Interaction effects were analyzed with ANOVA. Activity associated with depression and with insecure attachment was found in the cortico-striato-thalamic circuits of affect regulation. For early attachment (mother-friend contrast), depression scores correlated with activation of cortical and sub-cortical components of these circuits, while attachment insecurity correlated with sub-cortical activity in the same circuitry. Depression and attachment insecurity correlated with both cortical and sub-cortical activities for mother-stranger, and areas of overlap and of enhancing interactions between depression and insecure attachment were found. For late attachment (friend-stranger contrast), only cortical effects were found. Depression and attachment insecurity may be subserved by similar but distinct components of affect regulating circuits. Their interactions may explain the greater difficulty of treating depression in insecurely attached patients and suggest a contributing role for insecure attachment in depression. Further, differential sub-cortical vs cortical encoding of early vs late attachment suggests a top-down model of late attachment, potentially relevant to psychotherapeutic outcome.

Sex differences in romantic attachment: a meta-analysis

This article presents the first meta-analysis of sex differences in the avoidance and anxiety dimensions of adult romantic attachment, based on 113 samples (N = 66,132) from 100 studies employing two-dimensional romantic attachment questionnaires (Experiences in Close Relationships, Experiences in Close Relationships-Revised, and Adult Attachment Questionnaire). Overall, males showed higher avoidance and lower anxiety than females, with substantial between-study heterogeneity. Sex differences were much larger in community samples (bivariate D = .28) than in college samples (D = .12); web-based studies showed the smallest sex differences (D = .07) in the opposite direction. Sex differences also varied across geographic regions (overall Ds = .10 to .34). Sex differences in anxiety peaked in young adulthood, whereas those in avoidance increased through the life course. The relevance of these findings for evolutionary models of romantic attachment is discussed, and possible factors leading to underestimation of sex differences are reviewed.

The relationship between attachment, personality and antisocial tendencies in a prison sample: a pilot study

This study examined the role of adult attachment and personality in relation to antisocial tendencies (i.e. convictions for violence and interpersonal problems in romantic relationships) in Norwegian prison inmates (N=92). Attachment styles and personality were measured using self-report questionnaires (RSQ; Griffin & Bartholomew, 1994; and NEO-FFI, Costa & McCrae, 1992a). The prison inmates scored higher on avoidant than on anxious attachment style. While age and agreeableness (negatively associated) emerged as significant predictors of violence, anxious attachment explained most of the variances in aggression in intimate relationships. The study suggests that different types of antisocial tendencies could have different attachment and general personality correlates.

Early maternal separation and the trajectory of borderline personality disorder symptoms

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

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.

The development of personality disorders: perspectives from normal personality development in childhood and adolescence

The developmental pathways leading to personality disorders are poorly understood, but clues to these pathways come from recent research on personality disorders and normal personality development in childhood and adolescence. The first section of this paper reviews recent work on personality disorders in childhood and adolescence, and concludes that personality disorders in adolescence are already prevalent, moderately stable, and impairing. The second section draws on McAdams and Pals' personality model to offer a taxonomy of personality differences that can account for the known patterns of emerging personality pathology. This taxonomy includes youths' temperament and personality traits, mental representations (including attachment), coping strategies, and narrative identities. Individual differences in all of these domains may play critical roles in the development, manifestation, and course of personality disorders. Existing knowledge of normal and abnormal personality development can inform future research on the developmental pathways leading to personality pathology, the diagnostic criteria for personality disorders, and the development of validated treatments for personality disorders in the first two decades of life.

Child development and personality disorder

The evidence is surprisingly strong that even early adolescent personality disorders or elevated personality disorder symptoms have a broad range of negative effects well into adulthood, for the most part comparable to or even larger than those of Axis I disorders. Current evidence suggests that the most severe long-term prognosis is associated with borderline and schizotypal PDs and elevated symptoms. And of course, childhood conduct disorder is in a peculiar status, disappearing in adulthood to be manifest as a very severe disorder-antisocial PD-in a minority of those with the adolescent disorder.

The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including "reactive" counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed.