Association between childhood adversity and a diagnosis of personality disorder in young adulthood: a cohort study of 107,287 individuals in Stockholm County

Abstract

Childhood adversity (CA) may increase the risk for later developing of personality disorder (PD). However, less is known about the association between cumulative CA and PD, and the role of childhood psychopathology and school performance. The current study examined the relationship between a range of CAs and a diagnosis of PD in young adulthood, and the roles of childhood psychopathology and school performance in this relationship. All individuals born in Stockholm County 1987–1991 (n = 107,287) constituted our cohort. Seven CAs were measured between birth and age 14: familial death, parental criminality, parental substance abuse and psychiatric morbidity, parental separation and/or single-parent household, household public assistance and residential instability. Individuals were followed from their 18th birthday until they were diagnosed with PD or until end of follow-up (December 31st 2011). Adjusted estimates of risk of PD were calculated as hazard ratios (HR) with 95% confidence intervals (CI). Associations were observed between cumulative CA and PD. During the follow-up 770 individuals (0.7%) were diagnosed with PD. Individuals exposed to 3+ CAs had the highest risks of being diagnosed with PD (HR 3.0, 95% CI 2.4–3.7). Childhood psychopathology and low school grades further increased the risk of PD among individuals exposed to CA. Cumulative CA is strongly associated with a diagnosis of PD in young adulthood. Our findings indicate that special attention should be given in schools and health services to children exposed to adversities to prevent decline in school performance, and to detect vulnerable individuals that may be on negative life-course trajectories.Electronic supplementary materialThe online version of this article (doi:10.1007/s10654-017-0264-9) contains supplementary material, which is available to authorized users.

The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important?

“…This method of summing the number of adversities is known as the "ACE score" approach-an ACE score being the number of adversities reported. This approach has been replicated in hundreds of subsequent studies worldwide in relation to many different outcomes (e.g., Björkenstam et al, 2017;Dube et al, 2002;Hughes et al, 2017;Kelly-Irving, Lepage, Dedieu, Bartley, et al, 2013;Kelly-Irving, Lepage, Dedieu, Lacey, et al, 2013;Schilling et al, 2007). However, the limitations of ACE scores in both research and practice are becoming increasingly recognized (Lacey & Minnis, 2020).…”

<p>Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks</p>

“…The most supported theory of BPD posits that the disorder occurs in the context of an interaction between temperamental traits, especially impulsivity and emotion dysregulation, and an invalidating childhood environment characterized by intolerance toward the expression of private emotional experiences15 Children exposed to such adverse environments are therefore unable to learn how to effectively regulate their emotions, and they vacillate between emotional inhibition and extreme emotional lability15 Several studies have shown that BPD is associated with childhood abuse and neglect more than any other personality disorder,93,113 and emotion regulation difficulties have been shown to be key mediators in the relationship between childhood trauma and BPD114 As outlined above however, adverse and traumatic events are very prevalent in personality disorders as a whole115 but also in ADHD as well as in other psychiatric disorders116 For instance, a recent cohort study in Sweden found an increased risk for ADHD (OR 5.5, 95% CI 5.0–6.0) in individuals who had been repeatedly exposed to childhood adversity116 Given this, a critical issue is whether the same type of adverse and traumatic events is involved in the pathogenesis of BPD, ADHD, and BPD+ADHD. In one of the first studies investigating this topic, Philipsen et al8 found higher rates of emotional abuse in BPD females with childhood ADHD symptomatology compared to those who had few childhood ADHD symptoms, and this was associated in turn with more severe borderline symptomatology in adulthood.…”

Sociodemographic Characteristics, Adverse Childhood Experiences, and Substance Use and Psychiatric Disorders Among Adolescent-Limited, Adult-Onset, Life-Course-Persistent Offenders and Nonoffenders in a General Population Survey

“…Two of the most significant and recurring findings in the criminal behavior literature are that juvenile (Abram et al, 2003, 2004, 2015; Colins et al, 2010; Fazel et al, 2008; Gottfried & Christopher, 2017; McClelland et al, 2004; Ryan & Redding, 2004; Teplin et al, 2002; Teplin et al, 2012) and adult (Bronson et al, 2017; National Center on Addiction and Substance Abuse at Columbia University, 2010) offenders have high rates of substance use disorders and other psychiatric disorders and experience adverse childhood experiences (ACEs; e.g., sexual, physical abuse) (Aebi et al, 2015; Friestad et al, 2014; King et al, 2011; National Center on Addiction and Substance Abuse at Columbia University, 2010) disproportionately in relation to the general population. Furthermore, ACEs have been linked to substance use and psychiatric disorders (Li et al, 2016; Lindert et al, 2014; Maniglio, 2012; Varese et al, 2012) and these findings generalize across juvenile offenders (Baglivio et al, 2014; Fox et al, 2015; King et al, 2011; Underwood & Washington, 2016; Vahl et al, 2016), adult offenders (Friestad et al, 2014; Kim et al, 2016; Varese et al, 2012), psychiatric patients (Westermair et al, 2018), and general population samples (Björkenstam et al, 2017; McLaughlin et al, 2012).…”