Personality functioning and the pathogenic effect of childhood maltreatment in a high-risk sample

Abstract

Background While the psychopathological sequalae of childhood maltreatment are widely acknowledged, less is known about the underlying pathways by which childhood maltreatment might lead to an increased risk for mental health problems. Recent studies indicated that impaired personality functioning might mediate this relationship. The aim of the present paper was to extend the current literature by investigating the mediating effect of impaired personality functioning between different types of childhood maltreatment and self-reported mental health problems in a high-risk sample. Methods Overall, 173 young adults (mean age = of 26.61 years; SD = 3.27) with a history of residential child welfare and juvenile justice placements in Switzerland were included in the current study. The Childhood Trauma Questionnaire (CTQ-SF), Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1) and the self-report questionnaires of the Achenbach System of Empirically Based Assessment scales (ASEBA) were used. Mediation analyses were conducted through structural equation modeling. Results Overall, 76.3% (N = 132) participants indicated at least one type of childhood maltreatment, with emotional neglect being most commonly reported (60.7%). A total of 30.6% (N = 53) participants self-reported mental health problems. Emotional abuse (r = 0.34; p < .001) and neglect (r = 0.28; p < .001) were found to be most strongly associated with mental health problems. In addition, impaired personality functioning was fond to be a significant mediator for overall childhood maltreatment (β = 0.089; p = 0.008) and emotional neglect (β = 0.077; p = 0.016). Finally, impaired self-functioning was found to be a significant mediator when both self-functioning and interpersonal functioning were included as potential mediators in the relationship between overall childhood maltreatment (β1 = 0.177, p1 = 0.007) and emotional neglect (β1 = 0.173, p1 = 0.003). Conclusion Emotional neglect may be particularly important in the context of childhood maltreatment, personality functioning, and mental health problems and, therefore, should not be overlooked next to the more “obvious” forms of childhood maltreatment. Combining interventions designed for personality functioning with trauma-informed practices in standard mental health services might counteract the psychopathological outcomes of maltreated children and adolescents.

Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment

“…This encompasses adverse effects on identity diffusion, moral functioning, aggression, and reality testing. These findings resonate with preliminary data ( 9 ), which linked CEA with augmented challenges in PO and highlighted the mediating role of PO between CEA and BPD traits. Employing the PO model afforded a more comprehensive understanding of the repercussions of CEA on personality maturation, thus broadening the scope beyond earlier research that primarily examined CEA's negative influence concerning identity diffusion ( 17 , 18 ).…”

“…Preliminary research suggests that PO mediates the relationship between CEA and symptoms of borderline personality disorder ( 9 ). Yet, significant knowledge gaps persist concerning the impact of CEA on PO in adolescents, as well as the potential role of mentalizing.…”

“…Within this framework, personality disorders are characterized by structural impairments in self and personality functioning ( 40 ). Moreover, symptoms of personality disorders, such as self-harm, are perceived not merely as isolated behaviors, but as manifestations stemming from underlying personality vulnerabilities ( 9 ). There is a growing consensus that these dimensional models offer a more developmentally attuned and clinically pertinent perspective ( 2 , 41 , 42 ).…”

“…Drawing upon prior studies ( 18 , 30 , 32 , 53 ), we postulated that CEA would correlate with heightened challenges in mentalizing, typified by confusion regarding mental states. Further, based on initial observations ( 9 ), we anticipated a link between CEA and increased PO challenges. Given the dearth of preceding research focusing on mentalizing and PO, we refrained from asserting a definitive hypothesis.…”

Associations between different measures of personality pathology and resting-state autonomic function among adolescents.

“…It must further be taken into account that we cannot rule out the possibility that an underestimation of the level of interpersonal impairment may have influenced the reported patterns of association involving the interpersonal impairment domain score and the total score calculated from the two domains. Additionally, the possibility that the STiP-5.1 domain scores may have been differentially affected by specific comorbid diagnoses (Doubková et al, 2022; d’Huart et al, 2022) must be considered. The present study is based on accumulated evidence supporting the validity and reliability of PD diagnosis in adolescence (Cohen et al, 2005; Longman et al, 2016; Winsper, Lereya, et al, 2016; Winsper, Marwaha, et al, 2016), it is, however, crucial not to disregard the long-standing controversiality of PD diagnosis in preadulthood (Hutsebaut et al, 2013).…”