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Jonathan Hill, Child and Development Psychiatry, Royal Liverpool Children's Hospital, UK,
Michaela Swales, Child and Development Psychiatry, Royal Liverpool Children's Hospital, UK,
Marie Byatt, Child and Development Psychiatry, Royal Liverpool Children's Hospital, UK
‘Personality disorder’ (PD) is a term that is used in a variety of ways, some helpful and some less so. It can be synonymous with ‘not treatable’, ‘not within the remit of mental health services’, or even ‘nasty’. This chapter does not refer to any of these. We are referring to relatively persistent maladaptive behaviours and patterns of interpersonal and social role functioning, that are not readily accounted for by discrete episodes of psychiatric disorder.
The available definitions of personality disorder specify that it cannot be diagnosed before age 18. In many respects this simply reflects that many of the identifying features of the personality disorders refer to functioning within adult social roles. It might also be sensible to reserve the term for adults if it were clear that childhood and adolescence is essentially a period of transition and change, contrasted with adult life as a time during which change is unlikely, and if it were to be used to denote that the problems were not open to change. However there is ample evidence for strong continuities in some relevant characteristics, such as aggression and anxious inhibition over childhood and adolescence, and for the possibilities for change during adult life. Furthermore, it is not helpful to include inability to change in the definition of personality disorder. That is an issue that is available for empirical study in relation to different patterns of disorder.
Background. Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16.
Method. Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 in five primary care practices. Second-phase subjects for interview (n=197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.
Results. Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care.
Conclusions. The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.
Child sexual abuse (CSA) and poor parental care (neglect and institutional care) are associated with depression in adult life. Little is known about possible mechanisms underlying these associations.
To examine the role of adult intimate-love relationships as differential mediators or moderators of the associations between CSA, poor parental care and adult depression.
Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25–36 years in five primary care practices. Second-phase subjects for interview (n=198) were drawn from three strata defined on the basis of childhood adversities. Recalled childhood experiences and recent adult relationships and depression were assessed and rated independently. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample.
The risk for depression associated with CSA was unaffected by quality of adult relationships, while the risk associated with poor parental care was substantially altered.
There may be different pathways linking CSA and poor parental care to adult depression.
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