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 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.

Although antisocial personality disorder (ASPD) is more common among males and borderline PD (BPD) is more common among females, some authors have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of ASPD are elevated in the first degree relatives of those with BPD, and concurrent comorbidity rates for the two disorders are high. In this article, we present a common model of antisocial and borderline personality development. We begin by reviewing issues and problems with diagnosing and studying PDs in children and adolescents. Next, we discuss dopaminergic and serotonergic mechanisms of trait impulsivity as predisposing vulnerabilities to ASPD and BPD. Finally, we extend shared risk models for ASPD and BPD by specifying genetic loci that may confer differential vulnerability to impulsive aggression and mood dysregulation among males and impulsive self-injury and mood dysregulation among females. Although the precise mechanisms of these sex-moderated genetic vulnerabilities remain poorly understood, they appear to interact with environmental risk factors including adverse rearing environments to potentiate the development of ASPD and BPD.

One of the fundamental limitations of the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition, Text Revision (DSM-IV-TR) categorical model of personality disorder classification has been the lack of a strong scientific foundation, including an understanding of childhood antecedents. The DSM-IV-TR personality disorders, however, do appear to be well understood as maladaptive variants of the domains and facets of the general personality structure as conceptualized within the five-factor model (FFM). Integrating the classification of personality disorder with the FFM brings to an understanding of the personality disorders a considerable body of scientific research on childhood antecedents. The temperaments and traits of childhood do appear to be antecedent to the FFM of adult personality structure, and these temperament and traits of childhood and adolescence are the likely antecedents for adult personality disorder, providing further support for the conceptualization of the adult personality disorders as maladaptive variants of the domains and facets of the FFM. Conceptualizing personality disorders in terms of the FFM thereby provides a basis for integrating the classification of abnormal and normal personality functioning across the life span.

Consistent with principles of developmental psychopathology, this paper presents a broad psychodynamic structural developmental perspective that establishes conceptual continuities between processes of normal personality development, personality organization, concepts of psychopathology, and processes of therapeutic change. The major assumption of this approach is that personality development proceeds in a dialectic synergistic interaction between the development of capacities for interpersonal relatedness and the development of self-definition or identity. Extensive research demonstrates that these two dimensions define two broad types of personality organization, each with a particular experiential mode; preferred forms of cognition, defense, and adaptation; unique qualities of interpersonal relatedness and specific types of object and self-representation. Severe disruptions of this normal dialectic developmental process result in various forms of psychopathology organized in two basic configurations in which there is distorted defensive preoccupation, at different developmental levels, with one of these polarities (relatedness or self-definition) at the expense of the development of the other dimension. This paper reviews empirical findings supporting this approach to normal and disrupted personality development throughout the life cycle and considers its relationship to the internalizing–externalizing distinction in childhood and adolescence, attachment theory, and research on the interaction between biological and psychosocial factors in development across the life span. Finally, we discuss the implications of this approach for intervention and prevention.

Relations of avoidant personality disorder (AvPD) with shyness and inhibition suggest that a precursor of AvPD is withdrawal. Using a sample of 4.5- to 7-year-olds studied four times, 2 years apart, four and three classes of children differing in trajectories of mother- and teacher-reported withdrawal, respectively, were identified. Mothers and teachers generally did not agree on children's trajectories but the pattern of findings in the two contexts did not differ markedly. The mother-identified high and declining withdrawal class, in comparison with less withdrawn classes, and the teacher-identified high and declining class compared with low withdrawal classes, were associated with relatively high levels of anger and low levels of attentional control and resiliency. The mother-identified moderate and increasing withdrawal class was distinguished from less problematic withdrawal classes by higher anger, lower resiliency, and sometimes, lower attentional control. The teacher-identified low and increasing withdrawal class was distinguished from less problematic withdrawal classes by lower resiliency and lower attentional control. Findings are discussed in terms of the developmental precursors to social withdrawal and avoidant behavior.

Adolescents' trajectories of impulsive and hostile behaviors provide a dynamic index of risk for the emergence of Cluster B (antisocial and borderline) personality disorders in early adulthood. In the current study, we tested the hypothesis that preoccupied states of mind in the Adult Attachment Interview would increase both the level and rate of growth in adolescents' trajectories of aggressive and sexual risk-taking behaviors measured at ages 13, 15, and 17. Overall, preoccupied states of mind predicted higher levels of sexual risk taking and aggressive behaviors across all three assessments as well as higher rates of growth in sexual-risk taking and caregiver-reported aggression over time. In addition, preoccupied females showed slower rates of decline in self-reported hostile emotions than did preoccupied males. The effects of gender as a moderator of the relations between preoccupied status and risk trajectories for personality disorders are discussed.

Studies on the developmental course of personality disorders have suggested that adult personality disorders enclose both features with a natural plasticity over time, as well as stable components represented by underlying trait dimensions. The current study broadens this dimensional stability perspective toward an earlier developmental stage, and describes with different indices of stability the longitudinal behavior of basic childhood maladaptive trait dimensions in a community sample of 477 Flemish children. The results underscore structural, rank-order, and within-person stability for the disagreeableness, emotional instability, introversion, and compulsivity dimensions and suggest a similar maturation principle as has been proposed for adults. Individual growth curve analyses indicate that children's maladaptive trait scores generally decrease as they grow older, with a smaller decline for high-scoring individuals. Childhood maladaptive traits and general psychopathology dimensions show similar longitudinal patterns in terms of shape and change over time, supporting a spectrum conceptualization of Axis I related pathology and personality disorder precursors at young age. The implications of these findings for a developmental perspective on dimensional conceptualizations of personality disorders are discussed.

The present paper focuses on the trait domain of conscientiousness, its development, and its relation to psychopathology. The definition of conscientiousness and its interface with specific forms of psychopathology, such as externalizing psychopathology, are discussed first. Then an overview of the known developmental changes in conscientiousness across the life course is provided, as well as the potential shared developmental etiology of conscientiousness and externalizing psychopathology. Given the lack of data, testing etiological factors that may contribute to the development of both conscientiousness and externalizing disorders, we report on three studies examining the childhood experiences associated with both conscientiousness and externalizing behaviors. Last, future directions are discussed.

This study investigated the longitudinal impact of maltreatment parameters on personality processes and maladjustment and prospective relationships between personality trajectory classes and subsequent maladjustment outcomes. The sample involved maltreated (n = 249) and nonmaltreated (n = 200) children followed longitudinally between ages 6 and 10. Growth mixture modeling indicated multifinality in personality development depending on the risk status (i.e., maltreated vs. nonmaltreated). Two trajectory classes of ego resiliency were identified for maltreated children: those who showed a declining trajectory exhibited greater maladjustment. In contrast, three trajectory classes of ego control were identified for nonmaltreated children; the subgroups showing increases in ego undercontrol or dramatic changes from high ego undercontrol to high ego overcontrol exhibited poor adjustment. Experiencing multiple maltreatment subtypes and physical/sexual abuse were related to higher levels of ego undercontrol and externalizing symptomatology, whereas early onset of maltreatment was associated with the low and decreasing trajectory of ego resiliency and higher levels of internalizing symptomatology. The findings suggest that ego resiliency and ego control, personality processes related to self-regulation, may be important factors in identifying distinct pathways to later personality disorders as well as pathways to resilient functioning.

The clinical concept of psychopathy (“psychopathic personality”) is generally considered to entail persistent behavioral deviancy in the company of emotional–interpersonal detachment. However, longstanding debates continue regarding the appropriate scope and boundaries of the concept. Here, we review alternative historic descriptions of the disorder together with empirical findings for the best-established assessment instruments in use with adolescents and youth as a basis for formulating an integrative, triarchic model of psychopathy. The essence of the triarchic model is that psychopathy encompasses three distinct phenotypic constructs: disinhibition, which reflects a general propensity toward problems of impulse control; boldness, which is defined as the nexus of social dominance, emotional resiliency, and venturesomeness; and meanness, which is defined as aggressive resource seeking without regard for others (“dysaffliated agency”). These differing phenotypic components are considered in terms of relevant etiologic and developmental pathways. The triarchic conceptualization provides a basis for reconciling and accommodating alternative descriptive accounts of psychopathy, and a framework for coordinating research on neurobiological and developmental processes contributing to varying manifestations of the disorder.

The genetic and environmental basis of a well-replicated association between antisocial behavior (ASB) and resting heart rate was investigated in a longitudinal twin study, based on two measurements between the ages of 9 and 14 years. ASB was defined as a broad continuum of externalizing behavior problems, assessed at each occasion through a composite measure based on parent ratings of trait aggression, delinquent behaviors, and psychopathic traits in their children. Parent ratings of ASB significantly decreased across age from childhood to early adolescence, although latent growth models indicated significant variation and twin similarity in the growth patterns, which were explained almost entirely by genetic influences. Resting heart rate at age 9–10 years old was inversely related to levels of ASB but not change patterns of ASB across age or occasions. Biometrical analyses indicated significant genetic influences on heart rate during childhood, as well as ASB throughout development from age 9 to 14. Both level and slope variation were significantly influenced by genetic factors. Of importance, the low resting heart rate and ASB association was significantly and entirely explained by their genetic covariation, although the heritable component of heart rate explained only a small portion (1–4%) of the substantial genetic variance in ASB. Although the effect size is small, children with low resting heart rate appear to be genetically predisposed toward externalizing behavior problems as early as age 9 years old.

Adolescent aggression was explored in relation to neighborhood and genetic characteristics. Child saturation (the proportion of the population consisting of children under the age of 15), ethnic heterogeneity, poverty, and urbanicity of neighborhoods were examined in relation to adolescent aggression in 12,098 adolescents followed longitudinally for 1 year. Longitudinal analyses indicated that child saturation was positively associated with increases in aggression, with this finding emerging among those living in the same neighborhood at both testing times and those who moved between testing times. In a subsample of males for whom genetic data were available, the relation of child saturation to adolescent aggression was moderated by the monoamine oxidase A (MAOA) gene. The regression of aggression on child saturation was steeper for those with the low activity version of the MAOA allele than among those with the high activity version of the allele. The implications of the results for an understanding of the origins and ontogeny of aggression and personality disorders are discussed.

In the study of developmental psychopathology a dimensional, variable-oriented approach dominates over a typological approach. With the person-oriented research paradigm providing the metatheoretical framework, pros and cons of these two approaches are discussed, and it is pointed to different methodological realizations of the typological approach, and to the contexts where they might be appropriate. It is also pointed out that the two important and underused concepts of equifinality and multifinality with advantage can be incorporated in a person-oriented approach. An empirical example is given of the study of the structure of early adolescent problem behaviors and their relationship to later criminality where dimensional as well as typological analyses are carried out. The usefulness of the typological approach in studying the development and early manifestations of the personality disorder psychopathy is also discussed. It is concluded that the usefulness of a typological approach appears to be underestimated.

Borderline personality disorder (BPD) represents a severe distortion in the development of attachment, self, and emotion regulation. Study of children at high risk of developing BPD may inform precursors to BPD. In a low socioeconomic status sample of 30 children aged 4–7 whose mothers have BPD and 30 normative comparisons, representations of the caregiver–child relationship and of the self, and emotion regulation were assessed with a story-stem completion measure. In contrast to comparisons and controlling for major depressive disorder, children whose mothers have BPD told stories with the following: (a) more parent–child role reversal, more fear of abandonment, and more negative mother–child and father–child relationship expectations; (b) more incongruent and shameful representations of the self; and (c) poorer emotion regulation indicated by more confusion of boundaries between fantasy and reality and between self and fantasy, more fantasy proneness, less narrative coherence, and marginally more intrusion of traumatic themes. In the sample as a whole, (a) a maladaptive caregiver–child relationship composite was associated with maternal identity disturbance and self-harm; (b) a maladaptive self-composite was associated with maternal self-harm; and (c) a maladaptive emotion regulation composite was associated with maternal identity disturbance, negative relationships, and self-harm. Results are discussed in terms of putative precursors to BPD and preventive interventions.

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.