Johnson, Jeffrey G. PhD; Cohen, Patricia PhD; Brown, Jocelyn MD; Smailes, Elizabeth M. MA; Bernstein, David P. PhD
Background: Data from a community-based
longitudinal study were used to investigate whether childhood abuse and neglect
increases risk for personality disorders (PDs) during early adulthood.
Psychosocial and psychiatric interviews were administered to a representative
community sample of 639 youths and their mothers from 2 counties in the state
of New York in 1975, 1983, 1985 to 1986, and 1991 to 1993. Evidence of childhood
physical abuse, sexual abuse, and neglect was obtained from New York State
records and from offspring self-reports in 1991 to 1993 when they were young
adults. Offspring PDs were assessed in 1991 to 1993.
Persons with documented childhood abuse or neglect were more than 4 times
as likely as those who were not abused or neglected to be diagnosed with
PDs during early adulthood after age, parental education, and parental psychiatric
disorders were controlled statistically. Childhood physical abuse, sexual
abuse, and neglect were each associated with elevated PD symptom levels during
early adulthood after other types of childhood maltreatment were controlled
statistically. Of the 12 categories of DSM-IV PD symptoms, 10 were associated
with childhood abuse or neglect. Different types of childhood maltreatment
were associated with symptoms of specific PDs during early adulthood.
Conclusions: Persons in the community
who have experienced childhood abuse or neglect are considerably more likely
than those who were not abused or neglected to have PDs and elevated PD symptom
levels during early adulthood. Childhood abuse and neglect may contribute
to the onset of some PDs.
Arch Gen Psychiatry.1999;56:600-606
HAS indicated that many patients with personality disorders (PDs) report
histories of childhood abuse or neglect. These findings, and studies [13,14]
indicating that PDs are more prevalent among persons who experienced child
abuse than among matched comparison groups, have suggested that childhood
abuse and neglect may play an important role in the onset of PDs. [15,16] Most of this evidence, however, is based on retrospective reports by psychiatric patients. [17,18] Although research [19-22] has supported the validity of retrospective reports of childhood maltreatment, to infer from retrospective data [17,18,23,24]
alone that childhood maltreatment increases risk for the onset of PDs is
problematic. Until prospective research demonstrates that persons with documented
childhood maltreatment are at increased risk for PDs independent of other
risk factors, it cannot be established that childhood maltreatment plays
a role in the onset of PDs. 
Two longitudinal studies [25,26]
have supported the hypothesis that childhood maltreatment increases risk
for PDs. Family instability and lack of parental affection and supervision
during adolescence were found  to predict
dependent and passive-aggressive PDs among men. Physical and sexual abuse
were not assessed, however, and not all PDs were investigated. Childhood
maltreatment has been reported to predict increased risk for antisocial PD
during early adulthood.  Neither the association
between different types of maltreatment and risk for antisocial PD nor the
association between childhood maltreatment and other PDs was investigated.
Therefore, many questions about the effects of childhood maltreatment on
the risk for PDs remain unanswered. We report findings from a community-based
longitudinal study to investigate whether childhood maltreatment increases
the risk for DSM-IV  PDs during early adulthood
independent of the effects of offspring age and sex, difficult childhood
temperament, parental education, and parental psychiatric disorders.
Six hundred thirty-nine families with
children between the ages of 1 and 11 years from 2 counties in northern New
York State were representatively sampled and interviewed in 1975 
and reinterviewed in 1991 to 1993. These face-to-face interviews, also conducted
in 1983 and 1985 to 1986, were administered by extensively trained and supervised
lay interviewers.  At each assessment, written
informed consent was obtained from all participants after the study procedures
were fully explained. The 639 families in the present study were a subsample
of 776 families interviewed in 1983 for whom data regarding childhood maltreatment
were available from retrospective self-reports by the young adult participants
in 1991 to 1993 and from the New York State Central Registry for Child Abuse
and Neglect (NYSCR). Childhood maltreatment data were not available for 137
families who no longer lived in New York. These families did not differ from
the rest of the sample with regard to socioeconomic status, urban vs rural
status, or ethnicity, but there was a higher proportion of male offspring
and the mothers were less well educated. The 1983 sample was representative
of the regional population in a range of demographic variables, according
to US census data.  Demographic characteristics of the sample are presented in (Table 1). Further information regarding the study methodology is available from previous reports. [28,29]
Interview items used to assess early
adulthood PDs in 1991 to 1993 were drawn from the parent and youth versions
of the Diagnostic Interview Schedule for Children,  the Personality Diagnostic Questionnaire,  and the Disorganizing Poverty Interview. 
Items were originally selected by consensus among 1 psychiatrist and 2 clinical
psychologists based on correspondence with DSM-III-R diagnostic criteria.
 Following the publication of DSM-IV, 
items from the study protocol were added or deleted to maximize correspondence
with DSM-IV diagnostic criteria, most notably to assess depressive PD in
DSM-IV appendix B. One hundred fifty-two items were available to assess 88
(93.6%) of the 94 DSM-IV PD diagnostic criteria. For dependent, histrionic,
narcissistic, obsessive-compulsive, and paranoid PDs, items were available
for the assessment of 78% to 89% of the diagnostic criteria. For the other
7 PDs, all criteria were assessed. The Cronbach alpha inter-item reliability
coefficients for clusters A, B, and C PD symptoms were.66,.72, and.68, respectively.
For overall PD symptoms, the alpha was.87.
Personality disorder diagnoses were
assigned to persons who met DSM-IV diagnostic criteria, as reported by the
youth or mother. The use of multiple informants has been found [33,34] to increase the reliability and validity of psychiatric diagnoses. Evidence 
supports the reliability and validity of the protocol items and computer
algorithms used to assess PD symptoms (J.G.J.; P.C.; Andrew E. Skodol, MD;
John M. Oldham, MD; Stephanie Kasen, PhD; Judith Brook, PhD; unpublished
data, 1999). Adolescent DSM-IV PD symptoms predicted early adulthood Axis
I disorders and suicidality, and PD symptom stability when the participants
were adolescents was similar to the stability of PD symptoms among adults
in the community (J.G.J.; P.C.; Andrew E. Skodol, MD; John M. Oldham, MD;
Stephanie Kasen, PhD; Judith Brook, PhD; unpublished data, 1999).
Official data regarding childhood maltreatment
was obtained from the NYSCR. Cases referred to state agencies, investigated
by childhood protective services, and confirmed as verified cases of abuse
or neglect are retained in the NYSCR. The verification of physical abuse
required evidence of injury. The verification of sexual abuse required evidence
of sexual penetration or a judgment that the youth experienced unwanted sexual
contact. The verification of neglect required evidence of educational, emotional,
physical, or supervisory neglect. The NYSCR staff ascertained whether confirmed
cases of childhood maltreatment were present. Information about the type
of abuse was abstracted by one of us (J.B.) under the supervision of NYSCR
staff. To ensure confidentiality, participants were identified only by numbers,
and data were entered by persons who had no access to information that revealed
Self-reports of childhood maltreatment
were obtained from the offspring in 1991 to 1993. Participants were asked
whether, before age 18 years, they experienced the following events: anyone
they lived with had ever hurt them physically so that they were still injured
or bruised the next day, could not go to school as a result, or needed medical
attention; they had been left overnight without an adult caretaker before
age 10 years; and any older person who was not a boyfriend or girlfriend
had ever touched them sexually or forced them to touch the older person sexually.
Parental education and psychiatric disorders
were assessed as dichotomous variables. Maternal and paternal education was
assessed during the maternal interviews in 1975, 1983, and 1985 to 1986.
Low parental education was identified in 28.0% of the families, for whom
the mean number of years of parental education was less than 12. Parental
psychiatric disorders were assessed using 4 instruments administered during
the maternal interview: current maternal emotional problems were assessed
in 1983 and 1985 to 1986 using the Hopkins Symptom Checklist-90 
anxiety, depression, and interpersonal difficulty subscales; parental alcohol
and drug abuse between 1975 and 1985 to 1986 was assessed in 1983 and 1985
to 1986; the lifetime parental history of "trouble with the police" was assessed
in 1975, 1983, and 1985 to 1986; and the lifetime parental history of psychiatric
disorders was assessed in 1983 and 1985 to 1986, with items assessing whether
or not the parents had ever been treated for a mental disorder. Parental
psychiatric disorders were considered present if significant emotional problems,
substance abuse, or trouble with the police was present in either parent
in 1975, 1983, or 1985 to 1986 or if, in 1985 to 1986, either parent had
ever been treated for a mental disorder. Using these procedures, the lifetime
prevalence of parental psychiatric disorders was 38.0%. If the mother could
not provide information regarding the father's education or psychiatric disorders,
only information regarding the mother was used.
Nine dimensions of childhood temperament 
were assessed during the 1975 maternal interviews: clumsiness-distractibility,
nonpersistence-noncompliance, anger, aggression to peers, problem behavior,
temper tantrums, hyperactivity, crying-demanding, and moodiness. If a child
experienced severe problems in 1 or more of these domains, the child was
identified as having a difficult temperament. Difficult childhood temperament
has been found, in this sample, to predict behavior problems,  PDs,  and Axis I psychiatric disorders during adolescence  and drug use during early adulthood. 
Data analyses were conducted in 5 phases.
First, analyses of contingency tables, correlational analyses, and t tests
were computed to investigate whether risk factors identified by previous
research [40,41] predicted childhood maltreatment
and early adulthood PD symptom levels (ie, the number of PD diagnostic criteria
that were met). Second, analyses of covariance (ANCOVAs) were conducted to
investigate whether documented childhood abuse and neglect were associated
with elevated early adulthood PD symptoms after offspring age, parental education,
and parental psychiatric disorders were controlled. Third, logistic regression
analyses were conducted to investigate whether documented childhood maltreatment
was significantly associated with the risk for early adulthood PDs after
controlling for offspring age, parental education, and parental psychiatric
disorders. Fourth, ANCOVAs were computed to investigate whether documented
or self-reported childhood maltreatment was significantly associated with
elevated symptom levels of early adulthood PD after controlling for the covariates
that were associated with both early adulthood PD symptom levels and other
types of childhood maltreatment. Fifth, ANCOVAs were computed to investigate
whether specific types of PD symptoms remained significantly associated with
documented or self-reported childhood abuse or neglect after controlling
for other types of PD symptoms that were significantly associated with childhood
abuse or neglect. All statistical analyses were conducted using a comparison
group that included individuals who did not experience childhood abuse or
In the 639 families, there were 31 (4.9%)
documented cases of childhood maltreatment, including 15 cases (2.3%) of
physical abuse, 4 cases (0.6%) of sexual abuse, and 23 cases (3.6%) of neglect.
Twenty patients (3.1%) had 1 type of maltreatment, and 11 patients (1.8%)
had 2 kinds of maltreatment. Fifty-eight persons (9.1%) self-reported childhood
maltreatment, including 34 cases (5.3%) of physical abuse, 21 cases (3.3%)
of sexual abuse, and 17 cases (2.7%) of neglect. Forty-six persons (7.2%)
had 1 type of maltreatment, and 12 persons (1.9%) had 2 or 3 types of maltreatment.
There was little overlap between documented and self-reported cases of childhood
maltreatment. Only 8 cases of childhood abuse or neglect were identified
from both NYSCR records and self-reports, yielding a kappa coefficient of
0.11. There were 81 (12.7%) documented or self-reported cases of childhood
maltreatment, including 44 cases (6.9%) of physical abuse, 22 cases (3.4%)
of sexual abuse, and 39 cases (6.1%) of neglect. Fifty-nine persons (9.2%)
had 1 type of maltreatment, and 22 persons (3.4%) had 2 or 3 types of maltreatment.
Eighty-six youths (13.5%) were diagnosed as having PDs in 1991 to 1993.
Documented physical abuse was associated
with elevated symptom levels of antisocial, borderline, dependent, depressive,
passive-aggressive, schizoid, and total PDs after offspring age, parental
education, and parental psychiatric disorders were controlled statistically
(Table 2). Antisocial and depressive PD symptoms
remained significantly associated with documented physical abuse after symptoms
of other PDs were controlled statistically. Evidence of physical abuse, obtained
from either NYSCR records or retrospective self-reports, was associated with
elevated symptom levels of antisocial (F1,599 =10.62; P<.005), borderline (F1,599 =16.44; P<.005), passive-aggressive (F1,599 =6.06; P<.05), schizotypal (F1,599 =8.13; P<.005), and total PDs (F1,599
=6.95; P<.01) after controlling for offspring age, parental education,
parental psychiatric disorders, sexual abuse, and neglect.
Documented sexual abuse was associated
with elevated symptom levels of borderline PD after offspring age and parental
psychiatric disorders were controlled statistically (F1,577
=5.77; P<.02). Evidence of sexual abuse, obtained from either NYSCR records
or retrospective self-reports, was associated with elevated symptom levels
of borderline (F1,577 =31.09; P<.005), histrionic (F1,577 =11.50; P<.005), depressive (F1,577 =9.85; P<.005), and total PDs (F1,577
=11.02; P<.005) after controlling for offspring sex, parental education,
parental psychiatric disorders, physical abuse, and neglect.
Documented childhood neglect was associated
with elevated symptom levels of antisocial, avoidant, borderline, dependent,
narcissistic, paranoid, passive-aggressive, schizotypal, and total PD after
controlling for offspring age, parental education, and parental psychiatric
disorders (Table 3). Supplemental analyses
indicated that symptoms of antisocial, avoidant, borderline, narcissistic,
and passive-aggressive PD remained significantly associated with documented
neglect after co-occurring PD symptoms were controlled statistically. Evidence
of neglect, obtained from either NYSCR records or retrospective self-reports,
was associated with elevated symptom levels of antisocial (F1,594 =7.41; P<.05), avoidant (F1,594 =5.71; P<.05), borderline (F1,594 =17.90; P<.005), dependent (F1,594 =7.91; P<.01), narcissistic (F1,594 =7.30; P<.005), passive-aggressive (F1,594 =10.92; P<.005), schizotypal (F1,594 =11.33; P<.005), and total PDs (F1,594
=15.27; P<.005) after offspring age, parental education, parental psychiatric
disorders, physical abuse, and sexual abuse were controlled.
Documented childhood maltreatment was
associated with increased risk for antisocial, borderline, dependent, depressive,
narcissistic, paranoid, and passive-aggressive PDs after controlling for
offspring age, parental education, and parental psychiatric disorders (Table 4).
Antisocial, borderline, narcissistic, and passive-aggressive PD symptoms
remained significantly associated with documented childhood maltreatment
after controlling for symptoms of other PDs. Evidence of childhood abuse
or neglect, obtained from either NYSCR records or retrospective self-reports,
was associated with elevated symptom levels of antisocial (F1,637 =16.26; P<.005), avoidant (F (1),637 =4.97; P<.05), borderline (F1,637 =53.96; P<.005), dependent (F (1),637 =13.59; P<.005), depressive (F1,637 =9.89; P<.005), histrionic (F1,637 =8.66; P<.005), narcissistic (F1,637 =9.74; P<.005), passive-aggressive (F1,637 =9.19; P<.005), schizotypal (F1,637 =26.44; P<.005), and total PDs (F1,637
=31.65; P<.005) after offspring age, parental education, parental psychiatric
disorders, and difficult childhood temperament were controlled statistically.
As (Figure 1)
indicates, persons who experienced childhood maltreatment were at an elevated
risk for DSM-IV cluster B, cluster C, and appendix B PDs during early adulthood.
When the effects of co-occurring PDs were controlled statistically, however,
only cluster B (adjusted odds ratio=7.94; 95% confidence interval, 1.33-14.82)
and DSM-IV appendix B (adjusted odds ratio=4.43; 95% confidence interval,
1.45-13.87) PDs were independently associated with childhood abuse or neglect.
The major finding of the present study
is that persons with documented childhood abuse and neglect in a representative
community sample were more than 4 times as likely as those who had not been
abused or neglected to have PDs during early adulthood. This finding is particularly
meaningful because childhood maltreatment predicted early adulthood PDs even
after the effects of difficult childhood temperament, parental education,
and parental psychiatric disorders were controlled statistically. The present
findings are consistent with previous findings [1-13,18,25,42-45] suggesting that childhood physical abuse, sexual abuse, and neglect play an important role in the onset of some PDs.
These findings are also of interest because they are consistent with prior findings [1-12]
indicating that patients with PDs are more likely than persons without PD
to report histories of childhood maltreatment. Because concerns have been
raised [17,18,23,24] that patients' reports
of childhood maltreatment may be due in part to biased memory or reporting,
inferring from only retrospective findings that childhood maltreatment plays
a role in the onset of PDs has been problematic. Our findings and previous
longitudinal research [25,26] indicate that
the tendency of many patients with PDs to report childhood maltreatment is
not merely an artifact of biased memory or reporting. Childhood maltreatment
is indeed much more likely to have occurred among young adults with PDs than
among young adults without PDs.
Childhood physical abuse, sexual abuse,
and neglect may also be associated with elevations in different types of
PD symptoms. After symptoms of other PDs were accounted for, documented physical
abuse was associated with elevated antisocial and depressive PD symptoms,
sexual abuse was associated with elevated borderline PD symptoms, and neglect
was associated with elevated symptoms of antisocial, avoidant, borderline,
narcissistic, and passive-aggressive PDs. These findings, and previous research
[9,25,46] indicating that childhood physical
abuse, sexual abuse, and neglect may be differentially associated with PDs,
suggest that it is important that researchers investigate specific etiologic
models for each of the different PDs.
Although childhood neglect is more frequently reported than childhood physical or sexual abuse,  more research [48-50]
has investigated physical and sexual abuse than neglect. Thus, although childhood
physical and sexual abuse have been hypothesized to play an etiologic role
in PDs, [18,42] childhood neglect has not played
a prominent role in etiologic theories. Nonetheless, the present findings
and previous research indicating that childhood neglect is associated with
an increased risk for PDs, attachment difficulties, antisocial behavior,
and other interpersonal and psychological problems [39,51-55] suggest that future theoretical work regarding the onset of PDs should examine the deleterious effects of childhood neglect.
Although the association between self-reported
childhood maltreatment and PDs has received considerable investigation, few
hypotheses [56,57] have been developed regarding
the mechanisms of this association. Childhood maltreatment may independently
increase the risk for PDs; maladaptive parenting, rather than childhood maltreatment,
may increase the risk for PDs; childhood maltreatment may increase the risk
for PDs among persons with biological diatheses for psychiatric disorders;
and/or childhood maltreatment may be an indicator of preexisting PDs. Childhood
abuse and neglect may increase the risk for PDs independent of childhood
and parental psychiatric disorders. Many questions about the association
between childhood maltreatment and PDs will not be answered definitively
until further research is conducted.
Because the prevalence of specific PDs
and specific types of documented childhood maltreatment was low, it was necessary
to investigate associations between documented childhood maltreatment and
PD symptoms, rather than PD diagnoses. There was sufficient power, however,
to permit investigation of the association between any documented childhood
maltreatment and the risk for PDs during early adulthood. Furthermore, supplementing
documented evidence of childhood maltreatment with self-reports of childhood
abuse and neglect permitted investigation regarding unique associations between
different types of childhood maltreatment and different types of PD symptoms.
Because we conducted numerous statistical
analyses, some significant associations may have been due to chance. Although
numerous findings support the reliability and validity of the items and algorithms
used to assess PDs, it is possible that different findings would have been
obtained if a structured clinical interview such as the Structured Clinical
Interview for DSM-IV  had been administered.
Because a few PD diagnostic criteria were not assessed, more statistically
significant associations might have been obtained if all PD criteria had
been assessed. A strength of the present study is that we investigated whether
childhood maltreatment predicted PD symptoms after controlling for parental
psychiatric disorders. Diagnostic interviews were not administered to the
parents, however, and parental sociopathy was assessed using a measure of
parental trouble with the police, although the present findings were not
affected when this item was not included in the analyses. In addition, data
regarding paternal education and psychiatric disorders were obtained from
the mothers, and data were not available regarding interrater reliability.
Despite these limitations, our study
has numerous methodological strengths, including a representative sample,
a longitudinal design, the use of official records of childhood abuse and
neglect and retrospective self-report data, the assessment of all DSM-IV
PDs using data from both offspring and their mothers, and the use of statistical
procedures to control for offspring age and sex, difficult childhood temperament,
parental education, and parental psychiatric disorders. Thus, the present
findings contribute to an increased understanding of the association between
childhood maltreatment and early adulthood PD symptoms.
Accepted for publication January 14, 1999.
This study was supported by grant MH-36971 from the National Institute of Mental Health, Rockville, Md (Dr Cohen).
This article is also available on our Web site: http://www.ama-assn.org/psych.
Corresponding author: Jeffrey G. Johnson,
PhD, Box 60, New York State Psychiatric Institute, 1051 Riverside Dr, New
York, NY 10032.
1. Brodsky BS, Cloitre M, Dulit RA. Relationship of dissociation
to self-mutilation and childhood abuse in borderline personality disorder.
Am J Psychiatry. 1995;152:1788-1792.
2. Goldman SJ, D'Angelo EJ, DeMaso DR, Mezzacappa E. Physical
and sexual abuse histories among children with borderline personality disorder.
Am J Psychiatry. 1992;149:1723-1726.
3. Herman JL, Perry JC, van der Kolk BA. Childhood trauma
in borderline personality disorder. Am J Psychiatry. 1989;146:490-495.
4. Ogata SN, Silk KR, Goodrich S, Lohr NE, Westen D, Hill
EM. Childhood sexual and physical abuse in adult patients with borderline
personality disorder. Am J Psychiatry. 1990;147:1008-1013.
5. Weaver TL, Clum GA. Early family environments and traumatic
experiences associated with borderline personality disorder. J Consult Clin
6. Brown GR, Anderson B. Psychiatric morbidity in adult
inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry.
7. Paris J, Zweig-Frank H, Guzder J. Psychological risk
factors for borderline personality disorder in female patients. Compr Psychiatry.
8. Paris J, Zweig-Frank H, Guzder J. Risk factors for borderline
personality disorder in male outpatients. J Nerv Ment Dis. 1994;182:375-380.
9. Norden KA, Klein DN, Donaldson SK, Pepper CM, Klein LM.
Reports of the early home environment in DSM-III-R personality disorders.
J Personal Disord. 1995;9:213-223.
10. Shearer SL, Peters CP, Quaytman MS, Ogden RL. Frequency
and correlates of childhood sexual and physical abuse histories in adult female
borderline inpatients. Am J Psychiatry. 1990;147:214-216.
11. Raczek SW. Childhood abuse and personality disorders.
J Personal Disord. 1992;6:109-116.
12. Windle M, Windle RC, Scheidt DM, Miller GB. Physical
and sexual abuse and associated mental disorders among alcoholic inpatients.
Am J Psychiatry. 1995;152:1322-1328.
13. Pribor EF, Dinwiddie SH. Psychiatric correlates of incest
in childhood. Am J Psychiatry. 1992;149:52-56.
14. Silverman AB, Reinherz HZ, Giaconia RM. The long-term
sequelae of child and adolescent abuse: a longitudinal community study. Child
Abuse Negl. 1996;20:709-723.
15. Kroll J. PTSD/Borderlines in Therapy. New York, NY:
WW Norton & Co Inc; 1993.
16. Herman J. Trauma and Recovery. New York, NY: Basic Books
Inc Publishers; 1992.
17. Maughan B, Rutter M. Retrospective reporting of childhood
adversity: issues in assessing long-term recall. J Personal Disord. 1997;11:19-33.
18. Paris J. Childhood trauma as an etiological factor in
the personality disorders. J Personal Disord. 1997;11:34-49.
19. Bifulco A, Brown GW, Lillie A, Jarvis J. Memories of
childhood neglect and abuse: corroboration in a series of sisters. J Child
Psychol Psychiatry. 1997;38:365-374.
20. Brewin CR, Andrews B, Gotlib IH. Psychopathology and
early experience: a reappraisal of retrospective reports. Psychol Bull. 1993;113:82-98.
21. Herman JL, Schatzow E. Recovery and verification of
memories of childhood sexual trauma. Psychoanal Psychol. 1987;4:11-14.
22. Robins LN, Schoenberg SP, Holmes SJ, Ratcliff KS, Benham
A, Works J. Early home environment and retrospective recall: a test for concordance
between siblings with and without psychiatric disorders. Am J Orthopsychiatry.
23. Widom CS. Does violence beget violence? a critical examination
of the literature. Psychol Bull. 1989;106:3-28.
24. Loftus EF. The reality of repressed memories. Am Psychol.
25. Drake RE, Adler DA, Vaillant GE. Antecedents of personality
disorders in a community sample of men. J Personal Disord. 1988;2:60-68.
26. Luntz BK, Widom CS. Antisocial personality disorder
in abused and neglected children grown up. Am J Psychiatry. 1994;151:670-674.
27. American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric
28. Kogan LS, Smith J, Jenkins S. Ecological validity of
indicator data as predictors of survey findings. J Soc Serv Res. 1977;1:117-132.
29. Cohen P, Cohen J. Adolescent Life Values and Mental
Health. Mahwah, NJ: Lawrence Erlbaum Assoc Inc Publishers; 1996.
30. Costello EJ, Edelbrock CS, Duncan MK, Kalas R. Testing
of the NIMH Diagnostic Interview Schedule for Children (DISC) in a Clinical
Population: Final Report to the Center for Epidemiological Studies, National
Institute of Mental Health. Pittsburgh, Pa: University of Pittsburgh; 1984.
31. Hyler SE, Reider R, Williams JBW, Spitzer RL, Hendler
J, Lyons M. The Personality Diagnostic Questionnaire: development and preliminary
results. J Personal Disord. 1988;2:229-237.
32. Bernstein DP, Cohen P, Velez CN, Schwab-Stone M, Siever
LJ, Shinsato L. Prevalence and stability of the DSM-III-R personality disorders
in a community-based survey of adolescents. Am J Psychiatry. 1993;150:1237-1243.
33. Bird HR, Gould MS, Staghezza B. Aggregating data from
multiple informants in child psychiatry epidemiological research. J Am Acad
Child Adolesc Psychiatry. 1992;31:78-85.
34. Piacentini J, Cohen P, Cohen J. Combining discrepant
diagnostic information from multiple sources: are complex algorithms better
than simple ones?. J Abnorm Psychol. 1992;20:51-63.
35. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi
L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory.
Behav Sci. 1974;19:1-15.
36. Cohen P, Brook JS. Family factors related to the persistence
of psychopathology in childhood and adolescence. Psychiatry. 1987;50:332-345.
37. Kasen S, Cohen P, Brook JS, Hartmark C. A multiple-risk
interaction model: effects of temperament and divorce on psychiatric disorders
in children. J Abnorm Child Psychol. 1996;24:121-150.
38. Bernstein DP, Cohen P, Skodal A, Bezirganian S, Brook
JS. Childhood antecedents of adolescent personality disorders. Am J Psychiatry.
39. Brook JS, Whiteman M, Finch SJ, Cohen P. Young adult
drug use and delinquency: childhood antecedents and adolescent mediators.
J Am Acad Child Adolesc Psychiatry. 1996;35:1584-1592.
40. Brown J, Cohen P, Johnson JG, Salzinger S. A longitudinal
analysis of risk factors for child maltreatment: findings of a 17-year prospective
study of officially recorded and self-reported child abuse and neglect. Child
Abuse Negl. 1998;22:1065-1078.
41. Johnson JG, Cohen P, Dohrenwend BP, Link BG, Brook JS.
A longitudinal investigation of social causation and social selection processes
involved in the association between socioeconomic status and psychiatric disorders.
J Abnorm Psychol. In press.
42. Laporte L, Guttman H. Traumatic childhood experiences
as risk factors for borderline and other personality disorders. J Personal
43. Oldham JM, Skodol AE, Gallagher PE, Kroll ME. Relationship
of borderline symptoms to histories of abuse and neglect: a pilot study. Psychiatr
44. Steiger H, Jabalpurwala S, Champagne J. Axis II comorbidity
and developmental adversity in bulimia nervosa. J Nerv Ment Dis. 1996;184:555-560.
45. Weine SM, Becker DF, Levy KN, Edell WS, McGlashan TH.
Childhood trauma histories in adolescent inpatients. J Trauma Stress. 1997;10:291-298.
46. Bernstein DP, Stein JA, Handelsman L. Predicting personality
pathology among adult patients with substance use disorders: effects of childhood
maltreatment. Addict Behav. 1998;23:855-868.
47. National Center on Child Abuse and Neglect. Child Maltreatment,
1993. Washington, DC: US Dept of Health and Human Services; 1995.
48. Ruegg R, Frances A. New research in personality disorders.
J Personal Disord. 1995;9:1-48.
49. Wolock T, Horowitz B. Child maltreatment as a social
problem: the neglect of neglect. Am J Orthopsychiatry. 1984;15:223-238.
50. Straus MA, Kinard EM, Williams LM. The neglect scale.
Paper presented at: 4th International Conference on Family Violence Research;
July 23, 1995; Durham, NC.
51. Dubo ED, Zanarini MC, Lewis RE, Williams AA. Childhood
antecedents of self-destructiveness in borderline personality disorder. Can
J Psychiatry. 1997;42:63-69.
52. Widom CS. The cycle of violence. Science. 1989;244:160-166.
53. Gauthier L, Stollak G, Messe L, Aronoff J. Recall of
childhood neglect and physical abuse as differential predictors of current
psychological functioning. Child Abuse Negl. 1996;20:549-559.
54. Robins LN. Deviant Children Grow Up: A Sociological
and Psychiatric Study of Sociopathic Personality. Baltimore, Md: Williams
& Wilkins; 1966.
55. Bowlby J. Attachment and Loss. 2nd ed. New York, NY:
Basic Books Inc Publishers; 1982.
56. van der Kolk BA, Fisler RE. Childhood abuse and neglect
and loss of self-regulation. Bull Menninger Clin. 1994;58:145-168.
57. Dodge KA, Bates JE, Pettit GS. Mechanisms in the cycle
of violence. Science. 1990;250:1678-1683.
58. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin
L. Users Guide for the Structured Clinical Interview for DSM-IV Axis II Personality
Disorders (SCID-II). New York: New York State Psychiatric Institute; 1996.
Child Abuse; Child Neglect; Child Abuse, Sexual; Disease Susceptibility; Personality Disorders; Temperament