Future directions in personality pathology development research from a trainee perspective: Suggestions for theory, methodology, and practice
Section snippets
Theory
The field has shifted away from a view of PDs as discrete, categorical, non-overlapping, intransigent, and static diagnoses that onset in adulthood to a view of personality pathology as a transdiagnostic [2] hybrid [3,4] of dimensional [5] and categorical [6] elements, beginning in childhood/early adolescence [7], that is heterotypic in its development [8, 9, 10] and that is amenable to treatment in adults [11] and early intervention in childhood and adolescence [7]. These conceptual shifts
Future directions
Adopt and validate a unifying framework for PD and its development that cuts across a) theoretical orientations, b) age ranges, and c) types of PD, incorporating the strong empirical support for a dimensional foundation of PD. Research on the limited reliability and validity of specific PD diagnoses reflects the need for a framework that cuts across PDs and employs a common personality architecture with explicable heterogeneity in manifestation. Such a framework should integrate three levels of
Methodology
With the increase of interest in youth onset of personality pathology across the last decade, a greater number of studies have been designed with repeated measurements to assess risk mechanisms as early as childhood as predictors of later PD symptoms. These designs enable researchers to examine the predictive value of a range of constructs, mostly in relation to BPD with results largely supporting theories of transaction between biology and environment in BPD development [30]. Other studies
Clinical practice
The majority of early interventions or prevention efforts that target emergent personality pathology either utilize adult-based treatments that are downwardly applied to adolescents (e.g. mentalization-based therapy groups in adolescents with BPD symptoms [47]) or address broadband dimensions of psychopathology (e.g. impulsivity; externalizing symptoms) that may undergird aspects of PDs but that are non-specific and often do not take into account the insights afforded by the PD development
Future directions
Either integration across treatment approaches or better tailoring of interventions to specific individuals is needed. Evidence is clear that PD treatments from a range of theoretical backgrounds are moderately effective [11], though the bulk of this research has been conducted on BPD [56]. Given this, it is likely that interventions drawn from various approaches might be integrated into early interventions to maximize benefits. On the other hand, given evidence of multifinality, trajectories
Conclusion
Together, we suggest several avenues for future research and practice that incorporate the most recent insights in the field of personality pathology development. These consist of a more comprehensive, integrative, and lifespan-informed view of personality pathology that explains the development of personality pathology and how it interdigitates with other common forms of mental illness. We suggest tailored methodological techniques that match the complexity of non-linear and reciprocal
Conflict of interest statement
Nothing declared.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
CRediT authorship contribution statement
Benjamin N Johnson: Conceptualization, Writing - original draft, Writing - review & editing. Salome Vanwoerden: Conceptualization, Writing - original draft, Writing - review & editing.
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