Personality structure mediates the impact of childhood adversity on psychopathology in adolescents with personality disorder

Background: Personality disorders (PD) emerge in adolescence, a developmentally vulnerable period notable for emotional instability and high risk-taking behaviour. After decades of reluctance to diagnose PD in adolescence, early diagnosis and intervention are now called for. Patients present with severe psychopathology including heightened suicide risk. It is important to investigate underlying mechanisms for informed treatment planning. Childhood adversities (CA) are thought to play a key role in developing a PD. Objective: We aimed to deepen our understanding of the mechanism linking CA to psychopathology including suicidality in adolescent PD. Method: In 113 adolescents (mean age 15.6 (SD 1.23), 79 patients and 34 healthy controls), PD was dimensionally assessed using the Structured Interview for Personality Organisation, adapted to the adolescent language (STIPO-R-A), which encompasses identity, interpersonal relationships, defence mechanisms and coping strategies, level of aggression, and moral functioning. CA was assessed via self-report form (Childhood Trauma Questionnaire, CTQ). Mediation analyses were conducted to examine whether the level of personality organisation (PO) mediated the effect of CA on internalising, externalising problems and suicidality. Results: The effect of CA on internalising and externalising psychopathology in adolescents was fully mediated by PO. Furthermore, we could show a partial mediation of PO between CA and past suicide attempts. Conclusions: PO may represent a key mechanism for the development or persistence of mental health issues after CA, especially in adolescent PD. For early traumatised adolescents with impaired PO, treatment should not focus solely on trauma but must also address personality functioning. Childhood adversity is common in adolescent patients with personality disorder.The impact of childhood adversity on adolescent psychopathology is fully mediated by the underlying personality organisation.Treatment for early-traumatised adolescents with a PD should not primarily focus on trauma, but should rather target personality functioning. Childhood adversity is common in adolescent patients with personality disorder. The impact of childhood adversity on adolescent psychopathology is fully mediated by the underlying personality organisation. Treatment for early-traumatised adolescents with a PD should not primarily focus on trauma, but should rather target personality functioning.