PID-5 Trait Indicators of Emotional Instability and Childhood Adversity Antecedents

Abstract

Personality traits provide natural mechanisms through which childhood maltreatment may translate into psychiatric symptomatology. The PID-5 has provided a DSM-supported exemplar for canvassing traits that may contribute to the developmental trajectories of many personality and mood disorders. This general population survey (N = 2,430) examined associations between adverse childhood experiences (ACE questionnaire) and selected PID-5 trait indicators of emotional well-being (Depressivity, Anxiousness, and Emotional Lability). These associations were contrasted with others derived from traditional dimensional measures of childhood maltreatment. ACE counts and all six of the dimensional maltreatment indicators were linked to the three trait scores. Family emotional abuse and ACE counts provided equally strong correlates of Depressivity and Anxiousness. ACE counts and childhood sexual abuse were especially strong in their associations with all three traits. Graded relationships were found in these trait-adversity relationships with polyvictimized respondents generating the highest personality maladjustment. The odds of a trait score elevation (>1 SD) were raised substantially (two to five fold) by singular adversity exposures, and the co-occurrence of only two different forms of adversity maximized odds of extreme trait expression. These results contribute to an evidentiary base suggesting steeper developmental trajectories for personality maladjustment among maltreated youth.

Keywords

Personality Inventory for the DSM-5 Adverse Childhood Experiences Questionnaire childhood maltreatment polyvictimization childhood sexual abuse

Introduction

An estimated 30% to 50% of the variance in trait expression may be attributed to genetic lineage (Plomin et al., 2016) with wide variation found as a function of the specific trait dimension (Kendler et al., 2017). Remaining variance may be attributed to a range of putative physiological and developmental etiologic agents. Cicchetti (2016) provided one of the most comprehensive developmental models which posited that child abuse disrupts victim ability to master hierarchical, age-related, formative tasks such as the formation of secure parental attachments, emotional regulation, self-image integration, early peer relations, and other milestones. Evidence was also provided by this investigative team that developmental insults alter the neurobiological substrates that mediate temperament and personality expression (Cicchetti, 2002; Cicchetti & Rogosch, 2001, 2007; Kim & Cicchetti, 2006; Kim et al., 2009).

Personality traits provide natural mechanisms through which childhood maltreatment may translate into psychiatric symptomatology (Hovens et al., 2012; Oshri et al, 2013; Spinhoven et al, 2016).

The experimental section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) proposed a new conceptulization of the personality disorders based largely on dimensional trait indices. The new hybrid model would integrate dimensional and categorical conceptualizations of maladapative personality functioning. The personality disorders task force called for systematic research on a new open source inventory (PID-5; Krueger et al., 2012) which canvases five broad trait domains and 25 constituent personality facets. The PID-5 may also contribute to broader diagnostic and etiologic models of psychopathology that extend beyond its primary function as a comprehensive inventory of personality functioning per se (Krueger & Markon, 2014; Wright & Simms, 2015). This study examined three manifest PID-5 trait measures of affective instability (depressivity, anxiousness, & emotional lability) that have been shown to differentiate normative respondents from mood disordered psychiatric patients (Allen et al., 2018; Fowler et al., 2019; Lugo et al., 2019; Torres-Soto et al., 2019).

Maladjustment risks posed by childhood maltreatment

The DSM-5 (Risk and Prognostic Factors) identified child abuse or neglect as a risk factor in over two dozen psychiatric disorders. Childhood sexual and physical abuse are usually referred to in the literature by their respective acronyms (CSA & CPA). Labels for the measures of childhood maltreatment in this study are provided in Table 2. Meta-analytic evidence for these nexuses can be found for physical abuse (Norman et al., 2012), sexual abuse (Murad et al., 2010), exposure to domestic violence (Wolfe et al., 2003), and other forms of maltreatment. Maladaptive trait dispositions often co-occur with these symptom clusters either simultaneous or postcedent to adversity or abuse exposures (Combs et al., 2013; Settles et al., 2011).

Child polyvictimization victims typically show higher rates of psychological maladjustment than counterparts exposed to isolated forms of abuse (Finkelhor & Dziuba-Leatherman, 1994; Finkelhor et al., 2007, 2009). The impact of these cumulative developmental insults are thought to arise from a combination of additive main effects and idiosyncratic constituent factor interactions (Thibodeau et al., 2017). Polyvictimization associations with maladaptive outcomes tend to increase with cumulative adversities (Thibodeau et al., 2017), and CSA interactions with other adversities may elevate this gradient disproportionately (King et al., 2019). ACE counts have had appeal given assumptions that the nature and severity of individual adversities may matter less than their sheer number. This compelling risk identification function could potentially discount traditional efforts to examine additive, interactive, and mediational abuse and neglect effects through dimensional measures.

The ACE questionnaire

Health care researchers have identified graded relationships between adverse childhood experiences and physical and mental health status. The ACE questionnaire (Felitti et al., 1998) was developed at Kaiser Permanente to advance research on childhood adversity. Initial testing canvassed exposures to seven forms of childhood adversity that included abuse (sexual, physical, and psychological) and household dysfunction (mental illness, domestic violence, alcoholism, and incarceration). Three domain areas were added (Dong et al., 2004) to provide the popular ten-item screening questionnaire referred to by the ACE acronym (Stevens, 2012, Table 1).

Table 1.

ACE questionnaire item composition.

Item	Wording of the dichotomous survey item
1	Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
2	Did a parent or other adult in the household often or very often … Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
3	Did an adult or person at least 5 years older than you ever … Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
4	Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
5	Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6	Were your parents ever separated or divorced?
7	Was your mother or stepmother often pushed, grabbed, slapped, thrown at, kicked, bitten, hit with a fist or something hard, threatened with a knife or gun, or repeatedly hit over at least a few minutes?
8	Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
9	Was a household member depressed or mentally ill?
10	Did a household member ever go to prison before you turned 17?

Note. Respondents were required to complete all of the ACE items at the start of the survey so there was no missing data. Respondents were allowed a “rather not say” option which was used infrequently (<1%) and scored in the negative. An affirmed response was required to signify exposure to the respective adversity.

Table 2.

Descriptive statistics for maltreatment indicators and criterion variables.

Measures	Label	n	ɑ	M	SD	Range
^aSexual abuse & assault	CSA_LONG	2430	.95	2.37	3.55	0–14
^bPhysical abuse self-report	CPA_LONG	2430	.87	4.39	6.23	0–36
^cMaternal battering	BAT	2378	.90	1.37	2.73	0–12
^dConventional bullying	PECK	2430	.94	12.08	41.59	0–365
^eFamily emotional abuse	FEA_VEQ	2213	.78	16.96	22.59	0–104
^fPhysical/emotional neglect	NEG_AE	2430	.78	7.10	6.46	0–24
PID-5 depressivity	DEP	2418	.96	26.36	11.26	1–56
PID-5 anxiousness	ANX	2416	.93	22.35	7.75	3–36
PID-5 emotional lability	LAB	2417	.90	12.12	5.03	1–24

Note. CSA_LONG = unwelcome attempted or completed acts of sexual victimization prior to age 16 from any perpetration source (^aBarnett et al., 1993). CPA_LONG = acts of physical abuse perpetrated by a parent or step parent prior to age 16 (^bBarnett et al., 1993). BAT = frequency of observed acts of kicking, biting, pushing, shaking, grabbing, slapping, hitting, or use of a weapon directed toward their mother by a father or boyfriend prior to age 17 (^cChou & Koenen, 2019). PECK = Personal Experiences Checklist (acts of peer bullying (hitting, punching, kicking, shoving, wrecking belongings) experienced prior to age 17 (^dHunt et al., 2012); FEA_VEQ = acts of being targeted by a parent or sibling for emotional abuse (shouting, yelling, screaming, swearing, cursing, threats of violence) prior to age 16 (^eKing & Russell, 2017). NEG_AE = acts of parental or step-parental physical neglect prior to age 16 (^fBerger & Knutson, 1984). PID-5 = Personality Inventory for the DSM-5.

The ACE questionnaire provides a count of aggregated adversities. ACE impacts are likely constituted of both additive and interactive co-occurring effects. Individual adversity exposures are common (67.3%) and people often report more than 3 (12.0%) different exposures (Dong et al., 2004). Higher ACE counts are associated with a wide range of both physical (Dong et al., 2004; Felitti et al., 1998; Hillis et al., 2000) and mental health (Dube et al., 2001; van der Feltz-Cornelis et al., 2019) symptomatology. Odds ratio meta-analyses (Petruccelli et al., 2019) have usually illustrated graded relationships between ACE counts and maladaptive outcomes (ACE = 1, OR = 1.36; ACE = 2, OR = 1.71; ACE = 3, OR = 2.18; ACE > 3, OR = 3.57). These relationships tend to plateau after four or more adversity exposures (Dong et al., 2004; Hillis et al., 2000; van der Feltz-Cornelis et al., 2019). Reliance on higher threshold counts to establish risk may discount the significance of individual forms of adversity that can be salient (Negriff, 2020).

Study hypotheses

Associations were examined between ACE counts, dimensional measures of childhood maltreatment, and PID-5 trait indicators of emotional well-being (Depressivity, Anxiousness, and Emotional Lability). Four hypotheses were tested: H1) ACE count and all of the dimensional maltreatment indices will be positively associated with these trait scores; H2) Trait scoreswill be more closely associated with the dimensional maltreatment elevation count than the ACE score; H3) Childhood sexual abuse will be more closely associated with these trait scores than the remaining dimensional maltreatment indicators; H4) Co-occurrence and polyvictimization estimate derived from ACE questionnaire and maltreatment elevation (>1 SD) will be associated with trait scores in graded relationships.

Method

Sample composition and procedure

Respondents (n = 2,430) accessed the survey for financial compensation ($0.40) via Amazon’s Mechanical Turk website (mturk.com). This project was IRB approved, and all respondents provided informed consent. MTurk has been reviewed favorably as a representative crowdsourcing research platform (Buhrmester et al., 2011; Paolacci et al., 2010). This final sample was constituted of adults (18 years or older) who completed the ACE questionnaire items at the top of the survey. This final sample excluded respondents who failed to meet any of the five exclusion criteria. Online proxy/VPN detection software (https://iphub.info) was relied upon as a best practice to exclude users from outside of the country (n = 31) or dubious internet locales (n = 113). Respondents were excluded (n = 39) for their failure to identify a palindrome (“word spelled the same way both forward and backward”) in a multiple choice item early in the survey. An attention check embedded in the middle of the survey asked respondents to identify the first letter of the English alphabet (n = 6). A final survey item asked respondents if “we should trust that your responses represented an honest reflection of your life history?” Respondents were excluded (n = 195) if they indicated either “not really, my responses were semi-random” or “no, I didn't read most of the items and my responses were almost entirely random”). This sample varied in gender (Men, n = 713, 29.4%; Women, n = 1,717, 70.6%) and age (M = 35.25, SD = 12.07, Range = 18-87). Figure 1 illustrates the ethnic distributions in this sample as contrasted with 2018 national census figures.

Figure 1.

National and sample ethnic distributions. Ethnicity in this sample (White, 74.4%; Hispanic, 6.0%; Asian, 5.6%, African American, 8.1%; multi-racial, 4.2%; other, 1.3%) compared to that found in the United States population as of July 1, 2018 (United States Census Bureau, 2018: White, 60.7%; Black, 13.4%; Hispanic, 18.1%; Asian, 5.8%; American Indian, 1.3%; multi-racial, 2.7%).

Measurements

Personality Inventory for DSM-5 (PID-5)

The PID-5 (Krueger et al., 2012) is comprised of 220 four-point items. Scores are left uncalculated if more than 25% of the contributing items were left blank, and missing scores are prorated as specified by the test developers. The longitudinal stability of the PID-5 traits has been established (Wright et al., 2015). Three traits reflecting emotional stability were of interest in this study (Emotional Lability, ɑ = .91; Anxiousness, ɑ = .93; & Depressivity, ɑ = .96) due to their effectiveness in differentiating normative from psychiatric inpatients (Lugo et al., 2019). A recent exploratory structural equation model also recommended the use of these three PID-5 trait dimensions in their algorithm for measuring the ICD-11 (International Classification of Diseases, 11th Revision) personality domain of Negative Affectivity (Bach et al., 2017). Internalized symptomatology in this ICD-11 personality disorder model was sampled in both the Negative Affectivity and Detachment domains. The three PID-5 trait dimensions included in this study canvassed symptoms of internalized negative emotionality that have been associated with DSM-5 mood and/or anxiety disorder diagnoses.

ACE questionnaire

ACE items in this sample closely approximated the content domain of the ten adversity categories measured in the original normative analyses (Dong et al., 2004; Felitti et al., 1998). Mean test-retest kappa estimates for the ACE questionnaire have been found (Dube et al., 2001) to range from moderate to good for most of the original ACE adversity categories. The ACE count is temporally stable (κ = .64) with no major age or gender variations in these reliability findings. ACE disclosure rates do not appear to be altered by respondent mood state (Frampton et al., 2018).

Sexual abuse & assault self-report (CSA_LONG)

This CSA index (Barnett et al., 1993) was developed by the Consortium of Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) project to use with sexually victimized children and adolescents. Respondents recall acts perpetrated before and between the ages of 13 and 16. Minor wording modifications were made for adult sampling purposes (i.e., “genitalia” instead of “sexual parts”; “rape” in place of “put a part of his body inside your private parts. Scores were generated for childhood (“prior to age 13”) and adolescent (“between ages 13 and 16”) victimization using a scoring four-point frequency metric (0 = never; 1 = once; 2 = twice; 3 = multiple).

Physical abuse self-report (CPA_LONG)

This LONGSCAN index was also developed for use with adolescents identified in infancy or early childhood as being at elevated risk of maltreatment. Physical abuse measured by this index was perpetrated by “a parent or step-parent” with victim ages of 5 and 16. The scoring metric relied on a four-point frequency index (0 = never; 1 = once; 2 = twice; 3 = multiple).

Observed parental violence (OPV_VEQ)

The Violent Experiences Questionnaire (VEQ-R; King & Russell, 2017) is a childhood and adolescent (ages 5 to 16) maltreatment inventory. The OPV_VEQ index provided an estimate of the frequency with which physical violence was observed between parents or step-parents during upbringing (Physical Acts with or without Physical Injury: pushing, shoving, shaking, striking, kicking, punching, beating, burning or use of a weapon to inflict pain or injury).

Family emotional abuse (FEA_VEQ)

The VEQ-R (King & Russell, 2017) provided a measure of family emotional abuse in the form of exposure to acts of parental or sibling yelling, cursing, and/or threats of physical violence directed toward the respondent or between parents. FEA_VEQ scores do not include acts of actual physical violence.

Physical/emotional neglect (NEG_AE)

The Neglect subscale of the Assessing Environments III (Gauthier et al., 1996) inventory samples parental physical and/or emotional neglect using a four-point frequency index (“never” to “frequently”). The items were restricted to ages 5 through 16 with their wordings and four-point frequency index (“never” to “frequently”) retained.

Childhood maltreatment polyvictimization count (DIMEN)

A DIMEN score was calculated as the count of elevations (>1 SD) on the five dimensional child abuse and neglect indices used in this study (CSA_LONG, CSA_LONG, OPV_VEQ, FEA_VEQ, & NEG_AE). DIMEN scores provided a count of high maltreatment exposures derived from dimensional scores.

Results

Descriptive statistics

Table 2 presents descriptive statistics for the trait dimensions and maltreatment developmental antecedents. While significantly associated, the selected PID-5 facets were sufficiently independent in their distributions to warrant differentiated analyses (Anxiousness-Depressivity, r = .69; Anxiousness-Lability, r = .61; Depressivity-Lability, r = .58). The dimensional maltreatment indices were associated (p < .001) with all of the criterion measures (Table 3). Coefficient strength differences for each criterion measure were tested using an online calculator for dependent samples (Lee & Preacher, 2013). The ACE count was a better predictor of Depressivity and Anxiousness than all but one (family emotional abuse) of the maltreatment indicators. The ACE count was a better predictor of Emotional Lability than all but one (childhood sexual abuse) of the maltreatment indicators.

Table 3.

ACE frequency distributions and descriptive statistics.

Count	ACE	DIMEN	DIMENz	CSA	CPA	BAT	PECK	FEA	NEA
0	16.2%	55.8%
1	13.7%	24.1%
2	12.5%	10.2%
3	12.2%	5.8%
4	11.3%	3.0%
5	10.4%	0.8%
6	8.9%	0.3%
7	6.9%
8	4.5%
9	2.4%
10	1.1%
	Descriptive statistics			Descriptive statistics
M	3.43	0.80	0	2.37	4.39	1.37	12.08	16.96	7.10
SD	2.63	1.15	0.66	3.55	6.23	2.73	41.59	22.59	6.46
Range	0–10	0–6	−0.67 – 3.89	0–14	0–36	0–12	0–365	0–104	0–24
	Criterion measures			Criterion measures
DEP	^a.35	^a.30	^a.37	0.29^a	0.26^ac	0.15^b	0.18^bd	0.31^a	0.22^cd
ANX	^a.34	^b.21	^c.28	0.23^b	0.18^b	0.11^c	0.11^c	0.31^a	0.09^c
LAB	^a.30	^b.23	^ab.26	0.26^a	0.17^b	0.13^bc	0.09^c	0.24^a	0.11^c

Note. ACE = Adverse Childhood Experiences scale; DIMEN = count of elevations (>1 SD) on the six dimensional child maltreatment indices; DIMENz = mean standard score from the six maltreatment indices; PID-5 = Personality Inventory for the DSM-5; DEP = PID-5 Depressivity; ANX = PID-5 Anxiousness; LAB = PID-5 Emotional Lability. Respondent age controlled in each coefficient calculation. All correlation coefficients were significant (p < .001). Significant coefficient strength differences for each criterion measure designated by differing superscripts.

The relative strengths of association of the five maltreatment indices with the three trait criterion measures can be summarized as follows: Depressivity [childhood sexual abuse/family emotional abuse > maternal battering/bullying/parental neglect] Anxiousness [family emotional abuse > childhood sexual/physical abuse > maternal battering/bullying/parental neglect]; and Emotional Lability [childhood sexual abuse/family emotional abuse > physical abuse/maternal battering/bullying/parental neglect].

ACE scores were more closely associated than the DIMEN elevation count with Anxiousness and Emotional Lability. ACE and DIMEN counts were similar in their strengths of association with Depressivity. The mean standardized DIMENz score was similar in strength to ACE counts for Depressivity and Emotional Lability.

ACE questionnaire item differences

Criterion scores were significantly (p < .001) higher among the subset of the sample that endorsed each of the ten ACE items (Table 4). These cell differences were moderate in size but pervasive in their distribution.

Table 4.

ACE exposure associations with criterion scores.

ACE adversity	DEP		ANX		LAB
ACE adversity	F	d	F	d	F	d
Emotional abuse	213.14	.56	177.83	.50	137.67	.45
Physical abuse	113.78	.41	96.05	.36	77.39	.32
Sexual abuse	94.40	.39	73.25	.33	78.03	.34
Emotional neglect	346.92	.70	263.96	.61	179.43	.51
Physical neglect	99.97	.51	62.77	.40	49.04	.35
Parental divorce	29.85	.25	38.43	.28	19.67	.22
Domestic violence	21.72	.25	22.50	.26	24.95	.27
Family alcoholism	52.49	.29	97.03	.39	53.65	.29
Family mental illness	236.41	.61	294.78	.67	180.33	.55
Family incarceration	31.67	.38	13.93	.30	20.53	.34

Note. ACE item language content presented in Table 1. PID-5 = Personality Inventory for the DSM-5; DEP = PID-5 Depressivity; ANX = PID-5 Anxiousness; LAB = PID-5 Emotional Lability; Respondent age controlled in each analysis. All F-ratios were significant (p < .001).

ACE and DIMEN count odds ratios

The odds of extreme criterion maladjustment scores were signficantly higher for all ACE and DIMEN counts above 0 (Table 5). Graded relationships were found between ACE or DIMEN counts and all three trait facets. Chi square testing verified that the percent with a trait elevation (>1 SD) grew significantly higher with each successive increase in the ACE or DIMEN count (e.g., ACE = 4 cell had a significantly higher frequency of each trait elevation than ACE = 3). These odds increments were not evident in the extreme ends of each distribution (ACE > 8; DIMEN > 4). These odds ratio associations between ACE and DIMEN counts and dichotomized maladjustment outcomes are illustrated in Figure 2.

Table 5.

Odds ratios for categorical aggression indicators.

Adversity Count	Exceeds	Categorical Aggression Indicators
Adversity Count	n	DEPg	ANXg	LABg
ACE > 0	2,029	4.96***	5.32***	4.58***
ACE > 1	1,698	4.19***	3.48***	3.00***
ACE > 2	1,396	3.82***	3.55***	2.62***
ACE > 3	1,102	3.87***	3.32***	2.69***
ACE > 4	829	3.28***	2.98***	2.61***
ACE > 5	578	2.86***	2.87***	2.66***
ACE > 6	362	2.40***	2.76***	2.19***
ACE > 7	195	2.60***	2.88***	2.42***
ACE > 8	86	2.06**	2.97***	2.10***

DIMEN > 0	948	2.53***	1.92***	2.11***
DIMEN > 1	432	3.41***	2.72***	2.35***
DIMEN > 2	213	3.46***	2.49***	2.30***
DIMEN > 3	88	3.13***	2.30***	2.41**
DIMEN > 4	24	8.06***	3.10***	3.01***

Note. ACE = Adverse Childhood Experiences scale; DIMEN = count of elevations (>1 SD) on the five dimensional maltreatment indices. Odds ratio calculations based on dichotomized criterion group variable and the specified ACE count (subset exceeding threshold versus remaining sample). Indicators were dichotomized based on respondent z-scores (> 1 SD versus remaining sample); Personality Inventory for the DSM-5 (PID-5; DEPg = Depressivity; ANXg = Anxiousness; LABg = Emotional Lability). **p < .01. ***p < .001.

Figure 2.

ACE and DIMEN count associations with standardized and dichotomized criterion scores. Note. ACE = Adverse Childhood Experiences scale; DIMEN = count of elevations (>1 SD) on the six dimensional maltreatment indices. DEP = PID-5 Depressivity; LAB = PID-5 Emotional Lability; ANX = PID-5 Anxiousness.

Discussion

Personality traits are theoretically complex constructs that have been challenging to define, measure, and utilize meaningfully in research and clinical practice. The PID-5 has provided a DSM-supported prototype that holds promise for achieving greater uniformity in the identification of individual differences that differentiate normative from maladaptive personality functioning. These contemporary trait dimensions appear poised to play a central role in subsequent DSM personality disorder iterations. The value of selected trait dimensions in the detection of elevated risk for non-characterlogic disorders appears apparent as well. Trait indicators of emotional maladjustment such as depressivity, anxiousness, and emotional lability have held special appeal as risk indicators. This study examined childhood adversity as a potential contributor to the acquisition of these selected PID-5 trait dimenions which may later serve as diagnostic criteria for a range of personality and other disorders.

ACE count links to maladjustment have focused disproportionately on diagnostic sequellae rather than their potential personality mediators. While causative links cannot be established from survey research, personality findings can provide support for theoretical models that identify personality traits as indirect mediators of maltreatment effects. The impact of any form of developmental adversity can be conceptually deconstructed into its main effect, indirect (mediated) effect, and co-occurring `interaction effect with other formative insults. Main effects can also coalesce into an additive collective impact. Childhood adversities likely effect functioning through both their sheer number (additive effect) and their idiosyncratic interactions or co-occurrences. ACE counts in this study were found for the first time to serve as a risk indicator for selected PID-5 trait dimensions associated with emotional instability.

The present results help further clarify how childhood adversity and personality traits are associated in childhood development. ACE counts and all of the dimensional maltreatment indicators were significantly associated with the three trait scores. These relationships were best described as pervasive in nature but moderate in size (H1). ACE counts were more strongly associated with Anxiousness and Emotional Lability than the DIMEN index based on the five maltreatment indices (H2). While childhood sexual abuse was significantly associated with all three trait dimensions, equivalent coefficient strengths were found for a subset of the remaining abuse indicators (H3). Graded relationships were found between the trait scores and both (ACE) and polyvictimization (DIMEN) counts (H4). In summary, support was found for the first and fourth hypotheses. The DIMEN score was not more closely associated with the trait indicators than the ACE count (second hypothesis), and only partial support was found for the relative association strength of sexual abuse and trait scores over other maltreatment indicators (third hypothesis).

The sharp rise in the odds of trait score elevations that accompanied exposure to only one ACE or DIMEN event should caution researchers that adversities are not all equal and will often be consequential even in isolation (Negriff, 2020). These gradients were consistent with other data suggesting the consequential effects of even singular adversity exposures (Bright et al., 2016; Mersky et al., 2013; Negriff, 2020). The co-occurrence of only two different forms of childhood maltreatment was associated with maximized odds of extreme trait expression (possible exception of DIMEN > 4). Idiosyncratic two-way interactions may ultimately account disproportionately for variance in trait expression.

Clinical implications

Efforts continue within the mental health diagnostic community to reformulate the personality disorders into dimensional constructs that can be measured effectively through trait inventories such as the PID-5. The familiarity of practitioners with these emerging diagnostic formulations and measurement strategies should increase progressively over time. The risk posed by negative affectivity during development warrants close attention given its putative linkages to a range of mood and anxiety disorders. As recognition grows regarding the potential value of these traits as risk indicators, attention will turn progressively to their own developmental roots. ACE counts still provide the simplest available metric for identifying adversity-related risks for both personality and mood-related maladjustment, but differentiated dimensional indices may prove best for orienting practitioners to points of intervention that are most beneficial in the mitigation of harm from abuse and adversity exposures.

Design limitations and future research

This study relied on retrospective MTurk-based respondent disclosures using a cross-sectional research design. Inferences derived from these findings may not generalize fully to the general population or respondents that differ in ethnicity, religion, sexual orientation, and a host of other factors. ACE questionnaires are dichotomized and relatively brief. The combination of ACE and traditional child abuse measures may best advance both predictive and theoretical objectives. Interaction analyses should be broadened beyond the adversities of childhood sexual and physical abuse, and the ACE questionnaire could benefit from reliance on item weights specific to selected criterion outcomes. Contextual factors such as timing and chronicity of each adversity warrant continued systematic attention.

Conclusions

These findings expand a growing evidentiary base suggesting steeper developmental trajectories for personality maladjustment among youth exposed to various forms of childhood adversity. While dimensional child maltreatment indices provide psychometrically sound measures of common maladjustment antecedents, the ACE questionnaire has enhanced the breadth or bandwith of contemporary assessments of co-occurring developmental insults. Each approach has its strengths and limitations.

Footnotes

Notes

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PID-5 Trait Indicators of Emotional Instability and Childhood Adversity Antecedents

Abstract

Keywords

Introduction

Maladjustment risks posed by childhood maltreatment

The ACE questionnaire

Study hypotheses

Method

Sample composition and procedure

Measurements

Personality Inventory for DSM-5 (PID-5)

ACE questionnaire

Sexual abuse & assault self-report (CSALONG)

Physical abuse self-report (CPALONG)

Observed parental violence (OPVVEQ)

Family emotional abuse (FEAVEQ)

Physical/emotional neglect (NEGAE)

Childhood maltreatment polyvictimization count (DIMEN)

Results

Descriptive statistics

ACE questionnaire item differences

ACE and DIMEN count odds ratios

Discussion

Clinical implications

Design limitations and future research

Conclusions

Footnotes

Notes

References

Sexual abuse & assault self-report (CSA_LONG)

Physical abuse self-report (CPA_LONG)

Observed parental violence (OPV_VEQ)

Family emotional abuse (FEA_VEQ)

Physical/emotional neglect (NEG_AE)