title: Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind.
abstract: Childhood adversity has been found to be an important aetiological factor in the development of personality disorder (PD) in several studies. However, the role of disorganized attachment with unresolved mental states for traumatic experiences requires further investigation. This study explores the relationship between childhood adversities, unresolved states of mind, PD diagnosis and psychiatric distress. Two hundred forty-five adult participants, 124 from a clinical PD group and 121 non-psychiatric controls were assessed using the Structured Clinical Interview for DSM-IV, the Cassel Baseline Questionnaire, the Symptom Checklist-90-R and the Adult Attachment Interview, in order to ascertain presence of PD, childhood adversity, level of psychiatric distress and unresolved states of mind. Within the overall unresolved (U-overall) attachment category, a distinction was made between unresolved for abuse (U-abuse) and unresolved for loss (U-loss). The results indicated that childhood adversity was significantly associated with unresolved states of mind, as well as with overall PD diagnosis, paranoid PD, borderline PD, avoidant PD and psychiatric distress. Mediation analyses confirmed that U-overall and U-loss were significant mediators between childhood adversity and PD diagnoses, but surprisingly, U-abuse was not a significant mediator. The strength, limitations and clinical implications of the findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Child Attachment and Psychological Therapies Research Unit, The Anna Freud Centre and University College London, London, UK.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cirasola
authors.affiliation: Anna Freud Centre, London, UK.
authors.forename: Saul
authors.initials: S
authors.lastname: Hillman
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Chiesa
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D010554:Personality Disorders / Q000175:diagnosis* / Q000523:psychology; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult