Pathways of Personality Disorder: Combining Multiple Methods of Repeated Assessment Across Development and in Daily Life - PROJECT SUMMARY Personality disorder (PD) is a severely debilitating psychiatric illness. PD is associated with high healthcare costs, high rates of self-harm and suicidality, and greater disability than major depressive disorder. PD demonstrates a comparable or higher prevalence to depressive and anxiety disorders, and a comparable prevalence to physical conditions such as back pain and respiratory illness; yet, research on the developmental pathways of PD is scarce compared to that of other mental disorders, despite clear evidence for the onset of PD during adolescence. Moreover, a need has been identified to shift from static to dynamic models of psychopathology that focus on core underlying processes in order to innovate methods of detection, prevention, and intervention. The current study draws on recent advancements that identifies a single underling severity continuum of personality pathology, that is, maladaptive self and interpersonal functioning, as defined in the DSM-5 Alternative Model for Personality Disorders, and referred to as the Level of Personality Functioning (LPF). The LPF consists of identity, self-direction, empathy and intimacy – core developmental processes that emerge in adult form during adolescence, thereby allowing the empirical inquiry into the developmental trajectories of PD. Against this background, the current project leverages over 17 years (N = 348) of previously collected longitudinal data from the Preschool Depression Study (5R01MH090786-12) to investigate the prediction of daily LPF from developmental trajectories of emotion dysregulation, self- dysfunction and interpersonal dysfunction by combining this data with proposed new data collection of daily LPF using ecological momentary assessment (EMA). By combing these two forms of rich, repeated assessment, we will examine how core processes of PD unfold at the macro-level (across development) and manifest in emerging adulthood at the micro-level (in daily life with newly-collected EMA data). Aim 1 will identify associations between developmental trajectories of emotion dysregulation, self- and interpersonal dysfunction, and daily levels of LPF. It is hypothesized that increasing levels of emotion dysregulation, interpersonal dysfunction, and self-dysfunction across development will predict more pathological daily LPF. Aim 2 will elucidate the relative predictive power and interactions among emotion dysregulation, interpersonal dysfunction, and self-dysfunction in predicting adult daily LPF. It is hypothesized that disturbances in identity and self-function will interact with emotion dysregulation and interpersonal dysfunction to predict greater daily LPF, and that increases in self-dysfunction from adolescence to emerging adulthood will be the strongest predictor of daily LPF, as compared to trajectories of emotion dysregulation and interpersonal dysfunction. Together, this work will reveal dynamics and nuances in the development and daily functioning of personality disorder, aiding methods of targeted early intervention and prevention.
