Testing Developmental Mechanisms of Personality Impairment in Youth - Project Summary Personality disorders are complex and debilitating disorders associated with profound risk for suicide and substantial cost related to long-term intensive care, emergency room visits, and psychiatric hospitalizations. Although traditionally diagnosed only in adults, emerging risk for personality pathology can be reliably assessed in early adolescence. The level of personality functioning (LPF) is a dimensional measure of personality pathology that predicts the development of personality disorders across the lifespan and contributes to long-term dysfunction beyond the effects of other clinical concerns, such as anxiety, depression, attention- deficit/hyperactivity disorder, and conduct problems. LPF refers to the degree of disturbance in self (i.e., identity) and other (i.e., interpersonal) functioning, and as a dimensional measure, is sensitive to the individual differences in emerging identity and interpersonal development in early adolescence. Yet very little research has examined neurophysiological mechanisms of LPF in youth, missing critical early opportunities to target youth at risk for some of the most stigmatized and costly conditions. Deficits in the NIMH RDoC constructs of Attachment and Affiliation and Understanding of Self may underlie impaired LPF. At the self-report level, impaired LPF is associated with difficulty modulating responses to social acceptance cues and accurately encoding self-relevant information. However, examining these processes at the neural level, which is not confounded by lack of insight or other demand characteristics, may more clearly elucidate processes underlying impaired LPF. Individual differences in processing social acceptance cues and self-referential information can be reliably detected at the neural level using event-related potentials (ERPs), but have not been applied to understanding personality disorders in youth. For this work, a sample of 240 early adolescent youth (ages 10-13, 50% female) will be recruited, the majority (n=180) from two clinically diverse outpatient psychiatry clinics, while the remaining (n=80) youth will be comparison youth without a history of psychopathology. Neurophysiological assessments of social acceptance processing and self-referential processing will be administered, and will be tested as predictors of growth in LPF impairment measured over two years. LPF will be assessed using behavioral observations of parent and peer interactions and through daily ecological momentary assessment (EMA) collected over two years. Additionally, the effect of LPF on clinical indicators, including functional impairment, suicidality, and treatment use, will be tested, considering other key clinical concerns, including maladaptive traits, co-occurring mental health disorders, substance use, and sociodemographic and developmental factors. Results from this work will provide evidence to elucidate treatment targets to mitigate the long-term personal and societal burden associated with personality disorders.
