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Positive Childhood Experiences: Resilience and Recovery From Personality Disorder in Early Adulthood

Andrew E. Skodol, M.D.; Donna S. Bender, Ph.D.; Maria E. Pagano, Ph.D.; M. Tracie Shea, Ph.D.; Shirley Yen, Ph.D.; Charles A. Sanislow, Ph.D.; Carlos M. Grilo, Ph.D.; Maria T. Daversa, Ph.D.; Robert L. Stout, Ph.D.; Mary C. Zanarini, Ed.D.; Thomas H. McGlashan, M.D.; and John G. Gunderson, M.D.

Objective: Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder.

Method: Five hundred twenty patients with DSM-IV-based semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders were evaluated 6 times over 4 years between September 1996 and June 2002. Positive childhood experiences, including achievements, positive interpersonal relationships with others, and caretaker competencies, were measured using the Childhood Experiences Questionnaire-Revised. The effects of positive childhood experiences on clinically significant remission from personality disorder were determined using survival and proportional hazard regression analyses.

Results: Positive achievement experiences and positive interpersonal relationships during childhood or adolescence were significantly associated with remission from avoidant and schizotypal personality disorders. The greater the number of positive experiences and the broader the developmental period they spanned, the better the prognosis of these personality disorders.

Conclusions: The prognosis of certain personality disorders is better in patients whose developmental histories include positive experiences. Early treatment designed to foster personal strengths and competencies and to develop interpersonal skills might benefit young patients diagnosed with personality disorders.

(J Clin Psychiatry 2007;68:1102-1108)

Received May 11, 2006; accepted Dec. 13, 2006. From the New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York (Drs. Skodol and Bender); the Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr. Pagano); the Department of Psychiatry and Human Behavior, Brown University, Providence, R.I. (Drs. Shea and Yen); Yale Psychiatric Research, Yale University School of Medicine, New Haven, Conn. (Drs. Sanislow, Grilo, and McGlashan); McLean Hospital, Harvard Medical School, Belmont, Mass. (Drs. Daversa, Zanarini, and Gunderson); and the Decision Sciences Institute, Providence, R.I. (Dr. Stout). Dr. Skodol is now affiliated with the Institute for Mental Health Research, Phoenix, Ariz.

This work was funded by the National Institute of Mental Health (NIMH) grants MH 50837, MH 50838, MH 50839, MH 50840, MH 50850.

This article has been reviewed and approved by the Publications Committee of the Collaborative Longitudinal Personality Disorders Study. The overall study was funded by NIMH; the members of this committee report no other financial relationships relevant to the subject of this article.

In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: The authors have no personal affiliations or financial relationships with any proprietary entity producing health care goods consumed by, or used on, patients to disclose relative to the article.

Corresponding author and reprints: Andrew E. Skodol, M.D., Institute for Mental Health Research, 222 W. Thomas Road, Suite 414, Phoenix, AZ 85013 (e-mail: