Journal of Personality Disorders, 14(2), 171-187, 2000

2000 The Guilford Press

ASSOCIATIONS BETWEEN FOUR TYPES OF

CHILDHOOD NEGLECT AND PERSONALITY
DISORDER SYMPTOMS DURING ADOLESCENCE
AND EARLY ADULTHOOD: FINDINGS OF A

COMMUNITY-BASED LONGITUDINAL STUDY

Jeffrey

G. Johnson, PhD, Elizabeth M. Smailes, M Phil,

Patricia Cohen, PhD,

Jocelyn Brown, MD,

and

David P. Bernstein, PhD

Data from

community-based longitudinal study were used to in

vestigate
neglect and personal
disorder
levels
and early
adolescence
(PD) symptom
ity
during
adulthood. Psychosocial and psychiatric interviews were adminis
tered to a representative sample of 738 youths and their mothers
a

the association between childhood

from upstate New York in 1975, 1983, 1985-1986, and

1991-1993. Evidence of childhood cognitive, emotional,

physical,

and supervision neglect was obtained from the maternal inter

views that were conducted in 1975, 1983, and 1985-1986, and
from New York State records. PDs

were

assessed among the

they were adolescents, and in

youths
1991-1993, when they were young adults. Findings indicated that
childhood emotional, physical, and supervision neglect were asso
in 1985-1986, when

ciated with increased risk for PDs and with elevated PD symptom
during adolescence and early adulthood, after age, sex,

levels

childhood

physical

or

sexual abuse, other types of childhood

ne

and cooccurring PD symptoms were controlled statistically.

Childhood emotional neglect was associated with increased risk
for avoidant PD and with paranoid and Cluster A PD symptom

glect,

during adolescence and early adulthood. Childhood physi

cal neglect was associated with increased risk for schizotypal PD
and with Cluster A PD symptom levels during adolescence and
early adulthood. Childhood supervision neglect was associated
with increased risk for passive-aggressive and Cluster B PDs and
with borderline, paranoid, and passive-aggressive PD symptom
levels during adolescence and early adulthood. The present find
ings suggest that childhood emotional, physical, and supervision
neglect may play a role in the etiology of some PDs.
levels

From Columbia University and the New York State Psychiatric Institute (J.G.J. E.M.S. P.C.,
J.B.), and Fordham University (D.P.B.).
This study was supported by NIMH grant MH-36971 to Dr. Cohen.
Address correspondence to Jeffrey G. Johnson, PhD, Box 60, New York State Psychiatric In
,

stitute, 1051 Riverside Drive, New York, NY 10032.

171

JOHNSON ET AL.

172

large proportion

of

psychiatric patients with personality disorders (PDs)

or neglect (e.g., Bernstein etal., in press;

histories of childhood abuse

report
Brodsky, Cloitre,

6k Dulit, 1995; Dubo, Zanarini, Lewis, 6k Williams, 1997;

1989; Norden, Klein, Donaldson, Pepper, 6k Klein, 1995;

Oldham, Skodol, Gallaher, 6k Kroll, 1996; Ogata etal., 1990; Raczek, 1992;
Windle, Windle, Scheidt, 6k Miller, 1995), and research has indicated that
Herman et al.,

prevalent among victims of childhood abuse or neglect

than among comparison groups (e.g., Pribor 6k Dinwiddie, 1992; Silverman,
Reinherz, 6k Giaconia, 1996). These findings have suggested that child
abuse and neglect may play an important role in the etiology of PDs
antisocial PD is

more

(Herman, 1992; Kroll, 1993; Paris, 1997).

However,

although

investigation,
hood

neglect

childhood abuse has been the focus of considerable

few studies have

investigated the association between child

Ruegg 6k Frances, 1995). Despite the fact
frequently reported to Child Protective Ser

and risk for PDs (see

that childhood

neglect is more
physical or sexual abuse (National Center on Child
Abuse and Neglect, 1995), much more research has investigated childhood
physical and sexual abuse than neglect (Straus, Kinard, 6k Williams, 1995;
Wolock 6k Horowitz, 1984). Thus, although childhood physical and sexual
abuse have been hypothesized to play a role in the etiology of PDs (Laporte 6k
Guttman, 1996; Paris, 1997), childhood neglect has not played a prominent
role in etiological theories. Nonetheless, research has indicated that many
adults with PDs report a history of childhood neglect (e.g., Arbel 6k
vices than childhood

Stravynski, 1991;

Dubo etal., 1997; Oldham etal.,

1996), that retrospective

reports of low childhood parental care by patients with PDs are associated
with some types of PD symptoms (Norden et al., 1995), and that childhood
neglect is associated with attachment difficulties (Bowlby, 1982; Gauthier,
Stollak, Messe, 6k Aronoff, 1996) and antisocial behavior (Robins, 1966;
Widom, 1989).

indicating that PDs are associated with a history of

neglect is based on retrospective reports of childhood
maltreatment by psychiatric patients (Maughan 6k Rutter, 1997; Paris,
1997). Concerns about the potential effects of PDs on interpretation and re
call of childhood experiences make it problematic to base the inference that
childhood maltreatment contributes to risk for onset of PDs solely upon
such retrospective findings (Maughan & Rutter, 1997; Loftus, 1993; Paris,
1997; Widom, 1989), despite the fact that there is evidence supporting the
validity of retrospective reports of childhood maltreatment (e.g., Bifulco,
Most of the evidence

childhood abuse and

Brown, Lillie, 6k Jarvis, 1997; Brewin, Andrews, 6k Gotlib, 1993; Herman 6k

Schatzow, 1987; Robins et al., 1985). Until prospective research demon
strates that individuals who
treatment

are

are

known to have

at elevated risk for

subsequent

experienced

childhood mal

PDs, it will not be

determine whether childhood maltreatment contributes to the

PDs

possible
etiology

to

of

(Paris, 1997).

only three prospective longitudinal studies have suggested that

neglect may increase risk for the development of PDs. Drake,
Adler, and Vaillant (1988) reported that "environmental weaknesses," in
cluding family instability and lack of parental affection and supervision
during early adolescence were associated with increased risk for dependent
To date,

childhood

173

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

and

passive-aggressive

Unfortunately,

the

PDs in

community sample of middle-aged

of "environmental weaknesses"

men.

too

global
neglect, and a
number of PDs were too low in prevalence to be included in the analyses re
ported by Drake et al. (1988). Luntz and Widom (1994) reported that young
adults who experienced childhood abuse or neglect had a higher prevalence
to

permit

an

measure

assessment of the

specific

was

effects of childhood

of antisocial PD than did young adults in a comparison group. However,

Luntz 6k Widom ( 1 994) did not report whether childhood neglect, in particu

lar, increased risk for antisocial PD, and they did not investigate the associ
ation between childhood maltreatment and other PDs. Thus, many

questions have remained unanswered about the

hood

and risk for PDs

association between child

adolescence and adulthood.

neglect
during
recently reported findings indicating that childhood abuse and
neglect are associated with elevated PD symptom levels (Johnson, Cohen,
We have

Brown, Smailes, 6k Bernstein, 1999). However, we did not investigate asso

ciations involving four specific types of childhood neglect that have recently
been identified by Straus et al. (1995): cognitive, emotional, physical, and
supervision neglect. It was of interest to investigate these specific associa

complete understanding of the role that childhood ne

etiology of PDs will require investigation of the
glect
associations between specific types of childhood neglect and PD symptoms
during adolescence and early adulthood.
Data from the Children in the Community Study, a community-based pro
spective longitudinal study, were examined to investigate whether cognitive,
emotional, physical, and supervision neglect are associated with increased
risk for PDs and elevated PD symptom levels during adolescence and early
adulthood after offspring age and sex and childhood physical and sexual
abuse were controlled statistically. Data regarding specific types of childhood
neglect were obtained from both official state records and maternal reports.
tions because

may

a more

play

in

the

METHOD
PARTICIPANTS AND PROCEDURE

The

participants

in the

present study were

738

randomly sampled

families with chil

dren (367 males and 371 females) who were between the ages of 1 and 10 in 1975
and who resided in one of two counties in the State of New York (Kogan, Smith, &

Jenkins, 1977). In 1975, mothers were interviewed in their homes about family envi
ronment and child charactenstics. During each of three follow-up surveys that took

place in 1983, 1985-1986, and 1991-1993, parents and youths were interviewed re
garding parental behavior, the parent-child relationship, demographics, and men
tal health. At each assessment, written informed consent was obtained from youths
and their parents after the study procedures were fully explained.
The 738 families in the present study were a subsample of 776 families inter
viewed in 1983 who participated in follow-up assessments in 1985-1986 and
1991-1993. The 1983 sample was a close match to the area population of children in
this age range, according to the United States Census data on family income and
structure (Cohen & Cohen, 1996), and the geographic area selected for this study is
representative of the Northeastern region of the U.S. with regard to a wide range of

JOHNSON ET AL.

174

TABLE 1

Demographic

Characteristics of the

Sample Offspring

Mean

Standard

Range
(years)

(years)

Deviation

Age
1975

6.1

1-10

1983

13.8

9-18

2.57

1985-1986

16.1

12-20

2.74

1991-1993

22.0

18-28

2.72

2.79

(%)

Ethnicity
Caucasian

90

African Amencan

Other

Birth Order
First

40

Second

26

Later

34

Residence
Rural Communities and Small Towns

Large

Towns

53
8

Central Cities

12

Suburban Communities

26

Education
Less Than

High

demographic

School

Diploma

variables.

Participants for

available did not differ from the rest of the

whom child maltreatment data

sample with regard

to

were

family income,

not

wel

fare support, urbanicity, or race, but they were more likely to be male (60% as com
pared to 48% of the sample with maltreatment data) and their mothers had fewer
12.26 years as compared to 12.64 years in the families
years of education (mean
with maltreatment information). Demographic characteristics of the sample are pre
sented in Table 1 Further information regarding the study methodology is available
=

from previous reports (Cohen & Cohen, 1996;

Kogan

et

al., 1977).

ASSESSMENT OF PERSONALITY DISORDERS

Interview items used to

from the

assess

parent and youth

DSM-IV PD symptoms and

diagnoses

were

drawn

versions of the National Institute of Mental Health

Diag

nostic Interview Schedule for Children

(DISC-I; Costello, Edelbrock, Duncan, &

Kalas, 1984), the Personality Diagnostic Questionnaire (PDQ; Hyler et al., 1988),
and the Disorganizing Poverty Interview (Kogan et al., 1977). Items were originally
selected

the basis of their

correspondence with DSM-III-R diagnostic criteria

psychiatrist and two clinical psychologists
(Bernstein et al., 1993). Following the publication of DSM-IV, the items selected from

through

on

consensus

the available

among

one

and the algorithms were modified to maximize correspon

diagnostic criteria. Items from the study protocol were added
when necessary, most notably to permit assessment of depressive PD, which is in
cluded in DSM-IV Appendix B, but was not included in DSM-III-R. The median
Cronbach's alpha (a) inter-item reliability coefficient was a
.53. With regard to
measures

dence with DSM-IV

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

Cluster A, B, and C PD symptoms,
overall PD

symptoms,

We used 152 items to

Thirty-one items were

a=

.66, 72, and .68,

175

respectively.

With

regard

to

.87.

assess

88

(93.6%) of the 94

DSM-IV PD

administered to the mothers, 1 16 items

diagnostic

were

criteria.

administered to

the youths, and 5 items regarding the youths' behavior and

appearance were as
by the interviewers. The overall correlation between the youths' responses

sessed

and the mothers' responses to the items

assessing PD symptoms was r .34 (p <
.00 1) PD symptoms were assessed in interviews with both the
youth and the youth's
mother because research has demonstrated that the use of multiple informants in
=

creases the validity of

psychiatric diagnoses and symptom scales (Bird, Gould, &
Staghezza, 1992; Piacentini, Cohen, & Cohen, 1992). Thirty-six diagnostic criteria
were assessed with a
single interview item. The remaining 52 criteria were assessed
with two or more interview items. Item thresholds and algorithms were determined
empirically, so that only extreme response patterns were considered diagnostically
significant. Each disorder was assessed using a symptom scale indicating the num
ber of diagnostic criteria that were met. The term "diagnostic criteria" is used inter
changeably with the term "symptoms" throughout this report. If the number of
criteria met the DSM-IV diagnostic threshold, a PD diagnosis was assigned. All of the
DSM-IV PDs were assessed. However, antisocial PD was only assessed in
1991-1993 because most of the offspring were < 18 years old in 1983 and

1985-1986.

ASSESSMENT OF CHILDHOOD ABUSE AND NEGLECT

Interview items used to
sion of the

assess childhood neglect were obtained

Disorganizing Poverty Interview (Kogan et al., 1977),

tered to the

youths'

mothers in

1975,

1983, and

from the parent ver

was adminis

which

1985-1986.

Because

some

at least 18 years old, maternal responses were only considered to

indicate the presence of neglect if the youths were 1 7 years old or younger when the

participants

were

comprised the measure of childhood ne

glect used for the present study were selected because they assessed four domains of
childhood neglect cognitive, emotional, physical, and supervision neglect that
were identified by Straus and colleagues based upon their factor analytic research
(Straus et al., 1995). Items were included based on their correspondence with the
items in the cognitive, emotional, physical, and supervision neglect subscales of the
Neglect Scale (Straus et al., 1995).
The cognitive neglect subscale was comprised of seven interview items (e.g., "Do
you ever read to your child?"; "Do you help your child with his/her school work if
interviewwas conducted. The 35 items that

he/she doesn't understand?"), assessing four out of five ar

were identified by Straus et al. (1995). The internal reli
neglect
.50. The emotional
subscale
this
of
(Cronbach's
alpha coefficient) was a
ability
was comprised of 12 items (e.g., "I [do not] often praise my child"; "I
subscale
neglect
[do not] frequently show love for my child"), assessing four out of five areas of emo
tional neglect that were identified by Straus et al. (1995). The internal reliability of
there is
eas

something

that

that

of cognitive

this subscale

was a

.77. The

physical neglect

subscale

was

comprised of 6

items

(e.g., "Has your child ever been immunized against diptheria, polio, measles, Ger
man measles, and mumps?"; "Very poor cleanliness and upkeep of the interior living
[interviewer rating]"), assessing three out of five areas of physical
quarters,

that

were

identified by Straus et al. (1995). This subscale had

as

neglect
reliability
(e.g., "I allow

internal

was comprised of 10 items

pleases"; "I am tolerant of my child using as
he/she wants"), assessing three out of five areas of supervision

of a = .33. The supervision

as often
my child to go out

much marijuana

subscale

an

neglect
as

he

or

she

176

JOHNSON ET AL.

neglect

that

liability of a
childhood

were
=

identified

by Straus

etal. (1995). This subscale had

.67. The overall internal

neglect

subscales

was a

reliability

an

internal

re

of the 35 items comprising the four

.82.

For each subscale, childhood

neglect was considered to be present if two different

conditions were met: (1) childhood neglect subscale scores were required to be at
least two standard deviations above the sample mean in order for a given subtype of
neglect to be present; and (2) at least one extreme answer was required to be made in
response to items that were judged through consensus between a clinical psycholo
gist and a counseling psychologist, as being central to each subscale construct. Ex
amples of these extreme responses include the following: (1) never helps child with
his/her school work if there is something he/she doesn't understand (cognitive ne
glect); (2) does not frequently show love for child (emotional neglect); (3) did not take
my child to the doctor when he/she had at least two physical complaints including
problems with his/her stomach, sight, hearing or limbs (physical neglect); and (d)
did not restrict the child's activities (supervision neglect).
Data regarding childhood abuse and neglect were also obtained from the New
York State Central Registry for Child Abuse and Neglect (NYSCR). Cases referred
to state agencies, investigated by Childhood Protective Services, and confirmed
as verified cases of abuse or
neglect are retained in the NYSCR. Verification of
physical abuse required evidence of injury. Verification of sexual abuse required
evidence of sexual penetration or a judgement that the youth experienced un
wanted sexual contact. Verification of neglect required evidence of educational,
emotional, physical, or supervision neglect. NYSCR staff ascertained whether
confirmed cases of childhood maltreatment were present. Information regarding
the type of abuse was abstracted by one of the authors under the supervision of
NYSCR staff. To ensure confidentiality, participants were identified only by ID
numbers, and data were entered by individuals who had no access to information
identifying participants' identities.
Self-reports of childhood maltreatment were obtained from the offspring in
1991-1993. Participants were asked whether, before age 18: (1) anyone they lived
with ever hurt them physically so that they were still injured or bruised the next day,
,

could not go to school as a result, or needed medical attention; (2) they had been left
without an adult caretaker before age 10; and (3) any older person who

overnight
was

not

boy/girlfriend
sexually.

ever

touched them

sexually

or

forced them to touch the

older person

RESULTS

The

prevalences of the four types of childhood neglect and of DSM-IV PDs

during adolescence and/or early adulthood are presented in Table 2. Of the
25 cases of cognitive neglect, 21 were identified
through maternal reports
and 4 were officially documented. All 21 cases of emotional
neglect were
identified through maternal reports, and 1 was officially documented. Of the
24 cases of physical neglect, 20 were identified
through maternal reports
and 4 were officially documented. Of the 38 cases of
supervision neglect, 18
were identified
through maternal reports and 20 were officially docu
mented. Three cases of emotional neglect, 3 cases of physical
neglect, and
12 cases of supervision neglect were identified as victims of childhood
phys
ical or sexual abuse. No cases of cognitive neglect were identified as victims
of childhood physical or sexual abuse. Correlational analyses conducted

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

TABLE 2. Prevalence of Childhood
Early Adulthood [N 738)

Neglect

and

Personality

177

Disorders

During Adolescence

or

Number of Cases (%)

Four

of Childhood

Types
Cognitive

Neglect
25

(3.4)

Emotional

21

(2.8)

Physical

24

(3.3)

Supervision

38 (5.6)

Any Childhood Neglect

95

(12.9)

Paranoid

27

(3.7)

Schizoid

20 (2.7)

Personality

Disorder

During

Adolescence

Early

or

Adulthood

Schizotypal

34 (4.6)

Any DSM-IV Cluster

71

(9.6)

Borderline

21 (2.8)

Histrionic

24

(3.3)

Narcissistic

44

(6.0)

Any

DSM-iY Cluster B

76 (10.3)

Avoidant

28 (3.8)

Dependent
Obsessive-Compulsive

23

Any DSM-IV Cluster

53 (7.2)

(3.1)

7(1.0)

Depressive

15

Passive-Aggressive

38 (5.1)

Any

DSM-IV

using the

sums

(2.1)

180 (24.4)

of the items used to

assess

the four types of childhood

ne

glect

indicated that all of the intercorrelations between the four subscales

were

positive and statistically significant

at the .001 level.

CHILDHOOD EMOTIONAL NEGLECT AND PERSONALITY DISORDERS

DURING ADOLESCENCE AND EARLY ADULTHOOD

Analyses

of Covariance (ANCOVAs)

were

conducted to

investigate

the

asso

ciation between childhood emotional

adolescence and

neglect and PD symptoms during late

adulthood. PD distributions were somewhat posi

early
tively skewed, but were sufficiently approximate to normal distributions to
permit ANCOVAs to be conducted. As Table 3 indicates, paranoid PD symp
toms during adolescence and early adulthood were associated with a his

tory of childhood emotional neglect after offspring age and sex, childhood
physical and sexual abuse, childhood cognitive, physical, and supervision
neglect, and co-occurring PD symptoms were controlled statistically. Sup
plemental analyses indicated that schizoid and schizotypal PD symptoms

during adolescence and early

emotional neglect when it was

adulthood
assessed

were

as a

associated with childhood

continuous variable.

Individuals with a history of childhood emotional neglect were at in

creased risk for avoidant PD during adolescence or early adulthood after
controlling statistically for offspring age and sex, for childhood physical and

sexual abuse, and for childhood cognitive, physical, and supervision

ne-

JOHNSON ET AL.

178

TABLE 3. Childhood Emotional Neglecte and

Adolescence and Early Adulthood

Personality

PD Cnteria Pres

Disorder

ent

Among Those
Not Neglected

(PD)

Personality

Disorder Criteria Present in

PD Cnteria Present

Among

Victims

of Emotional

Neglect

Increase in

Fd

PD

Symptom
Levels

643)
Mean {SD)

(IV =21)
Mean (SD)

Paranoid

0.82

(0.81)

1.48

(1.04)

80

Schizoid

0.91

(0.81)

1.45

(1.15)

59

1.69

(0.90)

2.17

(1.02)

28

4.47ag

50

13.53cgh

(JV

Schizotypal
Any Cluster

(%)

la^i"*1
8.10b

(1.92)

5.10(2.51)

Borderline

1.04 (0.96)

1.64(1.22)

58

6.08a

Histnonic

1.55

1.83 (1.05)

18

0.94

1.37 (1.14)

2.02

(1.53)

47

4.99a

3.96

5.50 (3.22)

39

5.76a
11.23

3.41

Narcissistic

Any

Cluster B

(1.05)

(2.48)

Avoidant

0.76

(0.80)

1.36(1.23)

79

Dependent

1.08

(0.98)

1.71

(1.58)

58

Obsessive-Compulsive

0.77(0.71)

0.81

(0.77)

2.61

3.88 (3.18)

49

Any Cluster

C PD

(1.87)

Depressive

0.70 (0.81)

0.52

Passive-Aggressive

0.82

(0.84)

1.21

11.51

(5.97)

Any

PD

><05; bp<
Analyses

eReported

.01;

"p

<

7.70b
0.03

9.23b

(0.78)

1.18

(1.10)

48

3.12

16.21 (9.17)

41

10.33cg

.005.

of Covariance. controlling for offspring age. sex, and physical or sexual abuse (df= 1. 662).
by youths' mothers during prospective interviews or documented in New York State records.

Mean DSM-IV PD criteria met at interviews conducted

during adolescence and early adulthood.

controlling for other forms of childhood neglect.
hThis association remained statistically significant after controlling for other PD symptoms that were
significantly associated with childhood emotional neglect.

^This

association remained

gleet.

significant

Because there

childhood

neglect,

few

specific PDs among victims of

computed to provide reliable es
of
the
associations regarding specific
significance

were

cases

Fisher's Exact Test

timates of the statistical

PDs, and these

after

are

with
was

shown in Tables 4, 6, and 8.

CHILDHOOD COGNITIVE NEGLECT AND PERSONALITY DISORDERS

DURING ADOLESCENCE AND EARLY ADULTHOOD

Neither PDs

PD

symptoms during adolescence and early adulthood

history of childhood cognitive neglect after offspring
and
childhood
sex,
age,
physical abuse and sexual abuse were controlled
Correlational
statistically.
analyses indicated that findings did not vary
when childhood cognitive neglect was assessed as a continuous, rather
nor

were

associated with

than

dichotomous variable.

CHILDHOOD PHYSICAL NEGLECT AND PERSONALITY DISORDERS

DURING ADOLESCENCE AND EARLY ADULTHOOD

Symptoms of

Cluster A PDs

during adolescence and early adulthood were

history of childhood physical neglect after controlling sta
tistically for offspring age and sex, for childhood physical and sexual abuse,
associated with

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

1 79

TABLE 4. Childhood Emotional Neglect and Risk for

Personality Disorders
and Early Adulthood

Personality

Prevalence of PD

Disorder (PD)

Prevalence of PD

Among Those
Not Neglected

Victims
of Emotional

Among

in

Adolescence

Odds

95%

Ratio

Confidence
Interval

Neglect

Paranoid

3.0%

(19/643)

9.5%

(2/21)

3.46

0.75-15.92

Schizoid

2.6%

(17/643)

9.5%

(2/21)

3.87

0.84-17.98

Schizotypal
Any Cluster A

3.9%

(25/643)

4.8%

(1/21)

1.24

0.16-9.58

8.2%

(53/643)

19.0%

(4/21)

2.61

0.85-8.07

Borderline

2.0%

(13/643)

9.5% (2/21)

5.10

1.08-24.21

Histrionic

3.0%

(19/643)

9.5%

(2/21)

3.46

0.75-15.92

PD

Narcissistic

5.0%

(32/643)

14.3% (3/21)

3.18

0.89-11.36

9.2%

(59/643)

14.3% (3/21)

1.65

0.47-5.77

Avoidant

3.1%

(20/643)

14.3%

(3/21)

5.19abd

1.41-19.07

Dependent

3.0%

(19/643)

4.8%

(1/21)

1.64

0.20-12.88

Obsessive-Compulsive

0.9%

(6/643)

0.0%

(0/21)

Any Cluster C

6.4%

(41/643)

14.3%

(3/21)

2.45

0.69-8.65

Depressive

1.9%

(12/643)

0.0%

(0/21)

Passive-Aggressive

3.9%

(25/643)

14.3%

(3/21)

4.12

1.14-14.91

(140/643)

42.9% (9/21)

2.69acd

1.11-6.52

Any

Any

Cluster B PD

PD

PD

21.8%

"p < .05; ''Determined by Fisher's

determined by Cm-Square Test; dLogistic regression analyses

statistically significant after controlling for offspring age and sex. for
documented childhood physical or sexual abuse, and for childhood cognitive, physical, or supervision neglect.
Exact Test;

indicated that this association remained

for childhood

cognitive, emotional,

PD

and

supervision neglect, and for

co-occurring
symptoms (see Table 5) Supplemental analyses indicated
that schizoid and narcissistic PD symptoms during adolescence and early
adulthood
sessed

were

as a

associated with childhood

physical neglect when

it

was as

continuous variable.

Childhood

physical neglect was associated with increased risk for

schizotypal
during adolescence or early adulthood after offspring age
and sex, childhood physical and sexual abuse, childhood cognitive, emo
tional, and supervision neglect, and co-occurring PDs were controlled sta
tistically (see Table 6).
PD

CHILDHOOD SUPERVISION NEGLECT AND PERSONALITY DISORDERS

DURING ADOLESCENCE AND EARLY ADULTHOOD

Borderline, paranoid, and passive-aggressive PD symptoms during adoles

early adulthood were associated with childhood supervision ne

glect
controlling statistically for offspring age and sex, for childhood
and
sexual abuse, for childhood cognitive, emotional, and physical
physical
and
for co-occurring PD symptoms (see Table 7). Supplemental
neglect,
indicated
that schizoid and histrionic PD symptoms during ado
analyses
lescence and early adulthood were associated with childhood supervision
neglect when it was assessed as a continuous variable.
Childhood supervision neglect predicted increased risk for PDs during ado
lescence and early adulthood (see Table 8). Specifically, childhood supervision
cence

and

after

JOHNSON ET AL.

180

Physical Neglecte
Early Adulthood

TABLE 5. Childhood
Adolescence and

Personality

and

Personality

PD Cnteria Present

Disorder (PD)

Among Victims of
Physical Neglect
(JV

Mean

Paranoid

Disorder Criteria Present

F*

% Increase
in PD

Symptom

Levels

24)
(SD)

1.35(1.06)

65

8.54cg

Schizoid

1.40(0.96)

54

6.68ag

Schizotypal

2.38

(1.20)

41

10.61cg

5.12(2.50)

50

14.87cgh

Any

Cluster A PD

Borderline

1.73(1.31)

66

Histnomc

1.92(1.05)

24

1.57

Narcissistic

2.00 (1.37)

46

5.43a

5.65 (3.34)

43

7.47b

Avoidant

1.15(0.92)

51

4.24ag

Dependent

1.67(0.88)

55

6.15a

Obsessive-Compulsive

1.21

(0.92)

57

7.71b

4.02 (2.07)

51

10.60cg

Any

Any

Cluster B PD

Cluster C PD

Depressive

0.92

Passive-Aggressive

1.12

Any

PD

y<

.05;

Dp<

"p<

.01,

8.56c

(0.86)

31

1.02

(0.90)

37

2.02

16.83 (8.20)

46

14.00cg

.005.

Analyses of Covanance, controlling for offspring age, sex. and physical or sexual abuse (df 1. 662).
eReported by youths' mothers during prospective interviews or documented m New York State records.
Mean DSM-IV PD criteria met at interviews conducted during adolescence and early adulthood.
^This association remained significant after controlling for other forms of childhood neglect.
^his association remained statistically significant after controlling for other PD svmptoms that were signifi
cantly associated with childhood physical neglect.
=

neglect

was

associated with

sive-aggressive

statistically

for

increased

adolescence

PDs

during
offspring age

and

sex.

or

risk

early

Cluster B

and pas

controlling
physical and sexual
physical neglect, and for

for childhood

abuse, for childhood cognitive, emotional, and

co-occurring

for

adulthood after

PDs.

ANY CHILDHOOD NEGLECT AND PERSONALITY DISORDER

SYMPTOMS DURING ADOLESCENCE AND EARLY ADULTHOOD
ANCOVAs indicated that any evidence of childhood neglect was associated
with elevated paranoid, schizoid, schizotypal, borderline, narcissistic,

dependent, and passive-aggressive symptom levels during ado

early adulthood after offspring age and sex, childhood physical
abuse, and sexual abuse were controlled statistically. Additional analyses
avoidant,

lescence

were

or

conducted to

investigate whether findings differed

as

result of

whether maternal reports or official records were the source of information

regarding childhood neglect. Because there were so few cases of officially
documented emotional and
conducted with

regard

physical neglect, these analyses could only be

involving overall childhood neglect.

to associations

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

TABLE 6. Childhood
Early Adulthood

Personality

Physical Neglect

Disorder

(PD)

and Risk for

181

Personality Disorders

in Adolescence and

Prevalence of PD

Odds

95% Confidence

Among Victims of
Physical Neglect

Ratio

Interval

Paranoid

S 3%

(2/24)

2.99

0.65-13.62

Schizoid

4.2% (1/24)

1.60

0.20-12.55

Schizotypal
Any Cluster

A PD

Borderline
Histrionic

4.94acef

1.57-15.54

25.0% (6/24)

3.71ace

1.41-9.75

12.5% (3/24)

6.92ace

4 2%

Narcissistic

Any Cluster

Avoidant

Dependent

5.02bce

1.76-14.32

3.29ace

1.26-8.63

12.5% (3/24)

4.45

1.23-16.15

1.43

0.18-11.13

20.S%

Depressive

(1/24)
(5/24)

12.5%

.Any PD

45.8% (11/24)

.05;

p<

4.62

0.53-39.93

3.86ace

1.37-10.87

3.53

0.99-12.63

3.04bde

1.33-6.93

0.0% (0/24)

Passive-Aggressive

*p<

0.18-11.13

25.0% (6/24)

4.2% (1/24)

Cluster C PD

1.83-26.14

1.43

(1/24)

20.S% (5/24)

4.2%

Obsessive-Compulsive
Any

16.7% (4/24)

(3/24)

.01.

cDetermined by Fisher's

Exact Test.

Determined

by Chi-Square Test.
eLogistic regression analyses indicated that this association remained statistically significant after control
ling for offspring age and sex, for documented childhood physical or sexual abuse, and for childhood cogni
tive, emotional, or supervision neglect.
Logistic regression analyses indicated that this association remained statistically significant after
controlling for other PDs that were significantly associated with childhood physical neglect.

officially documented childhood neglect was associ

paranoid, schizoid, schizotypal, borderline, narcissistic,
avoidant, dependent, obsessive-compulsive, depressive, and pas
sive-aggressive symptom levels during adolescence or early adulthood after
the other variables were controlled statistically. Maternally-reported child
hood neglect was associated with elevated paranoid, schizotypal, border
line, narcissistic, and passive-aggressive symptom levels during
adolescence or early adulthood after offspring age and sex, childhood physi
Results indicated that
ated with elevated

cal abuse, and sexual abuse

were

that,

glect

identified

reported
by

controlled

statistically.

was

neglect are likely to have been

maternally reported childhood neglect.

mented childhood
cases

of

It should be noted

very little overlap between the cases of ne

the two sources, and that the 26 cases of officially docu

above, there

as

more severe

than the 75

CHILDHOOD NEGLECT AND ANTISOCIAL PERSONALITY DISORDER

SYMPTOMS DURING EARLY ADULTHOOD

Antisocial PD

was

only assessed

in 1 99 1- 1 993, because few

participants were

18 years old in 1983 and 1985-1986. Therefore, separate analyses were con
ducted to investigate whether the four types of childhood neglect were associ

ated with elevated antisocial PD symptoms in

early

adulthood.

Findings

JOHNSON ETAL.

182

TABLE 7.

Supervision Neglect

and Earlv

and

Personality

Disorder Cntena Present in Adolescence

Adulthoodf

Personalitv Disorder

PD Critena Present

(PD)

Among Victims of
Supervision Neglect
(JV 38)
=

Mean

F*

Increase in PD

Symptom Levels
(%)

(SD)

25.17cgh

Paranoid

1.47

(1.22)

79

Schizoid

1.11

(0.82)

22

2.88

Schizotypal

2.12 (1.22)

25

6.54ag

4.70

38

16.44cg

18.76cgh

Any Cluster

A PD

(2.60)

Borderline

1.86(1.45)

79

Histnomc

2.00(1.26)

29

5.48ag

Narcissistic

2.07

(1.60)

51

13.29cg

18.97cg

Any

Cluster B PD

5.92 (3.57)

49

Avoidant

1.12 (1.01)

47

8.50cg

Dependent

1.50

(1.28)

39

6.62ag

Obsessive-Compulsive

0.97 (0.78)

26

1.84

3.59

(2.43)

38

9.76cg

Depressive

1.11

(1.39)

59

5.91ag

Passive-Aggressive

1.45 (1.31)

77

17.31cgh

16.76 (8.72)

46

25.34cg

Any

Any

Cluster C PD

PD

Dp< .01: "p < .005.

1. 662).
Analyses of Covanance. controlling for offspring age, sex, and physical or sexual abuse (df
eReported by youths' mothers during prospective interviews or documented in New York State records.
Mean DSM-IV PD cntena met at interviews conducted during adolescence and early adulthood.
^This association remained significant after controlling for other forms of childhood neglect.
p< .05;

Hnis

association remained

cantly

statistically significant after controlling for other PD symptoms

neglect.

that

were

signifi

associated with childhood supervision

indicated that, after

offspring age and gender, childhood physical and sexual

abuse, and other types of childhood neglect were controlled statistically, nei
ther childhood cognitive, emotional, physical, nor supervision neglect were
associated with elevated antisocial PD symptoms or increased risk for antiso
cial PD during early adulthood. These findings did not vary when the four
types of childhood neglect were assessed as continuous variables.

DISCUSSION

The

principal findings of the present study are that childhood emotional,

physical, and supervision neglect were associated with increased risk for
PDs and elevated PD

symptom levels among adolescents and young adults

These
community.
findings are consistent with previous research in
that
a
childhood
environment characterized by parental
dicating
in the

neglect

was

associated with increased risk for PD

symptoms during adulthood

(Drake etal., 1988; Luntz & Widom, 1994) and with findings indicating that
patients with PDs are more likely than individuals without PDs to report
histories of childhood

neglect (e.g.,

1997; Oldham etal., 1996;

see

Arbel &

Norden etal.,

Stravynski, 1991; Dubo et al.,

1995). Although concerns have

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

183

TABLE 8. Childhood Supervision Neglect and Risk for Personality Disorders in Adolescence
and

Early

Adulthood

Personality

Disorder (PD)

Prevalence of
Among Victims

PD

of

10.5%

Schizoid

Interval

(4/38)

3.86adg

1.25-11.99

0.0% (0/38)

Schizotypal
Cluster A PD

Borderline
Histrionic
Narcissistic

Any

95% Confidence

Ratio

Supervision Neglect

Paranoid

Any

Odds

Cluster B PD

10.5%

(4/38)

2.90

0.96-8.83

18.4%

(7/38)

2.51

1.06-5.98

13.2%

(5/38)

7.34cdf

2.47-21.82

7.9%

(3/38)

2.82

0.79-9.97

15.8%

(6/38)

3.58adf
4.03cdfg

1.90-8.54
0.76-9.42

28.9% (11/38)

Avoidant

7.9%

(3/38)

2.67

Dependent

5.3%

(2/38)

1.82

1.40-9.18

Obsessive-Compulsive

0.0% (0/38)

Any Cluster C

4.3%

(1/38)

2.22

0.82-6.00

7.9%

(3/38)

4.51adg
4.64bdfg
4.44cef

1.22-16.71

PD

Depressive
Passive-Aggressive
Any

15.8% (6/38)

PD

*p<.05; bp<-01; cp

55.3%
<

(21/38)

1.78-12.10
2.28-8.64

.005.

Determined

by Fisher's Exact Test

eDetermined by Chi-Square Test
Logistic regression analyses indicated that this association remained statistically significant after control
ling for offspring age and sex, for documented childhood physical or sexual abuse, and for childhood cogni
tive, emotional, or physical neglect.
gLogistic regression analyses indicated that this association remained statistically significant after
controlling for other PDs that were significantly associated with childhood supervision neglect.

patients' reports of childhood maltreatment may be due in

or reports associated with psychiatric symptoms
(Loftus, 1993; Maughan & Rutter, 1997; Paris, 1997; Widom, 1989), the
present findings suggest that many patients with PDs report histories of
childhood neglect because the actual prevalence of childhood neglect is
higher among individuals with PDs than among those without PDs.
All three types of childhood neglect were associated with elevations in
overall PD symptom levels and with increased overall risk for PDs during
adolescence or early adulthood after offspring age and sex, childhood
physical and sexual abuse, and other types of childhood neglect were ac
counted for. However, there is evidence that childhood emotional, physi
cal, and supervision neglect were associated with elevations in different
types of PD symptoms (see Table 9). After childhood abuse, other types of
childhood neglect, and symptoms of other PDs were accounted for, child
been raised that

part

to biased memories

hood emotional abuse

was

associated with increased risk for avoidant PD

paranoid PD symptom levels, physical abuse was associated

with elevated schizotypal symptom levels, and supervision neglect was
associated with elevated borderline, paranoid, and passive-aggressive PD
symptom levels. These findings, and previous findings that different sub
types of childhood neglect were differentially associated with risk for spe
cific types of PD symptoms (e.g., Arbel & Stravynski, 1991; Dubo et al.,
and elevated

JOHNSON ET AL.

184

TABLE 9.
and Earlv

Summary: Types of Childhood Neglect

Adulthooda

Personality Disorder

Emotional

Associated With PDs

Physical Neglect

Neglect

During Adolescence

Supervision Neglect

(PD)
Paranoid

Symptoms

Symptoms

Schizoid
Disorder

Schizotypal
.Any Cluster A PD

Symptoms

Symptoms

Borderline

Symptoms

Histrionic

Narcissistic

Disorder

Any Cluster B PD
Avoidant

Disorder

Dependent
Obsessive-Compulsive
Any

Cluster C PD

Depressive
Passive-Aggressive
Any

PD

Symptoms

& Disorder

Symptoms

& Disorder

Symptoms

& Disorder

Symptoms

& Disorder

aSummary of significant findings

types of

childhood

neglect,

and

after offspring age and gender, childhood physical and sexual abuse, other
co-occurring PD symptoms were controlled statistically.

1997; Ogata etal., 1990), suggest that it may be important for researchers
investigate specific etiological models for each of the different PDs. It is

to

important to note that cognitive neglect was not associated with any PD
symptoms during adolescence or early adulthood. These findings would
appear to suggest that cognitive neglect may not play a role in the etiology
of PDs. However, different findings might have been obtained if cognitive

neglect

had been assessed with another instrument.

It will be of interest for future research to

investigate whether specific

types of childhood abuse and neglect are differentially associated with risk
for development of specific types of PD symptoms. Each PD may be associ
ated with a unique combination or profile of the eight major types of child
hood

maltreatment

nonverbal

(i.e., physical abuse, sexual abuse, verbal and

psychological abuse, and the four types of childhood neglect). It

will also be of interest to

investigate whether interpersonal factors such

as

attachment, social support, and Eriksonian psychosocial development

moderate and/or mediate associations between childhood neglect and risk
for PDs. Youths who experience neglect during late childhood or early ado
lescence may be less likely to develop PDs if they experienced secure attach
ment and optimal psychosocial development (e.g., basic trust, autonomy,
and initiative)

during early

childhood

if other adults

provide ongoing
neglect also
merit investigation. Different types of childhood neglect may have specific
effects on the course and treatment of PDs, and particular
psychotherapeutic interventions may be uniquely effective in promoting
therapeutic change among individuals with PDs who have experienced spe
cific forms of childhood neglect.
nurturance to the child. Treatment

or

implications

of childhood

CHILDHOOD NEGLECT AND PERSONALITY DISORDERS

As noted above, childhood

physical

neglect is

more

185

prevalent than either childhood

sexual abuse (National Center on Child Abuse and Neglect,

1995). However, the adverse effects of childhood physical and sexual abuse
have been investigated much more extensively than the effects of childhood
or

neglect (Straus et al., 1995; Wolock & Horowitz, 1984). Thus, childhood
physical and sexual abuse have been hypothesized to play a role in the etiol
ogy of PDs (e.g., Laporte & Guttman, 1996; Paris, 1997). but the hypothesis
that childhood neglect contributes to the development of PDs has not been
included in most theories of the etiology of PDs. Nonetheless, the
present
findings suggest that childhood emotional, physical, and supervision ne
glect may play a role in the etiology of some types of PDs.
It is important to acknowledge that the prevalence of specific PDs and of
specific types of childhood neglect was low, reducing the statistical power of
some analyses involving PD diagnoses. This concern
prompted us to inves
tigate the association between childhood neglect and PD symptoms during
adolescence and early adulthood. Our findings regarding these associations
provide a valuable supplement to our findings involving PD diagnoses be
cause they are less likely to be
adversely affected by low statistical power.
Another

methodological

interviews

used to

concern

is that, because items from the maternal

childhood

neglect, and because only severe

of cognitive, emotional, physical, and supervision neglect were in
cluded in our analyses, it is possible that the prevalence of some types of
were

assess

cases

childhood

provided

neglect were

underestimated. Because previous research has not

an accepted operational definition of each

researchers with either

type of childhood neglect or findings regarding the prevalence of these four

types of childhood neglect in the general population, it is necessary for re
searchers in this field to assess childhood neglect with measures that are
likely to undergo further revision as work in this field continues to progress.
Fortunately, because the maternal reports were supplemented with official
records of childhood neglect in the present study, there is reason to have in
creased confidence in the comprehensiveness of the assessment of child
hood cognitive, emotional, physical, and supervision neglect in the present
study.

Another
views

concern

were

is that, because

necessary to draw items from

PD

symptoms

predictive
measures

validated structured clinical inter

measures

that

were

in 1983 and 1985-1986, and the

early 1980s,

then available to

it

was

assess

sensitivity, specificity, and

power of the PD diagnoses could not be ascertained. Because the

used to assess PDs are unique to this study, it will be of particular

interest for future

view such

no

available for the assessment of PDs in the

as

longitudinal

the SCID-II (First,

research to

use a

structured clinical inter

Spitzer, Gibbon, & Williams, 1995) to inves

tigate associations between childhood neglect and subsequent PDs.

Despite the limitations acknowledged above, the present study has nu
merous methodological strengths, including the use of a longitudinal de
sign to investigate the relationship between childhood maltreatment and
PDs during early adulthood, the use of data from maternal interviews and
official records to assess childhood neglect, the use of data from official re
cords and retrospective self-reports to document the occurrence of child
hood

physical

and sexual abuse, the representativeness of the

sample,

JOHNSON ET AL.

186

comprehensive
spring

assessment of PDs

and their mothers, and the

using data obtained from both the off

use

of statistical

procedures to control for

the effects of age, gender, childhood abuse, and co-occurring PD symptoms.

For these reasons, and because this is the first report to present longitudi

findings regarding the association between specific types of childhood

neglect and the entire spectrum of DSM-IV PDs, the present findings con
tribute to an increased understanding of the association between childhood
neglect and PDs.

nal

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