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The effect of positive childhood experiences on adult personality psychopathology
Personality and Individual Differences 158 (2020) 109862
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The effect of positive childhood experiences on adult personality psychopathology
T
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Rumeysa Gunay-Oge , Fatmatuz Zehra Pehlivan, Sedat Isikli Hacettepe University Psychology Department, Ankara, Turkey
A R T I C LE I N FO
A B S T R A C T
Keywords: Positive childhood experiences Childhood adversity Childhood experiences Personality disorders Personality development
Most of the current literature on the subject focuses on the relationship between adverse childhood experiences and adult personality psychopathology; however, as far as is known, there is no research investigating the relationship between positive childhood experiences and adult personality disorder symptoms. The present study aims to highlight the association between positive childhood experiences and adult personality psychopathology. To investigate this association, 341 participants were recruited for this study, in which the Adverse Childhood Experiences Scale, the Benevolent Childhood Experiences Scale and the Coolidge Axis II Inventory Plus were used. Stepwise linear regressions supported the position that despite the presence of adverse childhood experiences, there are independent relationships between positive childhood experiences and 11 out of 14 personality disorder symptoms (Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, Paranoid, Passive-Aggressive, Schizoid, Schizotypal and Self-defeating Personality Disorder (PD) symptoms). Results did not support an independent relationship between positive childhood experiences and histrionic, sadistic or narcissistic personality disorder traits. The results of the study illuminate how positive childhood experiences may counteract long-term effects of childhood adversity.
1. Introduction A considerable body of research has focused on the relationship between adverse childhood experiences and the development of personality disorders in adulthood. Since the pathology of personality disorders is found to be associated with genetic and environmental factors and their interactions (Depue, 2009), and early childhood adversities are widely accepted to have long term detrimental effects on adulthood (Horwitz, Widom, Mclaughlin & White, 2001; Mullen, Martin, Anderson, Romans & Herbison, 1996), many studies understandably focus on the relationship between early adversities and the development of adult personality disorders. Indeed, the results of these studies indicate a special relationship between different types of childhood abuse or neglect and personality disorders (Afifi et al., 2011; Cohen et al., 2014; Lobbestael, Arntz & Bernstein, 2010; Zhang, Chow, Wang, Dai & Xiao, 2012). However, there is also some evidence that, for many, adverse childhood experiences have less direct effect on mental health than previously assumed (Horwitz et al., 2001). In the face of adversity, characteristics of individuals, such as cognitive flexibility and optimism, or characteristics of the environment, such as having a supportive family and adequate maternal care, may constitute a buffer effect ⁎
that contributes to resiliency, so that these individuals are better able to control and cope with stress, and become protected from developing mental disorders (Southwick & Charney, 2012). It can be assumed that risk and resilience factors have additive and interactive effects: while genetic, developmental, neurobiological and/ or psychological risk factors cause an increase in allostatic load, having protective factors increases the likelihood of stress resilience (Karatsoreos & McEwen, 2011). Even if the literature in the past has mostly been focused on the risk factors and their effects in adulthood, some recent articles focus on factors that promote resiliency (Skodol et al., 2007; Southwick & Charney, 2012). However, there is as yet no study focusing on positive childhood experiences that can play a role in reducing the risk of personality psychopathology and promoting healthy personality development. At this point, it is important to distinguish between mechanisms of resilience operating through promotive versus protective factors. Whereas promotive factors are evident by direct effects and are associated with favorable outcomes for individuals in both low and highrisk environments, protective factors serve as moderators or buffers that reduce the probability of harm as risk increases (Narayan, 2015). In this article, positive childhood experiences were considered as promotive factors that directly reduce the risk of personality psychopathology and
Corresponding author at: Hacettepe University Beytepe Campus, Faculty of Literature, Psychology Department, 06800 Ankara, Turkey. E-mail address: [email protected] (R. Gunay-Oge).
https://doi.org/10.1016/j.paid.2020.109862 Received 1 November 2019; Received in revised form 15 January 2020; Accepted 22 January 2020 0191-8869/ © 2020 Elsevier Ltd. All rights reserved.
Personality and Individual Differences 158 (2020) 109862
R. Gunay-Oge, et al.
school, a teacher who cared). The scale consists of 10 items which can be answered by yes, or no. A higher number of questions answered with “yes” indicates higher levels of positive childhood experiences. The scale has demonstrated adequate psychometric properties (Narayan et al., 2018).
enhance healthy personality development, including for those who experienced childhood adversity. Personality is comprised of psychological domain and characteristic behavior patterns. Psychological components include emotional state, cognitive organization, representation of self and others, and schemata for interpersonal interactions, while behavioral strategies modulate the psychological state (Siever, Koenigsberg & Reynolds, 2003). Since biological and environmental factors determine personality development and there is also an interaction between biology and environment, an individual's childhood experiences, such as abuse, may lead to both neurological changes, like hypothalamus and pituitary functioning, and to change in psychological components via directly affecting the selfconcept and schemata for interpersonal interactions (Larsen & Buss, 2008). Although massive trauma, such as abuse or neglect, can alter psychobiologic domains in the direction of severe psychopathology (Siever et al., 2003), positive childhood experiences, such as having safe caregivers and interpersonal support, can shape these domains in the direction of healthy personality development; the larger the number of positive experiences and the broader the period they spanned, the healthier personality development is likely to be (Reich, Zautra & Hall, 2010). Therefore, this study aims to investigate the relationship between positive childhood experiences and personality psychopathology level in adulthood, by also considering the history of adverse childhood experiences. In line with the model of resilience (Southwick & Charney, 2012), it is hypothesized that while adverse childhood experiences serve as a risk factor for personality psychopathology in adulthood, positive childhood experiences may counteract the longterm detrimental effects of the adverse childhood experiences, so that positive childhood experiences are associated with healthier personality development and less personality psychopathology in adulthood, despite early adversities.
2.2.3. Adverse childhood experiences The Turkish version of the Adverse Childhood Experiences Scale (Gündüz, Yaşar, Gündoğmuş, Savran & Konuk, 2018), which was originally developed by CDC and Permanente (Felitti et al., 1998) was used to assess childhood adversities (e.g. physical/sexual/emotional abuse, physical/emotional neglect) from birth to age 18. The scale consists of 10 items which can be answered by yes, or no. A higher number of questions answered with “yes” indicates higher levels of childhood adversity. The Turkish version of the scale has demonstrated adequate psychometric properties (Gündüz et al., 2018). 2.2.4. Personality psychopathology The Coolidge Axis II Inventory Plus (CATI+; Coolidge, 2006) was used to assess personality psychopathology. This revised version of the 250-item self-report measure is congruent with the personality disorder criteria of DSM-5. The Turkish adaptation of the inventory was made by Bilge (2014). This inventory consists of a 4-point Likert scale ranging from “strongly true” to “strongly false,” with higher scores indicating a higher level of personality psychopathology in a given domain. The Turkish version of the inventory has been accepted as valid and reliable since findings demonstrated strong psychometric evidence (Bilge, 2017). 2.3. Statistical analyses The SPSS 24 program was used in the statistical analyses of the data. First, the independent samples t-test and the Chi-square test of independence were calculated to see whether there was a statistical significant difference in terms of gender and age between participants who fully completed the study and those who quit the study without completing it, and also between participants of the online survey and the sample of university students. Next, correlations were used to examine the relationship between remembered positive and adverse childhood experiences and other variables. Then, hierarchical linear regressions (HLRs) were used to investigate the influence of remembered positive childhood experiences on adult personality psychopathology in terms of 14 different personality disorder symptom clusters. Adverse and positive childhood experiences were entered consecutively in each set to control the influence of remembered adverse childhood experiences on adult personality psychopathology. Finally, F-square (f 2) was calculated as a measure of the effect size in which 0.02 indicates a small effect, 0.15 a medium effect and 0.35 a large effect (Cohen, 2003).
2. Method 2.1. Participants 341 participants aged 18–62 were recruited for the study; however, only 259 participants completed the study, and 82 participants who didn't complete all the questionnaires were excluded from data analysis. Subjects were composed of 113 students of Hacettepe University and 146 people who voluntarily participated in the study by completing the online survey. All of the 82 participants who quit the study without completing it were in the online survey sample. The mean age of the 341 participants was 24.7 (SD = 7.05). The majority of participants were female (81.5%). 43.7% of participants were high school graduates, 41.3% were university graduates, and 14.1% were master/PhD graduates. As for marital status, 81.8% of participants were single and 16.7% were married. All participants signed a written informed consent form before completing the questionnaires, and institutional review board approvals were obtained for the study.
3. Results An independent samples t-test was performed to compare the mean age of the participants who fully completed the study and of those who quit the study without completing it. The results from the independent samples t-test indicated that there was a significant difference in age between participants who fully completed the study (M = 23.93, SD = 6.93, N = 259) and those who quit (M = 26.93, SD = 7.01, N = 82); t(339) = 3.40, p < 0.01. A chi-square test of independence was calculated comparing the gender differences of participants who fully completed the study and those who quit the study without completing it. No significant interaction was found in terms of gender (x2(1) = 0.365, p > 0.05). An independent samples t-test was also performed comparing the mean age of participants who were recruited for the study through an online survey to that of participants from the university students sample. The results from the independent samples t-test indicated that
2.2. Materials 2.2.1. Demographic information Demographic information, comprised of information on the age, gender, level of education and marital status of participants, was recorded via the demographic form designed for this study. 2.2.2. Positive childhood experiences The Benevolent Childhood Experiences (BCEs) Scale, which was recently developed by Narayan, Rivera, Bernstein, Harris and Lieberman (2018), was used to assess positive childhood experiences in the first 18 years of life. Items pertained to perceived safety and support (e.g., at least one safe caregiver, at least one good friend) and internal and external motivation (e.g., beliefs that gave comfort, enjoyment of 2
Personality and Individual Differences 158 (2020) 109862
Note. *p < 0.05; ** p < 0.001. Personality Traits: AN = Antisocial, AV = Avoidant, BO = Borderline, DE = Dependent, DP = Depressive, HI = Histrionic, NA=Narcissistic, OC ] Obsessive-Compulsive, PA = Paranoid, PG = Passive-Aggressive, SA = Sadistic, SD = Self-Defeating, SZ=Schizoid, ST=Schizotypal. ACE = Adverse Childhood Experiences Questionnaire. CCOYO(BCEs) = Benevolent Childhood Experiences Scale. α= Cronbach's alpha. n = 259.
– – 0.02 – −0.32** −0.02 – 0.32** −0.32** −0.10 – 0.74** 0.22** −0.32** −0.07 – 0.43** 0.69** 0.26** −0.27** −0.15** – 0.43** 0.38** 0.48** 0.21** −0.24** −0.15** – 0.43** 0.68** 0.48** 0.56** 0.19** −0.29** 0.24** – 0.64** 0.42** 0.61** 0.55** 0.69** 0.18** −0.26** −0.06 – 0.67** 0.72** 0.36** 0.71** 0.48** 0.60** 0.22** −0.23** −0.15** – 0.59** 0.58** 0.51** 0.43** 0.42** 0.22** 0.33** 0.16* −0.08 −0.25** – 0.59** 0.30** 0.14* 0.29** 0.21** 0.36** −0.22** −0.03 0.06 −0.03 −0.26** – 0.30** 0.43** 0.75** 0.61** 0.74** 0.39** 0.70** 0.53** 0.59** 0.25** −0.31** −0.16* – 0.70** 0.37** 0.51** 0.71** 0.50** 0.73** 0.32** 0.59** 0.36** 0.43** 0.14* −0.19** −0.27** – 0.37** 0.72** 0.62** −0.07 0.42** 0.66** 0.61** 0.64** 0.25** 0.50** 0.65** 0.61** 0.18** −0.21** −0.20** 1. AN 2. AV 3. BO 4. DE 5. DP 6. HI 7. NA 8.OC 9. PA 10.PG 11. SA 12.SD 13. SZ 14. ST 15. ACE 16. CCOYO (BCEs) 17. Age
74.54(12.24) 41.68(8.30) 47.18(9.63) 58.86(11.03) 14.51(4.66) 75.90(9.64) 64.26(8.93) 64.23(9.71) 39.54(7.36) 49.82(8.09) 25.23(5.89) 42.64(6.55) 19.91(4.21) 36.90(7.41) 1.65(1.83) 8.52(1.57) 23.93(6.93)
0.92 0.92 0.91 0.91 0.91 0.93 0.91 0.91 0.91 0.91 0.92 0.91 0.92 0.91 0.74 0.62 -
– 0.21** 0.61** 0.33** 0.45** 0.41** 0.43** 0.38** 0.44** 0.51** 0.82** 0.53** 0.34** 0.48** 0.22** 0.27** −0.17**
– 0.62** 0.73** 0.65** 0.52** 0.65** 0.54** 0.64** 0.38** 0.73** 0.28** 0.45** 0.27** −0.27** −0.26**
DP DE BO AV AN α Mean(SD)
Table 1 Descriptive Statistics, Cronbach Alphas, zero-order correlations between study variables.
HI
NA
OC
PA
PG
SA
SD
SZ
ST
ACE
BCE
Age
R. Gunay-Oge, et al.
there was no significant difference in the age of participants recruited for the study by online survey (M = 24.64, SD = 7.05, N = 146) and those from the sample comprised of university students (M = 23.02, SD = 6.68, N = 113); t(257) = 1.883, p > 0.05. A chi-square test of independence was also calculated comparing the differences of gender between participants from the online survey and from the university student sample. Again, no significant interaction was found (x2(1) = 1.780, p > 0.05). The results of the personality disorders symptoms of participants showed a wide range of positive and negative relationships with Adverse Childhood Experiences and Benevolent Childhood Experiences. Only Histrionic PD symptoms were not significantly related with ACE and BCE, and the Narcissistic PD symptom was not related with BCE (ps < 0.05). The zero-order correlations and descriptive statistics for all variables are presented in Table 1. While personality disorder symptoms, except Schizotypal PD symptoms, had a small-sized positive relationship with Adverse Childhood Experiences (rs from 0.14 to 0.26, p < 0.05), Schizotypal PD symptoms had a medium-sized positive relationship with Adverse Childhood Experiences (r = 0.32, p < 0.001). Also, all PD symptoms except Histrionic and Narcissistic PD symptoms were negatively related with Benevolent Childhood Experiences (p < 0.001). While there was a small-sized negative relationship with Benevolent Childhood Experiences for Antisocial, Avoidant, Borderline, Dependent, ObsessiveCompulsive, Paranoid, Passive-Aggressive, Sadistic and Self-defeating PD symptoms (rs from −0.19 to −0.29, p < 0.001), the negative relationship of Depressive, Schizoid and Schizotypal PD symptoms with Benevolent Childhood Experiences was medium-sized (rs = −0.31, −0.32 and −0.32, respectively, p < 0.001). Adverse Childhood Experiences and Benevolent Childhood Experiences also had a significant negative correlation (r = −0.32, p < 001). Age had no significant relationship with the symptoms of Paranoid, Schizoid and Schizotypal PD, Adverse Childhood Experiences and Benevolent Childhood Experiences (p > 0.05), while there was a negative association between age and other personality disorders (p < 0.001). A three-stage hierarchical multiple regression was conducted with Personality Disorders as the dependent variable. Gender and age were entered into the equation at the same time. Adverse Childhood Experiences (ACE) was entered at Step 2 of the regression to control for adversities experienced during early childhood. Benevolent Childhood Experiences (BCE) was entered at Step 3 (Table 2). The addition of Benevolent Childhood Experiences at the last step significantly contributed to each model (ps < 0.05) except Histrionic, Narcissistic and Sadistic PD symptoms. For Histrionic PD Symptoms, gender and age were the predictor of the model at Step 1 (p = 0.000). However, Adverse Childhood Experiences were not significantly associated with the level of Histrionic PD symptoms (p = 0.303). Similarly, adding Benevolent Adverse Childhood Experiences to model did not significantly contribute to the level of Histrionic PD symptoms (p = 0.927). For Narcissistic and Sadistic PD symptoms, in Step 1, gender and age were significantly associated with the level of Narcissistic (f 2 = 0.07, p = 0.000) and Sadistic PD symptoms (f 2 = 0.16, p = 0.000). When adding Adverse Childhood Experiences to Step 2, those experiences were also significantly associated with the level of Narcissistic (f 2 = 0.03, p = 0.009) and Sadistic PD symptoms (f 2 = 0.04, p = 0.001). However, adding Benevolent Adverse Childhood Experiences to the models did not significantly contribute to the level of Narcissistic (p = 0.802) and Sadistic PD symptoms (p = 0.087). Apart from Histrionic, Narcissistic and Sadistic PD symptoms, the hierarchical multiple regressions revealed that both Adverse and Benevolent Childhood Experiences were significant predictors of Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, Paranoid, Passive-Aggressive, Self-Defeating and Schizoid PD symptoms (Table 2). Adverse childhood experiences had a small-to-medium-sized effect, ranging from f 2 = 0.02 to f 2 = 0.11, at Step 2 for all personality 3
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Table 2 Hierarchical regressions examining incremental validity of BCE in predicting personality traits. Antisocial R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
0.17
0.04 0.30** −0.20** 0.21**
0.19
0.02 0.27** −0.19** 0.16** −0.15*
β
f
0.03 0.04 −0.16* 0.09
0.06 0.03 −0.16** 0.25**
0.15
0.05 −0.57 −0.15* 0.17** −0.26** β
0.03 0.08 −0.17** 0.10
0.07 0.07 −0.17** 0.26**
0.13
0.03 0.02 −0.16** 0.19** −0.21**
Avoidant R2 ΔR2
2
0.14 0.10 0.04 0.20 0.10 0.04 0.04 0.23 0.10 0.04 0.04 0.02
0.31** −0.19**
Self-Defeating R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
f
0.13
Depressive R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
Β
β
f
0.05
0.03 −0.12* −0.19** 0.19**
0.12
0.03 −0.17** −0.18** 0.12* −0.20**
Obsessive-Compulsive R2 ΔR2 β
2
0.03 0.01 0.03 0.10 0.01 0.03 0.07 0.17 0.01 0.03 0.07 0.06
f
0.02 0.04 −0.15* 0.07
0.05 0.03 −0.15* 0.22**
0.10
0.03 −0.01 −0.14* 0.17** −0.18**
f
0.04 0.01 0.04 0.08 0.01 0.04 0.03 0.10 0.01 0.04 0.03 0.02
−0.11 −0.19** 0.09
2
0.03 0.01 0.02 0.11 0.01 0.02 0.07 0.13 0.01 0.02 0.07 0.04
Schizoid R2
ΔR2
0.02 0.01 0.02 0.08 0.01 0.02 0.05 0.11 0.01 0.02 0.05 0.03
β
0.05 0.01 −0.07 0.22**
0.12
0.07 −0.05 −0.06 0.13* −0.29**
f
0.14
0.07 0.04 −0.26** 0.27**
0.17
0.03 −0.01 −0.25** 0.21** −0.20**
β
f
0.00 0.03 −0.06 0.04
0.03 0.02 −0.06 0.18**
0.08
0.05 −0.04 −0.05 0.11 −0.23**
2
0.01 0.01 0.01 0.06 0.01 0.01 0.05 0.14 0.01 0.01 0.05 0.07
Schizotypal R2 ΔR2
2
0.07 0.01 0.07 0.16 0.01 0.07 0.08 0.21 0.01 0.07 0.08 0.04
0.05 −0.26**
f
0.02 −0.07
β
0.07
Paranoid R2 ΔR2
2
0.01
0.05
Borderline R2 ΔR2
2
2
0.00 0.00 0.01 0.04 0.00 0.01 0.03 0.09 0.00 0.01 0.03 0.05
β
0.03 0.13* −0.11 0.12
0.10 0.11 −0.11 0.31**
0.17
0.04 0.06 −0.10 0.25** −0.22**
Dependent R2 ΔR2
β
0.07 0.00 −0.27** 0.09
0.02 0.01 −0.27** 0.14*
0.12
0.03 −0.05 −0.27** 0.09 −0.16**
Passive-Aggressive R2 ΔR2 β 0.06 0.02 −0.24** 0.10
0.04 0.01 −0.24** 0.20**
0.15
0.05 −0.05 −0.23** 0.12 −0.25**
f
f
2
0.08 0.01 0.07 0.10 0.01 0.07 0.02 0.13 0.01 0.07 0.02 0.02
f
2
0.06 0.01 0.06 0.11 0.01 0.06 0.04 0.18 0.01 0.06 0.04 0.05
2
0.03 0.01 0.03 0.14 0.01 0.03 0.11 0.20 0.01 0.03 0.11 0.04
Note: ACE = Adverse Childhood experiences. BCE = Benevolent Childhood Experiences. R2 = R2 from Step 1 of the regression; ΔR2 change in R2 in Step 2; β = standardized beta coefficients. f 2 = f-square effect size. ⁎ p < 0.05. ⁎⁎ p < 0.01.
Traumatic childhood experiences, such as physical, sexual, or emotional abuse and neglect, have been considered as risk factors that increase the likelihood of developing a personality disorder (Eikenaes, Egeland, Hummelen & Wilberg, 2015; Johnson, Bromley & McGeoch, 2005). However, while exposure to these events increases the likelihood that a personality disorder will develop, this is not to say that all children with such experiences will develop personality psychopathology. This observation suggests that various risk factors must occur to some extent so as to overwhelm a healthy development period and pave the way to later developing a personality disorder. It has also been suggested that various protective factors may exist that limit the negative effects of significant traumatic and adverse experiences. Exposure to more positive experiences is the key factor that appears to provide this protective function (Johnson et al., 2005). Another strength of the study is that although our results cannot be interpreted as a causal relationship, they provide a clear picture of the way in which adverse and benevolent childhood experiences have an effect on personality development. Statistically significant associations were observed between almost all of the different personality disorder symptoms and remembered positive childhood experiences, even with
disorders symptoms except for the symptoms of Histrionic PD. After the addition of Benevolent Childhood Experiences to Step 3, where both ACE and BCE entered the model, the effect size was larger than the model at Step 2. With the addition of BCE to the model, there was a medium-sized and significant effect for Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, PassiveAggressive, Self-Defeating, Schizoid and Schizotypal PD symptoms (f 2 = from 0.09 to 0.23), even after controlling for gender and age by entering them at the same time to the model at Step 1. 4. Discussion This study investigated how positive childhood experiences may counteract the negative effects of childhood adversity with regards to different personality disorders. As expected and in line with the current literature, childhood adversity is a risk factor for most personality disorder symptoms. However, remembered positive childhood experiences presented along with remembered negative childhood experiences demonstrated a significantly negative relationship with most of the personality disorder symptoms. 4
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the presence of childhood adversity. In that sense, these findings are useful for further research which seeks to explore the associations between personality psychopathology levels and early childhood experiences. These findings are also consistent with the already available study results about the correlates of personality disorders with childhood adversity (Afifi et al., 2011; Grover et al., 2007; Lobbestael et al., 2010) and share similarities with the study that emphasizes the role of positive childhood experiences on adult personality psychopathology (Skodol et al., 2007). Unlike the latter, our results also emphasize the important role of positive childhood experiences in changing the course of the development of personality symptomology, even in the presence of adverse childhood experiences. Thus, the findings are useful for mental health professionals, families, policy makers and trainers who search for an opportunity to enhance the healthy personality development of children and to reverse the negative effects of childhood adversity on personality through adding more positive experiences to children's lives. Despite the above-mentioned strengths of the current study, there are some limitations and methodological issues that may affect the interpretation of our results. First of all, since the overwhelming majority (81%) of the participants are female, the generalizability of the research findings is risky with regards to gender. Secondly, although at the beginning a total of 341 participants were recruited for the study, only 259 participants fully completed the study. Since some of the assessment tools used for this study have a large number of items (e.g. the CATI+ consists of 250 items), which requires a great deal of effort, time and patience, the drop-out rate is almost 25%. Such decrease in the sample size of the study can be considered to be one of the most important limitations which may have an impact on confidence interval and variation between sample statistics. Also, the mean age of participants who quit the study was significantly different than that of participants who completed it. This can be considered as a bias since there is a difference between the demographics of the people who completed the study and those that did not. The study was based on a normal population sample. The inventory used for measuring the symptom levels of personality disorders is not based on diagnoses; it merely measures symptom levels of different personality psychopathology. Thus, the results may not be generalized to a clinical population and do not show the relationship between childhood experiences and the diagnosis of personality disorders in adulthood. Thus, future studies may include diagnostic tools such as SCID-II, which allow diagnostic evaluation. Self-report tests that measure childhood experiences retrospectively may lead to either under- or over-reporting of the childhood experiences, and some participants might fail to remember some of their experiences during childhood. Another related limitation is that the reports of childhood experiences and personality disorder symptoms may result in bias because of poor insight and social appeal. Apart from these, our study needs further investigation to discover the underlying reason for why childhood adversity is not found to be related to Histrionic PD symptoms and why positive childhood experiences are not found to be related to Histrionic, Sadistic and Narcissistic PD symptoms, as well as what other factors might contribute to explain those relationships. Additionally, future research needs to focus on wider community populations to get more precise results. Lastly, we obtained total test scores predicting childhood experiences. However, future study can further try to identify how different forms of positive childhood experiences may cancel the effects on personality psychopathology of different forms of adverse childhood experiences. There is some evidence that particular types of childhood adversity are related with particular types of personality disorders, e.g. sexual abuse was found to be associated with borderline personality disorder, and physical abuse was found to be associated with antisocial personality disorder (Cohen et al., 2014; Lobbestael et al., 2010). However, further research is needed to explore the relationship
between particular types of positive childhood experiences and particular dimensions of personality. In conclusion, although the dominant focus in literature has always been on childhood adversities and their effects later in life, researchers who study resilience have simultaneously called for better understanding of individual, family, and community level factors that can counteract the deleterious effects of early adversity (Masten, 2014; Narayan et al., 2018). This study addresses an important gap in the literature by exploring the role of positive childhood experiences on personality development, taking a two-sided view in which both positive and adverse childhood experiences are evaluated. Moreover, the results of the study illuminate the importance of enhancing positive childhood experiences in addition to making an effort to prevent childhood adversities. Thus, the results of the study may guide professionals, researchers and also families to an emphasis of not only protecting children from early adversities, but also providing rich positive experiences for healthy personality development. To sum up, the present study may contribute to the prevention of adult personality psychopathology in both theoretical and practical ways and pave the way for a more comprehensive and wider perspective in this area. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CRediT authorship contribution statement Rumeysa Gunay-Oge: Conceptualization, Data curation, Methodology, Formal analysis, Resources, Writing - original draft. Fatmatuz Zehra Pehlivan: Data curation, Formal analysis, Software, Writing - original draft, Data curation. Sedat Isikli: Writing - review & editing, Supervision, Writing - review & editing. Declaration of Competing Interest None. Acknowledgments This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., Macmillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45(6), 814–822. https://doi.org/10.1016/j.jpsychires.2010.11.008. Bilge, Y. (2014). Coolidge Eksen İki Envanteri Plus'ın Türkçe adaptasyonu ve DSM-5′TE yer alan kişilik bozukluklarının davranışsal aktivasyon sistemleriyle ilişkilerinin incelenmesi (Yayınlanmamış doktora tezi). İstanbul: İstanbul Üniversitesi. Bilge, Y. (2017). Coolidge Eksen Ii Envanteri Plus Ta (Cati) Yer Alan Dsm-III-R, Dsm-IV-Tr Ve Dsm-5 Kişilik Bozukluklari Alt Ölçeklerinin Türkçe Güvenirlik Ve Geçerlik Çalişmasi. Journal of International Social Research, 10(53), 459–474. https://doi.org/10. 17719/jisr.20175334134. Cohen, J. (2003). A power primer. Methodological Issues and Strategies in Clinical Research, 279–284. https://doi.org/10.1037/14805-018. Cohen, L. J., Tanis, T., Bhattacharjee, R., Nesci, C., Halmi, W., & Galynker, I. (2014). Are there differential relationships between different types of childhood maltreatment and different types of adult personality pathology. Psychiatry Research, 215(1), 192–201. https://doi.org/10.1016/j.psychres.2013.10.036. Coolidge, F. L. (2006). The Coolidge Axis II inventory Plus-Revised: Manual. Colorado Springs, CO:Author. Depue, R. A. (2009). Genetic, environmental, and epigenetic factors in the development of personality disturbance. Development and Psychopathology, 21(4), 1031–1063. https://doi.org/10.1017/s0954579409990034. Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015). Correction: Avoidant Personality Disorder versus Social Phobia: The significance of childhood neglect. Plos One, 10(5), https://doi.org/10.1371/journal.pone.0128737. Felitti, V. J., Anda, R. F., Nordenberg, D, Williamson, D. F., Spitz, A. M., Edwards, V. K., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14(4), 245–258. Grover, K. E., Carpenter, L. L., Price, L. H., Gagne, G. G., Mello, A. F., Mello, M. F., & Tyrka, A. R. (2007). The relationship between childhood abuse and adult personality
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Narayan, A. J. (2015). Personal, dyadic, and contextual resilience in parents experiencing homelessness. Clinical Psychology Review, 36, 56–69. https://doi.org/10.1016/j.cpr. 2015.01.005. Narayan, A. J., Rivera, L. M., Bernstein, R. E., Harris, W. W., & Lieberman, A. F. (2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse and Neglect, 78, 19–30. https://doi.org/10.1016/j. chiabu.2017.09.022. Reich, J. W., Zautra, A., & Hall, J. S. (2010). Handbook of adult resilience. New York: Guilford Press. Siever, L. J., Koenigsberg, H. W., & Reynolds, D. (2003). Neurobiology of personality disorders: implications for a neurodevelopmental model. Neurodevelopmental Mechanisms in Psychopathology, 405–427. https://doi.org/10.1017/ cbo9780511546365.019. Skodol, A. E., Bender, D. S., Pagano, M. E., Shea, M. T., Yen, S., Sanislow, C. A., ... Gunderson, J. G. (2007). Positive childhood experiences. The Journal of Clinical Psychiatry, 68(07), 1102–1108. https://doi.org/10.4088/jcp.v68n0719. Southwick, S. M., & Charney, D. S. (2012). The Science of Resilience: Implications for the Prevention and Treatment of Depression. Science, 338(6103), 79–82. https://doi.org/ 10.1126/science.1222942. Zhang, T., Chow, A., Wang, L., Dai, Y., & Xiao, Z. (2012). Role of childhood traumatic experience in personality disorders in China. Comprehensive Psychiatry, 53(6), 829–836. https://doi.org/10.1016/j.comppsych.2011.10.004.
disorder symptoms. Journal of Personality Disorders, 21(4), 442–447. Gündüz, A., Yaşar, A. B., Gündoğmuş, İ., Savran, C., & Konuk, E. (2018). Çocukluk Çağı Olumsuz Yaşantılar Ölçeği Türkçe formunun geçerlilik ve güvenilirlik çalışması. Anatolian Journal of Psychiatry, 19(Special issue.1), 68–75. Horwitz, A. V., Widom, C. S., Mclaughlin, J., & White, H. R. (2001). The impact of childhood abuse and neglect on adult mental health: a prospective study. Journal of Health and Social Behavior, 42(2), 184. https://doi.org/10.2307/3090177. Johnson, J. G., Bromley, E., & McGeoch, P. G. (2005). Role of childhood experiences in the development of maladaptive and adaptive personality traits. In J. M. Oldham, A. E. Skodol, & D. S. Bender (Eds.). The American Psychiatric Publishing textbook of personality disorders (pp. 209–221). Arlington, VA, US: American Psychiatric Publishing, Inc. Karatsoreos, I. N., & Mcewen, B. S. (2011). Psychobiological allostasis: resistance, resilience and vulnerability. Trends in Cognitive Sciences, 15(12), 576–584. https://doi. org/10.1016/j.tics.2011.10.005. Larsen, R. J., & Buss, D. M. (2008). Personality psychology: Domains of knowledge about human nature. New York: McGraw-Hill Education. Lobbestael, J., Arntz, A., & Bernstein, D. P. (2010). Disentangling the relationship between different types of childhood maltreatment and personality disorders. Journal of Personality Disorders, 24(3), 285–295. Masten, A. S. (2014). Ordinary magic: Resilience in development. New York: Guilford. Mullen, P., Martin, J., Anderson, J., Romans, S., & Herbison, G. (1996). The long-term impact of the physical, emotional and sexual abuse of children: A community study. European Psychiatry, 11. https://doi.org/10.1016/0924-9338(96)89276-5.
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Contents lists available at ScienceDirect
Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid
The effect of positive childhood experiences on adult personality psychopathology
T
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Rumeysa Gunay-Oge , Fatmatuz Zehra Pehlivan, Sedat Isikli Hacettepe University Psychology Department, Ankara, Turkey
A R T I C LE I N FO
A B S T R A C T
Keywords: Positive childhood experiences Childhood adversity Childhood experiences Personality disorders Personality development
Most of the current literature on the subject focuses on the relationship between adverse childhood experiences and adult personality psychopathology; however, as far as is known, there is no research investigating the relationship between positive childhood experiences and adult personality disorder symptoms. The present study aims to highlight the association between positive childhood experiences and adult personality psychopathology. To investigate this association, 341 participants were recruited for this study, in which the Adverse Childhood Experiences Scale, the Benevolent Childhood Experiences Scale and the Coolidge Axis II Inventory Plus were used. Stepwise linear regressions supported the position that despite the presence of adverse childhood experiences, there are independent relationships between positive childhood experiences and 11 out of 14 personality disorder symptoms (Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, Paranoid, Passive-Aggressive, Schizoid, Schizotypal and Self-defeating Personality Disorder (PD) symptoms). Results did not support an independent relationship between positive childhood experiences and histrionic, sadistic or narcissistic personality disorder traits. The results of the study illuminate how positive childhood experiences may counteract long-term effects of childhood adversity.
1. Introduction A considerable body of research has focused on the relationship between adverse childhood experiences and the development of personality disorders in adulthood. Since the pathology of personality disorders is found to be associated with genetic and environmental factors and their interactions (Depue, 2009), and early childhood adversities are widely accepted to have long term detrimental effects on adulthood (Horwitz, Widom, Mclaughlin & White, 2001; Mullen, Martin, Anderson, Romans & Herbison, 1996), many studies understandably focus on the relationship between early adversities and the development of adult personality disorders. Indeed, the results of these studies indicate a special relationship between different types of childhood abuse or neglect and personality disorders (Afifi et al., 2011; Cohen et al., 2014; Lobbestael, Arntz & Bernstein, 2010; Zhang, Chow, Wang, Dai & Xiao, 2012). However, there is also some evidence that, for many, adverse childhood experiences have less direct effect on mental health than previously assumed (Horwitz et al., 2001). In the face of adversity, characteristics of individuals, such as cognitive flexibility and optimism, or characteristics of the environment, such as having a supportive family and adequate maternal care, may constitute a buffer effect ⁎
that contributes to resiliency, so that these individuals are better able to control and cope with stress, and become protected from developing mental disorders (Southwick & Charney, 2012). It can be assumed that risk and resilience factors have additive and interactive effects: while genetic, developmental, neurobiological and/ or psychological risk factors cause an increase in allostatic load, having protective factors increases the likelihood of stress resilience (Karatsoreos & McEwen, 2011). Even if the literature in the past has mostly been focused on the risk factors and their effects in adulthood, some recent articles focus on factors that promote resiliency (Skodol et al., 2007; Southwick & Charney, 2012). However, there is as yet no study focusing on positive childhood experiences that can play a role in reducing the risk of personality psychopathology and promoting healthy personality development. At this point, it is important to distinguish between mechanisms of resilience operating through promotive versus protective factors. Whereas promotive factors are evident by direct effects and are associated with favorable outcomes for individuals in both low and highrisk environments, protective factors serve as moderators or buffers that reduce the probability of harm as risk increases (Narayan, 2015). In this article, positive childhood experiences were considered as promotive factors that directly reduce the risk of personality psychopathology and
Corresponding author at: Hacettepe University Beytepe Campus, Faculty of Literature, Psychology Department, 06800 Ankara, Turkey. E-mail address: [email protected] (R. Gunay-Oge).
https://doi.org/10.1016/j.paid.2020.109862 Received 1 November 2019; Received in revised form 15 January 2020; Accepted 22 January 2020 0191-8869/ © 2020 Elsevier Ltd. All rights reserved.
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school, a teacher who cared). The scale consists of 10 items which can be answered by yes, or no. A higher number of questions answered with “yes” indicates higher levels of positive childhood experiences. The scale has demonstrated adequate psychometric properties (Narayan et al., 2018).
enhance healthy personality development, including for those who experienced childhood adversity. Personality is comprised of psychological domain and characteristic behavior patterns. Psychological components include emotional state, cognitive organization, representation of self and others, and schemata for interpersonal interactions, while behavioral strategies modulate the psychological state (Siever, Koenigsberg & Reynolds, 2003). Since biological and environmental factors determine personality development and there is also an interaction between biology and environment, an individual's childhood experiences, such as abuse, may lead to both neurological changes, like hypothalamus and pituitary functioning, and to change in psychological components via directly affecting the selfconcept and schemata for interpersonal interactions (Larsen & Buss, 2008). Although massive trauma, such as abuse or neglect, can alter psychobiologic domains in the direction of severe psychopathology (Siever et al., 2003), positive childhood experiences, such as having safe caregivers and interpersonal support, can shape these domains in the direction of healthy personality development; the larger the number of positive experiences and the broader the period they spanned, the healthier personality development is likely to be (Reich, Zautra & Hall, 2010). Therefore, this study aims to investigate the relationship between positive childhood experiences and personality psychopathology level in adulthood, by also considering the history of adverse childhood experiences. In line with the model of resilience (Southwick & Charney, 2012), it is hypothesized that while adverse childhood experiences serve as a risk factor for personality psychopathology in adulthood, positive childhood experiences may counteract the longterm detrimental effects of the adverse childhood experiences, so that positive childhood experiences are associated with healthier personality development and less personality psychopathology in adulthood, despite early adversities.
2.2.3. Adverse childhood experiences The Turkish version of the Adverse Childhood Experiences Scale (Gündüz, Yaşar, Gündoğmuş, Savran & Konuk, 2018), which was originally developed by CDC and Permanente (Felitti et al., 1998) was used to assess childhood adversities (e.g. physical/sexual/emotional abuse, physical/emotional neglect) from birth to age 18. The scale consists of 10 items which can be answered by yes, or no. A higher number of questions answered with “yes” indicates higher levels of childhood adversity. The Turkish version of the scale has demonstrated adequate psychometric properties (Gündüz et al., 2018). 2.2.4. Personality psychopathology The Coolidge Axis II Inventory Plus (CATI+; Coolidge, 2006) was used to assess personality psychopathology. This revised version of the 250-item self-report measure is congruent with the personality disorder criteria of DSM-5. The Turkish adaptation of the inventory was made by Bilge (2014). This inventory consists of a 4-point Likert scale ranging from “strongly true” to “strongly false,” with higher scores indicating a higher level of personality psychopathology in a given domain. The Turkish version of the inventory has been accepted as valid and reliable since findings demonstrated strong psychometric evidence (Bilge, 2017). 2.3. Statistical analyses The SPSS 24 program was used in the statistical analyses of the data. First, the independent samples t-test and the Chi-square test of independence were calculated to see whether there was a statistical significant difference in terms of gender and age between participants who fully completed the study and those who quit the study without completing it, and also between participants of the online survey and the sample of university students. Next, correlations were used to examine the relationship between remembered positive and adverse childhood experiences and other variables. Then, hierarchical linear regressions (HLRs) were used to investigate the influence of remembered positive childhood experiences on adult personality psychopathology in terms of 14 different personality disorder symptom clusters. Adverse and positive childhood experiences were entered consecutively in each set to control the influence of remembered adverse childhood experiences on adult personality psychopathology. Finally, F-square (f 2) was calculated as a measure of the effect size in which 0.02 indicates a small effect, 0.15 a medium effect and 0.35 a large effect (Cohen, 2003).
2. Method 2.1. Participants 341 participants aged 18–62 were recruited for the study; however, only 259 participants completed the study, and 82 participants who didn't complete all the questionnaires were excluded from data analysis. Subjects were composed of 113 students of Hacettepe University and 146 people who voluntarily participated in the study by completing the online survey. All of the 82 participants who quit the study without completing it were in the online survey sample. The mean age of the 341 participants was 24.7 (SD = 7.05). The majority of participants were female (81.5%). 43.7% of participants were high school graduates, 41.3% were university graduates, and 14.1% were master/PhD graduates. As for marital status, 81.8% of participants were single and 16.7% were married. All participants signed a written informed consent form before completing the questionnaires, and institutional review board approvals were obtained for the study.
3. Results An independent samples t-test was performed to compare the mean age of the participants who fully completed the study and of those who quit the study without completing it. The results from the independent samples t-test indicated that there was a significant difference in age between participants who fully completed the study (M = 23.93, SD = 6.93, N = 259) and those who quit (M = 26.93, SD = 7.01, N = 82); t(339) = 3.40, p < 0.01. A chi-square test of independence was calculated comparing the gender differences of participants who fully completed the study and those who quit the study without completing it. No significant interaction was found in terms of gender (x2(1) = 0.365, p > 0.05). An independent samples t-test was also performed comparing the mean age of participants who were recruited for the study through an online survey to that of participants from the university students sample. The results from the independent samples t-test indicated that
2.2. Materials 2.2.1. Demographic information Demographic information, comprised of information on the age, gender, level of education and marital status of participants, was recorded via the demographic form designed for this study. 2.2.2. Positive childhood experiences The Benevolent Childhood Experiences (BCEs) Scale, which was recently developed by Narayan, Rivera, Bernstein, Harris and Lieberman (2018), was used to assess positive childhood experiences in the first 18 years of life. Items pertained to perceived safety and support (e.g., at least one safe caregiver, at least one good friend) and internal and external motivation (e.g., beliefs that gave comfort, enjoyment of 2
Personality and Individual Differences 158 (2020) 109862
Note. *p < 0.05; ** p < 0.001. Personality Traits: AN = Antisocial, AV = Avoidant, BO = Borderline, DE = Dependent, DP = Depressive, HI = Histrionic, NA=Narcissistic, OC ] Obsessive-Compulsive, PA = Paranoid, PG = Passive-Aggressive, SA = Sadistic, SD = Self-Defeating, SZ=Schizoid, ST=Schizotypal. ACE = Adverse Childhood Experiences Questionnaire. CCOYO(BCEs) = Benevolent Childhood Experiences Scale. α= Cronbach's alpha. n = 259.
– – 0.02 – −0.32** −0.02 – 0.32** −0.32** −0.10 – 0.74** 0.22** −0.32** −0.07 – 0.43** 0.69** 0.26** −0.27** −0.15** – 0.43** 0.38** 0.48** 0.21** −0.24** −0.15** – 0.43** 0.68** 0.48** 0.56** 0.19** −0.29** 0.24** – 0.64** 0.42** 0.61** 0.55** 0.69** 0.18** −0.26** −0.06 – 0.67** 0.72** 0.36** 0.71** 0.48** 0.60** 0.22** −0.23** −0.15** – 0.59** 0.58** 0.51** 0.43** 0.42** 0.22** 0.33** 0.16* −0.08 −0.25** – 0.59** 0.30** 0.14* 0.29** 0.21** 0.36** −0.22** −0.03 0.06 −0.03 −0.26** – 0.30** 0.43** 0.75** 0.61** 0.74** 0.39** 0.70** 0.53** 0.59** 0.25** −0.31** −0.16* – 0.70** 0.37** 0.51** 0.71** 0.50** 0.73** 0.32** 0.59** 0.36** 0.43** 0.14* −0.19** −0.27** – 0.37** 0.72** 0.62** −0.07 0.42** 0.66** 0.61** 0.64** 0.25** 0.50** 0.65** 0.61** 0.18** −0.21** −0.20** 1. AN 2. AV 3. BO 4. DE 5. DP 6. HI 7. NA 8.OC 9. PA 10.PG 11. SA 12.SD 13. SZ 14. ST 15. ACE 16. CCOYO (BCEs) 17. Age
74.54(12.24) 41.68(8.30) 47.18(9.63) 58.86(11.03) 14.51(4.66) 75.90(9.64) 64.26(8.93) 64.23(9.71) 39.54(7.36) 49.82(8.09) 25.23(5.89) 42.64(6.55) 19.91(4.21) 36.90(7.41) 1.65(1.83) 8.52(1.57) 23.93(6.93)
0.92 0.92 0.91 0.91 0.91 0.93 0.91 0.91 0.91 0.91 0.92 0.91 0.92 0.91 0.74 0.62 -
– 0.21** 0.61** 0.33** 0.45** 0.41** 0.43** 0.38** 0.44** 0.51** 0.82** 0.53** 0.34** 0.48** 0.22** 0.27** −0.17**
– 0.62** 0.73** 0.65** 0.52** 0.65** 0.54** 0.64** 0.38** 0.73** 0.28** 0.45** 0.27** −0.27** −0.26**
DP DE BO AV AN α Mean(SD)
Table 1 Descriptive Statistics, Cronbach Alphas, zero-order correlations between study variables.
HI
NA
OC
PA
PG
SA
SD
SZ
ST
ACE
BCE
Age
R. Gunay-Oge, et al.
there was no significant difference in the age of participants recruited for the study by online survey (M = 24.64, SD = 7.05, N = 146) and those from the sample comprised of university students (M = 23.02, SD = 6.68, N = 113); t(257) = 1.883, p > 0.05. A chi-square test of independence was also calculated comparing the differences of gender between participants from the online survey and from the university student sample. Again, no significant interaction was found (x2(1) = 1.780, p > 0.05). The results of the personality disorders symptoms of participants showed a wide range of positive and negative relationships with Adverse Childhood Experiences and Benevolent Childhood Experiences. Only Histrionic PD symptoms were not significantly related with ACE and BCE, and the Narcissistic PD symptom was not related with BCE (ps < 0.05). The zero-order correlations and descriptive statistics for all variables are presented in Table 1. While personality disorder symptoms, except Schizotypal PD symptoms, had a small-sized positive relationship with Adverse Childhood Experiences (rs from 0.14 to 0.26, p < 0.05), Schizotypal PD symptoms had a medium-sized positive relationship with Adverse Childhood Experiences (r = 0.32, p < 0.001). Also, all PD symptoms except Histrionic and Narcissistic PD symptoms were negatively related with Benevolent Childhood Experiences (p < 0.001). While there was a small-sized negative relationship with Benevolent Childhood Experiences for Antisocial, Avoidant, Borderline, Dependent, ObsessiveCompulsive, Paranoid, Passive-Aggressive, Sadistic and Self-defeating PD symptoms (rs from −0.19 to −0.29, p < 0.001), the negative relationship of Depressive, Schizoid and Schizotypal PD symptoms with Benevolent Childhood Experiences was medium-sized (rs = −0.31, −0.32 and −0.32, respectively, p < 0.001). Adverse Childhood Experiences and Benevolent Childhood Experiences also had a significant negative correlation (r = −0.32, p < 001). Age had no significant relationship with the symptoms of Paranoid, Schizoid and Schizotypal PD, Adverse Childhood Experiences and Benevolent Childhood Experiences (p > 0.05), while there was a negative association between age and other personality disorders (p < 0.001). A three-stage hierarchical multiple regression was conducted with Personality Disorders as the dependent variable. Gender and age were entered into the equation at the same time. Adverse Childhood Experiences (ACE) was entered at Step 2 of the regression to control for adversities experienced during early childhood. Benevolent Childhood Experiences (BCE) was entered at Step 3 (Table 2). The addition of Benevolent Childhood Experiences at the last step significantly contributed to each model (ps < 0.05) except Histrionic, Narcissistic and Sadistic PD symptoms. For Histrionic PD Symptoms, gender and age were the predictor of the model at Step 1 (p = 0.000). However, Adverse Childhood Experiences were not significantly associated with the level of Histrionic PD symptoms (p = 0.303). Similarly, adding Benevolent Adverse Childhood Experiences to model did not significantly contribute to the level of Histrionic PD symptoms (p = 0.927). For Narcissistic and Sadistic PD symptoms, in Step 1, gender and age were significantly associated with the level of Narcissistic (f 2 = 0.07, p = 0.000) and Sadistic PD symptoms (f 2 = 0.16, p = 0.000). When adding Adverse Childhood Experiences to Step 2, those experiences were also significantly associated with the level of Narcissistic (f 2 = 0.03, p = 0.009) and Sadistic PD symptoms (f 2 = 0.04, p = 0.001). However, adding Benevolent Adverse Childhood Experiences to the models did not significantly contribute to the level of Narcissistic (p = 0.802) and Sadistic PD symptoms (p = 0.087). Apart from Histrionic, Narcissistic and Sadistic PD symptoms, the hierarchical multiple regressions revealed that both Adverse and Benevolent Childhood Experiences were significant predictors of Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, Paranoid, Passive-Aggressive, Self-Defeating and Schizoid PD symptoms (Table 2). Adverse childhood experiences had a small-to-medium-sized effect, ranging from f 2 = 0.02 to f 2 = 0.11, at Step 2 for all personality 3
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Table 2 Hierarchical regressions examining incremental validity of BCE in predicting personality traits. Antisocial R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
0.17
0.04 0.30** −0.20** 0.21**
0.19
0.02 0.27** −0.19** 0.16** −0.15*
β
f
0.03 0.04 −0.16* 0.09
0.06 0.03 −0.16** 0.25**
0.15
0.05 −0.57 −0.15* 0.17** −0.26** β
0.03 0.08 −0.17** 0.10
0.07 0.07 −0.17** 0.26**
0.13
0.03 0.02 −0.16** 0.19** −0.21**
Avoidant R2 ΔR2
2
0.14 0.10 0.04 0.20 0.10 0.04 0.04 0.23 0.10 0.04 0.04 0.02
0.31** −0.19**
Self-Defeating R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
f
0.13
Depressive R2 ΔR2 Step 1 Gender Age Step 2 Gender Age ACE Step 3 Gender Age ACE BCE
Β
β
f
0.05
0.03 −0.12* −0.19** 0.19**
0.12
0.03 −0.17** −0.18** 0.12* −0.20**
Obsessive-Compulsive R2 ΔR2 β
2
0.03 0.01 0.03 0.10 0.01 0.03 0.07 0.17 0.01 0.03 0.07 0.06
f
0.02 0.04 −0.15* 0.07
0.05 0.03 −0.15* 0.22**
0.10
0.03 −0.01 −0.14* 0.17** −0.18**
f
0.04 0.01 0.04 0.08 0.01 0.04 0.03 0.10 0.01 0.04 0.03 0.02
−0.11 −0.19** 0.09
2
0.03 0.01 0.02 0.11 0.01 0.02 0.07 0.13 0.01 0.02 0.07 0.04
Schizoid R2
ΔR2
0.02 0.01 0.02 0.08 0.01 0.02 0.05 0.11 0.01 0.02 0.05 0.03
β
0.05 0.01 −0.07 0.22**
0.12
0.07 −0.05 −0.06 0.13* −0.29**
f
0.14
0.07 0.04 −0.26** 0.27**
0.17
0.03 −0.01 −0.25** 0.21** −0.20**
β
f
0.00 0.03 −0.06 0.04
0.03 0.02 −0.06 0.18**
0.08
0.05 −0.04 −0.05 0.11 −0.23**
2
0.01 0.01 0.01 0.06 0.01 0.01 0.05 0.14 0.01 0.01 0.05 0.07
Schizotypal R2 ΔR2
2
0.07 0.01 0.07 0.16 0.01 0.07 0.08 0.21 0.01 0.07 0.08 0.04
0.05 −0.26**
f
0.02 −0.07
β
0.07
Paranoid R2 ΔR2
2
0.01
0.05
Borderline R2 ΔR2
2
2
0.00 0.00 0.01 0.04 0.00 0.01 0.03 0.09 0.00 0.01 0.03 0.05
β
0.03 0.13* −0.11 0.12
0.10 0.11 −0.11 0.31**
0.17
0.04 0.06 −0.10 0.25** −0.22**
Dependent R2 ΔR2
β
0.07 0.00 −0.27** 0.09
0.02 0.01 −0.27** 0.14*
0.12
0.03 −0.05 −0.27** 0.09 −0.16**
Passive-Aggressive R2 ΔR2 β 0.06 0.02 −0.24** 0.10
0.04 0.01 −0.24** 0.20**
0.15
0.05 −0.05 −0.23** 0.12 −0.25**
f
f
2
0.08 0.01 0.07 0.10 0.01 0.07 0.02 0.13 0.01 0.07 0.02 0.02
f
2
0.06 0.01 0.06 0.11 0.01 0.06 0.04 0.18 0.01 0.06 0.04 0.05
2
0.03 0.01 0.03 0.14 0.01 0.03 0.11 0.20 0.01 0.03 0.11 0.04
Note: ACE = Adverse Childhood experiences. BCE = Benevolent Childhood Experiences. R2 = R2 from Step 1 of the regression; ΔR2 change in R2 in Step 2; β = standardized beta coefficients. f 2 = f-square effect size. ⁎ p < 0.05. ⁎⁎ p < 0.01.
Traumatic childhood experiences, such as physical, sexual, or emotional abuse and neglect, have been considered as risk factors that increase the likelihood of developing a personality disorder (Eikenaes, Egeland, Hummelen & Wilberg, 2015; Johnson, Bromley & McGeoch, 2005). However, while exposure to these events increases the likelihood that a personality disorder will develop, this is not to say that all children with such experiences will develop personality psychopathology. This observation suggests that various risk factors must occur to some extent so as to overwhelm a healthy development period and pave the way to later developing a personality disorder. It has also been suggested that various protective factors may exist that limit the negative effects of significant traumatic and adverse experiences. Exposure to more positive experiences is the key factor that appears to provide this protective function (Johnson et al., 2005). Another strength of the study is that although our results cannot be interpreted as a causal relationship, they provide a clear picture of the way in which adverse and benevolent childhood experiences have an effect on personality development. Statistically significant associations were observed between almost all of the different personality disorder symptoms and remembered positive childhood experiences, even with
disorders symptoms except for the symptoms of Histrionic PD. After the addition of Benevolent Childhood Experiences to Step 3, where both ACE and BCE entered the model, the effect size was larger than the model at Step 2. With the addition of BCE to the model, there was a medium-sized and significant effect for Antisocial, Avoidant, Borderline, Dependent, Depressive, Obsessive-Compulsive, PassiveAggressive, Self-Defeating, Schizoid and Schizotypal PD symptoms (f 2 = from 0.09 to 0.23), even after controlling for gender and age by entering them at the same time to the model at Step 1. 4. Discussion This study investigated how positive childhood experiences may counteract the negative effects of childhood adversity with regards to different personality disorders. As expected and in line with the current literature, childhood adversity is a risk factor for most personality disorder symptoms. However, remembered positive childhood experiences presented along with remembered negative childhood experiences demonstrated a significantly negative relationship with most of the personality disorder symptoms. 4
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the presence of childhood adversity. In that sense, these findings are useful for further research which seeks to explore the associations between personality psychopathology levels and early childhood experiences. These findings are also consistent with the already available study results about the correlates of personality disorders with childhood adversity (Afifi et al., 2011; Grover et al., 2007; Lobbestael et al., 2010) and share similarities with the study that emphasizes the role of positive childhood experiences on adult personality psychopathology (Skodol et al., 2007). Unlike the latter, our results also emphasize the important role of positive childhood experiences in changing the course of the development of personality symptomology, even in the presence of adverse childhood experiences. Thus, the findings are useful for mental health professionals, families, policy makers and trainers who search for an opportunity to enhance the healthy personality development of children and to reverse the negative effects of childhood adversity on personality through adding more positive experiences to children's lives. Despite the above-mentioned strengths of the current study, there are some limitations and methodological issues that may affect the interpretation of our results. First of all, since the overwhelming majority (81%) of the participants are female, the generalizability of the research findings is risky with regards to gender. Secondly, although at the beginning a total of 341 participants were recruited for the study, only 259 participants fully completed the study. Since some of the assessment tools used for this study have a large number of items (e.g. the CATI+ consists of 250 items), which requires a great deal of effort, time and patience, the drop-out rate is almost 25%. Such decrease in the sample size of the study can be considered to be one of the most important limitations which may have an impact on confidence interval and variation between sample statistics. Also, the mean age of participants who quit the study was significantly different than that of participants who completed it. This can be considered as a bias since there is a difference between the demographics of the people who completed the study and those that did not. The study was based on a normal population sample. The inventory used for measuring the symptom levels of personality disorders is not based on diagnoses; it merely measures symptom levels of different personality psychopathology. Thus, the results may not be generalized to a clinical population and do not show the relationship between childhood experiences and the diagnosis of personality disorders in adulthood. Thus, future studies may include diagnostic tools such as SCID-II, which allow diagnostic evaluation. Self-report tests that measure childhood experiences retrospectively may lead to either under- or over-reporting of the childhood experiences, and some participants might fail to remember some of their experiences during childhood. Another related limitation is that the reports of childhood experiences and personality disorder symptoms may result in bias because of poor insight and social appeal. Apart from these, our study needs further investigation to discover the underlying reason for why childhood adversity is not found to be related to Histrionic PD symptoms and why positive childhood experiences are not found to be related to Histrionic, Sadistic and Narcissistic PD symptoms, as well as what other factors might contribute to explain those relationships. Additionally, future research needs to focus on wider community populations to get more precise results. Lastly, we obtained total test scores predicting childhood experiences. However, future study can further try to identify how different forms of positive childhood experiences may cancel the effects on personality psychopathology of different forms of adverse childhood experiences. There is some evidence that particular types of childhood adversity are related with particular types of personality disorders, e.g. sexual abuse was found to be associated with borderline personality disorder, and physical abuse was found to be associated with antisocial personality disorder (Cohen et al., 2014; Lobbestael et al., 2010). However, further research is needed to explore the relationship
between particular types of positive childhood experiences and particular dimensions of personality. In conclusion, although the dominant focus in literature has always been on childhood adversities and their effects later in life, researchers who study resilience have simultaneously called for better understanding of individual, family, and community level factors that can counteract the deleterious effects of early adversity (Masten, 2014; Narayan et al., 2018). This study addresses an important gap in the literature by exploring the role of positive childhood experiences on personality development, taking a two-sided view in which both positive and adverse childhood experiences are evaluated. Moreover, the results of the study illuminate the importance of enhancing positive childhood experiences in addition to making an effort to prevent childhood adversities. Thus, the results of the study may guide professionals, researchers and also families to an emphasis of not only protecting children from early adversities, but also providing rich positive experiences for healthy personality development. To sum up, the present study may contribute to the prevention of adult personality psychopathology in both theoretical and practical ways and pave the way for a more comprehensive and wider perspective in this area. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. CRediT authorship contribution statement Rumeysa Gunay-Oge: Conceptualization, Data curation, Methodology, Formal analysis, Resources, Writing - original draft. Fatmatuz Zehra Pehlivan: Data curation, Formal analysis, Software, Writing - original draft, Data curation. Sedat Isikli: Writing - review & editing, Supervision, Writing - review & editing. Declaration of Competing Interest None. Acknowledgments This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Afifi, T. O., Mather, A., Boman, J., Fleisher, W., Enns, M. W., Macmillan, H., & Sareen, J. (2011). Childhood adversity and personality disorders: Results from a nationally representative population-based study. Journal of Psychiatric Research, 45(6), 814–822. https://doi.org/10.1016/j.jpsychires.2010.11.008. Bilge, Y. (2014). Coolidge Eksen İki Envanteri Plus'ın Türkçe adaptasyonu ve DSM-5′TE yer alan kişilik bozukluklarının davranışsal aktivasyon sistemleriyle ilişkilerinin incelenmesi (Yayınlanmamış doktora tezi). İstanbul: İstanbul Üniversitesi. Bilge, Y. (2017). Coolidge Eksen Ii Envanteri Plus Ta (Cati) Yer Alan Dsm-III-R, Dsm-IV-Tr Ve Dsm-5 Kişilik Bozukluklari Alt Ölçeklerinin Türkçe Güvenirlik Ve Geçerlik Çalişmasi. Journal of International Social Research, 10(53), 459–474. https://doi.org/10. 17719/jisr.20175334134. Cohen, J. (2003). A power primer. Methodological Issues and Strategies in Clinical Research, 279–284. https://doi.org/10.1037/14805-018. Cohen, L. J., Tanis, T., Bhattacharjee, R., Nesci, C., Halmi, W., & Galynker, I. (2014). Are there differential relationships between different types of childhood maltreatment and different types of adult personality pathology. Psychiatry Research, 215(1), 192–201. https://doi.org/10.1016/j.psychres.2013.10.036. Coolidge, F. L. (2006). The Coolidge Axis II inventory Plus-Revised: Manual. Colorado Springs, CO:Author. Depue, R. A. (2009). Genetic, environmental, and epigenetic factors in the development of personality disturbance. Development and Psychopathology, 21(4), 1031–1063. https://doi.org/10.1017/s0954579409990034. Eikenaes, I., Egeland, J., Hummelen, B., & Wilberg, T. (2015). Correction: Avoidant Personality Disorder versus Social Phobia: The significance of childhood neglect. Plos One, 10(5), https://doi.org/10.1371/journal.pone.0128737. Felitti, V. J., Anda, R. F., Nordenberg, D, Williamson, D. F., Spitz, A. M., Edwards, V. K., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine, 14(4), 245–258. Grover, K. E., Carpenter, L. L., Price, L. H., Gagne, G. G., Mello, A. F., Mello, M. F., & Tyrka, A. R. (2007). The relationship between childhood abuse and adult personality
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