Emerging severe personality disorder in childhood

Personality disorder does not suddenly emerge at age eighteen years old. There are obvious links between early childhood temperament and the development of personality traits in later childhood. Nevertheless, clinicians do not routinely assess aspects of a child’s personality as part of a mental health examination. This may stem from a fear of ‘labelling’ a child should any problems in personality development be noted, particularly those likely to progress to a personality disorder in adult life. At present, there is little research evidence informing the development of the most commonly presenting adult personality disorders such as borderline and narcissistic personality disorders. There is also a dearth of information about normative personality development in childhood. In contrast, research evidence and clinical experience show that there are behavioural and neuro-cognitive markers for emerging antisocial personality disorder in early childhood. Brain imaging studies have suggested that early childhood trauma may adversely affect the development and functioning of the child’s brain. Research has also shown a genetic component in children with psychopathic (callous-unemotional) CU traits. Because adult individuals with psychopathic traits are over-represented in populations of the most dangerous incarcerated offenders, early identification of children with psychopathic traits is clearly important.