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Principal Investigator: Dara E Babinski
Organization: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
Fiscal Year: 2024
Award: $849,548
Funding agency: National Institute of Mental Health
Project Summary
Personality disorders are complex and debilitating disorders associated with profound risk for suicide and
substantial cost related to long-term intensive care, emergency room visits, and psychiatric hospitalizations.
Although traditionally diagnosed only in adults, emerging risk for personality pathology can be reliably assessed
in early adolescence. The level of personality functioning (LPF) is a dimensional measure of personality
pathology that predicts the development of personality disorders across the lifespan and contributes to long-term
dysfunction beyond the effects of other clinical concerns, such as anxiety, depression, attention-
deficit/hyperactivity disorder, and conduct problems. LPF refers to the degree of disturbance in self (i.e., identity)
and other (i.e., interpersonal) functioning, and as a dimensional measure, is sensitive to the individual differences
in emerging identity and interpersonal development in early adolescence. Yet very little research has examined
neurophysiological mechanisms of LPF in youth, missing critical early opportunities to target youth at risk for
some of the most stigmatized and costly conditions. Deficits in the NIMH RDoC constructs of Attachment and
Affiliation and Understanding of Self may underlie impaired LPF. At the self-report level, impaired LPF is
associated with difficulty modulating responses to social acceptance cues and accurately encoding self-relevant
information. However, examining these processes at the neural level, which is not confounded by lack of insight
or other demand characteristics, may more clearly elucidate processes underlying impaired LPF. Individual
differences in processing social acceptance cues and self-referential information can be reliably detected at the
neural level using event-related potentials (ERPs), but have not been applied to understanding personality
disorders in youth. For this work, a sample of 240 early adolescent youth (ages 10-13, 50% female) will be
recruited, the majority (n=180) from two clinically diverse outpatient psychiatry clinics, while the remaining (n=80)
youth will be comparison youth without a history of psychopathology. Neurophysiological assessments of social
acceptance processing and self-referential processing will be administered, and will be tested as predictors of
growth in LPF impairment measured over two years. LPF will be assessed using behavioral observations of
parent and peer interactions and through daily ecological momentary assessment (EMA) collected over two
years. Additionally, the effect of LPF on clinical indicators, including functional impairment, suicidality, and
treatment use, will be tested, considering other key clinical concerns, including maladaptive traits, co-occurring
mental health disorders, substance use, and sociodemographic and developmental factors. Results from this
work will provide evidence to elucidate treatment targets to mitigate the long-term personal and societal burden
associated with personality disorders.
Terms: <21+ years old><AD/HD><ADHD><Adolescent><Adolescent Youth><Adopted><Adult><Adult Human><Age><Anxiety><Attention><Attention deficit hyperactivity disorder><Caring><Characteristics><Childhood><Clinic><Clinical><Complex><Cues><Development><Diagnosis><Dimensions><Disease><Disorder><Dysfunction><ED visit><EEG><ER visit><Ecological momentary assessment><Electroencephalogram><Electroencephalography><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Event-Related Potentials><Female><Functional disorder><Functional impairment><Generalized Growth><Growth><History><Impairment><Individual Differences><Inequity><Intensive Care><International><Intervention><Intervention Strategies><Level of Evidence><Long-term prospective studies><Longterm prospective studies><Measures><Mental Depression><Mental Health><Mental Hygiene><Mental disorders><Mental health disorders><Methods><Modeling><NIMH><National Institute of Mental Health><Out-patients><Outcome><Outpatients><Parents><Pathology><Patient Self-Report><Personal awareness><Personality><Personality Development><Personality Disorders><Physiopathology><Predominantly Hyperactive-Impulsive Type Attention-Deficit Disorder><Predominantly Hyperactive-Impulsive Type Hyperactivity Disorder><Process><Psychiatric Disease><Psychiatric Disorder><Psychiatry><Psychological Health><Psychopathology><RDoC><Recording of previous events><Research><Research Domain Criteria><Resistance><Rewards><Risk><Sampling><Self Perception><Self image><Self view><Self-Report><Social Processes><Stigmatization><Suicide><Testing><Tissue Growth><Transact><Vulnerable Populations><Work><Youth><Youth 10-21><abnormal psychology><adulthood><ages><behavior observation><behavioral observation><clinical care><clinical significance><clinically significant><conduct problem><cost><critical developmental period><depression><developmental><disease classification><disorder classification><early adolescence><effective intervention><event related potential><fatal attempt><fatal suicide><flexibility><flexible><histories><improved><inpatient psychiatric care><inpatient psychiatric treatment><insight><intent to die><intervention refinement><interventional strategy><juvenile><juvenile human><life span><lifespan><longitudinal, prospective study><mental illness><neural><neural mechanism><neuromechanism><neurophysiological><neurophysiology><nosology><ontogeny><parent><pathophysiology><pediatric><peer><psychiatric hospitalization><psychiatric illness><psychological disorder><recruit><resistant><response><self awareness><self knowledge><social><social defects><social deficits><social disorders><social dysfunction><social stigma><socio-demographics><sociodemographics><stigma><substance use><substance using><suicidal><suicidal risk><suicidality><suicide risk><suicides><trait><vulnerable group><vulnerable individual><vulnerable people>