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The Children in the Community (CIC) Study is an ongoing investigation of the course of psychiatric disorders including personality disorders (PDs) in an epidemiological sample of about 800 youths. In addition to tracking developmental trajectories over 20 years from adolescence into adulthood, the CIC Study has used prospective data to investigate early risks for Axis II disorders and symptoms (including both environmental factors and early characteristics), implications of comorbidity with Axis I disorders, and associated negative prognostic risk of adolescent PDs into adulthood. The substantial independent impact of PD on subsequent Axis I disorders, suicide attempts, violent and criminal behavior, interpersonal conflict, and other problematic adult outcomes confirms the importance of attention to these problems when they manifest in early adolescence. The implications of study findings for potential changes in the DSM are discussed.
The CIC Study began as a follow-up to a 1975 study of a large random sample of children (ages 1-10 years) living in households in 100 residential areas sampled in 2 upstate New York counties. The original study was designed to assess the level of need for children's services and validate social indicators of that need (Kogan, Smith, & Jenkins, 1977). Data came from maternal interviews and covered a wide range of developmental, temperament, health, and environmental variables. When first followed-up in 1983, study goals shifted to focus on predictors of Axis I psychiatric disorders in early adolescence (mean age =14) (see Cohen & Cohen, 1996 for a full description of sampling method, retention, and characteristics). Axis I disorders were assessed in interviews with children and mothers using the Diagnostic Interview Schedule for Children (DISC-1 ; Costello, Edelbrock, Dulcan, Kalas, & Klaric, 1984). The protocol also covered theoretically and empirically plausible risks for disorders assessed with multiple measures of family, peer, neighborhood, and school environment. Health, personality, attitudes, values, and behaviors were reported by both parent and child.
From this first assessment Cohen was interested in exploring the development of PDs in children and adolescents. However, despite DSM-III recognition of likely early life origins of PDs, there were no existing age-appropriate PD measures for adolescents.
PD MEASUREMENT
To avoid lengthening the interview with unnecessary repetition, we used plausible symptom indicators already available in the protocol. Most of these child- and...