Table 3.
Potential significant environmental risk/protective factors of personality disorders.
| References | Risk factor | Total number of cases/total population | Number of primary studies | Effect size metric | Random effects summary effect size (95% CI) | P random | 95% PI (including null value) | I2 % | Small-study effects/excess statistical significance | eOR | Level of evidence | Level of evidence 2 (–n) > 1,000 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Antisocial personality disorder | ||||||||||||
| Nottell (39) | Genetic risk/mental disorders | 154/7,607 | 10 | OR | 4.10 (2.28, 2.76) | 2.3 × 10−6 | Yes | 89.5 | Yes/yes | 4.10 | IV | III |
| Nottell (39) | Disorders/pathology during childhood | 114/662 | 5 | OR | 12.82 (4.68, 35.11) | 6.9 × 10−7 | Yes | 55.4 | No/no | 12.82 | IV | II |
| Nottell (39) | Interpersonal factor | 965/4,280 | 17 | OR | 1.66 (1.16, 2.37) | 0.006 | Yes | 76.4 | No/NP | 1.66 | IV | IV |
| Nottell (39) | Rejecting | 109/470 | 2 | OR | 2.11 (1.36, 3.27) | 0.001 | NA | 0.00 | NA/yes | 2.11 | IV | IV |
| Nottell (39) | Parent disorder/pathology | 537/2,086 | 9 | OR | 2.08 (1.26, 3.44) | 0.004 | Yes | 73.4 | No/no | 2.08 | IV | IV |
| Nottell (39) | Behavioral factor | 177/851 | 4 | OR | 9.16 (5.96, 14.07) | 1.0 × 10−4 | No | 0.0 | No/no | 9.16 | IV | III |
| Borderline personality disorder | ||||||||||||
| Porter et al. (36) | Any childhood adversity | 16,098/182,816 | 97 | OR | 14.32 (10.80, 18.98) | 1.59 × 10−76 | No | 96.7 | Yes/yes | 14.32 | II | II |
| Porter et al. (36) | Childhood physical abuse | 2,869/37,732 | 30 | OR | 9.30 (6.57, 13.17) | 2.7 × 10−36 | No | 76.4 | Yes/yes | 9.30 | II | II |
| Porter et al. (36) | Childhood sexual abuse | 3,748/37,756 | 31 | OR | 7.95 (6.21, 10.17) | 4.54 × 10−61 | No | 67.5 | Yes/yes | 7.95 | II | II |
| Porter et al. (36) | Childhood emotional abuse | 3,525/37,287 | 27 | OR | 28.15 (14.76, 53.68) | 3.8 × 10−24 | Yes | 94.1 | Yes/yes | 28.15 | II | II |
| Porter et al. (36) | Childhood emotional neglect | 3,225/36,587 | 21 | OR | 22.86 (11.55, 45.22) | 2.4 × 10−19 | Yes | 94.9 | Yes/yes | 22.86 | II | II |
| Porter et al. (36) | Childhood physical neglect | 3,072/36,449 | 20 | OR | 5.73 (3.21, 10.21) | 3.4 × 10−9 | Yes | 93.4 | No/yes | 5.73 | II | II |
| Winsper et al. (38) | Sexual abuse | 231/660 | 9 | d | 0.70 (0.53, 0.87) | 1.1 × 10−15 | No | 0.0 | Yes/yes | 3.20 | IV | IV |
| Winsper et al. (38) | Physical abuse | 290/2,522 | 5 | d | 0.56 (0.33, 0.79) | 2.2 × 10−6 | No | 0.0 | No/yes | 2.76 | IV | IV |
| Winsper et al. (38) | Hostility/verbal abuse | 110/8,442 | 5 | d | 0.62 (0.46, 0.78) | 8.9 × 10−15 | No | 11.7 | No/NP | 3.07 | IV | I |
| Winsper et al. (38) | Neglect | 109/268 | 4 | d | 0.58 (0.03, 1.13) | 0.040 | Yes | 85.0 | Yes/yes | 2.86 | IV | IV |
| Fossati et al. (35) | Sexual abuse, overall | 705/2,260 | 19 | OR | 4.43 (3.43, 5.73) | 1.0 × 10−5 | No | 0.0 | Yes/NP | 4.43 | IV | III |
| Fossati et al. (35) | Sexual abuse, age 0–5 years | 98/191 | 3 | OR | 3.22 (1.23, 8.46) | 0.017 | Yes | 0.0 | No/NP | 3.22 | IV | IV |
| Fossati et al. (35) | Sexual abuse, by father | 252/454 | 6 | OR | 2.26 (1.00, 5.09) | 0.050 | Yes | 16.4 | Yes/NP | 2.26 | IV | IV |
| Fossati et al. (35) | Sexual abuse, by siblings | 252/454 | 6 | OR | 3.04 (1.15, 8.02) | 0.024 | Yes | 16.0 | No/no | 3.04 | IV | IV |
| Fossati et al. (35) | Sexual abuse, by other relatives | 252/454 | 6 | OR | 3.01 (1.28, 7.04) | 0.011 | Yes | 11.6 | No/no | 3.01 | IV | IV |
| Fossati et al. (35) | Sexual abuse, by non-relatives | 252/454 | 6 | OR | 3.16 (1.93, 5.18) | 1.0 × 10−5 | No | 0.0 | No/NP | 3.16 | IV | III |
| Fossati et al. (35) | Sexual abuse, by any relative | 62/91 | 2 | OR | 12.65 (2.77, 20.28) | 0.001 | NA | 0.00 | NA/no | 12.65 | IV | IV |
| Fossati et al. (35) | Sexual abuse, penetration | 84/132 | 2 | OR | 5.57 (1.56, 19.80) | 0.008 | NA | 0.0 | NA/NP | 5.57 | IV | IV |
| Porter et al. (36) | Any childhood adversity (clinical population) | 13,498/42,490 | 140 | OR | 2.64 | 0.008 | Yes | 85.1 | Yes/yes | 2.64 | IV | IV |
| Porter et al. (36) | Any childhood adversity (clinical population) | 5,054/11,785 | 45 | OR | 4.26 | 0.001 | Yes | 82.9 | Yes/NP | 4.26 | IV | IV |
| Porter et al. (36) | Physical abuse (other personality disorders) | 2,420/13,138 | 32 | OR | 2.51 | 0.008 | No | 55.1 | No/NP | 2.51 | IV | IV |
| Porter et al. (36) | Physical abuse (psychosis) | 780/2,078 | 16 | OR | 2.68 | 2.19 × 10−9 | No | 38.0 | No/no | 2.68 | IV | IV |
| Dependent personality disorder | ||||||||||||
| Kane and Bornstein (37) | Any childhood maltreatment | NA/178,670 | 22 | d | 0.30 (0.21, 0.38) | 1.0 × 10−11 | No | 56.0 | No | 1.71 | IV | II |
| Kane and Bornstein (37) | Any childhood abuse (including psychiatric disorders) | NA/4,542 | 12 | d | 0.42 (0.28, 0.56) | 3.6 × 10−9 | No | 57.1 | Yes | 2.14 | IV | II |
| Kane and Bornstein (37) | Any childhood abuse (community only) | 3,800/152,249 | 10 | d | 0.18 (0.01, 0.35) | 0.040 | Yes | 46.7 | No | 1.38 | IV | IV |
| Kane and Bornstein (37) | Physical abuse | 6,309/36,023 | 5 | d | 0.29 (0.03, 0.56) | 0.031 | Yes | 65.5 | No | 1.69 | IV | IV |
| Kane and Bornstein (37) | Sexual abuse | 3,854/35,623 | 7 | d | 0.42 (0.56, 0.68) | 0.002 | Yes | 72.2 | No | 2.14 | IV | IV |
| Kane and Bornstein (37) | Neglect | 3,457/35,948 | 4 | d | 0.32 (0.09, 0.56) | 0.007 | Yes | 56.8 | No | 1.78 | IV | IV |
| Kane and Bornstein (37) | Any sexual/physical childhood abuse | 111/1,066 | 4 | d | 0.43 (0.20, 0.20) | 1.6 × 10−4 | Yes | 0.0 | Yes | 2.18 | IV | III |
d, Cohen's d; OR, odds ratio; PI, prediction interval; I2, heterogeneity; eOR, equivalent OR; NA, not applicable; NP, not permitted.
Level of evidence I, convincing evidence; II, highly suggestive evidence; III, suggestive evidence; IV, weak evidence.