One in twelve people have personality difficulties severe enough to disrupt relationships, work, and daily life, yet researchers still do not know whether the neighbourhoods they grow up in help cause those problems. This project tackles that blind spot. While childhood trauma is a known individual risk factor for personality disorder, wider environmental influences—deprivation, housing quality, crime, air pollution—have been largely ignored, even though they are known to contribute to depression and psychosis. The researcher will combine a systematic review of existing studies with two large datasets: anonymised mental health records from a London NHS trust, and a long-running birth cohort from Southwest England that tracks people from childhood into adulthood. This will reveal which neighbourhood conditions are linked to later personality difficulties and diagnoses. If the research identifies specific neighbourhood factors that increase risk, it could shift prevention strategies away from purely individual treatment toward population-level changes—improving housing, reducing pollution, or targeting mental health services to the most affected areas. That approach has already shown promise for other conditions and could reduce both stigma and long-term healthcare costs.
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Context A personality disorder is a type of mental health condition where a person's way of thinking, feeling, and behaving differs significantly from what is normal in their culture. These differences can lead to severe difficulties in relationships, work, and daily life. About 1-in-12 people in the general population have difficulties associated with personality disorder. The condition is linked to high levels of distress, reduced quality of life, substantially reduced life expectancy, and high costs to health services. The challenge the project addresses Currently, the causes of personality difficulties and personality disorders are poorly understood. Many people with the condition have experienced trauma in childhood, and treatment and research has mainly focussed on supporting people at an individual level. However, it is likely that there are wider environmental factors that influence whether people develop personality difficulties. These include the type of neighbourhood that people grow up and live in. We already know that this plays a key role in the development of other mental health conditions, such as psychosis and depression. Factors that may be important include deprivation, housing quality, population density (how many people live in an area), local crime levels, and air pollution. It is possible that these also contribute to the development of personality disorders, but we do not know this. Aims and Objectives The overall aim of my fellowship is to look at the role that neighbourhood factors may play in the development of personality disorders, and also less severe, but important personality difficulties. The project will include three studies. Study 1) I will search medical databases to find all published studies that have previously looked at neighbourhood factors linked to personality disorder. I will bring all of this information together to help me to decide how to carry out the next two studies. Study 2) I will look at the anonymous health record data of people who have received mental health treatment in a large London mental health trust. I will look at the numbers of people diagnosed with personality disorder from areas with different levels of deprivation and other neighbourhood factors. This will help me to understand which neighbourhood factors are associated with the diagnosis. Study 3) I will use information from an existing study of people born in Southwest England, who have been followed-up since birth at several different points throughout their lives. I will see if the neighbourhood where people grow up is linked to personality difficulties in adulthood, and which factors in the environment could be contributing. Potential applications and benefits This project will fill a gap in our understanding of the causes of personality difficulties and disorders. People diagnosed with personality disorder are often heavily stigmatised. Improving our understanding of how social factors contribute, could reduce the stigma associated with the condition. By helping us to understand more about neighbourhood factors, this project will also inform future health policy on personality disorder. This could include strategies to prevent personality difficulties from developing in the first place. In other mental health conditions this includes improving housing, parenting programmes, or improving the quality of the neighbourhoods that people grow up in. It could also help us target services to the areas they are needed most. This type of ‘population-level’ approach could reduce inequality and ultimately could be more cost-effective than current care.
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