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Brown S, Tezanos KM, Nugent NR. Childhood Maltreatment, Executive Function, and Suicide Attempts in Adolescents. CHILD MALTREATMENT 2024; 29:672-683. [PMID: 37279026 DOI: 10.1177/10775595231182047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Evidence suggests that child maltreatment is a risk factor for adolescent suicidal behavior. However, the differential influence of distinct forms of child maltreatment on adolescent suicide attempts is understudied and the factors that might exacerbate or ameliorate these associations warrant attention. We examined the associations between two distinct forms of child maltreatment (threat and deprivation) and suicide attempt history, and investigated whether executive function domains moderated these associations. Participants were 119 adolescents (M = 15.24, SD = 1.46, 72.3% female) recruited from an inpatient psychiatric hospital during hospitalization for suicidal thoughts and behaviors. Results indicated that the executive function domains of initiation, shifting, and planning/organization moderated the associations between threat and suicide attempt history. Associations between threat and suicide attempt history were significant only when initiation and shifting T-scores were lower (OR = 1.22, p = .03 and OR = 1.32, p = .01, respectively). The association between threat and suicide attempt history trended toward significance when planning/organization T-scores were lower (OR = 1.15, p = .10). None of the executive function domains moderated the link between deprivation and suicide attempt history. Findings highlight the need for research investigating whether initiation, shifting, and planning/organization might be amendable to intervention in the context of threat-related child maltreatment.
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Affiliation(s)
- Shaquanna Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Katherine M Tezanos
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Tironi M, Charpentier Mora S, Liotti M, Fiorini Bincoletto A, Tanzilli A, Cavanna D, Lingiardi V, Speranza AM, Giovanardi G, Bizzi F. Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning. J Clin Psychol 2024. [PMID: 39101491 DOI: 10.1002/jclp.23733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
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Affiliation(s)
- Marta Tironi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | | | - Marianna Liotti
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Annalisa Tanzilli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
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Quayle E, Schwannauer M, Varese F, Allsopp K, Cartwright K, Chan C, Chitsabesan P, Green V, Hewins W, Larkin A, Newton A, Niebauer E, Radford G, Richards C, Sandys M, Shafi S, Ward J, Whelan P, Bucci S. Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse. CHILD ABUSE & NEGLECT 2024; 154:106883. [PMID: 38870708 DOI: 10.1016/j.chiabu.2024.106883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial. OBJECTIVE To explore the barriers and enablers to the future integration of i-Minds into clinical practice. PARTICIPANTS AND SETTING Twelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh). METHODS Semi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs. RESULTS Practitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support. CONCLUSIONS Practitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.
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Affiliation(s)
- Ethel Quayle
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom; NHS Lothian, Edinburgh, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester Academic Health Science, University of Manchester, Manchester, United Kingdom.; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kate Allsopp
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Cindy Chan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Amanda Larkin
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Alice Newton
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Marina Sandys
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Pauline Whelan
- Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Manchester Academic Health Science, University of Manchester, Manchester, United Kingdom.; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
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van Ee E, de Beijer D, Florisson D, Geuskens F. Making sense of change after Intensive Trauma Treatment: a mixed-methods study into adolescents' experience of efficacy. Child Adolesc Psychiatry Ment Health 2024; 18:92. [PMID: 39060919 PMCID: PMC11282781 DOI: 10.1186/s13034-024-00781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND While evidence-based interventions are effective for children with post-traumatic stress disorder (PTSD), some adolescents may not respond sufficiently. Intensive trauma treatment (ITT) has shown promise for adults, but research on its efficacy for adolescents is limited. This study therefore aimed to explore the efficacy and subjective experience of change in adolescents participating in ITT. METHODS The present study employed a mixed-methods approach among a sample of adolescents with PTSD (N = 22; 90.1% female, age M = 17.0, SD = 1.72) who participated in an ITT program. Clinical data and narratives were combined to assess treatment efficacy and subjective experiences of change. RESULTS Quantitative analysis revealed a significant reduction in PTSD symptoms post-ITT, aligning with prior research. Qualitative analysis highlighted themes such as negative thoughts impacting treatment success, the importance of social support, and identity-related struggles. CONCLUSIONS The study contributes to understanding ITT efficacy and emphasizes the need for developmental sensitivity, systemic interventions, and continued research to enhance PTSD treatment for adolescents.
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Affiliation(s)
- Elisa van Ee
- Psychotraumacentrum Zuid-Nederland, Bethaniëstraat 10, Den Bosch, The Netherlands.
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, The Netherlands.
| | - Dani de Beijer
- Psychotraumacentrum Zuid-Nederland, Bethaniëstraat 10, Den Bosch, The Netherlands
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, The Netherlands
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Wais M, Bégin M, Sharp C, Ensink K. Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing. Front Psychol 2024; 15:1364001. [PMID: 39021654 PMCID: PMC11252049 DOI: 10.3389/fpsyg.2024.1364001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor. Method Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ). Results 27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor. Discussion CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.
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Affiliation(s)
- Marissa Wais
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
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Gielkens EMJ, Sobczak S, Gerrits N, Rosowsky E, Stas L, Rossi G, van Alphen SPJ. Feasibility of EMDR toward Personality Functioning in Older Adults with PTSD. Clin Gerontol 2024:1-12. [PMID: 38656832 DOI: 10.1080/07317115.2024.2344793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Severe posttraumatic stress disorder (PTSD) in older adults (≥60 years) has been found to be associated with maladaptive personality functioning and personality disorders (PD). Emerging evidence in adults supports that reprocessing adverse events with Eye Movement Desensitization and Reprocessing (EMDR) could improve personality functioning and reduce full PDdiagnosis. METHODS A multicenterfeasibilitystudy in 24 older PTSD-patients receiving weekly EMDR-sessions for either 3, 6 or 9 months. A linear-mixed-model was used with personality functioning (SIPP-SF) as dependent variable and time, PTSD-severity (CAPS-5), and "othertreatment" as predictor variables. Secondary, pre- and posttreatment percentages were calculated for the PDspresence. RESULTS Symptom changes over time showed a significant influence of CAPS-5 on SIPP-SF (b = -1.40, 95% CI=[-2.48 to -0.33], p = .012), no significant effect of time for total SIPP-SF, and a significant improvement of SIPP-SF "identityintegration"-scale over time (b = 9.20, 95% CI=[0.97-17.42], p = .029). There was a marginal significant effect of "othertreatment" (b = 8.42, 95% CI=[-0.30-17.13], p = .058). There was 31% full PDs-decrease. CONCLUSIONS Observed improvements in personality functioning from pre to post EMDRtreatment were explained by PTSD-severity. Identityintegration improved significantly over time. Results suggest that participants with "othertreatment" showed more severe baseline-pathology and thus lower personality functioning. CLINICAL IMPLICATIONS EMDR, in addition to being a feasible treatment option for older adults with PTSD, improves personality functioning and reduces the presence of PDs over time.'
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Affiliation(s)
- Ellen M J Gielkens
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sjacko Sobczak
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience; School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Rotterdam Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Nienke Gerrits
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
| | - Erlene Rosowsky
- William James College, Department of Clinical Psychology, Newton, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Lara Stas
- Vrije Universiteit Brussel (VUB), Biostatistics and Medical Informatics Research Group, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Core Facility - Support for Quantitative and Qualitative Research (SQUARE), Brussels, Belgium
| | - Gina Rossi
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Clinical center of excellence for older adults with personality disorders, Mondriaan Mental Health Centre, Heerlen-Maastricht, The Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Yang L, Huang M. Childhood maltreatment and mentalizing capacity: A meta-analysis. CHILD ABUSE & NEGLECT 2024; 149:106623. [PMID: 38245975 DOI: 10.1016/j.chiabu.2023.106623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/02/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The protective role of mentalizing capacity against the adverse effects of childhood maltreatment (CM) is acknowledged; however, empirical studies have yielded diverse conclusions regarding the relationship between childhood maltreatment and mentalizing capacity. OBJECTIVE This meta-analytic review aims to comprehensively summarize and quantify the association between childhood maltreatment and mentalizing capacity. PARTICIPANTS AND SETTING A total of 23 studies involving 3910 participants were included in the analysis. METHODS Systematic searches across eight bibliographic databases identified peer-reviewed publications describing empirical studies on the interplay between CM and mentalizing capacity. Effect sizes (r) were synthesized using random-effects models. A moderated effects analysis was conducted on five variables: participant gender, age group, mental health status, mentalizing capacity measurement, and childhood maltreatment measurement. RESULTS The findings showed a significant moderate negative correlation between childhood maltreatment and mentalizing capacity (r = -0.21, 95 % CI = [-0.26, -0.15]). This suggests that heightened severity of childhood maltreatment corresponds to lower mentalizing capacity. Moreover, the strength of this correlation was influenced by participant gender, age group, mental health status, mentalizing capacity measurement, and CM measurement. CONCLUSIONS The controversy surrounding the link between CM and mentalizing capacity gains clarity when considering significant moderating variables. The pooled effect provides a preliminary definition of the magnitude and direction of this correlation.
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Affiliation(s)
- Linhua Yang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China
| | - Manxia Huang
- Department of Psychology, Institute of Education, China University of Geosciences, Wuhan, China.
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Gander M, Buchheim A, Kohlböck G, Sevecke K. Unresolved attachment and identity diffusion in adolescence. Dev Psychopathol 2024:1-10. [PMID: 38305076 DOI: 10.1017/s0954579424000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.
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Affiliation(s)
- Manuela Gander
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Anna Buchheim
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
| | - Gabriele Kohlböck
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
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Ensink K, Deschênes M, Bégin M, Cimon L, Gosselin T, Wais M, Normandin L, Fonagy P. Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment. Front Psychiatry 2024; 14:1302137. [PMID: 38268556 PMCID: PMC10806145 DOI: 10.3389/fpsyt.2023.1302137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Childhood emotional abuse (CEA) is a recognized risk factor for adolescent mentalizing challenges. However, there's limited understanding about how CEA might influence personality development and elevate the risk of adolescent personality pathology. A deeper grasp of these pathways is crucial, given that adolescence is a pivotal developmental phase for identity integration, personality consolidation, and the emergence of personality disorders. As the emphasis shifts to dimensional perspectives on adolescent personality pathology, the spotlight is increasingly on adolescents' evolving personality organization (PO). Within this framework, personality disorder manifestations stem from inherent vulnerabilities in PO. A comprehensive understanding of how CEA leads to these inherent vulnerabilities in PO can inform enhanced interventions for at-risk adolescents. Nonetheless, our comprehension lacks insight into potential pathways to PO, especially those involving external factors like maltreatment and individual traits like mentalizing. This study sought to bridge these gaps by employing latent factor analysis and structural equation modeling to explore connections between emotional maltreatment, adolescent mentalizing, and PO. Methods A community-based cohort of 193 adolescents (aged 12-17) took part in self-report assessments: the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), the Reflective Functioning Questionnaire for Youth (RFQ-Y), and the Inventory for Personality Organization for Adolescents (IPO-A). Results The structural equation model revealed a significant direct influence of CEA on both RFQ-Confusion and PO, and a noteworthy direct effect of RFQ-Confusion on PO. Remarkably, the model accounted for 76.9% of the PO variance. CEA exhibited a significant indirect impact on PO through RFQ-Confusion, which was accountable for 52.3% of the CEA effect on PO, signifying a partial mediation by mentalizing. Discussion These insights carry substantial clinical implications, especially for devising integrated, trauma-informed strategies for adolescents with personality pathologies. This is particularly relevant for enhancing mentalizing and bolstering personality consolidation among adolescent CEA survivors.
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Affiliation(s)
- Karin Ensink
- École de Psychologie, Université Laval, Québec, QC, Canada
| | | | - Michaël Bégin
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurie Cimon
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | | | - Marissa Wais
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Lina Normandin
- École de Psychologie, Université Laval, Québec, QC, Canada
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Azarmehr R, Reck AJ, Zhang L, Oshri A. COVID-19-related stress exacerbates the effect of child maltreatment on negative affect via increased identity confusion during adolescence. J Adolesc 2024; 96:18-30. [PMID: 37718632 PMCID: PMC10843095 DOI: 10.1002/jad.12249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Exposure to childhood maltreatment may undermine the crucial developmental task of identity formation in adolescence, placing them at risk for developing negative affect. The current study investigated whether COVID-19-related stress intensified the indirect link between child maltreatment and adolescents' negative affect through identity confusion. METHOD Using multidimensional assessments of child maltreatment (threat vs. deprivation), the study included a sample of 124 adolescents (Mage = 12.89, SD = 0.79; 52% female) assessed before (January 2018 to March 2020) and during the pandemic (May to October 2020) in Georgia, United States. The majority of the participants were European American (78.8%), followed by African American (11.5%), Hispanic (3.8%), Asian/Pacific Islander (1.0%), and other (4.8%). We used structural equation modeling to test (a) the mediating role of identity confusion in the link between childhood maltreatment and negative affect and (b) whether COVID-19-related stress moderated these indirect effects. Simple slopes and Johnson-Neyman plots were generated to probe regions of significant interaction effects. RESULTS Threat and deprivation predicted an increase in adolescent identity confusion. Additionally, childhood threat and deprivation were indirectly linked to adolescents' negative affect through increased levels of identity confusion. COVID-19-related stress significantly exacerbated the link between identity confusion and negative affect. CONCLUSION Identity confusion is a mechanism underlying the link between child maltreatment and the development of negative affect in adolescence. Our results inform prevention and intervention programs that aim to reduce negative affect among adolescents who experience threatening and depriving rearing environments.
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Affiliation(s)
- Rabeeh Azarmehr
- Department of Human Development and Family Science, University of Georgia, Dawson Hall, 305 Sanford Drive, Athens, GA, 30602, United States
- Youth Development Institute, University of Georgia, Room 208, 105 Foster Road (Pound Hall), Athens, GA, 30606, United States
| | - Ava J. Reck
- Department of Human Development and Family Science, University of Georgia, Dawson Hall, 305 Sanford Drive, Athens, GA, 30602, United States
- Youth Development Institute, University of Georgia, Room 208, 105 Foster Road (Pound Hall), Athens, GA, 30606, United States
| | - Linhao Zhang
- Department of Human Development and Family Science, University of Georgia, Dawson Hall, 305 Sanford Drive, Athens, GA, 30602, United States
- Youth Development Institute, University of Georgia, Room 208, 105 Foster Road (Pound Hall), Athens, GA, 30606, United States
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Dawson Hall, 305 Sanford Drive, Athens, GA, 30602, United States
- Youth Development Institute, University of Georgia, Room 208, 105 Foster Road (Pound Hall), Athens, GA, 30606, United States
- Integrated Life Sciences, Behavioral and Cognitive Neuroscience, University of Georgia, Athens, GA, United States
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Jańczak MO. Mentalization, emotional dysregulation and attachment to alternative attachment figures in retrospectively defined earned secure adults. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2023; 12:30-40. [PMID: 38756200 PMCID: PMC11094461 DOI: 10.5114/cipp/172328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/24/2022] [Accepted: 09/14/2023] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Researchers have tried to identify mechanisms through which an individual overcomes negative life experiences, proposing earning security as one of them. Retrospectively defined earned secures are recognized as individuals exhibiting secure attachments to their parents while evaluating the quality of their childhood care as low. This study aimed to examine attachment, mentalization, and emotional dysregulation in this group. We hypothesized that earned secures will report better mentalizing, lower emotion dysregulation, and more secure attachment to figures other than parents than insecure individuals. PARTICIPANTS AND PROCEDURE female adult sample (N = 272) completed the Experiences in Close Relationships-Relationship Structures questionnaire, Parental Bonding Instrument, Difficulties in Emotion Regulation Scale, and Mental State Task. The time devoted to psychotherapy and demographics were also controlled as contextual variables. RESULTS We identified an 'earned secure' group (14% of the sample), exhibiting secure attachment to mothers in adulthood despite reported inadequate care during childhood, along with the continuously secure, insecure, and 'lost secure' groups. People from the earned secure and secure groups reported better emotional regulation and some aspects of mentalization than those in the insecure and lost secure groups. They equally frequently reported the presence of an adult other than parents who were important to them in childhood, but the attachment to them was more secure. We did not find evidence of differences between the groups in the duration of psychotherapy. CONCLUSIONS Secure attachment to alternative attachment figures, along with some mentalization and emotional regulation aspects, may be considered significant factors for earning security.
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Affiliation(s)
- Monika Olga Jańczak
- Faculty of Psychology and Cognitive Sciences, Adam Mickiewicz University, Poznan, Poland
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12
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Dixius A, Möhler E. Effects of a Standardized DBT-A Program on Identity Development in Adolescents. Brain Sci 2023; 13:1328. [PMID: 37759929 PMCID: PMC10526514 DOI: 10.3390/brainsci13091328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Identity diffusion plays a central role in the onset of borderline personality disorders. Dialectical Behavioral Therapy for Adolescents (DBT-A) is a treatment program for adolescents with emotional instability and dysregulation. The interest of this study is to examine the potential effects of a standardized and certified DBT-A therapy program on the identity development of adolescents in an inpatient setting. METHODS A total of 138 adolescents aged 13 to 18 years with symptoms of severe emotional instability were assessed before and after a certified and standardized 12-week in-patient DBT-A program targeting emotional regulation with the following standardized instruments: the Assessment of Identity Development in Adolescence (AIDA), Scale of the Experience of Emotions (SEE), and Symptom Checklist (SCL-90-R). RESULTS The results indicate a significant change in identity development, emotion regulation, and general symptoms of psychopathology after treatment with DBT-A. CONCLUSIONS In this large sample of adolescents, DBT-A significantly improved identity development and reduced identity diffusion, however, without a treatment-as-usual control group as a limitation. Nevertheless, our results may become clinically relevant for the prevention of chronic impairment in emotionally unstable adolescents.
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Affiliation(s)
- Andrea Dixius
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrucken, Germany;
- SHG Clinic for Child and Adolescent Psychiatry, 66119 Saarbrucken, Germany
| | - Eva Möhler
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrucken, Germany;
- SHG Clinic for Child and Adolescent Psychiatry, 66119 Saarbrucken, Germany
- Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany
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13
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De Moor EL, Van der Graaff J, Branje S. Identity development across the transition from primary to secondary school: The role of personality and the social context. SELF AND IDENTITY 2023. [DOI: 10.1080/15298868.2023.2196087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Elisabeth L. De Moor
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Susan Branje
- Department of Youth and Family, Utrecht University, Utrecht, The Netherlands
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14
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Bucci S, Varese F, Quayle E, Cartwright K, Machin M, Whelan P, Chitsabesan P, Richards C, Green V, Norrie J, Schwannauer M. A Digital Intervention to Improve Mental Health and Interpersonal Resilience in Young People Who Have Experienced Technology-Assisted Sexual Abuse: Protocol for a Nonrandomized Feasibility Clinical Trial and Nested Qualitative Study. JMIR Res Protoc 2023; 12:e40539. [PMID: 36943343 PMCID: PMC10131936 DOI: 10.2196/40539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 10/29/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use among YP is now common. A digital intervention aimed at improving mentalization in YP who have experienced TASA may reduce the risk of revictimization and future harm and make YP more resilient and able to manage distress that might result from TASA experiences. OBJECTIVE In this paper, we describe a protocol for determining the feasibility of the i-Minds trial and the acceptability, safety, and usability of the digital intervention (the i-Minds app) and explore how to best integrate i-Minds into existing routine care pathways. METHODS This is a mixed methods nonrandomized study aimed to determine the feasibility, acceptability, safety, and usability of the intervention. Participants aged between 12 and 18 years who report distress associated with TASA exposure will be recruited from the United Kingdom from the National Health Service (NHS) Trust Child and Adolescent Mental Health Services, sexual assault referral centers, and a web-based e-therapy provider. All participants will receive the i-Minds app for 6 weeks. Coproduced with YP and a range of stakeholders, the i-Minds app focuses on 4 main topics: mentalization, TASA and its impact, emotional and mental health, and trauma. A daily prompt will encourage YP to use the app, which is designed to be used in a stand-alone manner alongside routine care. We will follow participants up after the intervention and conduct interviews with stakeholders to explore the acceptability of the app and trial procedures and identify areas for improvement. Informed by the normalization process theory, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS and NHS e-therapy providers. RESULTS This study was approved by the Research Ethics Board of Scotland. We expect data to be collected from up to 60 YP. We expect to conduct approximately 20 qualitative interviews with participants and 20 health care professionals who referred YP to the study. The results of this study have been submitted for publication. CONCLUSIONS This study will provide preliminary evidence on the feasibility of recruiting YP to a trial of this nature and on the acceptability, safety, and usability of the i-Minds app, including how to best integrate it into existing routine care. The findings will inform the decision to proceed with a powered efficacy trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Registry (ISRCTN) ISRCTN43130832; https://www.isrctn.com/ISRCTN43130832. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40539.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ethel Quayle
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Prathiba Chitsabesan
- Pennine Care NHS Foundation Trust, Greater Manchester, United Kingdom
- University College London, London, United Kingdom
| | | | | | - John Norrie
- Population Health Sciences, Usher Institute, Centre for Population Health Sciences, Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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15
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Spidel A, Kealy D. Sexual risk behavior among individuals seeking outpatient mental health services: Associations with childhood emotional neglect and identity dysfunction. Bull Menninger Clin 2023; 87:6-24. [PMID: 36856476 DOI: 10.1521/bumc.2023.87.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This study was developed to examine sexual risk behavior among patients seeking community-based mental health services, including associations with psychological distress, identity dysfunction, and childhood emotional neglect. A mediation model was examined regarding identity dysfunction mediating the link between emotional neglect and sexual risk behavior. A total of 245 outpatients completed questionnaires regarding perceived risky sexual behavior, psychological distress, identity dysfunction, and emotional neglect. Sexual risk behavior was found to be a prevalent issue among individuals seeking outpatient mental health services, with 13% reporting engagement in unsafe sexual practices at least some of the time. Mediation analysis revealed that childhood emotional neglect was indirectly linked with sexual risk behavior through the mediating effect of identity dysfunction. Thus, findings suggest a pathway to sexual risk behaviors through perceived childhood emotional neglect and identity dysfunction. Clinical attention to identity-related vulnerability among this population may be warranted in aiming to mitigate risk-taking associated with sexual practices.
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Affiliation(s)
- Alicia Spidel
- Lecturer in the Criminology Department of Kwantlen Polytechnic University, and a clinician in the Mental Health and Substance Use Services of the Fraser Health Authority, Surrey, British Columbia, Canada
| | - David Kealy
- Associate professor in the Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Samaey C, Lecei A, Achterhof R, Hagemann N, Hermans KSFM, Hiekkaranta AP, Kirtley OJ, Reininghaus U, Boets B, Myin-Germeys I, van Winkel R. The role of identity in the development of depressive, anxiety, and psychosis symptoms in adolescents exposed to childhood adversity. J Adolesc 2023. [PMID: 36737250 DOI: 10.1002/jad.12145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Childhood adversity is a major risk factor for psychiatric disorders and has especially been associated with an admixture of depressive, anxiety, and psychosis symptoms. Identity formation, a main developmental task during adolescence, may be impacted by these adverse experiences and act as an important process in the association between childhood adversity and psychopathology. METHODS We investigated the association between childhood adversity, identity formation, and depressive, anxiety, and psychosis symptoms cross-sectionally in 1913 Flemish adolescents between 11 and 20 years old (mean = 13.76, SD = 1.86). Adolescents completed questionnaires during the first wave of the SIGMA study between January 2018 and May 2019. RESULTS Childhood interpersonal adversity was associated with increased identity confusion and decreased identity synthesis. Additionally, identity confusion was associated with increased self-reported levels of psychopathology and potentially mediated the association between childhood adversity and psychopathology. CONCLUSION This study highlights the importance of promoting healthy identity formation in adolescents with and without exposure to adverse childhood experiences.
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Affiliation(s)
- Celine Samaey
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | - Aleksandra Lecei
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium
| | - Robin Achterhof
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Noëmi Hagemann
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Karlijn S F M Hermans
- Strategy and Academic Affairs, Administration and Central Services, Leiden University, Leiden, The Netherlands
| | - Anu P Hiekkaranta
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Olivia J Kirtley
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany.,ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King's College London, London, London, UK
| | - Bart Boets
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Developmental Psychiatry, Leuven, Belgium.,KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Inez Myin-Germeys
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Ruud van Winkel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, Leuven, Belgium.,KU Leuven, University Psychiatric Center (UPC), Leuven, Belgium
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17
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Labonté LE, Kealy D. Understanding loneliness: The roles of self- and interpersonal dysfunction and early parental indifference. Bull Menninger Clin 2023; 87:266-290. [PMID: 37695883 DOI: 10.1521/bumc.2023.87.3.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Many factors are implicated in developing and maintaining loneliness, including aspects of personality functioning and experience of early adverse childhood events. This study aimed to examine the relationship between domains of personality dysfunction, including self- and interpersonal functioning, and loneliness and determine whether such personality factors mediate the relationship between childhood parental indifference and loneliness. In total, 393 community-dwelling adults, mean age 34.3 (SD = 12.67), were recruited online for cross-sectional assessment of loneliness, personality functioning, big-five personality traits and perceived childhood parental indifference. Linear regression analyses were conducted followed by a parallel mediation model. Self- and interpersonal dysfunction were positively associated with loneliness and remained significant predictors of loneliness after controlling for five-factor personality traits. Impaired personality functioning accounted for 12% of loneliness variance. Finally, self-dysfunction mediated the relationship between childhood parental indifference and loneliness. Findings emphasize the importance of addressing personality functioning when developing psychosocial interventions aimed at tackling loneliness.
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Affiliation(s)
- Laura E Labonté
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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19
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Wekerle C, Kim K, Wong N. Child Sexual Abuse Victimization: Focus on Self-Compassion. Front Psychiatry 2022; 13:818774. [PMID: 35308875 PMCID: PMC8924043 DOI: 10.3389/fpsyt.2022.818774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Katherine Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nikki Wong
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Branje S, de Moor EL, Spitzer J, Becht AI. Dynamics of Identity Development in Adolescence: A Decade in Review. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2021; 31:908-927. [PMID: 34820948 PMCID: PMC9298910 DOI: 10.1111/jora.12678] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 06/06/2023]
Abstract
One of the key developmental tasks in adolescence is to develop a coherent identity. The current review addresses progress in the field of identity research between the years 2010 and 2020. Synthesizing research on the development of identity, we show that identity development during adolescence and early adulthood is characterized by both systematic maturation and substantial stability. This review discusses the role of life events and transitions for identity and the role of micro-processes and narrative processes as a potential mechanisms of personal identity development change. It provides an overview of the linkages between identity development and developmental outcomes, specifically paying attention to within-person processes. It additionally discusses how identity development takes place in the context of close relationships.
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21
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Kealy D, Ben‐David S, Spidel A, Wadsley‐Rose S, Kim D. Self‐reassurance moderated by identity dysfunction: Associations with distress and impairment. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David Kealy
- Department of Psychiatry University of British Columbia – Vancouver Vancouver BC Canada
| | - Shelly Ben‐David
- School of Social Work University of British Columbia – Okanagan Kelowna BC Canada
| | - Alicia Spidel
- Department of Criminology Kwantlen Polytechnic University Surrey BC Canada
- Mental Health and Substance Use Services Fraser Health Authority Surrey BC Canada
| | - Saffron Wadsley‐Rose
- Department of Psychiatry University of British Columbia – Vancouver Vancouver BC Canada
| | - Dan Kim
- Mental Health and Substance Use Services Fraser Health Authority Surrey BC Canada
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22
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Feasibility of Using Child Maltreatment Measurement Instruments in the Primary Care Setting: A Systematic Review. J Pediatr Nurs 2021; 61:e1-e14. [PMID: 33926746 DOI: 10.1016/j.pedn.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023]
Abstract
PROBLEM Child maltreatment is a devastating epidemic affecting millions of children and adolescents in the United States (U.S.) every year. Primary care providers (PCPs) encounter these victims but need resources to aid in the recognition of maltreatment. The purpose of this review is to evaluate child maltreatment measurement instruments and determine feasibility of use by U.S. PCPs. ELIGIBILITY CRITERIA A systematic search was conducted in the PubMed, CINAHL, and PsycInfo databases from 2014 until 2020. Eligibility criteria included articles conducted in the U.S., with use of a child maltreatment measurement instrument, and subjects less than 18 years old. Eligible articles were reference searched to find the original studies for each instrument and were included if they were published in a peer-reviewed paper, could be located, and addressed the development or validation of the instrument. SAMPLE Of the 3816 articles, 111 used a child maltreatment measurement instrument. Sixteen of the 27 identified instruments were evaluated for feasibility using a quality rating with criteria including psychometrics, construct measurement, administration, availability, and cost. RESULTS Six instruments were recommended for use by PCPs. CONCLUSIONS This is the first review evaluating the use of child maltreatment measurement instruments by PCPs and it highlights the combination of psychometric evaluation and other pertinent feasibility criteria to recommend several instruments for use by PCPs. IMPLICATIONS Use of these instruments by PCPs may serve to identify children and families who are at risk for or suffering from maltreatment.
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Raemen L, Luyckx K, Palmeroni N, Verschueren M, Gandhi A, Grobler A, Claes L. Trauma and self-harming behaviors in high school students: The mediating role of identity formation. J Adolesc 2021; 92:20-29. [PMID: 34388608 DOI: 10.1016/j.adolescence.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study investigated the link between trauma and self-harming behaviors in South African high school students, and examined the mediating role of identity formation. Traumatic experiences have been commonly associated with self-harming behaviors in adolescents. However, research addressing this association in non-Western countries is limited. METHODS A total of 552 South African high school students aged 13-21 (60.4% female; Mage = 16 years) were included in the study. Students completed self-report questionnaires on traumatic experiences, identity formation, and self-harming behaviors (disturbed eating behaviors and suicidal thoughts and behaviors). RESULTS Structural equation modelling indicated that the association between traumatic experiences and self-harming behaviors was partially mediated by identity formation. Traumatic experiences were associated with more identity diffusion, bulimia, and suicidal thoughts and behaviors. Identity diffusion, in turn, was associated with more drive for thinness, bulimia, body dissatisfaction, and suicidal thoughts and behaviors. Identity consolidation was positively associated with drive for thinness and negatively with body dissatisfaction and suicidal thoughts and behaviors. No moderation effects by gender or age were found. CONCLUSIONS Traumatic experiences were associated with higher levels of identity diffusion, which, in turn, were associated with more self-harming behaviors in South African high school students. These findings suggest the importance of focusing on identity diffusion in prevention and intervention programs targeting self-harming behaviors.
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Affiliation(s)
- Leni Raemen
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Nina Palmeroni
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | - Amarendra Gandhi
- Leuven Biostatistics and Statistical Bioinformatics Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Adelene Grobler
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium; Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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24
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Musetti A, Starcevic V, Boursier V, Corsano P, Billieux J, Schimmenti A. Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning. J Clin Psychol 2021; 77:1666-1684. [PMID: 33837547 PMCID: PMC8252635 DOI: 10.1002/jclp.23138] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/03/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents. DESIGN Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range 13-19 years). RESULTS A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use. CONCLUSIONS The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed.
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Affiliation(s)
- Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural IndustriesUniversity of ParmaParmaItaly
| | - Vladan Starcevic
- Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Discipline of PsychiatryUniversity of SydneySydneyNew South WalesAustralia
| | | | - Paola Corsano
- Department of Humanities, Social Sciences and Cultural IndustriesUniversity of ParmaParmaItaly
| | - Joël Billieux
- Institute of PsychologyUniversity of Lausanne, GeopolisLausanneSwitzerland
- Centre for Excessive GamblingLausanne University Hospitals (CHUV)LausanneSwitzerland
| | - Adriano Schimmenti
- Faculty of Human and Social SciencesUKE—Kore University of Enna, Cittadella UniversitariaEnnaItaly
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25
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Musetti A, Giammarresi G, Goth K, Petralia A, Barone R, Rizzo R, Concas I, Terrinoni A, Basile C, Di Maggio C, Lopez F, Terrone G, Alessandra A, Messena M, Imperato C, Sibilla F, Caricati L, Mancini T, Corsano P, Aguglia E. Psychometric Properties of the Italian Version of the Assessment of Identity Development in Adolescence (AIDA). IDENTITY 2021. [DOI: 10.1080/15283488.2021.1916748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | | | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics, Basel, Switzerland
| | - Antonino Petralia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Catania, Catania, Italy
| | - Rita Barone
- Department of Clinical and Experimental Medicine, Section of Child Neurology and Psychiatry, University of Catania, Catania, Italy
| | - Renata Rizzo
- Department of Clinical and Experimental Medicine, Section of Child Neurology and Psychiatry, University of Catania, Catania, Italy
| | - Ilaria Concas
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Catania, Catania, Italy
| | - Arianna Terrinoni
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
| | - Consuelo Basile
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
| | - Chiara Di Maggio
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
| | - Felipe Lopez
- Associazione Nazionale Assessment E Psicodiagnostica, Rome, Italy
| | - Grazia Terrone
- Department of History, Cultural Heritage, Education and Society, University of Rome Tor Vergata, Rome, Italy
| | | | - Mattia Messena
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Chiara Imperato
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | - Federica Sibilla
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | - Luca Caricati
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | - Tiziana Mancini
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | - Paola Corsano
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Borgo Carissimi, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Catania, Catania, Italy
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Sekowski M, Gambin M, Sharp C. The Relations Between Identity Disturbances, Borderline Features, Internalizing Disorders, and Suicidality in Inpatient Adolescents. J Pers Disord 2021; 35:29-47. [PMID: 33779274 DOI: 10.1521/pedi_2021_35_501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Previous studies have demonstrated positive associations between identity disturbances and suicidality in adolescents; however, mechanisms underlying these relationships are not well understood. The authors propose that borderline features and various internalizing disorders may mediate these relations. The aim of this study was to test a multiple mediation model of the associations between these constructs using structural equation modeling. Ninety-six inpatient adolescents aged 12-17 years completed the Assessment of Identity Development in Adolescents, the Childhood Interview for DSM-IV Borderline Personality Disorder, the Youth Self-Report, and the Columbia-Suicide Severity Rating Scale. Findings partly confirmed the theoretical model. Borderline features mediated the positive effect of identity disturbances on suicidal ideation severity. Mediations of withdrawn/depression and anxiety/depression on the effect of identity disruption on suicidal ideation intensity were demonstrated. Identity disruptions and borderline and depressive symptoms could be possible targets for interventions for youth experiencing suicidal ideation.
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Affiliation(s)
- Marcin Sekowski
- Department of Psychology, The Maria Grzegorzewska University, Warsaw
| | | | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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27
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Zettl M, Akin Z, Back S, Taubner S, Goth K, Zehetmair C, Nikendei C, Bertsch K. Identity Development and Maladaptive Personality Traits in Young Refugees and First- and Second-Generation Migrants. Front Psychiatry 2021; 12:798152. [PMID: 35126207 PMCID: PMC8813733 DOI: 10.3389/fpsyt.2021.798152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Refugees are often exposed to a variety of stressors and traumatic events, posing a significant risk for the development of mental disorders. Young refugees may be particularly at risk because adverse life events affect identity formation, a developmental task that is typically expected in adolescence and emerging adulthood. Trauma and cultural changes may alter identity development, potentially leading to identity diffusion, a core concept of personality disorders. However, previous research on personality pathology among refugees is scarce. In this study, we examine identity development and maladaptive personality traits in young refugees and migrants. Refugees from 22 countries of origin were recruited in a German reception center (n = 120) and a group of adults with a migration background in first- or second generation was obtained via web-based recruitment (n = 281). Identity development was measured using the Assessment of Identity Development in Adolescence - Short Form. Maladaptive personality traits were assessed with the Personality Inventory for DSM-5-Brief Form. Group differences between refugees and migrants regarding identity development and trait expression were investigated using t-tests. The relationship between the two measures and their corresponding subscales was examined by means of correlation analyses. Refugees reported significantly higher levels of identity diffusion, negative affectivity, detachment, antagonism, and disinhibition compared to migrants. No significant differences were found for psychoticism. Correlation analyses revealed low to moderate positive associations between identity diffusion and maladaptive trait expression. Possible implications for early phase of resettlement, preventive psychiatric care and further research questions are discussed.
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Affiliation(s)
- Max Zettl
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, Medical Faculty, University Hospital Heidelberg, Heidelberg, Germany
| | - Zeynep Akin
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sarah Back
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Svenja Taubner
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, Medical Faculty, University Hospital Heidelberg, Heidelberg, Germany
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatric Research, Psychiatric University Clinics (UPK), Basel, Switzerland
| | - Catharina Zehetmair
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany.,Department of General Psychiatry, Medical Faculty, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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28
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Hatkevich C, Sumlin E, Sharp C. Examining Associations Between Child Abuse and Neglect Experiences With Emotion Regulation Difficulties Indicative of Adolescent Suicidal Ideation Risk. Front Psychiatry 2021; 12:630697. [PMID: 33889096 PMCID: PMC8057346 DOI: 10.3389/fpsyt.2021.630697] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: Preliminary work indicates one specific aspect of emotion dysregulation (i.e., limited access to emotion regulation strategies) uniquely associates with adolescent suicide ideation. An optimal score cut point on a measure of this emotion dysregulation impairment has been identified to indicate risk for past-year suicidal ideation. Examining types of child abuse and neglect associated with being above cut-off on this measure may point to interactive environmental effects associated with subsequent risk for suicidal ideation. The primary aim of this study was to investigate the relations between multiple types of child abuse and neglect with being above cutoff on a measure of limited access to emotion regulation strategies in a psychiatrically severe adolescent sample. Method: The full sample included 203 psychiatric adolescents (Mean age = 15.31 years; 66.5% female; 74.4% White), assigned to two groups: (1) those at or above cutoff on the access to emotion regulation strategies subscale (n = 139); and (2) those below cutoff (n = 64). Results: Significant differences were only evidenced between the emotion regulation cutoff groups on emotional abuse, after covarying for other types of abuse and neglect; significant group differences were not evidenced on any other type of abuse or neglect (sexual or physical abuse, emotional or physical neglect). Conclusion: Relative to other types of abuse and neglect, emotional abuse may be differentially related to experiencing limited access to emotion regulation strategies, at the level indicative of suicide ideation risk. Clinical implications are discussed.
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Affiliation(s)
- Claire Hatkevich
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Eric Sumlin
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
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29
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Truskauskaite-Kuneviciene I, Brailovskaia J, Kamite Y, Petrauskaite G, Margraf J, Kazlauskas E. Does Trauma Shape Identity? Exploring the Links Between Lifetime Trauma Exposure and Identity Status in Emerging Adulthood. Front Psychol 2020; 11:570644. [PMID: 33041939 PMCID: PMC7522346 DOI: 10.3389/fpsyg.2020.570644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022] Open
Abstract
In emerging adulthood, coherent identity plays a protective role against the development of the disturbed psychosocial functioning and is seen as one of the defining characteristics of positive youth development. The factors that shape the identity are still understudied and little quantitative research has addressed, how trauma exposure is linked to emerging adults' identity. Therefore, the current study aimed to investigate how exposure to traumatic experiences over the lifetime is associated with current identity status among emerging adults in an academic environment and to explore links between different types of traumatic experiences as well as the severity of exposure to trauma and identity statuses. The study sample consisted of 1,614 first-year undergraduate students from Lithuania with the age range of 18-29 years (M = 19.09, SD = 1.05, 68.28% female). The three distinct identity profiles were identified using the Latent Class Analysis, representing diffused, undifferentiated, and coherent identity statuses. The results provided no clear evidence of links between traumatic experiences and identity status for overall exposure and most types of traumatic events. However, our study concerns the potential importance of severe traumatic experiences, such as sexual trauma, on identity.
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Affiliation(s)
| | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Yuka Kamite
- Department of Psychology, Hiroshima University, Hiroshima, Japan
| | | | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
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30
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Gambin M, Woźniak-Prus M, Konecka A, Sharp C. Relations between attachment to mother and father, mentalizing abilities and emotion regulation in adolescents. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2020. [DOI: 10.1080/17405629.2020.1736030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Alicja Konecka
- Department of Psychology, University of Warsaw, Warsaw, Poland
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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31
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Abstract
Trauma can alter the course of identity development and destabilize existing identity commitments. Trauma, whether past or current, can also impact the resources a person brings to identity work. However, identity can also be a lens through which trauma is perceived and interpreted, helping to determine whether a traumatic experience results in posttraumatic stress disorder or posttraumatic growth. Despite the apparent implications each construct has for the other, the scholarship at the intersection of trauma and identity remains sparse. This Special Issue explores how and when trauma and identity influence one another by considering their association across various adolescent populations, methodologies, traumatic event types, and facets of identity. In doing so, this Special Issue lays the groundwork necessary for exploring, proposing, and testing more complex and nuanced reciprocal relations models between identity and trauma.
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