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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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Guo X, Wu S, Dong W, Zhang Y, Su Y, Chen C. The Effect of Bullying Victimization on Adolescent Non-Suicidal Self-Injury: The Mediating Roles of Alexithymia and Self-Esteem. Psychol Res Behav Manag 2024; 17:783-797. [PMID: 38444719 PMCID: PMC10911978 DOI: 10.2147/prbm.s450195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Background & Aim Non-suicidal self-injury (NSSI) in adolescents is a serious public health issue influenced by the interaction of multiple factors. The purpose of this study was to investigate the multiple mediating roles of alexithymia and self-esteem in the association between bullying victimization and NSSI in a sample of Chinese adolescents. Methods A survey of 1299 adolescents from two public middle schools in Henan Province, China, was undertaken. Data were collected using the Chinese version of the Delaware bullying victimization scale-student (DBVS-S), the Toronto Alexithymia-20 Scale (TAS-20-C), the Rosenberg self-esteem scale (RSES), and the adolescent self-injury questionnaire. Besides, we performed a structural equation modeling (SEM) with latent variables using AMOS 26.0 to examine the relationship between variables and the mediating effects. Results The SEM analysis found that not only can bullying victimization directly impact NSSI, but that alexithymia and self-esteem have a chain mediating effect in the association between bullying victimization and NSSI. This mediating effect contributed 22.47% to the total effect. Conclusion These findings validate bullying victimization, alexithymia, and low self-esteem are important variables that affect NSSI among Chinese adolescents. Educators need to implement some prevention and intervention strategies to ameliorate the campus atmosphere and adolescents' mental health aimed at avoiding NSSI behavior in adolescence.
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Affiliation(s)
- Xiajun Guo
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Sijia Wu
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Wanglin Dong
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yiqiu Zhang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Yue Su
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of China
| | - Chaoran Chen
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, Henan, People’s Republic of 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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Budia JM, Alcover CM, Fernández-Muñoz JJ, Blanco-Fernández A, Félix-Alcántara MP. Attachment, motivational systems and anorexia nervosa: A systematic review and proposed framework for eating disorders. Clin Psychol Psychother 2023; 30:913-930. [PMID: 36861498 DOI: 10.1002/cpp.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION There is a direct association between patients with insecure attachment style (IAS), behavioural inhibition (BIS) and behavioural activation (BAS) motivational systems, and anorexia nervosa (AN). However, the possible direct relationships between these three variables have not been studied. OBJECTIVE The main objective of this study is to analyse the relationship between these variables and propose a framework for analysing and understanding these relationships. METHODOLOGY A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching the following terms: 'anorexia', 'attachment' and those related to motivational systems. The final search was limited to publications in English dated between 2014-2022 for 'anorexia and attachment' and 2010-2022 for 'anorexia and BIS/BAS'. RESULTS Of the 587 articles retrieved, 30 were included in this study for the textual data analysis of the relationship between anorexia and attachment (17), anorexia and motivational systems (10) and anorexia, attachment and motivational systems (3). An association between avoidant IAS, AN and hypersensitivity to punishment of the BIS was observed in the analysis. A relationship was also observed with hyperreinforcement sensitivity of the BAS. After reviewing the articles, a possible relationship between the three factors, along with other mediating factors, was found. DISCUSSION AN is directly related to the avoidant IAS and to BIS. Similarly, bulimia nervosa (BN) was directly related with anxious IAS and BAS. However, contradictions were found in the BN-BAS relationship. This study proposes a framework for analysing and understanding these relationships.
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Xiao Q, Song X, Huang L, Hou D, Huang X. Association between life events, anxiety, depression and non-suicidal self-injury behavior in Chinese psychiatric adolescent inpatients: a cross-sectional study. Front Psychiatry 2023; 14:1140597. [PMID: 37465253 PMCID: PMC10350536 DOI: 10.3389/fpsyt.2023.1140597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/24/2023] [Indexed: 07/20/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is a major public health concern among adolescents. Further research is needed into contributors to this behavior, in particular among adolescents with psychiatric disorders. The aim of the present study was to explore the impact of life events and emotional stress on NSSI among hospitalized psychiatric adolescents. Methods In this cross-sectional study, 505 Chinese psychiatric adolescent inpatients 10-19 years old completed questionnaires about sociodemographic characteristics and NSSI as well as the Adolescent Self-Rating Life Events Checklist (ASLEC), the State-Trait Anxiety Inventory Form Y, and the Center for Epidemiological Studies Depression Scale. Chi-square test was used to compare the incidence of NSSI in psychiatric adolescent patients with different sociodemographic. T-test was used to compare the total scores and dimension scores of the ASLEC, STAI-Y, and CES-D between the NSSI group and the non-NSSI group. A binary logistic regression model was built to explore the relationships among sociodemographic characteristics, questionnaire scores and NSSI. Results Most psychiatric adolescent inpatients (393, 77.8%) reported NSSI behavior. The higher risk for NSSI was observed among female (odds ratio [OR] 2.665, 95% confidence interval [CI] 1.575-4.510), younger adolescents (10-14 years; OR 2.021, 95% CI 1.258-3.245), with a suicide history (OR 2.479, 95% CI 1.549-3.967), or with depression symptom (OR 3.217, 95% CI 1.572-6.582) and those with higher scores of ASLEC (OR 1.019, 95% CI 1.010-1.029). Conclusion Our study in China is one of the first to apply to adolescent inpatients the diagnostic criteria of NSSI in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. Our analysis suggests that NSSI prevalence is disturbingly high among adolescents with mental illness in China. A better understanding of contributing factors, especially negative life events and negative emotions, may guide interventions that can reduce its prevalence.
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Affiliation(s)
- Qingqing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaozhen Song
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Lijuan Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Dandan Hou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuehua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Gander M, Lenhart L, Steiger R, Buchheim A, Mangesius S, Birkl C, Haid-Stecher N, Fuchs M, Libal A, Dabkowska-Mika A, Gizewski ER, Sevecke K. Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment. Brain Sci 2023; 13:brainsci13050798. [PMID: 37239270 DOI: 10.3390/brainsci13050798] [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: 03/07/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Lukas Lenhart
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Birkl
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Nina Haid-Stecher
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Anna Libal
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Agnieszka Dabkowska-Mika
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Buchheim A, Ziegenhain U, Kindler H, Waller C, Gündel H, Karabatsiakis A, Fegert J. Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology. Front Hum Neurosci 2022; 16:890262. [PMID: 35923749 PMCID: PMC9341217 DOI: 10.3389/fnhum.2022.890262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach. Methods Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood. Results Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences. Conclusion We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.
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Affiliation(s)
- Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | | | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Jörg Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
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Aghamohammadi S, Mazaheri M, Fata L, Mootabi F. Relationship between Non-Suicidal Self-Injury and Attachment: Protocol for Systematic Review and Meta-Analysis (Preprint). JMIR Res Protoc 2022; 12:e40808. [DOI: 10.2196/40808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/28/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
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Arnold S, Wiese A, Zaid S, Correll CU, Jaite C. Lifetime prevalence and clinical correlates of nonsuicidal self-injury in youth inpatients with eating disorders: a retrospective chart review. Child Adolesc Psychiatry Ment Health 2022; 16:17. [PMID: 35227292 PMCID: PMC8884089 DOI: 10.1186/s13034-022-00446-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Youths with eating disorders (EDs) engaging in nonsuicidal self-injury (NSSI) are at higher suicide risk because EDs and NSSI are associated with suicidality. However, epidemiologic data on NSSI lacks in the vulnerable group of youth ED inpatients. METHODS This retrospective chart review included patients up to 18 years of age with an ICD-10 diagnosis of anorexia nervosa, restricting type (AN-R), anorexia nervosa, binge-purge type (AN-BP), and bulimia nervosa (BN), treated at the child and adolescent inpatient department of the University Hospital in Berlin, Germany, between 1990 and 2015. Across and within ED subgroups, lifetime NSSI prevalence, methods of self-harm, and clinical correlates were evaluated. Independent correlations of demographic and clinical factors with NSSI were identified via multivariable regression models. RESULTS Of 382 inpatients (median = 15.6 (range = 9-18) years, females = 97.1%), 21.5% reported lifetime NSSI, consisting of cutting = 86.6%, scratching = 12.2%, and hitting = 8.5%. NSSI was more frequent in BN (47.6%) and AN-BP (39.3%) than AN-R (8.3%) (Φ = 0.43). Across ED subgroups, NSSI was associated with a higher prevalence of psychiatric comorbidities (AN-R: Φ = 0.55; AN-BP: Φ = 0.69; BN: Φ = 0.78), suicidal ideation (AN-R: Φ = 0.30; AN-BP: Φ = 0.38; BN: Φ = 0.29), and psychiatric medication use (AN-R: Φ = 0.23; AN-BP: Φ = 0.64; BN: Φ = 0.60). In multivariable regression analyses, NSSI was independently associated with a higher prevalence of psychiatric comorbidities (AN-R: OR = 2.93 [1.42, 6.04]; AN-BP: OR = 2.67 [1.13, 6.31]; BN: OR = 3.75 [1.71, 8.23]). Additionally, independent correlates with NSSI in AN-R included a higher prevalence of suicidal ideation (OR = 0.21 [0.72, 0.64]) and less weekly weight gain (OR = 0.03 [0.02, 0.43]), while in BN, NSSI was correlated with longer inpatient treatment duration (OR = 1.01 [1.00, 1.02]). CONCLUSIONS There is a high lifetime prevalence of NSSI among youth with AN and BN requiring inpatient treatment, especially those with binge-purge behaviors. Treatment programs must be tailored to address psychiatric comorbidities and suicidality to improve patient care and suicide prevention. TRIAL REGISTRATION This study was not considered a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants, however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of an intervention on participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Antonia Wiese
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Zaid
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph U. Correll
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany ,grid.440243.50000 0004 0453 5950Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Charlotte Jaite
- grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité – Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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