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Gecha T, McLaren V, Sharp C. Clinical cut-off scores for the Borderline Personality Features Scale for Children to differentiate among adolescents with Borderline Personality Disorder, other psychopathology, and no psychopathology: a replication study. Borderline Personal Disord Emot Dysregul 2024; 11:21. [PMID: 39183330 PMCID: PMC11346013 DOI: 10.1186/s40479-024-00264-1] [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: 02/11/2024] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Despite being one of the most popular measures of borderline pathology in adolescents, only one study has evaluated clinical cut-off scores for the Borderline Personality Features Scale for Children (BPFS-C) using a small sample without a healthy comparison group (Chang B, Sharp C, Ha C. The Criterion Validity of the Borderline Personality Features Scale for Children in an Adolescent Inpatient Setting. J Personal Disord. 2011;25(4):492-503. https://doi.org/10.1521/pedi.2011.25.4.492 .). The purpose of the current study was to replicate and improve on the limitations of the prior study conducted by Chang et al. to more definitively establish clinical cut-off scores for the self- and parent-report versions of the BPFS-C to detect clinical and sub-clinical borderline personality disorder (BPD) in a large sample of adolescents with BPD, other psychopathology, and no psychopathology. METHODS A total of 900 adolescents ranging from ages 12-17 participated in this study. The clinical sample consisted of 622 adolescents recruited from an inpatient psychiatric facility, and the healthy control sample consisted of 278 adolescents recruited from the community. All participants completed the BPFS-C and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD). RESULTS Using three-way ROC analyses, cut-off scores on the self- and parent-report versions of the BPFS-C distinguishing adolescents with BPD from those with subclinical BPD, and those with subclinical BPD from healthy adolescents were established. CONCLUSIONS These findings support the use of both versions of the BPFS-C to detect adolescents with BPD and sub-clinical BPD.
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2
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Sack L, Seddon JA, Sosa-Hernandez L, Thomassin K. Typologies of Non-Suicidal Self-Injury Functions and Clinical Correlates Among Inpatient Youth. Child Psychiatry Hum Dev 2024; 55:999-1009. [PMID: 36350479 DOI: 10.1007/s10578-022-01465-x] [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] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
This study identified typologies of specific non-suicidal self-injury (NSSI) functions among youth admitted for psychiatric hospitalization and investigated clinically relevant correlates. Inpatient youth (n = 68) aged 10-17 years reported on their reasons to engage in NSSI, frequency and severity of NSSI, and symptoms of borderline personality disorder (BPD). A latent class analysis using youth's specific NSSI functions as indicators found two NSSI function typologies, which were differentially associated with clinical correlates. The Multiple Functions class (n = 28) endorsed to "feel something," "punish self," "escape feelings," "relieve anxiety," "stop feeling self-hatred," "stop feeling angry," "show much they are hurting," and "create a hurt that can be soothed." Conversely, the Single/Avoidant Function class (n = 40) endorsed one primary function-i.e., to "escape feelings." Youth in the Multiple Functions class reported significantly more frequent self-injury and greater BPD symptomology. The present study illustrates the importance of examining constellations of specific NSSI functions in inpatient care settings, given their unique associations with NSSI frequency and features of BPD. These findings could inform targeted psychological screening and, in turn, guide the implementation of interventions for elevated NSSI frequency and BPD symptomology among inpatient youth, based on NSSI functions endorsed.
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Affiliation(s)
- Leah Sack
- Department of Psychology, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 1V4, Canada.
| | - Jessica A Seddon
- Department of Psychology, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 1V4, Canada
| | | | - Kristel Thomassin
- Department of Psychology, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 1V4, Canada
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3
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Barkauskienė R, Sharp C, Kerr S, Gaudiešiūtė E, Goth K, Skabeikytė-Norkienė G. Examining the Validity of the Levels of Personality Functioning Questionnaire for Adolescents Aged 12-18 (LOPF-Q 12-18): A Replication and Extension With a Sample of Lithuanian Adolescents. J Pers Disord 2024; 38:330-349. [PMID: 39093632 DOI: 10.1521/pedi.2024.38.4.330] [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: 08/04/2024]
Abstract
With the shift to the dimensional model of personality pathology, the need for measures assessing personality functioning in adolescence has emerged. The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) was developed specifically for adolescents, tailoring the Alternative Model of Personality Disorders in the DSM-5. Using the Lithuanian LoPF-Q 1218, we further investigate its validity by reexamining its factorial structure and extending convergent, discriminant, and incremental validity analyses. A total of 1,048 community-based and clinically referred 12-18-year-old adolescents completed the LoPF-Q 12-18 along with other self-report measures of personality pathology, psychopathological symptoms, and psychosocial functioning. In line with previous findings, the results supported the bifactor model consisting of a strong general factor and little multidimensionality caused by the group factors, overall suggesting an essentially unidimensional structure. Further analyses provided additional information on the construct validity of the LoPF-Q 12-18.
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Affiliation(s)
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
| | - Sophie Kerr
- Department of Psychology, University of Houston, Houston, Texas
| | | | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, University Clinics Saarland, Homburg, Germany
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4
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Berg L, Pringsheim TM, Lerario M, Martino D. Psychological Factors Associated with Functional Tic-like Behaviours during the COVID-19 Pandemic. Res Child Adolesc Psychopathol 2024; 52:1157-1172. [PMID: 38427218 DOI: 10.1007/s10802-024-01184-y] [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] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
Functional tic-like behaviours (FTLB) are a female predominant functional neurological disorder that escalated in incidence during the SARS CoV2 pandemic. This study compared social and adaptive functioning, social media use, pandemic experiences, and psychiatric comorbidities between FTLB (n = 35), Tourette Syndrome (TS) (n = 22), and neurotypical (NT) (n = 25) participants ages 11 to 25 years. The psychiatric comorbidity burden for participants with FTLB was formidable, with frequencies ranging from 1.5 to 10 times higher for major depressive disorder and panic disorder compared to TS and NT participants. Borderline personality disorder (BPD), agoraphobia, social anxiety disorder, and generalized anxiety disorder were also significantly more common in FTLB compared to NT participants. Vulnerable attachment scores, social phobia and social interaction anxiety symptoms were higher in participants with FTLB than NT but not TS. Overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic and TS content were not significantly different between groups. FTLB participants rated their mental health declined more severely during the pandemic than both TS and NT participants and were more likely to experience trouble sleeping, loneliness, and difficulty affording housing and food than NT participants. Participants with FTLB were significantly more likely to identify as gender minority people than TS and NT, though there were no significant differences based on gender identity in the study variables within the FTLB group. The association and potential pathways explaining how psychiatric disorders may be contributing to FTLB, and why certain groups appear at particular risk are discussed.
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Affiliation(s)
- Lindsay Berg
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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5
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Balzen KM, Blacutt M, Lind M, Penner F, Sharp C. Awareness of Narrative Identity Questionnaire (ANIQ) in Early Adolescents: Psychometric Evaluation and Association with Features of Personality Disorder. J Pers Assess 2024; 106:337-346. [PMID: 37732705 DOI: 10.1080/00223891.2023.2258979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023]
Abstract
Identity formation is central to adolescent development. Challenges in establishing a stable sense of self is associated with maladaptive identity function, which has been recognized as a core feature of personality pathology. The narrative identity framework offers a unique lens to garner salient information about one's sense of self. The Awareness of Narrative Identity Questionnaire (ANIQ) is a self-report measure of narrative identity validated in adults but is yet to be validated in adolescents. The current study aimed to conduct the first psychometric evaluation of the ANIQ in a sample of 205 youth aged 10-14 years (M = 12.1 ± 1.06 years; 50.7% female; 73.7% Hispanic) recruited from a public charter school. Results confirmed the four-factor structure of the ANIQ and showed high internal consistency. Convergent validity was supported through negative associations between the ANIQ and borderline personality features and identity diffusion. Incremental validity of the ANIQ over identity diffusion in predicting borderline personality features was also examined, but not supported. Overall, results support the ANIQ as a promising instrument for the assessment of narrative identity in youth. However, some improvements to the ANIQ might be necessary in order to use it as a clinical tool in identifying youth with personality pathology.
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Affiliation(s)
| | | | - Majse Lind
- Department of Psychology, Aalborg University
| | | | - Carla Sharp
- Department of Psychology, University of Houston
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6
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Johnsen L, Bird JC, Salkovskis P, James AC, Stratford HJ, Sheaves B. Sleep disruption in adolescent inpatients: prevalence, associations with clinical outcomes, and clinician perspectives. J Sleep Res 2024; 33:e14056. [PMID: 37787462 DOI: 10.1111/jsr.14056] [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: 04/07/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Sleep problems are common for adolescents with psychiatric disorders, and sleep treatment may aid mental health recovery. Inpatient admissions are likely a particularly challenging time for sleep. Despite this little is known about the nature of sleep problems, and how sleep treatments could be optimised for this setting. This mixed-methods study set out to better understand sleep disturbances in adolescent inpatients. Study 1 examined the prevalence of Sleep Condition Indicator-assessed insomnia at admission and associations with psychiatric symptoms and admission length in 100 inpatients (aged 11-17 years) on one unit in Oxford. Data were gathered from admission routine measures and medical records. Associations were analysed using linear regressions. Half of the inpatients (n = 50) screened positive for insomnia at admission. Moderate-large significant associations were observed between more severe insomnia and more severe depression (β = -0.56), anxiety (β = -0.51), self-harm (β = -0.49), psychotic experiences (β = -0.32), and conduct problems (β = -0.30), but not admission length. Study 2 gained 12 clinicians' perspectives on sleep problems on the unit via a focus group and semi-structured interviews, analysed using thematic analysis. Ward staff observed insomnia and excessive daytime sleepiness in adolescent inpatients and a reciprocal relationship with mental health symptoms. Ward processes were barriers (e.g., night-time observations) and facilitators (e.g., regular routines) of sleep. Cognitive behavioural therapy for insomnia was not routinely offered but viewed as potentially helpful. Insomnia may be a common problem for adolescent inpatients, associated with greater psychopathology, but not admission length. The possible benefits of psychological sleep interventions for adolescents admitted to psychiatric units now require testing.
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Affiliation(s)
- Laura Johnsen
- Berkshire Healthcare NHS Foundation Trust, Thatcham, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Salkovskis
- The Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Bryony Sheaves
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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7
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Bud S, Szentágotai-Tătar A. Assessing Measurement Consistency: A Study of the BPFSC Invariance Across Age and Sex in Romanian Adolescents. Psychol Rep 2024:332941241239592. [PMID: 38508200 DOI: 10.1177/00332941241239592] [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: 03/22/2024]
Abstract
The Borderline Personality Feature Scale for Children (BPFSC) is a widely used instrument and currently the only dimensional measure to investigate Borderline Personality features in children and adolescents. The present study aimed to investigate the factor structure and measurement invariance across age and sex in a community sample of 634 adolescents (mean age = 16.72, standard deviation = 1.31). To test for measurement invariance, we conducted multi-group confirmatory factor analysis (MG-CFA). Analysis showed residual invariance across age and sex. Based on the results, we conclude that BPFSC is a valid and reliable instrument to assess Borderline Personality features in adolescents. Implications for evidence-based assessment of Borderline Personality features in adolescence are discussed.
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Affiliation(s)
- Samuel Bud
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentágotai-Tătar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
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8
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Benzi IMA, Fontana A, Di Pierro R, Parolin L, Ensink K. Unpacking the p-factor. Associations Between Maladaptive Personality Traits and General Psychopathology in Female and Male Adolescents. Res Child Adolesc Psychopathol 2024; 52:473-486. [PMID: 37938410 PMCID: PMC10896943 DOI: 10.1007/s10802-023-01146-w] [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] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
Adolescence is a period of rapid physical, psychological, and neural maturation that makes youth vulnerable to emerging psychopathology, highlighting the need for improved identification of psychopathology risk indicators. Recently, a higher-order latent psychopathology factor (p-factor) was identified that explains latent liability for psychopathology beyond internalizing and externalizing difficulties. However, recent proposals suggest reconceptualizing the p-factor model in terms of impairments in personality encompassing difficulties in both self-regulation (borderline features) and self-esteem (narcissistic features), but this remains untested. To address this, this study examined the p-factor structure and the contribution of borderline and narcissistic features using two cross-sectional data collections. In Study 1, 974 cisgender adolescents (63% assigned females at birth; age range: 13-19; Mage = 16.68, SD = 1.40) reported on internalizing and externalizing problems (YSR) to test via structural equation models (SEM) different theoretical models for adolescent psychopathology. In Study 2, 725 cisgender adolescents (64.5% assigned females at birth; age range: 13-19; Mage = 16.22, SD = 1.32) reported internalizing and externalizing problems (YSR), borderline personality features (BPFSC-11), and narcissistic personality traits (PNI), to explore, via SEM, the contribution of borderline and narcissistic traits to the p-factor and accounting for gender differences. Results confirmed the utility of a bi-factor model in adolescence. Furthermore, findings highlighted the contribution of borderline features and narcissistic vulnerability to general psychopathology. The study provides the first evidence supporting a p-factor model reconceptualized in terms of personality impairments encompassing difficulties in self-regulation and self-esteem in adolescents.
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Affiliation(s)
- Ilaria Maria Antonietta Benzi
- Department of Brain and Behavioral Sciences, University of Pavia, Piazza Botta Adorno Antoniotto, 11, 27100, Pavia, Italy.
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | | | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Karin Ensink
- Department of Psychology, Laval University, Quebec, QC, Canada
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9
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James KM, Balderrama-Durbin C, Israel E, Feurer C, Gibb BE. Self- and co-regulation of physiological activity during mother-daughter interactions: The role of adolescent non-suicidal self-injury. J Child Psychol Psychiatry 2024; 65:91-99. [PMID: 37469027 PMCID: PMC10796835 DOI: 10.1111/jcpp.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern that is thought to increase risk for future self-injurious behaviors, including suicide attempts. Notably, NSSI is especially prevalent among adolescents, which underscores a critical need to identify modifiable risk factors that could be targeted to reduce future risk. The current study examined self- and co-regulation of physiological responses during mother-daughter interactions in adolescent girls with and without a history of NSSI. METHODS Participants were 60 girls aged 13-17 with (n = 27) and without (n = 33) a history of NSSI and their mothers. Adolescents and their mothers completed positive and negative interaction tasks during which physiological reactivity was assessed via respiratory sinus arrhythmia (RSA). RESULTS Using Actor-Partner Interdependence Modeling (APIM), we found that adolescents with an NSSI history demonstrated a higher RSA setpoint than adolescents without this history during the negative, but not positive, interaction task. In addition, there were differences in co-regulation during the negatively valenced interaction, such that mothers of daughters with NSSI were more reactive to fluctuations in their daughters' RSA than mothers of daughters without an NSSI history. CONCLUSIONS These findings highlight intra- and interpersonal aspects of physiological dysregulation associated with NSSI that could provide promising targets of intervention to reduce future risk in adolescent girls.
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Affiliation(s)
| | | | - Elana Israel
- Binghamton University (SUNY), Department of Psychology
| | - Cope Feurer
- University of Illinois Chicago, Department of Psychiatry
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10
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Boone K, Whalen DJ, Barch DM, Luby JL, Luking KR. Self-Reported Gonadal Pubertal Timing Predicts Adolescent Borderline Personality Symptoms: Two Extended Replications With Prospective and Cross-Sectional Data. J Pers Disord 2023; 37:661-677. [PMID: 38038660 DOI: 10.1521/pedi.2023.37.6.661] [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: 12/02/2023]
Abstract
The current study investigated the understudied relationship between pubertal timing and borderline personality disorder (BPD) symptoms in males and females. We conducted hierarchical linear regressions in a longitudinal Cohort 1 (N = 117) and a cross-sectional Cohort 2 (N = 127). Cohort 1: Pubertal timing was self-reported at age 10; BPD symptoms and covariates were assessed between ages 13 and 19. Cohort 2: All assessments were between ages 8 and 12. Covariates: race, age, internalizing and externalizing symptoms, and income-to-needs ratio. Sex differences were examined post hoc. In Cohort 1, early gonadal timing was associated with more BPD symptoms in females (beta = .46, p = .002), and late gonadal timing was associated with more BPD symptoms in males (beta = -.23, p = .035). In Cohort 2, early gonadal timing was associated with more BPD symptoms (beta = .21, p = .033) without sex moderation. Results indicate that early gonadal development could be a risk indicator for the emergence of BPD in adolescence, particularly in females, which could inform causal mechanisms and intervention targets.
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Affiliation(s)
- Kiran Boone
- Department of Psychology, Washington University in St. Louis
| | - Diana J Whalen
- Department of Psychology, Washington University in St. Louis
| | - Deanna M Barch
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine in St. Louis
| | - Joan L Luby
- Department of Psychology, Washington University in St. Louis
- Department of Psychiatry, Washington University School of Medicine in St. Louis
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11
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Robinson Lake J, Bear N, Fletcher C, Pace G, Salmin I, Brealey G. The impact of a combined mentalisation-based therapy and therapeutic community programme for adolescents with borderline personality disorder traits on service utilisation in Western Australia. Personal Ment Health 2023; 17:300-312. [PMID: 36960575 DOI: 10.1002/pmh.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 03/25/2023]
Abstract
This study assessed the effect of a mentalisation-based therapy (MBT) treatment programme on the utilisation of Western Australian public hospitals for mental health presentations over an 18-month period. Hospital data included the number of visits to the emergency department (ED), the number of inpatient admissions to hospital and length of stay of the admissions. Participants included 76 adolescents aged 13-17 years old, who presented with borderline personality disorder (BPD) traits. The Touchstone treatment programme is a time-limited intensive programme that utilises MBT in the context of a therapeutic community. Hospital data for the participants were collected and analysed from three time points; 6 months prior to attending the programme, during the 6-month programme (active treatment) and 6 months after the programme. Results found a statistically significant decrease in hospital utilisation from pre to post programme, with a decline in ED visits, inpatient admissions and admission length of stay. This study presents promising preliminary evidence for the effectiveness of an intensive MBT programme as an intervention for adolescents with BPD features and has significant implications for the public health system in terms of providing effective community-based treatment for this difficult to treat population as well as reducing pressure on tertiary care.
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Affiliation(s)
- Jemima Robinson Lake
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Natasha Bear
- Child and Adolescent Health Service, Bentley, Western Australia, Australia
| | - Carl Fletcher
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Giulia Pace
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Ivan Salmin
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Georgia Brealey
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
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12
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Zimmermann R, Konjufca J, Sakejo P, Kilonzo M, Quevedo Y, Blum K, Biba E, Mosha T, Cottin M, Hernández C, Kaaya S, Arenliu A, Behn A. Mental Health Information Reporting Assistant (MHIRA)-an open-source software facilitating evidence-based assessment for clinical services. BMC Psychiatry 2023; 23:706. [PMID: 37784115 PMCID: PMC10544613 DOI: 10.1186/s12888-023-05201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.
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Affiliation(s)
- Ronan Zimmermann
- Psychiatric University Hospitals of Basel, Basel, Switzerland.
- Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Jon Konjufca
- Faculty of Psychology, University of Basel, Basel, Switzerland
- University of Prishtina "Hasan Prishtina", Pristina, Kosovo
| | - Peter Sakejo
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mrema Kilonzo
- Faculty of Psychology, University of Basel, Basel, Switzerland
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Yamil Quevedo
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Kathrin Blum
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | | | | | - Marianne Cottin
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Universidad Finis Terrae, Santiago, Chile
| | - Cristóbal Hernández
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Universidad Adolfo Ibáñez, Santiago, Chile
| | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Alex Behn
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
- Pontificia Universidad Católica de Chile, Santiago, Chile
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13
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Keating L, Wilson S, Dainty J, Jones D, Hill J. Finding Voices: a survey of young people's experiences of the ED. Emerg Med J 2023; 40:708-714. [PMID: 37586788 PMCID: PMC10579507 DOI: 10.1136/emermed-2023-213299] [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: 04/23/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Mental health presentations in young people are increasing. Recurrence of self-harm (SH) presentations is common and of great concern since self-harm is known to be a risk factor for suicide. Previous reports suggest that the ED experience for this group is poor. A study was carried out at the Royal Berkshire NHS Foundation Trust. The objective was to pilot new and existing measures to capture the perceived needs and expectations of young people attending ED following SH compared with those attending with suspected fractures (SFs). METHODS Young people were approached to complete a questionnaire as they arrived in ED and again before they left. Questionnaires were a combination of pre-existing tools as well as piloting novel questions specific to the ED where no suitable tool previously existed. Satisfaction with the ED treatment was measured along with reattendance up to one year later. RESULTS The survey was started in 2019 and suspended in March 2020 at the outset of the COVID-19 pandemic and subsequently closed, having screened 917 and recruited 104 adolescents. All the measures showed satisfactory psychometric properties with internal consistencies (alpha) of over 0.75. The two patient groups differed at baseline: it was found that the SH group had lower mood on the Short Mood and Feelings Questionnaire (p<0.001) and scored more highly on the Borderline Personality Features Scale for Children than the SF group (p<0.001) but the expectations of care across both groups was similar. Using the experience measures, the SH group was less satisfied with treatment than the SF group (p=0.0263). CONCLUSION Our findings underline the similarities between the two groups in terms of their expectations of care. Terminating the study early at the outset of the COVID-19 pandemic has precluded any further firm conclusions to be drawn. Further research is needed.
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Affiliation(s)
- Liza Keating
- University Department of Emergency Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Sarah Wilson
- Emergency Department, Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Jack Dainty
- Faculty of Medicine and Health Sciences, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| | - Dominic Jones
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Hill J, Fonagy P, Osel T, Dziobek I, Sharp C. The social domains organization of mentalizing processes in adolescents: a contribution to the conceptualization of personality function and dysfunction in young people. J Child Psychol Psychiatry 2023; 64:1470-1479. [PMID: 37259851 DOI: 10.1111/jcpp.13838] [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] [Accepted: 04/12/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND We propose and evaluate a contribution to the conceptualization and assessment of personality functioning based on social domains and mentalizing hypotheses. Social domains are distinct social contexts, such as with acquaintances and friends, with differentiated expectations regarding participants' behaviours and social attributions. The capacity to organize social participation according to these expectations requires the ability, we suggest, to modulate mentalizing processes domain by domain. Drawing on evidence that social domain organization is impaired in borderline personality disorder (BPD) and that hypermentalizing, a heightened interpretation of others' motives, thoughts or emotions, is elevated in adolescent BPD, we hypothesized that hypermentalizing levels in adolescents will vary by social domain and that elevated BPD features will be associated with impairment of this domain organization of hypermentalizing. METHODS Measures including the borderline personality features scale for children (BPFSC) and the movie for the assessment of social cognition (MASC) were administered to 171 adolescents aged 12-17 recruited from public schools and community organizations in a large metropolitan area in southwestern United States. Mean hypermentalizing scores were computed for adolescent interpretations of sequences in the MASC focusing on the social domains of acquaintance, friends and romantic interactions. RESULTS There was a progressive increase in hypermentalizing scores across the acquaintance, friends and romantic interactions (repeated measures ANOVA, p < .001, all pairwise comparisons, p ≤ .02), which was markedly reduced in the presence of elevated BPD features (interaction term, p = .007). CONCLUSIONS Hypermentalizing is organized according to social domain and this organization is impaired in the presence of elevated BPD features. The findings are consistent with the proposal that personality functioning entails a social domains organization of hypermentalizing, which is impaired in personality dysfunction. Identifying mentalizing processes domain by domain has the potential to create a personalized focus for the treatment of adolescents with personality difficulties.
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Affiliation(s)
- Jonathan Hill
- School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Philosophy, University of Reading, Reading, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Tiziana Osel
- School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Isabel Dziobek
- Institut fur Psychologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
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15
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Kerr S, McLaren V, Cano K, Vanwoerden S, Goth K, Sharp C. Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18): Factor Structure, Validity, and Clinical Cut-Offs. Assessment 2023; 30:1764-1776. [PMID: 36124366 PMCID: PMC10200067 DOI: 10.1177/10731911221124340] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) is the only self-report measure informed by the Level of Personality Functioning (Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5; American Psychiatric Association, 2013]) Alternative Model of Personality Disorders developed for adolescents. The present investigation includes two studies evaluating the English LoPF-Q 12-18. In Study 1, single-factor and bifactor structures (unidimensional severity criterion and four specific factors: identity, self-direction, empathy, intimacy) were evaluated in an ethnically diverse community sample (N = 453; age 10-18; 57% female). Study 2 used a community control (n = 298; age 10-18; 54.4% female) and clinical sample (n = 94; age 11-18; 58.5% female) to examine reliability, validity, and clinical utility. Study 1 results supported the bifactor model, with a robust general factor and little multidimensionality caused by the group factors, suggesting an essentially unidimensional structure. Study 2 revealed good internal consistency and construct validity and provided clinical cut-offs, supporting the use of the LoPF-Q 12-18 total score in research and clinical applications.
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Affiliation(s)
| | | | | | | | - Kirstin Goth
- Psychiatric University Clinics Basel, Switzerland
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16
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Vanwoerden S, McLaren V, Stepp SD, Sharp C. Are We Thinking about the Same Disorder? A Trifactor Model Approach to Understand Parents' and Their Adolescents' Reports of Borderline Personality Pathology. J Pers Assess 2023; 105:487-498. [PMID: 35191795 PMCID: PMC9393208 DOI: 10.1080/00223891.2022.2039165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/05/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
Multiple informant assessment is the norm when evaluating borderline personality pathology (BPP) in adolescence, especially by including reports from both parents and adolescents. However, these reports tend to be discrepant, and it is unclear how to integrate. The current study used a trifactor model to isolate sources of variance in parents' and adolescents' reports of BPP due to their shared and unique perspectives in a sample of 652 inpatient adolescents (63% female; Mage = 15.31, SD = 1.45) and their parents (81% mothers). Consensus/agreement was characterized by the externalizing features of BPP whereas idiosyncratic views of adolescent BPP covered the full latent BPP construct, suggesting that simple aggregation of parent and adolescent reports is inappropriate. Measurement invariance suggested that unique perspectives were characterized by slightly different operationalizations of BPP and response biases for specific features of BPP. Attachment security and parents' interpersonal problems predicted shared and unique perspectives differently for female and male adolescents. Lastly, we found that shared and unique perspectives differentially predicted interview based BPP, length of stay, and adolescent mentalizing. In sum, findings replicate previous evidence of parent-child informant discrepancy in youth psychopathology, broadly, and provide insights specific to BPP. Discussion includes practical recommendations for assessment and interpretation of BPP assessment.
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Affiliation(s)
| | | | | | - Carla Sharp
- Department of Psychology, University of Houston
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17
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Calvo N, Marin JL, Vidal R, Sharp C, Duque JD, Ramos-Quiroga JA, Ferrer M. Discrimination of Borderline Personality Disorder (BPD) and Attention-Deficit/Hyperactivity Disorder (ADHD) in adolescents: Spanish version of the Borderline Personality Features Scale for Children-11 Self-Report (BPFSC-11) Preliminary results. Borderline Personal Disord Emot Dysregul 2023; 10:15. [PMID: 37189168 DOI: 10.1186/s40479-023-00223-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/05/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Although the diagnosis of Borderline Personality Disorder (BPD) during adolescence has been questioned, many recent studies have confirmed its validity. However, some clinical manifestations of BPD could be identifiable in adolescents with other pathologies, such as Attention-Deficit/Hyperactivity Disorder (ADHD). The objective of the present study is to examine the capacity of the self-report Borderline Personality Features Scale Children-11 (BPFSC-11) to discriminate between BPD and ADHD adolescents. METHODS One hundred and forty-five participants were grouped based on their diagnosis: 58 with BPD, 58 with ADHD, and 29 healthy volunteers as a control group. Between-group differences and the ROC curve were performed to test if the total score for the BPFSC-11 and/or its factors can significantly discriminate between BPD and other adolescent groups. RESULTS The results show that the total BPFSC-11 score has good discriminant capacity among adolescents diagnosed with BPD, ADHD and healthy volunteers. However, different patterns of discriminative capacity were observed between the three groups for emotional dysregulation and impulsivity/recklessness factors. CONCLUSIONS Our results support the hypothesis that the BPFSC-11 is an adequate instrument for discriminating between BPD and ADHD in adolescents, who can present significant psychopathological overlap. Tools to identify BPD in adolescence, as well as for better differential diagnosis, would improve the possibility of offering specific treatments targeting these populations.
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Affiliation(s)
- Natalia Calvo
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain.
- Psychiatry, Mental Health and Addictions Group. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Grup TLP Barcelona (Grup TLP BCN), Barcelona, Spain.
| | - Jorge Lugo Marin
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Group. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Raquel Vidal
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Group. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carla Sharp
- Department of Psychology, University of Houston, Texas, USA
| | - Juan D Duque
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
| | - Josep-Antoni Ramos-Quiroga
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Group. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Grup TLP Barcelona (Grup TLP BCN), Barcelona, Spain
| | - Marc Ferrer
- Psychiatry Department, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Hospital Universitari Vall d'HebronUniversitat Autònoma de Barcelona, Passeig Vall d´Hebron 119-129, 08035, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Group. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Grup TLP Barcelona (Grup TLP BCN), Barcelona, Spain
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18
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James KM, Balderrama-Durbin C, Kobezak HM, Recchia N, Foster CE, Gibb BE. Dynamics of Affective Reactivity during Mother-Daughter Interactions: The Impact of Adolescent Non-Suicidal Self-Injury. Res Child Adolesc Psychopathol 2023; 51:597-611. [PMID: 36607473 DOI: 10.1007/s10802-022-01011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
Non-suicidal self-injury (NSSI) is an alarming public health concern that is particularly widespread among adolescents. The current study examined affective responses during mother-daughter interactions in adolescent girls with and without a history of NSSI. Participants were 60 girls aged 13-17 with (n = 27) and without (n = 33) a history of NSSI and their mothers. Adolescents and their mothers completed two interaction tasks: one positive and one negative. During these interactions, facial affect was assessed via electromyography (EMG). Results of Actor-Partner Interdependence Modeling (APIM) revealed several intra- and interpersonal disruptions in affect during both tasks among dyads in which the adolescent had an NSSI history. Findings suggest deficits in both self- and co-regulation of facial affect during mother-daughter interactions involving dyads in which the adolescents reports NSSI. Ultimately, if replicated and extended in longitudinal research, these disruptions may prove to be promising targets of intervention to reduce risk for future NSSI in adolescent girls.
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Affiliation(s)
- Kiera M James
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902, USA. .,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15260, USA.
| | | | - Holly M Kobezak
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902, USA
| | - Nicolette Recchia
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902, USA
| | - Claire E Foster
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902, USA
| | - Brandon E Gibb
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY, 13902, USA
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19
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Maladaptive Self- and Interpersonal Functioning Increments General Psychiatric Severity in the Association with Adolescent Personality Pathology. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010120. [PMID: 36670670 PMCID: PMC9856791 DOI: 10.3390/children10010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Dimensionalized diagnostic systems, especially the entry criterion of maladaptive self and interpersonal functioning, hold particular advantages for the downward extension of personality pathology to young persons, but require conceptual clarification. The current study evaluated the distinctiveness of maladaptive self and interpersonal functioning by examining its incremental value over and above general psychiatric severity in the association with personality pathology. A community sample of N = 419 youth (50.4% female; Mage = 11.91, SD = 1.19) between the ages of 10 and 14 completed measures of maladaptive self- and interpersonal functioning, general psychiatric severity (internalizing-externalizing spectrum), and personality pathology. Results showed that, as expected, maladaptive self- and interpersonal functioning incremented general psychiatric severity in the association with personality pathology in adolescents. Results contribute to the literature base illustrating the value of the entry criterion of the ICD-11 and AMPD diagnostic system.
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20
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Bogaerts A, Claes L, Raymaekers K, Buelens T, Bastiaens T, Luyckx K. Trajectories of adaptive and disturbed identity dimensions in adolescence: developmental associations with self-esteem, resilience, symptoms of depression, and borderline personality disorder features. Front Psychiatry 2023; 14:1125812. [PMID: 37168080 PMCID: PMC10165116 DOI: 10.3389/fpsyt.2023.1125812] [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: 12/16/2022] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
To advance our understanding of adolescents' identity formation and how it may play into their psychological functioning, this study investigated developmental trajectory classes of adaptive and disturbed dimensions of identity formation, and whether adolescents belonging to different trajectory classes develop differently on self-esteem, resilience, symptoms of depression, and borderline personality disorder (BPD) features. Three-wave longitudinal data from 2,123 Flemish adolescents was used (54.2% girls; Mage = 14.64, range = 12-18 at T1). Results pointed to four trajectory classes of identity formation: adaptive identity, identity progression, identity regression, and diffused identity. The adaptive identity class presented with stable high levels of self-esteem and resilience, and stable low levels of symptoms of depression and BPD, whereas opposite results were obtained for the diffused identity class. The identity progression class reported an increase in self-esteem and resilience as well as a decrease in symptoms of depression and BPD, whereas opposite results were obtained for the identity regression class. These results emphasize that adaptive and disturbed dimensions of identity formation are closely related to markers of well-being and psychopathology among adolescents, and could help identify adolescents with an increased risk for negative psychological functioning or increased opportunity for positive psychological functioning.
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Affiliation(s)
- Annabel Bogaerts
- Department of Clinical Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Annabel Bogaerts,
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Koen Raymaekers
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek, Brussels, Belgium
| | - Tinne Buelens
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Tim Bastiaens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Kortenberg, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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21
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James KM, Miskovic V, Woody ML, Owens M, Connolly E, Gibb BE. Attentional capture by angry faces in girls who self-injure: Evidence from steady state visual evoked potentials. Suicide Life Threat Behav 2022; 52:1149-1158. [PMID: 35965476 PMCID: PMC9742197 DOI: 10.1111/sltb.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/08/2022] [Accepted: 07/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a significant public health concern, not only because of the personal and social cost of the behavior itself, but also because it increases risk for future self-injurious behaviors, including suicide attempts. NSSI is increasingly prevalent during adolescence, which highlights the need for research aimed at identifying modifiable risk factors that can be targeted to reduce future risk. Building from theoretical models that highlight interpersonal processes, this study examined whether adolescents with an NSSI history exhibit greater difficulty inhibiting attention to emotionally salient interpersonal stimuli (face), indexed via steady state visual evoked potentials (SSVEPs), which provide a direct neural index of the ability to inhibit attention to task-irrelevant stimuli. METHODS Adolescent girls aged 13-17 with (n = 26) and without (n = 28) an NSSI history completed a change-detection computer task during which frequency-tagged SSVEPs were used to assess adolescents' ability to inhibit attention to affectively salient stimuli from spatially superimposed targets. RESULTS Compared with adolescents with no NSSI history, adolescents with NSSI demonstrated difficulty inhibiting attention to angry adult faces. CONCLUSIONS These findings underscore specific deficits in attentional filtering among girls with an NSSI history, which, if replicated and extended, could be a promising intervention target for reducing risk for future NSSI.
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Affiliation(s)
- Kiera M. James
- Binghamton University (SUNY), Department of Psychology
- University of Pittsburgh, Department of Psychology
| | | | | | - Max Owens
- University of South Florida St. Petersburg
| | - Evan Connolly
- Binghamton University (SUNY), Department of Psychology
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22
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The Effects of Childhood Emotional and Physical Maltreatment on Adolescents' Disordered Eating Behaviors: The Mediating Role of Borderline Personality Features. J Nerv Ment Dis 2022; 210:831-837. [PMID: 35703279 DOI: 10.1097/nmd.0000000000001556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over time, a complex crossroad between disordered eating behaviors (DEBs) and borderline personality features (BPFs) and their association with childhood emotional and physical maltreatment have been established. The present study aimed at evaluating the direct and indirect effect of physical and emotional abuse and neglect on DEB via BPF in a nonclinical adolescent sample. A total of 786 adolescents (48.3% male; mean age, 16.25 years; SD, 1.76) participated in the study. The mediation model suggested the pivotal predictive role of emotional maltreatment compared with the physical one. Indeed, both emotional abuse and neglect directly and indirectly predicted disordered eating via BPF ( β = 0.097; p < 0.001 and β = 0.042; p < 0.01, respectively). Likely, the emotional maltreatment represents the beginning of a developmental cascade that culminates in DEB as a maladaptive coping strategy in response to negative emotions, through BPF. On the contrary, physical maltreatment seems to be less involved in the developmental cascade.
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23
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Zimmermann R, Steppan M, Zimmermann J, Oeltjen L, Birkhölzer M, Schmeck K, Goth K. A DSM-5 AMPD and ICD-11 compatible measure for an early identification of personality disorders in adolescence–LoPF-Q 12–18 latent structure and short form. PLoS One 2022; 17:e0269327. [PMID: 36129913 PMCID: PMC9491532 DOI: 10.1371/journal.pone.0269327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
The LoPF-Q 12–18 (Levels of Personality Functioning Questionnaire) was designed for clinical use and to promote early detection of personality disorder (PD). It is a self-report measure with 97 items to assess personality functioning in adolescents from 12 years up. It operationalizes the dimensional concept of personality disorder (PD) severity used in the Alternative DSM-5 Model for Personality Disorders and the ICD-11. In this study, we investigated the factorial structure of the LoPF-Q 12–18. Additionally, a short version was developed to meet the need of efficient screening for PD in clinical and research applications. To investigate the factorial structure, several confirmatory factor analysis models were compared. A bifactor model with a strong general factor and four specific factors showed the best nominal fit (CFI = .91, RMSEA = .04, SRMR = .07). The short version was derived using the ant colony optimization algorithm. This procedure resulted in a 20-item version with excellent fit for a hierarchical model with four first order factors to represent the domains and a secondary higher order factor to represent personality functioning (CFI = .98, RMSEA = .05, SRMR = .04). Clinical validity (effect size d = 3.1 between PD patients and controls) and clinical utility (cutoff ≥ 36 providing 87.5% specificity and 80.2% sensitivity) for detecting patients with PD were high for the short version. Both, the long and short LoPF-Q 12–18 version are ready to be used for research and diagnostic purposes.
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Affiliation(s)
- Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
- Division of Developmental and Personality Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Lara Oeltjen
- Department of Psychological Methods, Institute of Psychology, Friedrich-Schiller-Universität Jena, Jena, Germany
| | - Marc Birkhölzer
- Juvenile Forensic Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Kirstin Goth
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
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24
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Sharp C, McLaren V, Musetti A, Vanwoerden S, Hernandez Ortiz J, Schmeck K, Birkhoelzer M, Goth K. The Assessment of Identity Development in Adolescence (AIDA) Questionnaire: First Psychometric Evaluation in Two North American Samples of Young People. J Pers Assess 2022:1-12. [PMID: 36121311 DOI: 10.1080/00223891.2022.2119860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The Assessment of Identity Development in Adolescence (AIDA) is a recently developed measure of identity diffusion in young people. Originally validated in Switzerland, the English version has not yet been validated. Our aim was to evaluate the AIDA's internal factor structure, internal consistency, incremental validity, and relations to other variables in adolescents and young adults and derive clinical cutoffs for use in clinical settings. Study 1, involving 2,119 undergraduate students between the ages of 18-25 years, confirmed the expected bi-factor structure for the AIDA. Study 2 involved the recruitment of 122 adolescent inpatients (ages 12-17), of whom 36 met full DSM-based criteria for Borderline Personality Disorder, in addition to 164 adolescents of the same age, recruited from public schools (total 286 adolescents). Results of both studies demonstrated strong internal consistency and correlations of the expected magnitude and direction with other self-report measures of personality pathology. In addition, Study 2 demonstrated that the AIDA could successfully discriminate between adolescent inpatients with and without BPD, as well as healthy controls, and established preliminary clinical cutoffs that should be replicated in future studies. In all, these studies provide support for further validation and use of the AIDA in young people.
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25
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Affiliation(s)
- Carla Sharp
- From the Department of Psychology, University of Houston, Houston
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26
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Balzen KM, Goette WF, Sachs R, Krantz SM, Heerschap J, Kennard BD, Emslie GJ, Stewart SM. Borderline personality features influence treatment response to suicide prevention. J Affect Disord 2022; 311:515-522. [PMID: 35623481 DOI: 10.1016/j.jad.2022.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Suicide is a notable risk for individuals with features of borderline personality disorder. Given the centrality of interpersonal difficulties in this disorder, we proposed that the negative interpersonal cognitions (perceived burdensomeness and thwarted belongingness) identified by the Interpersonal Theory of Suicide (IPTS) may explain the associations between suicidal ideation and borderline personality features. METHOD Participants were 322 suicidal youth (74% girls) aged 11-18 years (M, SD = 14.74, 1.6) in an intensive outpatient program in the southwest United States. Youth completed measures assessing borderline personality features at program entry, and suicidal ideation and IPTS variables at entry and exit. RESULTS Borderline personality features did not moderate associations of IPTS variables and suicidal ideation. For the entire sample, changes in suicidal ideation from entry to discharge occurred in tandem with changes in perceived burdensomeness and depressive symptoms, but not thwarted belongingness. Youth with elevated borderline personality features entered with greater suicidal ideation, but improved more from treatment entry to exit. Regardless of level of borderline personality features, changes in negative interpersonal cognitions over treatment were associated with changes in suicidal ideation. LIMITATIONS Self-report measures and lack of sample diversity are study limitations. CONCLUSIONS This research highlights the clinical utility of the IPTS variables and the importance of promoting competence and interpersonal connectedness when treating this population. Findings indicate that the IPTS variables carry the same fundamental information for contributing to suicidal ideation, regardless of level of borderline personality features.
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Affiliation(s)
- Kennedy M Balzen
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - William F Goette
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Raney Sachs
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Savannah M Krantz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Jessica Heerschap
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Betsy D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Graham J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America
| | - Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, United States of America; Department of Psychiatry, Children's Health Children's Medical Center, Dallas, TX, United States of America.
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Biberdzic M, Grenyer BF, Normandin L, Ensink K, Clarkin JF. A bifactor model of personality organization in adolescence: the validity of a brief screening measure assessing severity and core domains of functioning. BMC Psychiatry 2022; 22:459. [PMID: 35804330 PMCID: PMC9270814 DOI: 10.1186/s12888-022-03926-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Both the latest edition of the DSM-5 as well as the new ICD-11 have established a new focus in the diagnosis of personality disorders: the assessment of personality functioning. This recent shift in focus converges with long-standing psychodynamic conceptualizations of personality pathology, particularly Kernberg's object relations model. Although a significant amount of research supports these models in adults, much less is known about the validity of these frameworks in youth. Considering the paucity of brief measures of personality functioning in adolescents, the current study aimed to develop and investigate the validity of the Inventory of Personality Organization for Adolescents-Short Form, a theoretically-informed measure assessing severity and core domains of functioning in adolescents. METHODS A total sample of N = 525 adolescents aged 13 to 19 years were recruited through a community University-Health Psychology Clinic as current patients (n = 94) or who responded to an online research call (n = 431). RESULTS Results indicate that a bifactor model provided the best fit to the data and consisted of a general factor reflecting core self-other functioning and three specific factors, representing additional dimensions of personality organization. CONCLUSIONS A brief 15-item version of the IPO-A was successfully derived for time-efficient screening of personality pathology in youth. Similarities with the ICD-11 framework are discussed.
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Affiliation(s)
- M. Biberdzic
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - B. F. Grenyer
- grid.1007.60000 0004 0486 528XIllawarra Health and Medical Research Institute and School of Psychology, University of Wollongong, Wollongong, Australia
| | - L. Normandin
- grid.23856.3a0000 0004 1936 8390Department of Psychology, Laval University, Quebec, QC Canada
| | - K. Ensink
- grid.23856.3a0000 0004 1936 8390Department of Psychology, Laval University, Quebec, QC Canada
| | - J. F. Clarkin
- grid.5386.8000000041936877XPersonality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, NY USA
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Associations among ADHD symptoms, ODD symptoms, and borderline personality features: A network analysis. Res Child Adolesc Psychopathol 2022; 50:1399-1414. [PMID: 35723811 DOI: 10.1007/s10802-022-00943-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common childhood syndromes that exhibit a high degree of comorbidity. Both ADHD and ODD symptoms in childhood predict higher levels of borderline personality features (BPF) later in development. Yet ADHD, ODD, and BPF each consist of a heterogeneous group of symptoms, and symptom-level associations between these groups remain unclear. The present study examined symptom-level associations, as well as sex differences in symptom-level associations, among ADHD, ODD, and BPF using network analysis. Caregivers of 962 children between the ages of 5 and 12 completed rating scales of ADHD, ODD, and BPF. Assessment of Bridge Expected Influence indicated a number of bridge symptoms linking ADHD to ODD; these bridge symptoms were primarily from the hyperactive-impulsive (rather than the inattentive) dimension of ADHD (e.g., blurts out answers, leaves seat, runs excessively). A smaller number of bridge symptoms were identified linking ADHD and ODD to BPF, and these bridge symptoms were different for girls versus boys. Overall, several ADHD hyperactive-impulsive symptoms were related to the BPF item gets in trouble for doing things without thinking, and the ODD item touchy/easily annoyed was related to the BPF item goes back and forth between different feelings. Moreover, whereas we observed stronger links between ODD antagonistic symptoms (e.g., blames others) and BPF among girls, we observed stronger links between ODD oppositional symptoms (e.g., defies/refuses to comply) and BPF among boys. Taken together, results provide a more nuanced, symptom-level understanding of the overlap among ADHD, ODD, and BPF.
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Carreiras D, Cunha M, Castilho P. Trajectories of borderline features in adolescents: A three-wave longitudinal study testing the effect of gender and self-disgust over 12 months. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2022.111577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents. Dev Psychopathol 2022; 35:876-890. [PMID: 35440357 DOI: 10.1017/s0954579422000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although associations among borderline personality disorder (BPD), social rejection, and frontal EEG alpha asymmetry scores (FAA, a neural correlate of emotion regulation and approach-withdrawal motivations) have been explored in different studies, relatively little work has examined these relations during adolescence in the same study. We examined whether FAA moderated the relation between BPD features and rejection sensitivity following a validated social exclusion paradigm, Cyberball. A mixed, clinical-community sample of 64 adolescents (females = 62.5%; Mage = 14.45 years; SD = 1.6; range = 11-17 years) completed psychodiagnostic interviews and a self-report measure of BPD (Time 1). Approximately two weeks later (Time 2), participants completed a resting EEG recording followed by Cyberball. FAA moderated the relation between BPD features and overall feelings of rejection following Cyberball: individuals with greater relative left FAA had the highest and lowest feelings of social rejection depending on whether they had high and low BPD feature scores, respectively. Results remained after controlling for age, sex, gender, depression, and BPD diagnosis. These results suggest that FAA may moderate the relation between BPD features and social rejection, and that left frontal brain activity at rest may be differentially associated with those feelings in BPD. Findings are discussed in terms of the link between left frontal brain activity in the regulation and dysregulation of social approach behaviors, characteristic of BPD.
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31
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Hendriks E, Muris P, Meesters C, Houben K. Childhood Disorder: Dysregulated Self-Conscious Emotions? Psychopathological Correlates of Implicit and Explicit Shame and Guilt in Clinical and Non-clinical Children and Adolescents. Front Psychol 2022; 13:822725. [PMID: 35356351 PMCID: PMC8959856 DOI: 10.3389/fpsyg.2022.822725] [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: 11/26/2021] [Accepted: 01/28/2022] [Indexed: 01/09/2023] Open
Abstract
This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8-17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions.
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Affiliation(s)
- Eline Hendriks
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Peter Muris
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.,Departement Sielkunde, Stellenbosch University, Stellenbosch, South Africa
| | - Cor Meesters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Katrijn Houben
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Barkauskienė R, Gaudiešiūtė E, Adler A, Gervinskaitė-Paulaitienė L, Laurinavičius A, Skabeikytė-Norkienė G. Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents. Front Psychiatry 2022; 13:828301. [PMID: 35479485 PMCID: PMC9035636 DOI: 10.3389/fpsyt.2022.828301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
The recent development of a dimensional view toward personality disorder opens up the field of personality research based on the constructs of personality functioning (Criterion A) and maladaptive personality traits (Criterion B) as core components of personality pathology. However, little is known about the roles of these aspects in relation to borderline personality features during adolescence. The current study aimed at exploring the associations of Criterion A and B and their contribution in predicting borderline personality features in adolescence. A sample of 568 adolescents aged 11-17 (M = 14.38, SD = 1.57; 42.4% males) from different backgrounds (community-based, psychiatric inpatients, and youth forensic care) completed a set of questionnaires among which were measures of personality functioning, maladaptive personality traits, and borderline personality features. The findings reveal that Criterion A and B are strongly interrelated and both are significant in predicting borderline personality features in adolescents. Further, the results showed the incremental value of Criterion A beyond the level of underlying psychopathology and maladaptive personality traits suggesting the distinctive function of Criterion A to capture the features of borderline personality. These findings extend the knowledge about the dimensional aspects of personality pathology in adolescence. The implications in relation to the new personality disorder model in the ICD-11 are highlighted.
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Affiliation(s)
| | | | - Asta Adler
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Bohus M, Stoffers-Winterling J, Sharp C, Krause-Utz A, Schmahl C, Lieb K. Borderline personality disorder. Lancet 2021; 398:1528-1540. [PMID: 34688371 DOI: 10.1016/s0140-6736(21)00476-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 02/18/2021] [Indexed: 12/15/2022]
Abstract
Borderline personality disorder (BPD) is a mental disorder with a high burden on patients, family members, and health-care systems. The condition was previously regarded as untreatable, but progress in understanding and management has resulted in earlier diagnosis and better treatment outcomes. A coherent syndrome of BPD typically onsets during adolescence (after age 12 years). BPD is often preceded by or co-develops with symptoms of internalising disorders (depression and anxiety), externalising disorders (conduct problems, hyperactivity, and substance use), or both. BPD is associated with various poor outcomes, including low occupational and educational attainment, lack of long-term relationships, increased partner conflict, sexual risk-taking, low levels of social support, low life satisfaction, and increased service use. Psychotherapy is the main treatment for BPD; drug treatment is only indicated for comorbid conditions that require medication, or during a crisis if psychosocial interventions are insufficient. Awareness of BPD by non-specialists, as well as specialists, is key to appropriate early intervention.
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Affiliation(s)
- Martin Bohus
- Institute for Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Harvard Medical School, Boston, MA, USA
| | - Jutta Stoffers-Winterling
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden Institute of Brain and Cognition, Leiden, Netherlands
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany; Leibniz Institute for Resilience Research, Mainz, Germany.
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Carreiras D, Cunha M, Castilho P. Which self-compassion components mediate the relationship between adverse experiences in childhood and borderline features in adolescents? EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2021. [DOI: 10.1080/17405629.2021.1981283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diogo Carreiras
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
| | - Marina Cunha
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
- Miguel Torga Institute of Higher Education, Coimbra, Portugal
| | - Paula Castilho
- University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Coimbra, Portugal
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Sharp C, Vanwoerden S, Schmeck K, Birkhölzer M, Goth K. An Evaluation of Age-Group Latent Mean Differences in Maladaptive Identity in Adolescence. Front Psychiatry 2021; 12:730415. [PMID: 34603108 PMCID: PMC8484521 DOI: 10.3389/fpsyt.2021.730415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Little is known about the differences between age groups in maladaptive personality function as denoted in Criterion A of the Alternative Model for Personality Disorder (AMPD) in the DSM-5, which is the entry criterion for diagnosing personality disorder in the upcoming ICD-11. The current study aimed to address this gap by evaluating latent mean age group differences in maladaptive identity, which is one aspect that has been identified as an important feature of maladaptive, general personality function as represented in the DSM-5 and ICD-11. We were also interested whether mean differences would track with mean differences in borderline personality disorder (BPD) features given prior data suggesting that general personality function overlap with the construct of BPD. A community sample of N = 2,381 adolescents, representing a mix of different socio-economic and educational backgrounds, ages 12-18 (M = 14.92, SD = 1.94; 46% male) completed a measure of maladaptive identity. A subset (n = 1,165) completed a measure of borderline personality features. Latent variable modeling was used to evaluate latent mean differences across seven age bands. Results suggested a normative increase in maladaptive identity after age 12, which remained consistent until age 17 when it dropped back to levels observed in 12-year-olds. Maladaptive identity was significantly associated with mean-level increases in borderline personality features, with these constructs becoming more closely associated with increasing age.
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Affiliation(s)
- Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Salome Vanwoerden
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
| | - Marc Birkhölzer
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, University Clinics of Basel, Basel, Switzerland
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Munawar K, Aqeel M, Rehna T, Shuja KH, Bakrin FS, Choudhry FR. Validity and Reliability of the Urdu Version of the McLean Screening Instrument for Borderline Personality Disorder. Front Psychol 2021; 12:533526. [PMID: 34489768 PMCID: PMC8417833 DOI: 10.3389/fpsyg.2021.533526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/23/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Although the translation and the validation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) are performed in various languages and samples, no study has established the validity and reliability of the Urdu version of MSI-BPD in individuals with cardiac problems. Materials and Methods: The Urdu version of the MSI-BPD was prepared through the standard back-translation method. The translation and adaption were completed in four steps: forward translation, adaption and translation, back translation and committee approach, and cross-language validation. The sample, selected through the purposive sampling method, comprised of 150 adults with cardiac problems (men = 75 and women = 75), with an age range of 23-78 years (M = 55, SD = 10.6). The Cronbach alpha reliability and factorial validity of the MSI-BPD were assessed through confirmatory factor analysis (CFA) and Pearson correlation analyses. Internal consistency and test-retest reliability (at 2 weeks' interval) were used to evaluate the reliability. Statistical analyses were performed, using SPSS (version 22) and Structural Equation Modeling (SEM) software. Results: Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu MSI-BPD α = 0.79; English MSI-BPD α = 0.77) as well as test-retest correlation coefficients for 15 days (r = 0.94). Conclusions: Findings suggested that the MSI-BPD, with important limitations, can be used as an effective preliminary screening tool to measure BPD in Urdu-speaking adults with cardiac problems. Further validations should be conducted to make the translated version of the MSI-BPD an appropriate tool to screen BPD in hospitals and mental health care settings.
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Affiliation(s)
- Khadeeja Munawar
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences (JCSMHS), Monash University Malaysia, Subang Jaya, Malaysia
| | - Muhammad Aqeel
- Department of Psychology, Foundation University, Islamabad, Pakistan
| | - Tasnim Rehna
- Department of Applied Psychology, National University of Modern Languages, Islamabad, Pakistan
| | - Kanwar Hamza Shuja
- Department of Psychology, Capital University of Science & Technology, Islamabad, Pakistan
| | - Faizah Safina Bakrin
- School of Pharmacy, Kumpulan Perubatan Johor (KPJ) Healthcare University College, Nilai, Malaysia
| | - Fahad Riaz Choudhry
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Selayang, Malaysia
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Bogaerts A, Claes L, Buelens T, Gandhi A, Kiekens G, Bastiaens T, Luyckx K. The Self-Concept and Identity Measure in Adolescents. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2021. [DOI: 10.1027/1015-5759/a000623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Identity difficulties have been associated with various psychiatric conditions and are considered a central issue in personality pathology. Following the Alternative Model for Personality Disorders, measures of self- and interpersonal functioning have been developed. Although these measures were intended to be separate ratings of self-other deficits, only a global rating was obtained. Moreover, these measures fall short in bridging the gap between developmental and clinical identity work. To capture both adaptive and disturbed identity dimensions, Kaufman et al. (2015) developed the Self-Concept and Identity Measure (SCIM) that assesses consolidated identity, disturbed identity, and lack of identity. Using two-wave longitudinal data (2,150 adolescents; 54.2% girls; age range = 12–19), this study investigated the factor structure and reliability of the Dutch SCIM, its measurement invariance across time, its longitudinal measurement invariance across gender and age groups, and associations of the SCIM with identity synthesis and confusion, Big-Five personality traits, and borderline personality disorder features. Consolidated identity scores were positively related to identity synthesis and adaptive Big-Five traits, whereas negatively related to identity confusion, neuroticism, and borderline features. Opposite associations were obtained for disturbed identity and lack of identity scores. The Dutch SCIM appeared to produce valid and reliable scores and seemed suited to assess longitudinal identity functioning in Belgian adolescents.
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Affiliation(s)
- Annabel Bogaerts
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Belgium
| | - Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
| | - Amarendra Gandhi
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Tim Bastiaens
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Campus Kortenberg, Kortenberg, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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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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Stoffers-Winterling J, Krause-Utz A, Lieb K, Bohus M. [What do we know about borderline personality disorder? Current aspects of etiology, diagnostics and treatment]. DER NERVENARZT 2021; 92:643-652. [PMID: 34104974 DOI: 10.1007/s00115-021-01140-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Borderline personality disorder (BPS) is considered as a severe mental disorder with a high burden for patients, family members and the healthcare system. Recent years have brought significant advances in understanding and treating BP, leading to an earlier diagnosis and better treatment outcomes. OBJECTIVE This article outlines the current state of knowledge on the epidemiology, diagnostics, psychopathology and treatment of BPD and identifies open questions. MATERIAL AND METHODS Based on a literature search in the PubMed, PsycINFO and EMBASE databases, the latest developments in the topic of BPD for the areas of diagnostics, epidemiology, etiology and treatment are illuminated in a narrative review. Where possible systematic review articles, meta-analyses and evidence-based practice guidelines were also considered. STATE OF THE SCIENCE At the core of BPS are disorders of emotion regulation, self-image, and interpersonal interaction. The suicide rates range from 2% to 5% and life expectancy is significantly shortened compared with the general population. The effectiveness of differentiated, disorder-specific psychotherapy (especially dialectic behavioral therapy, DBT) is well established. Psychotherapeutic care in the outpatient sector, especially in the field of pediatric and adolescent psychiatry, is still insufficient. PERSPECTIVES Questions about the etiopathology, especially genetic and postulated neurobiological parameters that determine affective hypersensitivity, are largely open. Nosologically, the differentiation from comorbid complex posttraumatic stress disorder (cPTSD) is certainly an important issue, which also has therapeutic consequences.
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Affiliation(s)
| | - Annegret Krause-Utz
- Abteilung für Klinische Psychologie, Leiden Institute of Brain and Cognitio, AK Leiden, Universität Leiden, Leiden, Niederlande
| | - Klaus Lieb
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Martin Bohus
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Lehrstuhl für Psychosomatische Medizin und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, Zentralinstitut für Seelische Gesundheit Mannheim, J 5, 68159, Mannheim, Deutschland.
- Harvard Medical School, Boston, USA.
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Campbell SM, Zimmer-Gembeck M, Duffy A. At the Junction of Clinical and Developmental Science: Associations of Borderline Identity Disturbance Symptoms With Identity Formation Processes in Adolescence. J Pers Disord 2021; 35:8-28. [PMID: 32985957 DOI: 10.1521/pedi_2020_34_484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Developmental scientists describe the role confusion that can occur for adolescents as they are forming a personal identity. Clinical psychologists describe low self-worth, lack of self-clarity, feelings of emptiness, and dissociation as the key elements of identity disturbance, and they link these to borderline personality disorder. In this study, the authors aimed to work at the juncture of these approaches by considering interrelations between four elements of identity disturbance, typical identity formation processes reflective of identity commitment and confusion, and borderline features. Australian youth (N = 505, 63% female and aged 12-20 years) recruited from clinical and community settings reported on identity commitment, exploration and reconsideration, four elements of identity disturbance, and borderline features. Identity confusion (especially reconsideration) and disturbance were associated with elevated borderline symptoms. Emptiness stood out as the strongest correlate of borderline symptoms. Youth reporting greater emptiness were nearly twice as likely to report a high borderline symptom profile.
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Affiliation(s)
| | | | - Amanda Duffy
- Griffith University, School of Applied Psychology, Southport, Australia
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Primi C, Fioravanti G, Casale S, Donati MA. Measuring Problematic Facebook Use among Adolescents and Young Adults with the Bergen Facebook Addiction Scale: A Psychometric Analysis by Applying Item Response Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2979. [PMID: 33799401 PMCID: PMC8001507 DOI: 10.3390/ijerph18062979] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 01/09/2023]
Abstract
The Bergen Facebook Addiction Scale (BFAS) is widely used, but psychometric evidence by applying Item Response Theory (IRT) is lacking. Considering the advantages of this psychometric approach, the aim of study was to investigate the psychometric properties of the Italian version of the BFAS among adolescents and young adults. Participants were 1134 (50% males, Mean age = 20.7, SD = 3.5, range = 14-33 years) Italian high school students and undergraduates. The unidimensionality of the scale was confirmed (χ2/df = 2.8, CFI = 0.99, TLI = 0.98, and RMSEA = 0.04 [C.I. = 0.02-0.06]) and IRT analysis showed that the scale assesses medium and high levels of the trait, and that it is useful in order to discriminate different levels of Problematic Facebook use (PFU) within this range of trait, in which the scale is sufficiently informative. The relationships of BFAS θ scores with theoretically related constructs provided support to the validity of the scale. In accordance with previous studies, BFAS scores were positively correlated with Problematic Internet use and problematic Social Network use, negatively correlated with self-esteem, and positively related to loneliness. The Differential Item Functioning (DIF) analysis showed that BFAS is invariant across gender, and only one item had uniform and small-in-size DIF. Additionally, we tested age invariance. Since only 17% of the BFAS items were non-invariant, we determined that the BFAS exhibited minor non-invariance as a whole. An analysis of the adequacy of the polythetic and monothetic criteria to define the range of the trait indicative of problematic use was also conducted. Overall, this study offers evidence that BFAS is a valuable and useful scale for measuring high levels of PFU among Italian adolescents and young adults.
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Affiliation(s)
- Caterina Primi
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), Section of Psychology, University of Florence, 50100 Florence, Italy; (C.P.); (M.A.D.)
| | - Giulia Fioravanti
- Department of Health Sciences, Psychology Unit, University of Florence, 50100 Florence, Italy;
| | - Silvia Casale
- Department of Health Sciences, Psychology Unit, University of Florence, 50100 Florence, Italy;
| | - Maria Anna Donati
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), Section of Psychology, University of Florence, 50100 Florence, Italy; (C.P.); (M.A.D.)
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43
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 2021; 3:CD013667. [PMID: 33677832 PMCID: PMC8094399 DOI: 10.1002/14651858.cd013667.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most countries, often repeated, and associated with suicide. Evidence assessing the effectiveness of interventions in the treatment of SH in children and adolescents is lacking, especially when compared with the evidence for psychosocial interventions in adults. This review therefore updates a previous Cochrane Review (last published in 2015) on the role of interventions for SH in children and adolescents. OBJECTIVES To assess the effects of psychosocial interventions or pharmacological agents or natural products for SH compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator, placebo, alternative pharmacological treatment, or a combination of these) for children and adolescents (up to 18 years of age) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialized Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic Reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing specific psychosocial interventions or pharmacological agents or natural products with treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, placebo, alternative pharmacological treatment, or a combination of these, in children and adolescents with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratios (ORs) and their 95% confidence internals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 17 trials with a total of 2280 participants. Participants in these trials were predominately female (87.6%) with a mean age of 14.7 years (standard deviation (SD) 1.5 years). The trials included in this review investigated the effectiveness of various forms of psychosocial interventions. None of the included trials evaluated the effectiveness of pharmacological agents in this clinical population. There was a lower rate of SH repetition for DBT-A (30%) as compared to TAU, EUC, or alternative psychotherapy (43%) on repetition of SH at post-intervention in four trials (OR 0.46, 95% CI 0.26 to 0.82; N = 270; k = 4; high-certainty evidence). There may be no evidence of a difference for individual cognitive behavioural therapy (CBT)-based psychotherapy and TAU for repetition of SH at post-intervention (OR 0.93, 95% CI 0.12 to 7.24; N = 51; k = 2; low-certainty evidence). We are uncertain whether mentalisation based therapy for adolescents (MBT-A) reduces repetition of SH at post-intervention as compared to TAU (OR 0.70, 95% CI 0.06 to 8.46; N = 85; k = 2; very low-certainty evidence). Heterogeneity for this outcome was substantial ( I² = 68%). There is probably no evidence of a difference between family therapy and either TAU or EUC on repetition of SH at post-intervention (OR 1.00, 95% CI 0.49 to 2.07; N = 191; k = 2; moderate-certainty evidence). However, there was no evidence of a difference for compliance enhancement approaches on repetition of SH by the six-month follow-up assessment, for group-based psychotherapy at the six- or 12-month follow-up assessments, for a remote contact intervention (emergency cards) at the 12-month assessment, or for therapeutic assessment at the 12- or 24-month follow-up assessments. AUTHORS' CONCLUSIONS Given the moderate or very low quality of the available evidence, and the small number of trials identified, there is only uncertain evidence regarding a number of psychosocial interventions in children and adolescents who engage in SH. Further evaluation of DBT-A is warranted. Given the evidence for its benefit in adults who engage in SH, individual CBT-based psychotherapy should also be further developed and evaluated in children and adolescents.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Childhood maltreatment, personality vulnerability profiles, and borderline personality disorder symptoms in adolescents. Dev Psychopathol 2021; 34:1163-1176. [PMID: 33494855 DOI: 10.1017/s0954579420002151] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adverse childhood experiences are significant risk factors in the development of adolescent borderline personality disorder symptoms (BPDs). Theorists have posited that two personality vulnerabilities factors, self-criticism and dependency, may inform our understanding of this relationship. However, no research has examined the associations between early negative experiences, personality vulnerabilities, and adolescent BPDs. The current study aimed to identify profiles of dependency and self-criticism to examine the associations of these profiles with cumulative forms of childhood maltreatment (CM) and BPDs as well as to explore the mediating and moderating role of vulnerable personality profiles in the relationship between cumulative CM and BPDs. Two hundred and forty-one nonclinical and clinical adolescents participated in the study (Mage = 16.37, SD = 1.84). The findings indicated three different profiles: average dependent profile, dependent and self-critical profile, and self-critical profile. Individuals in the average dependent profile presented lower levels of CM and BPDs. Mediation analyses showed that relative to the average dependent profile, a higher cumulative CM history predicted a higher probability of belonging in the dependent and self-critical profile or the self-critical profile and, in turn, this was associated with higher levels of BPDs. No moderating effects of profiles of dependency and self-criticism were found.
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Abstract
The main aim of this study was to examine the associations between emotion dysregulation and psychopathology in adolescence. A representative sample of 1,500 adolescent students (50% female) aged 12 to 19 years (M = 15.08, SD = 1.44) was recruited from schools and colleges located in the province of district Punjab, Pakistan, using a stratified sampling technique. Structural equation modeling (SEM) was used to test associations between five dimensions of emotion regulation difficulties and five forms of psychopathology by gender (male/female). The model provided an adequate fit to the data among girls and boys. In the model tested among boys, seven positive associations between emotion regulation difficulties and psychopathology variables were found. The model tested with girls included one negative and 13 positive associations between the study variables. Findings can be used for designing universal prevention programs to prevent the development of psychopathology.
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Affiliation(s)
- Huma Zafar
- Viqar un Nisa College for Women, Rawalpindi, Pakistan
- The University of Sheffield, Sheffield, UK
| | - Agata Debowska
- The University of Sheffield, Sheffield, UK
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Daniel Boduszek
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
- University of Huddersfield, Huddersfield, UK
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Plakolm Erlač S, Bucik V, Gregorič Kumperščak H. Explicit and Implicit Measures of Identity Diffusion in Adolescent Girls With Borderline Personality Disorder. Front Psychiatry 2021; 12:805390. [PMID: 35046857 PMCID: PMC8762200 DOI: 10.3389/fpsyt.2021.805390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
The present study is the first to examine both the implicit and explicit self-concept of identity diffusion in a sample of adolescent patients with borderline personality disorder (BPD). A clinical sample of adolescent girls with diagnosed BPD (N = 30; M age = 15.9 years) and a sample of girls with a healthy personality development (N = 33; M age = 16.6 years) completed an implicit association test (IAT) that was adjusted to identity diffusion, the core of BPD. Common domains of child and adolescent psychopathology and core components of BPD were assessed using self-reports on the Strengths and Difficulties Questionnaire (SDQ), the Borderline Personality Features Scale for Children-11 (BPFSC-11) and the Assessment of Identity Development in Adolescence (AIDA). BPD patients scored significantly higher on explicit measures of borderline pathology than girls with a healthy personality development. A crucial finding for this study was that girls with BPD had a significantly lower implicit preference for stability than their counterparts in the control group. Moreover, explicit measures of borderline personality pathology were significantly correlated with an implicit measure of identity diffusion, the core of BPD. However, when looking at the predictive ability of implicit and explicit measures, only explicit identity diffusion was significantly associated with borderline features. Our data suggests that adolescent girls with BPD differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to BPD related characteristics, which further advances the need for the identification of at-risk adolescents.
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Affiliation(s)
- Sara Plakolm Erlač
- Child and Adolescent Psychiatry Unit, Pediatrics Clinic, University Medical Centre Maribor, Maribor, Slovenia.,Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - Valentin Bucik
- Department of Psychology, University of Ljubljana, Ljubljana, Slovenia
| | - Hojka Gregorič Kumperščak
- Child and Adolescent Psychiatry Unit, Pediatrics Clinic, University Medical Centre Maribor, Maribor, Slovenia
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Rivnyák A, Pohárnok M, Péley B, Láng A. Identity Diffusion as the Organizing Principle of Borderline Personality Traits in Adolescents-A Non-clinical Study. Front Psychiatry 2021; 12:683288. [PMID: 34295274 PMCID: PMC8289896 DOI: 10.3389/fpsyt.2021.683288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Growing evidence shows that diagnosing and treating borderline personality disorder (BPD) is of high relevance for affected youths. Although identity crisis is part of the normative developmental process, identity diffusion is a potential candidate for being an appropriate concept in further developing screening tools and interventions for BPD treatment in adolescence. We hypothesized that severity of borderline traits (as indicated by the strength of their associations with identity diffusion) would be negatively associated with non-clinical adolescents' endorsement of borderline features' presence. We also hypothesized that identity diffusion had a central role in the network of borderline personality traits and could be conceived of as a latent organizing principle of borderline personality disorder. In our study, 169 non-clinical adolescents (81 girls and 88 boys; M age = 15.38; SDage = 1.52) filled out self-report measures of borderline personality features and identity diffusion. According to our results, having strong feelings and interpersonal sensitivity were the two most endorsed borderline personality features. Borderline personality features were positively correlated with identity diffusion. The more severe a borderline personality feature was, the less relevant it was for non-clinical adolescents. According to a network analysis, identity diffusion was the most central and least redundant element of the network of borderline personality traits. Results are discussed from a clinical point of view, further encouraging professionals to use identity diffusion screening tools to detect BPD in adolescence.
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Affiliation(s)
- Adrienn Rivnyák
- Faculty of Humanities and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Melinda Pohárnok
- Faculty of Humanities and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Bernadette Péley
- Faculty of Humanities and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
| | - András Láng
- Faculty of Humanities and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
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48
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Buelens T, Costantini G, Luyckx K, Claes L. Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach. Front Psychiatry 2020; 11:580922. [PMID: 33329123 PMCID: PMC7728714 DOI: 10.3389/fpsyt.2020.580922] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/02/2020] [Indexed: 12/26/2022] Open
Abstract
In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, M age = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.
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Affiliation(s)
- Tinne Buelens
- Research Unit Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Giulio Costantini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Koen Luyckx
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Laurence Claes
- Research Unit Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Babinski DE, Castagna PJ, Waschbusch DA. Preliminary Investigation of the Psychometric Properties of the Parent Version of the Borderline Personality Features Scale for Children (BPFS-P). J Pers Assess 2020; 103:602-612. [PMID: 33124913 DOI: 10.1080/00223891.2020.1835934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is growing evidence that features of borderline personality disorder (BPD) emerge in childhood and present long-term risk for the development of BPD. Thus, valid and reliable assessments of BPD features in childhood are needed. This study examined the psychometric properties of the parent version of the Borderline Personality Features Scale for Children (BPFS-P) in a large, representative sample (N = 1,050; 51.5% male; Mage = 8.42, SD = 2.31; Agerange = 5 to 12 years). The factor structure of the BPFS-P was examined, and measurement invariance was tested across child age and sex as well as caregiver informant sex. Additionally, the unique contribution of the identified factors of the BPFS-P to overall impairment and need for treatment beyond co-occurring dimensions of additional psychopathology was examined. A one factor structure was identified, which demonstrated measurement invariance across child sex and age as well as caregiver informant sex. BPD features measured with the BPFS-P contributed unique variance to explaining overall impairment and need for treatment. These findings point to the potential of the BPFS-P to break new ground in identifying youth at risk for BPD.
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Affiliation(s)
- Dara E Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA
| | | | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA
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50
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Somma A, Gialdi G, Krueger RF, Markon KE, Frau C, Lovallo S, Fossati A. Dysfunctional personality features, non-scientifically supported causal beliefs, and emotional problems during the first month of the COVID-19 pandemic in Italy. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020; 165:110139. [PMID: 32501318 PMCID: PMC7247995 DOI: 10.1016/j.paid.2020.110139] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022]
Abstract
The present study aimed at assessing the impact of demographic characteristics, maladaptive personality traits and causal beliefs about COVID-19 on perceived emotional problems in a sample of Italian community-dwelling adults (N = 1043) in the first month of the social distancing period due to the COVID-19 pandemic in Italy. Hierarchical logistic regression analysis results showed that dysfunctional personality domains and non-scientifically supported causal beliefs explained all the variance that was originally explained by demographic variables (i.e., age and gender). In particular, negative affectivity and detachment represented relevant risk factors for reduced emotional well-being in our sample. A significant positive association was observed also between emotional problems and supernatural causal beliefs on the COVID-19 infection. Our data supported the importance of considering the impact of quarantine measures on psychological well-being, while suggesting possible risk factors related to individual differences in personality and causal beliefs.
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