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Buhl-Nielsen B, Steele H, Steele M. Attachment and body representations in adolescents with personality disorder. J Clin Psychol 2024; 80:1981-1997. [PMID: 38822751 DOI: 10.1002/jclp.23705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/20/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes toward the body and the impact this might have for the development of psychopathology is however less well elucidated. METHOD A total of 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders [OPD] and 63 comprising a normative control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror. RESULTS The AAIs from the Borderline group were predominantly insecure-preoccupied and unresolved. These adolescents had significantly lower levels of a positive and integrated sense of self and body than the other groups. Regression results revealed a high loving relationship with fathers, low involving anger with father, high coherence of mind, slight derogation of mother & low levels of unresolved loss uniquely and additively predicted 55% of variance in the summary score assigned to MI responses, that is, the summary score for a Positive and Integrated Body Representation (PIBR). CONCLUSION Unfavorable attachment experiences and current states of mind regarding attachment may give rise to problems with establishing PIBRs, and thus play a role in the development of psychopathology, especially BPD.
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Affiliation(s)
- Bernadette Buhl-Nielsen
- Department of Child and Adolescent Psychiatry, Region Sjaelland and University of Copenhagen, Copenhagen, Denmark
| | - Howard Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
| | - Miriam Steele
- Psychology Department, The New School for Social Research, New York, New York State, USA
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2
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Wyssen A, Lerch S, Reichl C, Mürner-Lavanchy I, Sigrist C, Schär S, Cavelti M, Koenig J, Kaess M. Comparing the new concept of impairment in personality functioning with borderline personality disorder: differential psychosocial and psychopathological correlates in a clinical adolescent sample. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02555-y. [PMID: 39150466 DOI: 10.1007/s00787-024-02555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
Borderline personality disorder (BPD) is an established diagnosis in adolescence with high comorbidity and psychosocial impairment. With the introduction of the alternative model for personality disorders in DSM-5 (AMPD), personality functioning is operationalized using the Level of Personality Functioning Scale (LPFS), which has been shown to be associated with severity of personality pathology. The present study aimed at examining differential psychopathological and psychosocial correlates of LPFS and BPD. A total of 526 adolescent in- and outpatients were interviewed with the STiP-5.1 (LPFS) and the SCID-II. Mixed linear regression was used to investigate the associations between the two interviews with measures of psychopathology and psychosocial impairment. 11.4% met the diagnostic threshold of both interviews, 16.1% only of the LPFS, and 64.1% were below the diagnostic threshold in both interviews (no PD). The BPD only group was larger than expected-8.4% of patients who met criteria for BPD did not fulfill criteria for significant impairment in the LPFS. The highest burden was found in individuals concurrently showing significant impairment in LPFS and fulfilling BPD diagnosis (LPFS + BPD). Differences between the LPFS only group and the BPD only group were found in risk behavior and traumatic experiences, with higher prevalence in the BPD group. Findings confirm the high psychopathological burden and psychosocial impairment associated with both BPD and LPFS. Those exceeding the diagnostic threshold of LPFS in combination with a BPD diagnosis are characterized by greatest disability. Not all adolescents fulfilling formal BPD diagnosis showed a clinically significant impairment in LPFS, which may refer to a distinct diagnostic group.
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Affiliation(s)
- Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christine Sigrist
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Hauryski S, Potts A, Swigart A, Babinski D, Waschbusch DA, Forrest LN. Characterizing psychopharmacological prescribing practices in a large cohort of adolescents with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:17. [PMID: 39103898 DOI: 10.1186/s40479-024-00262-3] [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: 02/01/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Psychiatric medications are not efficacious for treating borderline personality disorder (BPD), yet many patients with BPD are prescribed multiple psychiatric medications. This study aimed to (1) characterize psychiatric medication prescribing practices in adolescents with BPD and (2) assess whether demographic features are associated with prescribing practices. METHOD This sample was N = 2950 pediatric patients with BPD (ages 10-19) across the U.S. Data came from the NeuroBlu database, which includes data from 30 U.S. healthcare systems and hundreds of hospitals. Poisson regressions and chi-squared tests determined whether gender, race, and ethnicity were associated with (1) number of unique psychiatric medications prescribed and (2) number of unique medication classes prescribed. RESULTS Roughly two-thirds (64.85%) of youth were prescribed any medications. Of these youth, 79.40% were prescribed ≥ 2 unique medications and 72.66% were prescribed ≥ 2 unique medications classes. The mean number of unique medications was 3.50 (SD = 2.50). The mean number of unique medication classes was 2.35 (SD = 1.15). The most commonly prescribed medication classes were antidepressants and antipsychotics, which were often prescribed in combination. Poisson regressions showed that boys were prescribed more unique medications (M = 3.67) than girls (M = 3.47). Non-Latinx youth were prescribed significantly more unique medications (M = 44.12) than Latinx youth (M = 3.60, p = .01). CONCLUSIONS Results characterize psychiatric medication prescribing practices in youth with BPD. Prescribing practices vary by demographics, such that boys and non-Latinx youth are prescribed more medications than girls and Latinx youth, respectively. These demographic differences suggest that prescribers may treat BPD differently based on patient demographic characteristics.
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Affiliation(s)
- Sarah Hauryski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Alexandra Potts
- Department of Psychiatry, Medical University of South Carolina, Charleston, USA
| | - Alison Swigart
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Dara Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
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Blaha Y, Cavelti M, Lerch S, Steinhoff A, Koenig J, Kaess M. Risk-taking and self-harm behaviors as markers of adolescent borderline personality disorder. Eur Child Adolesc Psychiatry 2024; 33:2743-2753. [PMID: 38194081 PMCID: PMC11272750 DOI: 10.1007/s00787-023-02353-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents.
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Affiliation(s)
- Yasmine Blaha
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Annekatrin Steinhoff
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Boyd SI, Moore A, Moghaddas S, Hamilton JL. Perceived functions and importance of digital media use and adolescent depression and suicidal ideation. J Adolesc 2024; 96:1001-1011. [PMID: 38402410 DOI: 10.1002/jad.12311] [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: 06/28/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Although social media (SM) use is nearly ubiquitous among adolescents, there is a lack of clarity concerning the relationship between SM use and mental health outcomes like depression and suicidal ideation (SI), which increase during adolescence. Much of the previous literature has focused on the frequency of SM use; however, the current study examined the relationship between the perceived importance of three types of interactions and functions of SM use and depressive symptoms and suicidal ideation. METHODS A sample of 4057 adolescents (M age = 14.6; 47.0% girls; 69.0% Non-Hispanic/Latine White) were recruited via an online survey manager between February and March 2019. Participants completed the Adolescent Digital Technology Interactions and Importance (ADTI) Scale, which assessed the perceived importance of bridging online and offline experiences (bridging), going outside one's identity or offline experience (identity), and facilitating social connections (social). Participants also completed measures of depressive symptoms and SI and a self-report measure of SM use. A series of path analyses were conducted to examine the relationship between bridging, identity, social, and depressive symptoms and SI. RESULTS After accounting for covariates (gender identity, racial identity, age, and SM use), bridging was negatively associated with depressive symptoms, whereas identity was positively associated with depressive symptoms. Bridging and social connection were negatively associated with SI, whereas identity was positively associated with SI. Gender moderated these relationships; however, racial identity did not. CONCLUSION The results highlight the importance of understanding adolescent SM use beyond screen time in relation to depression and SI.
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Affiliation(s)
- Simone Imani Boyd
- Department of Psychology, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA
| | - Adia Moore
- School of Social Work, Columbia University, New York, USA
| | | | - Jessica L Hamilton
- Department of Psychology, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA
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Klinkby IMI, Hastrup LH, Bo S, Storebø OJ, Simonsen E, Kongerslev MT. Prevalence and incidence of personality disorders among children and adolescents in Danish mental health services: a nationwide register study. Eur Child Adolesc Psychiatry 2024; 33:1731-1740. [PMID: 37566164 PMCID: PMC11211120 DOI: 10.1007/s00787-023-02274-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
A few epidemiological studies have examined personality disorders (PDs) among children and adolescents in secondary mental health services. This study aims to describe the prevalence and incidence of PDs among children and adolescents who have attended Danish child and adolescent psychiatric services (CAPS). Using register-based data, we studied all patients under the age of 18 years who were admitted to in- and outpatient CAPS (N = 115,121) in Denmark from 2007 to 2017. A total of 4952 patients were diagnosed with a PD during the study period. The mean prevalence was 859 patients per year, and the mean incidence was 274 patients per year, including an increased incidence and prevalence of borderline, anxious, and unspecified PDs over the decade. The number of patients diagnosed with PDs increased from 700 to 851 per year, but the proportion of patients with PDs compared to all psychiatric diagnoses decreased from 4.2% to 2.8% over the study period. The PD population had an older age (14.8 years vs. 11.3 years; p < 0.001), a higher likelihood of being female (74% vs. 44%; p < 0.001), and four times more contacts with the psychiatric emergency departments than other patients with a psychiatric diagnosis. Future studies should focus on (a) implementing further epidemiological studies in different countries; (b) tracking diagnostic practices to facilitate comparisons and provide feedback for training clinicians and raising awareness; and (c) estimating trajectories of PDs, including costs within the CAPS, to facilitate informed decision-making regarding the future organization and provision of services to these children, adolescents, and their families.
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Affiliation(s)
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Sune Bo
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Mental Health Services Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Erik Simonsen
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- Research Unit, Region Zealand Mental Health Services East, Roskilde, Denmark.
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Williams R, Fiorentino F, Lingiardi V, Moselli M, Sharp C, Tanzilli A. The assessment of pathways towards suicide in adolescent patients: A PDM-2-oriented approach. Psychol Psychother 2024. [PMID: 38742777 DOI: 10.1111/papt.12529] [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: 09/14/2023] [Revised: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Increasing evidence has supported the mutual relationship between suicidal motivations and personality pathology, especially in adolescence. Distinctive aspects of personality functioning can explain the tendency to resort to suicidal ideation and behaviours, which, in turn, may play a specific role in exacerbating severe impairments in self-regulation mechanisms that underlie personality pathology. DESIGN This study illustrates, through two clinical cases, the clinical utility of using the Psychodynamic Diagnostic Manual - Second Edition (PDM-2) to better understand distinct pathways of suicidal processes. METHODS Two adolescents, named Luis and Gael, who attempted suicide multiple times were assessed using the Psychodiagnostic Chart Adolescent (PDC-A) of the PDM-2 to evaluate their mental functioning, emerging personality styles or syndromes, and symptom patterns. They were interviewed using the Motivational Interview for Suicidality in Adolescence (MIS-A) to identify the motivations underpinning their suicidal behaviour. RESULTS The results showed that Luis presented a narcissistic personality characterized by the need to deny his vulnerabilities through suicidal fantasies as a form of escape, while Gael presented a borderline personality characterized by the use of suicide attempts to express her inner and unspeakable pain. CONCLUSION The study seems to support the reciprocal interconnections between personality functioning and suicidal motivations that should be better identified to plan tailored and more effective interventions.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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8
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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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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] [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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10
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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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11
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Ruchensky JR, Kelley SE, Massey C, Richardson LA, Blais MA, Stein MB. Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample. J Pers Assess 2024; 106:72-82. [PMID: 37220386 DOI: 10.1080/00223891.2023.2203240] [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: 07/08/2022] [Revised: 02/06/2023] [Accepted: 03/31/2023] [Indexed: 05/25/2023]
Abstract
The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) - a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.
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Affiliation(s)
- Jared R Ruchensky
- Department of Psychology & Philosophy, Sam Houston State University, Huntsville, Texas
| | - Shannon E Kelley
- Clinical Psychology Department, William James College, Newton, Massachusetts
| | - Christina Massey
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura A Richardson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michelle B Stein
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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12
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Benzi IMA, Carone N, Parolin L, Martin-Gagnon G, Ensink K, Fontana A. Different epistemic stances for different traumatic experiences: implications for mentalization. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:708. [PMID: 38156583 PMCID: PMC10772857 DOI: 10.4081/ripppo.2023.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
Traumatic experiences may impair reflective functioning (RF), making it difficult for individuals to understand their own and others' mental states. Epistemic trust (ET), which enables evaluating social information as reliable and relevant, may vary in association with RF. In this study, we explored the implications of different ET stances (i.e., trust, mistrust, and credulity) in the relation between different childhood traumatic experiences (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and different types of RF impairments (uncertainty and certainty about mental states). A non-clinical community sample of 496 cisgender emerging adults (mage = 24.91, standard deviation = 2.66, 71.85% assigned female at birth, 63.63% heterosexual) reported on their childhood traumatic experiences, ET, and RF. We used structural equation models to examine direct and indirect associations. The results showed significant indirect effects between emotional abuse and uncertainty about mental states through credibility. We also observed significant indirect effects between emotional abuse and certainty about mental states through mistrust and credibility. The findings suggest that a lack of discrimination when evaluating knowledge from others (i.e., credulity) might promote increased uncertainty in RF when emerging adults have experienced emotional abuse in their childhood. Conversely, a tendency to view all information sources as unreliable or ill-intentioned (i.e., mistrust) may foster greater certainty in RF as a protective mechanism against an unreliable and potentially harmful world when combined with childhood emotional abuse. The implications for clinical practice and intervention are discussed.
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Affiliation(s)
| | - Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia.
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan.
| | | | - Karin Ensink
- Department of Psychology, Laval University, Quebec.
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Mihailescu I, Efrim-Budisteanu M, Andrei LE, Buică AM, Moise M, Nicolau IG, Iotu AD, Grădilă AP, Costea T, Priseceanu AM, Rad F. Cognitive Coping Strategies among Inpatient Adolescents with Depression and Psychiatric Comorbidity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1870. [PMID: 38136072 PMCID: PMC10742032 DOI: 10.3390/children10121870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
The aim of the present study is to describe and measure the cognitive emotion regulation strategies of inpatient adolescents with clinical depression, aged 13-18, and to analyse these coping strategies in relation to different comorbidities of Major Depressive Disorder (MDD). METHODS There were 112 adolescents with MDD who were admitted to hospital and 78 healthy adolescents included in the study. The Cognitive Emotion Regulation Questionnaire (CERQ) was used to assess nine specific cognitive coping strategies. A cognitive coping style model for depression in adolescents was described by analysing the differences between the two groups. The CERQ scores in MDD participants, grouped by comorbidity, were also assessed. RESULTS Adolescents with MDD had significantly higher scores for Self-Blame and Catastrophising strategies, and significantly lower scores for Positive Refocusing, Refocusing on Planning, and Positive Reappraisal. Adolescents with MDD and Borderline Personality Disorder (BPD) traits had significantly higher scores for Rumination, Catastrophising, and Blaming Others than adolescents with MDD and anxiety or with no comorbidity. CONCLUSIONS Clinical depression in adolescents is associated with a cognitive profile that consists of an increased use of maladaptive coping styles and low employment of adaptive strategies. Early identification can contribute to the development of specific, individualised prevention and intervention programmes, while further longitudinal studies are necessary to adequately measure the outcome of these interventions.
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Affiliation(s)
- Ilinca Mihailescu
- Child and Adolescent Psychiatry Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.M.); (L.E.A.); (A.M.B.); (M.M.); (F.R.)
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | - Magdalena Efrim-Budisteanu
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Lucia Emanuela Andrei
- Child and Adolescent Psychiatry Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.M.); (L.E.A.); (A.M.B.); (M.M.); (F.R.)
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | - Alexandra Mariana Buică
- Child and Adolescent Psychiatry Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.M.); (L.E.A.); (A.M.B.); (M.M.); (F.R.)
| | - Mihaela Moise
- Child and Adolescent Psychiatry Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.M.); (L.E.A.); (A.M.B.); (M.M.); (F.R.)
| | - Ingrid Georgiana Nicolau
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | - Alexandra Diana Iotu
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | - Adriana Petruța Grădilă
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | - Teodora Costea
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
| | | | - Florina Rad
- Child and Adolescent Psychiatry Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.M.); (L.E.A.); (A.M.B.); (M.M.); (F.R.)
- Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry, 041914 Bucharest, Romania; (I.G.N.); (A.D.I.); (A.P.G.)
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14
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Carreiras D, Cunha M, Sharp C, Castilho P. The Clinical Interview for Borderline Personality Disorder for Adolescents (CI-BOR-A): Development, acceptability and expert panel evaluation. Personal Ment Health 2023; 17:377-386. [PMID: 37183381 DOI: 10.1002/pmh.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/02/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder with marked impulsivity, instability, emotional dysregulation and self-harm. These features tend to develop over time and can be identified in adolescence. Early diagnosis is the first step to prevent the development of these features to a personality disorder. The purpose of this study was to develop the Clinical Interview for BPD for Adolescents (CI-BOR-A), a new instrument based on a sound clinical interview for BPD in youth (CI-BPD). We tested its acceptability with 43 adolescents and its content validity with the quantitative and qualitative evaluation of 23 experts in mental health. The CI-BOR-A is a hybrid semi-structured interview that considers both categorical and dimensional approaches of personality disorders of DSM-5-TR, including 16 items, decision tables for diagnosis, and an appendix to explore self-harm history further. Adolescents accepted the interview, and none refused to complete the assessment. The expert panel considered the interview relevant, clear, accurate and complete. Important feedback was provided in terms of structure and content to improve the CI-BOR-A quality. In general, the CI-BOR-A is a rigorous interview to assess BPD in adolescents and adds an important contribution to early detection in clinical and community settings.
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Affiliation(s)
- Diogo Carreiras
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Miguel Torga Higher Institute, Coimbra, Portugal
| | - Marina Cunha
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Miguel Torga Higher Institute, Coimbra, Portugal
| | | | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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15
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Williams R, Chiesa M, Moselli M, Frattini C, Casini M, Fonagy P. The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior? Borderline Personal Disord Emot Dysregul 2023; 10:32. [PMID: 37907967 PMCID: PMC10619325 DOI: 10.1186/s40479-023-00238-9] [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: 04/07/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Current research points to the importance personality pathology and Major Depression e as relevant psycopathological risk factors for understanding suicidal risk in adolescence. Literature has mainly focused on the role of BPD, however current orientations in personality pathological functioning suggest that BPD may be the representative of a general personality disturbance, a factor of vulnerability underlying diverse psychopathological variants and aspects of maladaptive functioning. However, recent studies seem to have neglected the contributions that other specific personality disorders and personality pathology as a general factor of vulnerability for suicidality; and only marginally investigated the interaction of personality disorder (PD) as an overall diagnosis and individual PDs and major depression (MDD). In this paper, the independent and cumulative effects of MDD and DSM-IV PDs on suicidal risk are investigated in a sample of adolescents observed in a longitudinal window of observation ranging from three months preceding the assessment to a six-month follow up period of clinical monitoring. METHODS A sample of 118 adolescents (mean age = 15.48 ± 1.14) referred for assessment and treatment on account of suicidal ideation or behavior were administered the CSSRS, SCID II, Kiddie-SADS at admission at inpatient and outpatient Units. All subjects included in the study had reported suicidal ideation or suicide attempts at the C-SSRS; The CSSRS was applied again to all patients who reported further suicidal episodes during the six-months follow-up period of clinical monitoring. Dimensional diagnoses of PDs was obtained by summing the number of criteria met by each subject at SCID-%-PD 5, In order, to test the significance of the associations between the variables chosen as predictors (categorical and dimensional PDs and MD diagnosis), and the suicidal outcomes variables suicide attempts, number of suicide attempts and potential lethality of suicide attempt, non-parametric bivariate correlations, logistic regression models and mixed-effects Poisson regression were performed PD. RESULTS The categorical and dimensional diagnosis of PD showed to be a significant risk factors for suicide attempt and their recurrence, independently of BPD, that anyway was confirmed to be a specific significant risk factor for suicidal behaviors. Furthermore, PD assessed at a categorical and dimensional level and Major Depression exert an influence on suicidal behaviors and their lethality both as independent and cumulative risk factors. LIMITATIONS Besides incorporating dimensional thinking into our approach to assessing psychopathology, our study still relied on traditionally defined assessment of PD. Future studies should include AMPD-defined personality pathology in adolescence to truly represent dimensional thinking. CONCLUSION These results point to the importance of early identification of the level of severity of personality pathology at large and its co-occurrence with Major Depression for the management of suicidal risk in adolescence.
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Affiliation(s)
- Riccardo Williams
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy.
| | - Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marta Moselli
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - Camillla Frattini
- Department of Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, "Sapienza" - University of Rome, Rome, Italy
| | - MariaPia Casini
- Section of Child and Adolescent Neuro-Psychiatry, "Sapienza" - University of Rome, Rome, Italy
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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16
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Obi-Obasi O, Cano K, Sharp C. Specificity of Insecure Attachment in Adolescents With Borderline Personality Disorder in Psychiatric Inpatient and Community-Dwelling Adolescents. J Pers Disord 2023; 37:751-760. [PMID: 38038655 DOI: 10.1521/pedi.2023.37.6.751] [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
Borderline personality disorder (BPD) has been conceptualized as a disorder of attachment. However, the specificity of attachment insecurity to BPD in adolescents remains unclear. In this study, an inpatient sample (n = 521), of which 173 (33.2%) met the criteria for BPD, and a control sample of community-dwelling adolescents (n = 294) ages 12-17 were compared on a self-report measure of attachment security. In addition, hierarchical regression analyses were carried out to examine the incremental contribution of BPD symptoms, over and above internalizing and externalizing symptoms, in predicting attachment security. Results showed expected group differences such that adolescents with BPD evidenced higher levels of attachment insecurity to both fathers and mothers than psychiatric and community-dwelling controls. BPD features also incremented internalizing and externalizing problems associated with attachment security. However, because psychiatric controls also evidenced high levels of attachment insecurity, we conclude that while attachment insecurity is particularly salient for BPD, it is not necessarily specific to the disorder.
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Affiliation(s)
| | - Kiana Cano
- Department of Psychology, University of Houston, Houston, Texas
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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17
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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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18
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Uzar M, Dmitrzak-Węglarz M, Słopień A. Mentalizing in Adolescents with Borderline Personality Disorder. Brain Sci 2023; 13:1473. [PMID: 37891840 PMCID: PMC10605837 DOI: 10.3390/brainsci13101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.
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Affiliation(s)
- Magdalena Uzar
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
| | - Monika Dmitrzak-Węglarz
- Department of Psychiatric Genetics, Medical Biology Center, Poznan University of Medical Sciences, Rokietnicka St. 8, 60-806 Poznan, Poland;
| | - Agnieszka Słopień
- Department of Child and Adolescent Psychiatry, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences, Szpitalna 27/33 St., 60-572 Poznan, Poland;
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19
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Dixius A, Möhler E. Effects of a Standardized DBT-A Program on Identity Development in Adolescents. Brain Sci 2023; 13:1328. [PMID: 37759929 PMCID: PMC10526514 DOI: 10.3390/brainsci13091328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Identity diffusion plays a central role in the onset of borderline personality disorders. Dialectical Behavioral Therapy for Adolescents (DBT-A) is a treatment program for adolescents with emotional instability and dysregulation. The interest of this study is to examine the potential effects of a standardized and certified DBT-A therapy program on the identity development of adolescents in an inpatient setting. METHODS A total of 138 adolescents aged 13 to 18 years with symptoms of severe emotional instability were assessed before and after a certified and standardized 12-week in-patient DBT-A program targeting emotional regulation with the following standardized instruments: the Assessment of Identity Development in Adolescence (AIDA), Scale of the Experience of Emotions (SEE), and Symptom Checklist (SCL-90-R). RESULTS The results indicate a significant change in identity development, emotion regulation, and general symptoms of psychopathology after treatment with DBT-A. CONCLUSIONS In this large sample of adolescents, DBT-A significantly improved identity development and reduced identity diffusion, however, without a treatment-as-usual control group as a limitation. Nevertheless, our results may become clinically relevant for the prevention of chronic impairment in emotionally unstable adolescents.
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Affiliation(s)
- Andrea Dixius
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrucken, Germany;
- SHG Clinic for Child and Adolescent Psychiatry, 66119 Saarbrucken, Germany
| | - Eva Möhler
- Department of Clinical Pharmacy, Saarland University, 66123 Saarbrucken, Germany;
- SHG Clinic for Child and Adolescent Psychiatry, 66119 Saarbrucken, Germany
- Child and Adolescent Psychiatry, Saarland University Hospital, 66421 Homburg, Germany
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20
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Bax OK, Chartonas D, Parker J, Symniakou S, Lee T. Personality disorder. BMJ 2023; 382:e050290. [PMID: 37666510 DOI: 10.1136/bmj-2019-050290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Orestis Kanter Bax
- Basildon Complex Needs Psychotherapy and Personality Disorder Service, Essex Partnership University NHS Foundation Trust, UK
- Centre for Understanding Personality (CUSP), London
| | - Dimitrios Chartonas
- Centre for Understanding Personality (CUSP), London
- Camden and Islington Personality Disorder Service, Camden and Islington NHS Foundation Trust
| | - Jennie Parker
- Centre for Understanding Personality (CUSP), London
- Berkshire Healthcare NHS Foundation Trust
| | | | - Tennyson Lee
- Centre for Understanding Personality (CUSP), London
- Deancross Personality Disorder Service, East London NHS Foundation Trust
- Institute of Psychoanalysis, British Psychoanalytical Society
- Blithdale Health Centre, Clinical Director East End Health Network
- Wolfson Institute, Queen Mary University of London
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21
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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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22
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Williams K, Fleck L, Fuchs A, Koenig J, Kaess M. Mother-child interactions in adolescents with borderline personality disorder traits and the impact of early life maltreatment. Child Adolesc Psychiatry Ment Health 2023; 17:96. [PMID: 37563641 PMCID: PMC10416495 DOI: 10.1186/s13034-023-00645-4] [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: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Early detection and intervention of borderline personality disorder (BPD) in adolescence has become a public health priority. Theoretical models emphasize the role of social interactions and transgenerational mechanisms in the development of the disorder suggesting a closer look at caregiver-child relationships. METHODS The current study investigated mother-adolescent interactions and their association with adolescent BPD traits by using a case-control design. Thirty-eight adolescent patients with ≥ 3 BPD traits and their mothers (BPD-G) were investigated in contrast to 35 healthy control dyads (HC-G). Maternal, adolescent and dyadic behavior was coded using the Coding Interactive Behavior Manual (CIB) during two interactions: a fun day planning and a stress paradigm. Additional effects of maternal and/or adolescent early life maltreatment (ELM) on behavior were also explored. RESULTS BPD-G displayed a significantly lower quality of maternal, adolescent and dyadic behavior than the HC-G during both interactions. Maternal and adolescent behavior was predicted by BPD traits alone, whilst dyadic behavior was also influenced by general adolescent psychopathology. Exploratory analyses of CIB subscales showed that whilst HC-G increased their reciprocal behavior during stress compared to the fun day planning, BPD-G dyads decreased it. Maternal ELM did not differ between groups or have any effect on behavior. Adolescent ELM was correlated with behavioral outcome variables, but did not explain behavioral outcomes above and beyond the effect of clinical status. DISCUSSION/CONCLUSION Our data suggest a stronger focus on parent-child interactions in BPD-specific therapies to enhance long-term treatment outcomes in adolescent BPD patients. Further research employing study designs that allow the analyses of bidirectional transactions (e.g. longitudinal design, behavioral microcoding) is needed.
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Affiliation(s)
- Katharina Williams
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany.
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany.
| | - Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
| | - Julian Koenig
- Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Medical Faculty, University of Heidelberg, Blumenstr. 8, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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23
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Robin M, Bellone L, Belbèze J, Kazemian K, Radjack R, Corcos M. Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective. Front Psychiatry 2023; 14:1110788. [PMID: 37608992 PMCID: PMC10441123 DOI: 10.3389/fpsyt.2023.1110788] [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: 11/29/2022] [Accepted: 06/16/2023] [Indexed: 08/24/2023] Open
Abstract
Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
| | - Laura Bellone
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Jean Belbèze
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Koucha Kazemian
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
| | - Rahmeth Radjack
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Villejuif, France
- Paris Cité University, Paris, France
- Maison de Solenn, Department of Adolescent Psychiatry, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
- Paris Cité University, Paris, France
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Franssens R, Abrahams L, Van Raemdonck L, Verbeke L, De Clercq B. Capturing Between- and Within-Person Variability of Borderline Traits in Youth from a Developmentally Sensitive Situational Judgment Perspective. J Pers Assess 2023; 105:499-507. [PMID: 35946943 DOI: 10.1080/00223891.2022.2093732] [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: 12/13/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 10/15/2022]
Abstract
The significance of early maladaptive traits for understanding the roots of borderline personality disorder (BPD) is increasingly endorsed. Given the interpersonal nature of BPD and fluctuations in phenotypic symptomatology, this study aims to test the assumption that a situation-contingent contextualized assessment of borderline traits is a viable avenue to more fully capture the way underlying traits are reflected in socioaffective behavior that occurs in age-relevant situations. We aimed to explore the extent to which the variability on these responses represents a meaningful construct for understanding the clinical richness of BPD. Toward this end, a contextualized measure of DSM-5 BPD traits was developed along a situational judgment test (SJT) format, allowing us to explore both between-person and within-person variability in a more economic format than repeated measurement does. Examination of the psychometric properties of the SJT revealed distinctive correlational patterns of the situation-based traits with symptom scales of a youth BPD measure, but also indicated that for certain traits consistency in trait level across different situations is more maladaptive, whereas for other traits a greater degree of variability in trait expression is more maladaptive. Overall, this work could set the stage for further research on the potential of SJTs for understanding personality vulnerabilities both at the dispositional and the dynamic level.
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Affiliation(s)
- Raissa Franssens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Loes Abrahams
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Lisa Van Raemdonck
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Lize Verbeke
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Barbara De Clercq
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Gupta N, Gupta M, Madabushi JS, Zubiar F. Integrating Psychosocial Risks With Emerging Evidence for Borderline Personality Disorders in Adolescence: An Update for Clinicians. Cureus 2023; 15:e40295. [PMID: 37448386 PMCID: PMC10337505 DOI: 10.7759/cureus.40295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Borderline personality disorder (BPD) has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence. Various genetic, neurobiological, psychological, and social factors are implicated in the etiology of BPD. With emerging evidence on BPD development in adolescence, the review focused on recent literature to understand the role of psychosocial risk factors. The effects of adverse familial environment, physical, emotional, verbal, and sexual abuse, intergenerational transmission of psychopathological traits, maternal neglect and rejection, low socioeconomic status, bullying victimization, and dating violence were reviewed to understand their role in the development of BPD. BPD is a highly complex, serious, and enduring mental illness that has now been widely accepted to have symptoms that onset in early adolescence and could be diagnosed as early as age 12. BPD symptoms are stable, phenomenologically distinct from externalizing and internalizing disorders, and often present with co-occurring disorders, which during assessment could not explain impairments associated with BPD. New measures like the Difficulties in Emotion Regulation Scale (DERS), detailed developmental histories, understanding of psychosocial risks, shared decision-making, and psychoeducation could assist in early diagnosis and improvement of long-term outcomes. The implementation of evidence-based treatments is a challenge given higher costs and access to services; therefore, modifications in the treatment based on the core principles of these strategies should be considered. It is imperative to screen for psychosocial factors early in higher-risk groups. The assessment of familial factors, parental histories of psychopathologies, and histories of childhood abuse is important in context with impairing symptoms of clinical presentation and dimensional aspects of self-functioning. The role of family therapies, parental psychoeducation, and the integration of trauma-informed care approaches are important for clinical outcomes. Also, coordinated efforts with multiple stakeholders like school awareness programs, anti-bullying policies, legislation, and enforcement of existing laws might be instrumental in addressing issues related to victimization by peers.
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Affiliation(s)
- Nihit Gupta
- Psychiatry, University of West Virginia, Glen Dale, USA
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh , USA
| | | | - Faiza Zubiar
- Psychiatry, The Trenton Psychiatric Hospital, Trenton, USA
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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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Peters JR, Crowe ML, Morgan T, Zimmerman M, Sharp C, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, McGlashan TH, Morey LC, Skodol AE, Yen S. Borderline personality disorder symptom networks across adolescent and adult clinical samples: examining symptom centrality and replicability. Psychol Med 2023; 53:2946-2953. [PMID: 35094733 PMCID: PMC9339041 DOI: 10.1017/s0033291721004931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Numerous theories posit different core features to borderline personality disorder (BPD). Recent advances in network analysis provide a method of examining the relative centrality of BPD symptoms, as well as examine the replicability of findings across samples. Additionally, despite the increase in research supporting the validity of BPD in adolescents, clinicians are reluctant to diagnose BPD in adolescents. Establishing the replicability of the syndrome across adolescents and adults informs clinical practice and research. This study examined the stability of BPD symptom networks and centrality of symptoms across samples varying in age and clinical characteristics. METHODS Cross-sectional analyses of BPD symptoms from semi-structured diagnostic interviews from the Collaborative Longitudinal Study of Personality Disorders (CLPS), the Methods to Improve Diagnostic Assessment and Service (MIDAS) study, and an adolescent clinical sample. Network attributes, including edge (partial association) strength and node (symptom) expected influence, were compared. RESULTS The three networks were largely similar and strongly correlated. Affective instability and identity disturbance emerged as relatively central symptoms across the three samples, and relationship difficulties across adult networks. Differences in network attributes were more evident between networks varying both in age and in BPD symptom severity level. CONCLUSIONS Findings highlight the relative importance of affective, identity, and relationship symptoms, consistent with several leading theories of BPD. The network structure of BPD symptoms appears generally replicable across multiple large samples including adolescents and adults, providing further support for the validity of the diagnosis across these developmental phases.
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Affiliation(s)
| | - Michael L. Crowe
- Alpert Medical School of Brown University, Providence, USA
- VA Boston Healthcare System, Boston, USA
| | - Theresa Morgan
- Butler Hospital, Alpert Medical School of Brown University, Providence, USA
| | - Mark Zimmerman
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, USA
| | | | | | | | - M. Tracie Shea
- Alpert Medical School of Brown University, Providence, USA
| | | | | | | | | | - Shirley Yen
- Alpert Medical School of Brown University, Providence, USA
- Beth Israel Deaconess Medical Center, Massachusetts Mental Health Center, Harvard Medical School, Boston, USA
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28
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Locati F, Milesi A, Conte F, Campbell C, Fonagy P, Ensink K, Parolin L. Adolescence in lockdown: The protective role of mentalizing and epistemic trust. J Clin Psychol 2023; 79:969-984. [PMID: 36256870 PMCID: PMC9874639 DOI: 10.1002/jclp.23453] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isolation imposed by the COVID-19 pandemic was highly stressful for most people, especially for adolescents. Here we examine whether mentalizing and epistemic trust were protective factors in relation to emotional distress during the lockdown. METHOD A total of 131 nonclinical adolescents, aged between 12 and 18 years, were evaluated during the lockdown using the Reflective Functioning Questionnaire for Youth, Inventory of Parent and Peer Attachment, Perceived Stress Scale, and Difficulties in Emotion Regulation Scale. RESULTS Results from network analysis showed that epistemic trust and mentalizing were negatively associated with perceived stress and emotion dysregulation. Epistemic trust in fathers was associated with level of perceived stress, and epistemic trust in mothers with emotion dysregulation. CONCLUSION These findings suggest that epistemic trust and the capacity to mentalize were low in adolescents during lockdown, and this was associated with high levels of stress. However, robust levels of epistemic trust and mentalizing may have acted as protective factors that buffered individuals from the risk of emotional dysregulation during the lockdown.
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Affiliation(s)
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Karin Ensink
- Faculté des sciences sociales, Université Laval, Québec, Canada
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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29
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Bizzi F, Riva A, Charpentier Mora S, Tironi M, Sforza SE, Milani LM, Nacinovich R. Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3670. [PMID: 36834365 PMCID: PMC9959039 DOI: 10.3390/ijerph20043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Anna Riva
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Simone Charpentier Mora
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Sofia Elena Sforza
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine and Surgery, University of Brescia, 25123 Brescia, Italy
| | - Lorenzo Maria Milani
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- NeuroMI—Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milan, Italy
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30
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Ellison WD, Huprich S, Behn A, Goodman M, Kerr S, Levy KN, Nelson SM, Sharp C. Attitudes, Clinical Practices, and Perceived Advocacy Needs of Professionals With Interests in Personality Disorders. J Pers Disord 2023; 37:1-15. [PMID: 36723421 DOI: 10.1521/pedi.2023.37.1.1] [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] [Indexed: 02/02/2023]
Abstract
Experts in personality disorders (PDs) generally prefer dimensional diagnostic systems to categorical ones, but less is known about experts' attitudes toward personality pathology diagnoses in adolescents, and little is known about public health shortfalls and advocacy needs and how these might differ geographically. To fill these gaps, the International Society for the Study of Personality Disorders surveyed 248 professionals with interests in PDs about their attitudes toward different diagnostic systems for adults and adolescents, their PD-related clinical practices, and perceived advocacy needs in their area. Results suggested that dimensional diagnostic systems are preferable to categorical and that skepticism about personality pathology in adolescents may not be warranted. The most pressing advocacy need was the increased availability of PD-related services, but many other needs were identified. Results provide a blueprint for advocacy and suggest ways that professional societies can collaborate with public health bodies to expand the reach of PD expertise and services.
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Affiliation(s)
| | - Steven Huprich
- Department of Psychology, University of Detroit Mercy, Detroit, Michigan
| | - Alex Behn
- School of Psychology, Pontificia Universidad Católica de Chile and Millennium Institute for Research in Depression and Personality, Santiago, Chile
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Bronx, New York
| | - Sophie Kerr
- Department of Psychology, University of Houston, Houston, Texas
| | - Kenneth N Levy
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania
| | - Sharon M Nelson
- Serious Mental Illness Treatment, Resource, and Evaluation Center, Veterans Health Administration, Ann Arbor, Michigan
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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31
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Cervantes BR, Kerr S, Vanwoerden S, Sharp C. Operationalizing intimacy and identity aspects of personality functioning in relation to personality disorder in adolescents. Front Psychiatry 2023; 14:1153274. [PMID: 37113535 PMCID: PMC10126270 DOI: 10.3389/fpsyt.2023.1153274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
According to dimensional models of personality pathology, deficits in interpersonal (intimacy and empathy) and self (identity and self-direction) function (Criterion A) are core to all personality disorders. These aspects of personality functioning (Criterion A) have seldom been evaluated for how they might relate to one another in the context of personality pathology in adolescents. Moreover, the use of performance-based measures to evaluate aspects of Criterion A function remains an untapped resource. Therefore, the present study aimed to evaluate relations between two features of Criterion A, maladaptive intimacy and maladaptive (or diffused) identity, in adolescence. For intimacy, we leverage a performance-based approach to studying intimacy, operationalized in a developmentally relevant way (perceived parental closeness). For identity, we rely on a validated self-report measure of identity diffusion. We examined the relationship between these features with each other and their relations with borderline features. Additionally, we explored whether identity diffusion mediated the expected relationship between perceived parental closeness and borderline features. We hypothesized that greater distance in perceived parental closeness would be associated with higher levels of borderline features, as well as higher levels of identity diffusion, and that identity diffusion would account for the relationship between intimacy and personality pathology. The sample included 131 inpatient adolescents (M age = 15.35, 70.2% female). Results indicated that intimacy, operationalized as perceived parental closeness, with both mothers and fathers was significantly associated with levels of identity diffusion and borderline features. In addition, greater feelings of closeness with parents were associated with lower severity of borderline features via healthier identity function. Implications of the results, limitations, and future directions are discussed.
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Affiliation(s)
| | - Sophie Kerr
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Salome Vanwoerden
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
- *Correspondence: Carla Sharp,
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Bäumer AV, Fürer L, Birkenberger C, Wyssen A, Steppan M, Zimmermann R, Gaab J, Kaess M, Schmeck K. The impact of outcome expectancy on therapy outcome in adolescents with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:30. [PMID: 36464739 PMCID: PMC9721041 DOI: 10.1186/s40479-022-00200-1] [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: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Outcome expectancy has been found to be a significant predictor of psychotherapy outcome. However, given that severity, chronicity and comorbidity are moderators of outcome expectancy, it is important to provide evidence of whether the same holds true in clinical conditions marked by these attributes, such as in borderline personality disorder (BPD). The aim of the present study was to investigate the role of patients' outcome expectancy in adolescents undergoing early intervention for BPD using pre-post difference of psychosocial functioning as outcome. METHODS Forty-four adolescent BPD patients were treated with Dialectical Behavior Therapy for Adolescents (DBT-A) or Adolescent Identity Treatment (AIT). We investigated the effect of outcome expectancy on outcome with type of treatment as moderator. Based on the relevant literature, we assess the correlation between outcome expectancy and pretreatment symptomatology, namely BPD severity, personality functioning, childhood trauma and depression. RESULTS The results showed a significant effect of expectancy on outcome (stand. β = 0.30, p = 0.020) above autoregression. ANOVA analysis revealed no difference between the two treatments. Further, results indicate that pretreatment symptomatology, i.e., depression, childhood trauma and personality functioning dimensions self-direction and intimacy, are associated with early treatment expectancy. CONCLUSION Outcome expectancy as a common factor plays a key role in successful psychotherapy with adolescent BPD patients. Elevated pretreatment depression, childhood trauma and impairment in personality functioning dimensions self-direction and intimacy are risk factors associated with lower expectancy. Low outcome expectancy should be addressed in early psychotherapy to improve the therapeutical process.
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Affiliation(s)
- Anna-Valeska Bäumer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Carolin Birkenberger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
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Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
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Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
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34
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McKay MT, Clarke MC, Donnelly P, Percy A. The McLean Screening Instrument for Borderline Personality Disorder: What, and why in a clinical cohort? Psychiatry Res 2022; 317:114868. [PMID: 36219901 DOI: 10.1016/j.psychres.2022.114868] [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: 04/09/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 01/04/2023]
Abstract
Borderline Personality Disorder is a severe psychiatric disorder with debilitating consequences. Screening for the disorder is problematic as symptoms overlap with other psychiatric disorders. The McLean Screening Instrument (MSI) assesses endorsement (yes/no) of 10 symptoms, with a cut-off of seven indicating potential caseness. Participants were (N = 68) from an established clinical cohort who completed a structured clinical interview, the MSI, the Childhood Trauma Questionnaire, and the Adolescent and Adult Time Attitudes Scale. A proportion (N = 20) also completed a follow-up interview examining their rationale for endorsing MSI items. Total number of MSI items endorsed was meaningfully related to scores on emotional neglect and negative time attitudes. There was substantive overlap between MSI threshold (≥7 items) and lifetime diagnosis of a mental disorder. The stated rationale for endorsing MSI items, was less indicative of personality trait, and was related more to particular developmental periods, one-off episodes, and life-contexts. Additionally, participants conflated constructs such as emptiness with loneliness, and moodiness with general emotionality. Those meeting MSI threshold recalled more childhood emotional neglect, and were more negative about all time periods. It is apparent that scoring of the MSI is driven by prevailing life circumstances as much as enduring personality traits.
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Affiliation(s)
- Michael T McKay
- Department of Psychology, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland; Northern Ireland Public Health Research Network, School of Medicine, Ulster University,Ireland.
| | - Mary C Clarke
- Department of Psychology, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, Ireland
| | - Paul Donnelly
- School of Sport, Ulster University, Newtownabbey, Ireland
| | - Andrew Percy
- School of Social Sciences, Education, and Social Work, Queens University, Belfast, Ireland
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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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Svela EW, Korsgaard HO, Stänicke LI, Ulberg R. Inter-Rater Reliability of the Structured Interview of DSM-IV Personality (SIDP-IV) in an Adolescent Outpatient Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12283. [PMID: 36231585 PMCID: PMC9566621 DOI: 10.3390/ijerph191912283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Personality disorders (PDs) are a class of mental disorders which are associated with subjective distress, decreased quality of life and broad functional impairment. The presence of one or several PDs may also complicate the course and treatment of symptom disorders such as anxiety and depression. Accurate and reliable means of diagnosing personality disorders are thus crucial to ensuring efficient treatment planning and resource allocation, a fact which is widely acknowledged within the adult mental health field. In adolescents, on the other hand, the consensus view has been that the rapid and discontinuous processes of normal personality development render the construct of PD in adolescents clinically unhelpful and conceptually dubious. However, recent research has established the reliability and validity of the construct, heralding an increased interest in the field, with important conceptual and clinical implications. The present article presents reliability data for the Structured Interview of DSM-IV Personality (SIDP-IV) in an adolescent outpatient population. For this study, 25 interviews conducted by experienced clinicians were blindly re-scored based on sound recordings, which allowed for the calculation of intra-class correlation metrics. The intra-class correlation coefficient for categorical diagnosis of specific personality disorders was found to be 0.876 (95% CI 0.718-0.945); Cohen's kappa for presence/absence of personality diagnosis was found to be 0.896. The present study found excellent intra-rater reliability for the sample, which suggests that the SIDP-IV is a suitable instrument for assessing personality pathology in adolescent populations.
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Affiliation(s)
- Eirik Wixøe Svela
- Psychiatric Outpatient Clinic, Lovisenberg Hospital, 0653 Oslo, Norway
| | | | - Line Indrevoll Stänicke
- The Nic Waal Institute, Lovisenberg Hospital, 0853 Oslo, Norway
- Department of Psychology, University of Oslo, 0315 Oslo, Norway
| | - Randi Ulberg
- Division of Mental Health and Addiction, University of Oslo, 0315 Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, 0373 Oslo, Norway
- Division of Mental Health, Vestfold Hospital Trust, 3125 Tønsberg, Norway
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Quevedo Y, Booij L, Herrera L, Hernández C, Jiménez JP. Potential epigenetic mechanisms in psychotherapy: a pilot study on DNA methylation and mentalization change in borderline personality disorder. Front Hum Neurosci 2022; 16:955005. [PMID: 36171872 PMCID: PMC9510615 DOI: 10.3389/fnhum.2022.955005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Genetic and early environmental factors are interwoven in the etiology of Borderline Personality Disorder (BPD). Epigenetic mechanisms offer the molecular machinery to adapt to environmental conditions. There are gaps in the knowledge about how epigenetic mechanisms are involved in the effects of early affective environment, development of BPD, and psychotherapy response. We reviewed the available evidence of the effects of psychotherapy on changes in DNA methylation and conducted a pilot study in a sample of 11 female adolescents diagnosed with BPD, exploring for changes in peripheral DNA methylation of FKBP5 gene, which encodes for a stress response protein, in relation to psychotherapy, on symptomatology and underlying psychological processes. For this purpose, measures of early trauma, borderline and depressive symptoms, psychotherapy outcome, mentalization, and emotional regulation were studied. A reduction in the average FKBP5 methylation levels was observed over time. Additionally, the decrease in FKBP5 methylation observed occurred only in those individuals who had early trauma and responded to psychotherapy. The results suggest an effect of psychotherapy on epigenetic mechanisms associated with the stress response. The finding that epigenetic changes were only observed in patients with early trauma suggests a specific molecular mechanism of recovery. The results should be taken with caution given the small sample size. Also, further research is needed to adjust for confounding factors and include endocrinological markers and therapeutic process variables.
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Affiliation(s)
- Yamil Quevedo
- Departamento de Psiquiatría y Salud Mental Oriente, Universidad de Chile, Santiago, Chile
- Millenium Institute for Depression and Personality Research, Santiago, Chile
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Sainte-Justine Hospital Research Centre, Montreal, QC, Canada
| | - Luisa Herrera
- Programa de Genética Humana, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Cristobal Hernández
- Millenium Institute for Depression and Personality Research, Santiago, Chile
- Escuela de Psicología, Universidad Adolfo Ibañez, Santiago, Chile
| | - Juan Pablo Jiménez
- Departamento de Psiquiatría y Salud Mental Oriente, Universidad de Chile, Santiago, Chile
- Millenium Institute for Depression and Personality Research, Santiago, Chile
- *Correspondence: Juan Pablo Jiménez
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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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Semovski V, King CB, Stewart SL. Mental Health Service Urgency in Children's Mental Health: Factors Impacting the Need for Expedited Services. Child Psychiatry Hum Dev 2022; 53:765-775. [PMID: 33835279 DOI: 10.1007/s10578-021-01161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/21/2022]
Abstract
Delayed access to mental health services for children and adolescents has been linked to an increased risk of harm and nonattendance to scheduled appointments. While studies suggest that the lack of standardized assessments for prioritizing individuals has contributed to long wait times, the inconsistent use of assessments across service sectors in Ontario continues to persist. This has contributed to a paucity of information surrounding which children and adolescents may require urgent mental health services. Using a large secondary data set, this study examined whether service sector (e.g., school), and other individual client characteristics (e.g., age, sex, legal guardianship, interpersonal and school conflict) predicted greater mental health service urgency in 61,448 children and adolescents assessed using the interRAI Child and Youth Mental Health Screener. Binary logistic regression revealed that all predictors, except for sector, showed a significant effect on service urgency. Findings are instrumental in prioritization, reducing the likelihood that children with acute needs remain on waitlists.
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Affiliation(s)
- Valbona Semovski
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada.
| | - Colin B King
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
| | - Shannon L Stewart
- Faculty of Education, The University of Western Ontario, 1137 Western Road, London, ON, N6G 1G7, Canada
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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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Cottin M, Blum K, Konjufca J, Quevedo Y, Kaaya S, Behn A, Schmeck K, Sharp C, Zimmermann R. Digital use of standardised assessment tools for children and adolescents: can available paper-based questionnaires be used free of charge in electronic format? BMC Psychiatry 2022; 22:379. [PMID: 35659275 PMCID: PMC9166519 DOI: 10.1186/s12888-022-04023-w] [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: 01/28/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
QUESTION Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. METHODS For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. RESULTS In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. CONCLUSIONS Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument's authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.
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Affiliation(s)
- Marianne Cottin
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile ,grid.440629.d0000 0004 5934 6911School of Psychology, Finis Terrae University, Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Kathrin Blum
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland
| | - Jon Konjufca
- grid.449627.a0000 0000 9804 9646University of Prishtina, Pristina, Kosovo ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yamil Quevedo
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.443909.30000 0004 0385 4466Department of Psychiatry East Campus, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sylvia Kaaya
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania ,grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - Alex Behn
- grid.488997.3Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile ,grid.7870.80000 0001 2157 0406School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Klaus Schmeck
- grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals of the University of Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Carla Sharp
- grid.266436.30000 0004 1569 9707Department of Psychology, University of Houston, Houston, TX USA
| | - 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.
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Preyde M, DiCroce M, Parekh S, Heintzman J. Exploring screening for borderline personality disorder in pediatric inpatients with psychiatric Illness. Psychiatry Res 2022; 309:114397. [PMID: 35074643 DOI: 10.1016/j.psychres.2022.114397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022]
Abstract
Borderline Personality Disorder (BPD) is a severe psychiatric illness associated with poor personal and interpersonal functioning. Screening for BPD in adolescents and provision of specialized treatment may improve life circumstances in vocations and relationships. The purpose of this study was to determine the number of pediatric inpatients who would screen positive for BPD with a self-rating measure, and to compare their personal and interpersonal characteristics with youth who did not screen positive. A survey with self-report measures was administered to patients to screen for BPD. The mean age of the sample was 15 years and 71% identified as female gender. Of 109 patients 72 (66%) screened positive for BPD while only eight (7%) patients were diagnosed by psychiatrists with BPD or features of BPD. There were no statistically significant differences between those who scored positive versus negative for BPD in age, gender, or avoidant anxiety. There were statistically significant differences in anxious attachment, distress, clinical symptoms, problematic use of electronic devices, considered suicide, past trauma and prior suspensions from school. This exploration in pediatric inpatients suggests that many of these patients may be at risk for a diagnosis of BPD later in life and may benefit from early identification and specialized intervention.
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Affiliation(s)
- Michèle Preyde
- College of Social and Applied Human Sciences, Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada.
| | - Marco DiCroce
- College of Social and Applied Human Sciences, Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Shrenik Parekh
- Grand River Hospital, 835 King Street West, Kitchener, Ontario, Canada
| | - John Heintzman
- Grand River Hospital, 835 King Street West, Kitchener, Ontario, Canada
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Parr AC, Calancie OG, Coe BC, Khalid-Khan S, Munoz DP. Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder. Front Neurosci 2022; 15:667399. [PMID: 35237117 PMCID: PMC8882924 DOI: 10.3389/fnins.2021.667399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.
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Affiliation(s)
- Ashley C. Parr
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
- *Correspondence: Ashley C. Parr,
| | - Olivia G. Calancie
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Brian C. Coe
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Sarosh Khalid-Khan
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Douglas P. Munoz,
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Brager-Larsen A, Zeiner P, Klungsøyr O, Mehlum L. Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients? BMC Psychiatry 2022; 22:58. [PMID: 35081930 PMCID: PMC8790924 DOI: 10.1186/s12888-022-03712-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm. METHODS Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models. RESULTS A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt. CONCLUSION Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.
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Affiliation(s)
- Anne Brager-Larsen
- Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372, Oslo, Norway.
| | - Pål Zeiner
- grid.55325.340000 0004 0389 8485Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372 Oslo, Norway
| | - Ole Klungsøyr
- grid.55325.340000 0004 0389 8485Section for treatment research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lars Mehlum
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Bégin M, Ensink K, Bellavance K, Clarkin JF, Normandin L. Risky Sexual Behavior Profiles in Youth: Associations With Borderline Personality Features. Front Psychol 2022; 12:777046. [PMID: 35095660 PMCID: PMC8789890 DOI: 10.3389/fpsyg.2021.777046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Adolescence and young adulthood are peak periods for risky sexual behaviors (RSB) and borderline personality disorder (BPD) features. RSB is a major public health concern and adolescents with BPD may be particularly vulnerable to RSB, but this is understudied. The aim of this study was to identify distinct RSB profiles in youth and determine whether a specific profile was associated with BPD features. Participants were 220 adolescents and young adults (age 14-21) recruited from the community. To identify groups of adolescents and young adults who engage in similar RSB, a latent profile analysis (LPA) was conducted on sexually active youth (57%). Next ANOVA was used to identify how profiles differed in terms RSB dimensions and BPD features. We identified three distinct RSB profiles: (1) a Low RSB profile that was manifested by the majority (77.7%) of youth; (2) an Unprotected Sex in Relationships profile (13.3%) and; (3) an Impulsive Sex Outside Relationships profile (12%) which was manifested by youth with significantly higher BPD features. The findings shed light on the difficulties youth with BPD manifest around integrating sexuality, intimacy, fidelity, and love. This contrasts with the majority of youth who are sexually active in the context of relationships and engage in little or no RSB. The findings have important clinical implications. Adolescent sexuality is frequently in the blind spot of clinicians. To address the elevated risk of RSB in adolescents with BPD, interventions are needed to help adolescents navigate this period and improve their understanding of the reasons for RSB while addressing difficulties in establishing sexual and attachment relationships.
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Affiliation(s)
- Michaël Bégin
- École de Psychologie, Université Laval, Quebec, QC, Canada
| | - Karin Ensink
- École de Psychologie, Université Laval, Quebec, QC, Canada
| | | | - John F. Clarkin
- Weill Cornell Medical College, Cornell University, New York, NY, United States
| | - Lina Normandin
- École de Psychologie, Université Laval, Quebec, QC, Canada
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d’Huart D, Bürgin D, Seker S, Birkhölzer M, Jenkel N, Boonmann C, Fegert JM, Schmid M, Schmeck K. Risikofaktoren für und Stabilität einer Persönlichkeitsstörung vom Jugendalter bis ins junge Erwachsenenalter in einer Hochrisikopopulation. KINDHEIT UND ENTWICKLUNG 2022. [DOI: 10.1026/0942-5403/a000367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Studien zeigen, dass Persönlichkeitsstörungen (PS) weniger stabil und bei einer frühzeitigen Erkennung gut behandelbar sind. Fragestellung: Ziel dieser Studie ist, 1) die Prävalenz von PS bei ehemalig fremdplatzierten jungen Erwachsenen zu beschreiben, 2) die kategoriale Stabilität von PS vom Jugendalter bis ins junge Erwachsenenalter zu bestimmen und 3) prospektive Risikofaktoren für eine PS im Erwachsenenalter zu identifizieren. Methoden: 180 ehemalig fremdplatzierte junge Erwachsene ( M = 26.3 Jahre) aus einer schweizweiten Längsschnittstudie wurden untersucht. Ergebnisse: 35 % der Teilnehmenden wiesen eine PS auf. Die kategoriale Stabilität belief sich auf 47 %. Folgende Risikofaktoren für eine PS im Erwachsenenalter wurden identifiziert: vorangehende PS, psychopathische Persönlichkeitszüge, Substanzmissbrauch, emotionale Vernachlässigung, kumulierte Misshandlungserfahrungen und Deliktschwere. Diskussion und Schlussfolgerung: Die kategoriale Stabilität irgendeiner PS in dieser Stichprobe gilt als mittelgradig. Dies unterstreicht die Notwendigkeit, PS nicht mehr mit einem lebenslangen, unveränderbaren Schicksal gleichzusetzen. Das Erkennen möglicher Risikofaktoren ist eine wichtige Voraussetzung, um individuelle Behandlungsmöglichkeiten zu gewährleisten und einer Chronifizierung entgegenzuwirken.
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Affiliation(s)
- Delfine d’Huart
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - David Bürgin
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Süheyla Seker
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Marc Birkhölzer
- Jugendforensische Ambulanz (JAM), Klinik für Forensik, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Nils Jenkel
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Cyril Boonmann
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Deutschland
| | - Marc Schmid
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
| | - Klaus Schmeck
- Forschungsabteilung der Klinik für Kinder und Jugendliche, Universitäre Psychiatrische Kliniken Basel, Schweiz
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Tromp N, van Dijk R, Saunders R, Fonagy P. Mentalization-Based Treatment in Adolescent Inpatients: A Naturalistic Multi-Informant Study of Outcomes. J Pers Disord 2021; 35:881-901. [PMID: 33764822 DOI: 10.1521/pedi_2021_35_517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present era of major cutbacks in intensive treatment programs throughout Europe stresses the importance of evaluating the outcomes of such programs for adolescents with severe personality pathology and comorbidity. Personality pathology has proven to be a valid concept in adolescents, with relatively high prevalence, that needs to be targeted by evidence-based interventions. The present study focused on the evaluation of outcomes of a 12-month mentalization-based treatment for adolescents (MBT-A) program in 118 inpatient adolescents with personality pathology symptoms, using a multi-informant multidomain design. The results showed that during treatment, adolescents improved on general psychiatric symptoms, personality pathology dimensions, and health-related and generic quality of life. Improvement was not only statistically significant, but also clinically important, especially for internalizing domains. Implications for clinical practice and research are discussed.
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Affiliation(s)
- Noor Tromp
- Parlan Jeugdhulp, Alkmaar, The Netherlands
| | | | | | - Peter Fonagy
- University College London, and Anna Freud National Centre for Children and Families, London, United Kingdom
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Bagattini N. Psychic structure, unconscious conflict and adolescent psychopathology: The contributions of OPD-CA–2. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.2001680] [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]
Affiliation(s)
- Nicolás Bagattini
- Clinical Research Department – Uno, Mental Health Institute, Psychology PhD Program- The Catholic University, Montevideo, Uruguay
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50
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Guilé JM, Zavaglia E, Berthiaume C, Bergeron L. Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2053-2062. [PMID: 33745001 DOI: 10.1007/s00127-021-02067-z] [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] [Received: 05/07/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.
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Affiliation(s)
- Jean Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens-Picardie University Medical Centre , Amiens, France. .,Psychiatry Residency Program, Department of Psychiatry, University of Picardie-Jules Verne, Amiens, France. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Elissa Zavaglia
- Department of Psychology, Montreal University, Montreal, QC, Canada.,Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Claude Berthiaume
- Research Centre, Hôpital en Santé Mentale Rivières-Des-Prairies, CIUSSS du Nord-de-L'Île-de-Montréal, Montréal, Québec, Canada
| | - Lise Bergeron
- Department of Psychology, Montreal University, Montreal, QC, Canada
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