1
|
Marrero RJ, Bello M, Morales-Marrero D, Fumero A. Emotion Regulation Difficulties, Family Functioning, and Well-Being Involved in Non-Suicidal Self-Injury and Suicidal Risk in Adolescents and Young People with Borderline Personality Traits. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1057. [PMID: 37371288 DOI: 10.3390/children10061057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Individuals with a borderline personality disorder (BPD) or BPD traits usually have a lifetime history of harmful behaviors. Emotion regulation difficulties are a risk factor for suicide, whereas adequate family functioning and well-being play an important protective role. This study aims to determine the role of emotion regulation difficulties, well-being, and family functioning in the suicide risk and non-suicidal self-injury (NSSI) in adolescents and young people with BPD traits. From a sample of 285 young people, 103 (36.1%) had BPD traits (mean age = 16.82, SD = 2.71), and 68.93% were females. The results showed significant differences in personal and family variables according to the type of harmful behavior. Suicide attempts (SA) were mainly predicted by difficulties in impulse control, whereas NSSI was predicted by low family satisfaction. Programs designed to prevent SA and NSSI should consider individual differences, as well as the type of harmful behaviors exhibited.
Collapse
Affiliation(s)
- Rosario J Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Spain
| | - Macarena Bello
- Instituto Andrés Bello, 38007 Santa Cruz de Tenerife, Spain
| | - Daida Morales-Marrero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
| | - Ascensión Fumero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología y Logopedia, Universidad de La Laguna, 38200 La Laguna, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 La Laguna, Spain
| |
Collapse
|
2
|
Chu C, Buchman-Schmitt JM, Joiner TE, Rudd MD. Personality Disorder Symptoms and Suicidality: Low Desire and High Plans for Suicide in Military Inpatients and Outpatients. J Pers Disord 2017; 31:145-155. [PMID: 26959962 PMCID: PMC5311028 DOI: 10.1521/pedi_2016_30_241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study characterizes the personality disorder (PD) symptoms of patients who endorse a perplexing combination of low desire and high plans for suicide. Five PD (antisocial, narcissistic, borderline, dependent, avoidant) symptoms were examined at the junction of two suicide risk factors: (a) suicidal desire/ideation and (b) resolved plans/preparations. Participants (N = 250) were recruited from U.S. Army Medical Center affiliated sites, including two outpatient clinics, an inpatient facility, and an emergency room. Self-report measures of PD and suicide symptoms were administered. The interaction of desire and plans was entered into multiple regression equations predicting PD symptoms. Patients endorsing low desire and high plans for suicide reported significantly more antisocial and narcissistic symptoms and fewer borderline, avoidant, and dependent PD symptoms. These findings support the existence of patients who endorse suicide plans in the absence of strong suicidal desire and suggest that they display antisocial and narcissistic personality characteristics. Future directions and clinical implications are discussed.
Collapse
|
3
|
Bergeron L, Smolla N, Berthiaume C, Renaud J, Breton JJ, St.-Georges M, Morin P, Zavaglia E, Labelle R. Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents-Revised A DSM-5-Based Self-Report Screen for Mental Disorders, Borderline Personality Traits, and Suicidality. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:211-222. [PMID: 27638424 PMCID: PMC5317018 DOI: 10.1177/0706743716670129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The Dominic Interactive for Adolescents-Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5). This study aimed to examine the reliability and the validity of this instrument. METHODS French- and English-speaking adolescents aged 12 to 15 years ( N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. RESULTS For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. CONCLUSIONS Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents' mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.
Collapse
Affiliation(s)
- Lise Bergeron
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychology, Université de Montréal, Montréal, Québec
- Lise Bergeron, PhD, Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, 7070 Perras Boulevard, Montréal, QC H1E 1A4, Canada.
| | - Nicole Smolla
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychiatry, Université de Montréal, Montréal, Québec
| | - Claude Berthiaume
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Johanne Renaud
- CIUSSS de l’Ouest-de-l’Île-de-Montréal, Douglas Mental Health University Institute, Montréal, Québec
- Department of Psychiatry, McGill University, Montréal, Québec
| | - Jean-Jacques Breton
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychiatry, Université de Montréal, Montréal, Québec
| | - Marie St.-Georges
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Pauline Morin
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Elissa Zavaglia
- Department of Psychology, Université de Montréal, Montréal, Québec
| | - Réal Labelle
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Research Centre, CIUSSS de l’Est-de-l’Île-de-Montréal, Montréal, Québec
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec
| |
Collapse
|
4
|
Hallquist MN, Hipwell AE, Stepp SD. Poor self-control and harsh punishment in childhood prospectively predict borderline personality symptoms in adolescent girls. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 124:549-64. [PMID: 25961815 DOI: 10.1037/abn0000058] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Developmental theories of borderline personality disorder (BPD) propose that harsh, invalidating parenting of a child with poor self-control and heightened negative emotionality often leads to a coercive cycle of parent-child transactions that increase risk for BPD symptoms such as emotion dysregulation. Although parenting practices and child temperament have previously been linked with BPD, less is known about the prospective influences of caregiver and child characteristics. Using annual longitudinal data from the Pittsburgh Girls Study (n = 2,450), our study examined how reciprocal influences among harsh parenting, self-control, and negative emotionality between ages 5 and 14 predicted the development of BPD symptoms in adolescent girls ages 14 to 17. Consistent with developmental theories, we found that harsh punishment, poor self-control, and negative emotionality predicted BPD symptom severity at age 14. Only worsening self-control between ages 12 and 14, however, predicted growth in BPD symptoms from 14 to 17. Furthermore, the effects of harsh punishment and poor self-control on age 14 BPD symptoms were partially mediated by their earlier reciprocal effects on each other between ages 5 and 14. Our findings underscore the need to address both child and parental contributions to dysfunctional transactions in order to stem the development of BPD symptoms. Moreover, problems with self-regulation in early adolescence may indicate heightened risk for subsequent BPD. Altogether, these results increase our understanding of developmental trajectories associated with BPD symptoms in adolescent girls.
Collapse
|
5
|
Fonagy P, Speranza M, Luyten P, Kaess M, Hessels C, Bohus M. ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice. Eur Child Adolesc Psychiatry 2015; 24:1307-20. [PMID: 26271454 DOI: 10.1007/s00787-015-0751-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/17/2015] [Indexed: 12/26/2022]
Abstract
Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.
Collapse
Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Versailles General Hospital, Faculty of Health Sciences, Research Unit EA4047, University of Versailles Saint-Quentin-en-Yvelines, 177 rue de Versailles, 78157, Le Chesnay, France
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Box 3722, 3000, Leuven, Belgium
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany
| | - Christel Hessels
- Expertise Centre for Personality Disorders, GGz Centraal, PO Box 3051, 3800 DB, Amersfoort, The Netherlands
| | - Martin Bohus
- Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
- Faculty of Health, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
6
|
Biskin RS. The Lifetime Course of Borderline Personality Disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:303-8. [PMID: 26175388 PMCID: PMC4500179 DOI: 10.1177/070674371506000702] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 01/12/2023]
Abstract
Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption. This paper reviews the course of BPD throughout life, including childhood, adolescence, and adulthood. BPD can be accurately identified in adolescence, and the course of the disorder, in adolescence and adulthood, is generally similar, with reductions in symptoms over time. Functional recovery is less consistent, and further research on factors or treatments that may improve the long-term functional outcome of patients with BPD is warranted.
Collapse
Affiliation(s)
- Robert S Biskin
- Staff Psychiatrist, Institute of Community and Family Psychiatry, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec; Assistant Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| |
Collapse
|
7
|
Predicting borderline personality disorder symptoms in adolescents from childhood physical and relational aggression, depression, and attention-deficit/hyperactivity disorder. Dev Psychopathol 2014; 26:817-30. [DOI: 10.1017/s0954579414000418] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractDevelopmental cascade models linking childhood physical and relational aggression with symptoms of depression and attention-deficit/hyperactivity disorder (ADHD; assessed at ages 10, 11, 12, 13, and 14) to borderline personality disorder (BPD) features (assessed at age 14) were examined in a community sample of 484 youth. Results indicated that, when controlling for within-time covariance and across-time stability in the examination of cross-lagged relations among study variables, BPD features at age 14 were predicted by childhood relational aggression and symptoms of depression for boys, and physical and relational aggression, symptoms of depression, and symptoms of ADHD for girls. Moreover, for boys BPD features were predicted from age 10 ADHD through age 12 depression, whereas for girls the pathway to elevated BPD features at age 14 was from depression at age 10 through physical aggression symptoms at age 12. Controlling for earlier associations among variables, we found that for girls the strongest predictor of BPD features at age 14 was physical aggression, whereas for boys all the risk indicators shared a similar predictive impact. This study adds to the growing literature showing that physical and relational aggression ought to be considered when examining early precursors of BPD features.
Collapse
|
8
|
Un changement de paradigme au sein du DSM ? Le cas de la personnalité borderline à l’adolescence. EVOLUTION PSYCHIATRIQUE 2014. [DOI: 10.1016/j.evopsy.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
9
|
Courtney-Seidler EA, Klein D, Miller AL. Borderline personality disorder in adolescents. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2013. [DOI: 10.1111/cpsp.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Lereya ST, Winsper C, Heron J, Lewis G, Gunnell D, Fisher HL, Wolke D. Being bullied during childhood and the prospective pathways to self-harm in late adolescence. J Am Acad Child Adolesc Psychiatry 2013; 52:608-18.e2. [PMID: 23702450 DOI: 10.1016/j.jaac.2013.03.012] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/01/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess whether being bullied between 7 and 10 years of age is directly associated with self-harm in late adolescence when controlling for previous exposure to an adverse family environment (domestic violence, maladaptive parenting); concurrent internalizing and externalizing behavior; and subsequent psychopathology (borderline personality disorder and depression symptoms). METHOD A total of 4,810 children and adolescents in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort were assessed to ascertain bullying exposure (between 7 and 10 years of age) and self-harm at 16 to 17 years. RESULTS A total of 16.5% of 16- to 17-year-olds reported self-harm in the previous year. Being bullied was associated with an increased risk of self-harm directly, and indirectly via depression symptoms in early adolescence. The association between an adverse family environment (exposure to maladaptive parenting and domestic violence) and self-harm was partially mediated by being bullied. CONCLUSIONS Being bullied during childhood increases the risk of self-harm in late adolescence via several distinct pathways, for example, by increasing the risk of depression and by exacerbating the effects of exposure to an adverse family environment; as well as in the absence of these risk exposures. Health practitioners evaluating self-harm should be aware that being bullied is an important potential risk factor.
Collapse
|
11
|
Affiliation(s)
- Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station, Texas 77843;
| | | |
Collapse
|
12
|
Speranza M, Pham-Scottez A, Revah-Levy A, Barbe RP, Perez-Diaz F, Birmaher B, Corcos M. Factor structure of borderline personality disorder symptomatology in adolescents. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:230-7. [PMID: 22480588 DOI: 10.1177/070674371205700406] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. METHOD The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. RESULTS The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. CONCLUSIONS The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.
Collapse
Affiliation(s)
- Mario Speranza
- Centre Hospitalier de Versailles, Service de Pédopsychiatrie, Le Chesnay, France.
| | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
This paper reviews recent studies of biological and environmental risk and protective factors and patterns of continuity leading to borderline personality disorder (BPD). It focuses on prospective studies of children and adolescents and studies of young people with borderline pathology, reporting findings from genetics, neurobiology, experimental psychopathology, environmental risk, and precursor signs and symptoms. Studies of individuals earlier in the course of BPD demonstrate relatively consistent environmental risk factors, but neurobiological and experimental psychopathology findings are still inconsistent. Also, temperamental and mental state abnormalities that resemble aspects of the BPD phenotype emerge in childhood and adolescence and presage the BPD syndrome in adolescence or adulthood. Further work is required to better understand the roles that all these factors play in the developmental pathways to BPD and to increase their specificity for BPD in order to facilitate prevention and early intervention.
Collapse
Affiliation(s)
- Andrew M Chanen
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia.
| | | |
Collapse
|
14
|
Sharp C, Mosko O, Chang B, Ha C. The cross-informant concordance and concurrent validity of the Borderline Personality Features Scale for Children in a community sample of boys. Clin Child Psychol Psychiatry 2011; 16:335-49. [PMID: 20921039 DOI: 10.1177/1359104510366279] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Borderline Personality Disorder Features Scale for Children (BPFSC) is currently the only dimensional measure specifically developed to assess borderline features in children and adolescents. Few studies have investigated this measure for its concurrent validity and concordance between youth self-report and parent-report versions. To this end, the current study had two aims: (1) to investigate the cross-informant concordance (youth self-report vs. parent-report) of the BPFSC; and (2) to examine the concurrent validity of the BPFSC by showing that youth scoring high on the BPFSC also show poor clinical and psychosocial functioning, as measured by a standard Axis I scale. A community sample (N = 171) of boys between the ages of 8 and 18 completed the BPFSC and a self-report measure of Axis I psychopathology. Parents completed a newly developed parent-report version of the BPFSC (BPFSP) and a standard measure of Axis I psychopathology to index clinical and psychosocial functioning. Findings confirmed expectations. Modest concordance between parent- and self-report ratings were found. In addition, youth with borderline features showed poorer clinical and psychosocial functioning in all domains, especially where externalizing problems were concerned. Concurrent validity and modest parent-child concordance were demonstrated for the BPFSC. The BPFSC and BPFSP show promise as dimensional measures to assess borderline features in boys. However, a criterion validity study is needed before the measure can be used.
Collapse
Affiliation(s)
- Carla Sharp
- Psychology Department, University of Houston, Houston, TX 77024, USA.
| | | | | | | |
Collapse
|
15
|
Sulz S. [Hysteria I. Histrionic personality disorder. A psychotherapeutic challenge]. DER NERVENARZT 2010; 81:879-87; quiz 888. [PMID: 20585747 DOI: 10.1007/s00115-010-3016-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
What is left of Freud's hysteria in modern diagnostics is the histrionic personality. Psychological and somatic functional disorders, such as dissociative and somatoform disorders are freed from the label of being hysterical, but even the histrionic personality disorder does not enjoy professional agreement as far as diagnostics and therapy are concerned. This disorder is characterized by dramatization, suggestibility, superficial changing affects, impressionist cognitive style, preoccupation with outward appearance, seductive behavior and the wish to take centre stage, a compensatory attitude resulting from important childhood relationships. A comorbidity with narcissistic and antisocial personality exists and also with ADHS.
Collapse
Affiliation(s)
- S Sulz
- Katholische Universität Eichstätt und Centrum für Integrative Psychotherapie, München, Deutschland.
| |
Collapse
|
16
|
Clark LA. Emergent Issues in Assessing Personality Pathology: Illustrations from Two Studies of Adolescent Personality and Related Pathology. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2010. [DOI: 10.1007/s10862-010-9203-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
17
|
Hopwood CJ, Grilo CM. Internalizing and externalizing personality dimensions and clinical problems in adolescents. Child Psychiatry Hum Dev 2010; 41:398-408. [PMID: 20213247 DOI: 10.1007/s10578-010-0175-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ostensible psychiatric comorbidity can sometimes be explained by shared relations between diagnostic constructs and higher order internalizing and externalizing dimensions. However, this possibility has not been explored with regard to comorbidity between personality pathology and other clinical constructs in adolescents. In this study, personality pattern scales from the Millon Adolescent Clinical Inventory in a sample of 492 adolescent inpatients were subjected to a principal components analysis to yield oblique internalizing and externalizing dimensions. Relations between personality dimensions and well-established measures of psychopathology (depression, alcohol abuse, drug abuse) and other indicators of clinical dysfunction (self-esteem, suicidality, violence) were assessed before and after controlling for these higher-order personality dimensions. Associations between personality scales and indicators of psychopathology and clinical dysfunction were minimal with these higher order components controlled. These results suggest that internalizing and externalizing personality dimensions explain most of the associations between personality patterns and indicators of psychopathology and clinical dysfunction in adolescent patients.
Collapse
Affiliation(s)
- Christopher J Hopwood
- Clinical Psychology, Department of Psychology, Michigan State University, East Lansing, MI 48824-1116, USA.
| | | |
Collapse
|
18
|
Tackett JL, Ostrov JM. Measuring Relational Aggression in Middle Childhood in a Multi-Informant Multi-Method Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2010. [DOI: 10.1007/s10862-010-9184-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
A unifying perspective on personality pathology across the life span: developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Dev Psychopathol 2009; 21:687-713. [PMID: 19583880 DOI: 10.1017/s095457940900039x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.
Collapse
|
20
|
Multifinality in the development of personality disorders: a Biology x Sex x Environment interaction model of antisocial and borderline traits. Dev Psychopathol 2009; 21:735-70. [PMID: 19583882 DOI: 10.1017/s0954579409000418] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although antisocial personality disorder (ASPD) is more common among males and borderline PD (BPD) is more common among females, some authors have suggested that the two disorders reflect multifinal outcomes of a single etiology. This assertion is based on several overlapping symptoms and features, including trait impulsivity, emotional lability, high rates of depression and suicide, and a high likelihood of childhood abuse and/or neglect. Furthermore, rates of ASPD are elevated in the first degree relatives of those with BPD, and concurrent comorbidity rates for the two disorders are high. In this article, we present a common model of antisocial and borderline personality development. We begin by reviewing issues and problems with diagnosing and studying PDs in children and adolescents. Next, we discuss dopaminergic and serotonergic mechanisms of trait impulsivity as predisposing vulnerabilities to ASPD and BPD. Finally, we extend shared risk models for ASPD and BPD by specifying genetic loci that may confer differential vulnerability to impulsive aggression and mood dysregulation among males and impulsive self-injury and mood dysregulation among females. Although the precise mechanisms of these sex-moderated genetic vulnerabilities remain poorly understood, they appear to interact with environmental risk factors including adverse rearing environments to potentiate the development of ASPD and BPD.
Collapse
|
21
|
Langenkamp AG, Frisco ML. Family Transitions and Adolescent Severe Emotional Distress: The Salience of Family Context. SOCIAL PROBLEMS 2008; 55:238-253. [PMID: 23766546 PMCID: PMC3678775 DOI: 10.1525/sp.2008.55.2.238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We use the life course perspective to argue that family transitions like divorce and remarriage are turning points in adolescents' lives and that emotional distress associated with these events are shaped by the circumstances surrounding them. Using the National Longitudinal Study of Adolescent Health (Add Health), we explore how family transitions net of family structure are related to two types of emotional distress, acute depressive symptoms and excessive binge drinking, and whether family context moderates these associations. We find that going through a family transition is related to both outcomes, but only under certain circumstances. As maternal-adolescent emotional distance increases, the probability of severe emotional distress following a family transition increases. In addition, transitioning out of a single mother versus a mother-father household is related to a lower probability of reporting acute depressive symptoms.
Collapse
|
22
|
Miller AL, Muehlenkamp JJ, Jacobson CM. Fact or fiction: diagnosing borderline personality disorder in adolescents. Clin Psychol Rev 2008; 28:969-81. [PMID: 18358579 DOI: 10.1016/j.cpr.2008.02.004] [Citation(s) in RCA: 215] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 02/07/2008] [Accepted: 02/13/2008] [Indexed: 01/16/2023]
Abstract
Borderline Personality Disorder (BPD) has long been considered a mental health problem that results in considerable costs in terms of human suffering and psychiatric expenses among adult patients. Although the diagnosis of BPD for adolescents is frequently used in clinical settings, the field of mental health has questioned whether one should diagnose BPD among adolescents. This paper reviews the recent empirical literature (identified through PsycINFO 1980 to present) to evaluate prevalence, reliability, and validity of a BPD diagnosis in adolescents. It is concluded that the features BPD diagnoses in adolescents are comparable to those in adults. Furthermore, there appears to be a legitimate subgroup of adolescents for whom the diagnosis remains stable over time as well as a less severe subgroup that moves in and out of the diagnosis. While caution is warranted, formal assessment of BPD in adolescents may yield more accurate and effective treatment for adolescents experiencing BPD symptomatology. More longitudinal research is necessary to further explicate the issues of diagnosing BPD in adolescents.
Collapse
Affiliation(s)
- Alec L Miller
- Department of Psychiatry, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | |
Collapse
|
23
|
Abstract
Recently, more empirical studies have been devoted to the investigation of borderline personality disorder (BPD) in children and adolescents. Against this background, the purpose of the current review is to compare research findings on diagnostic-related phenomena in child and adolescent samples with those in adult samples to establish the utility of the BPD construct in childhood and adolescence. A search of relevant publications reported in Pubmed and PsycInfo from 1940 (the first clinical descriptions of BPD in childhood) to 2006 was carried out. A total of 58 studies were included. The review of the adult literature was not exhaustive but relied on excellent existing and comprehensive reviews of the adult literature carried out in the past 5 years. Although significant differences seem to exist between juveniles and adults in diagnostic-related phenomena associated with BPD, these can be explained by the principle of heterotypic continuity in development. Moreover, enough overlap between juvenile and adult BPD has been observed to warrant further empirical investigation into the construct of juvenile BPD. Specific areas for future research in juvenile BPD suggested by this review include studies of comorbidity, measure development, and the use of neurobiological measures such as functional neuroimaging.
Collapse
Affiliation(s)
- Carla Sharp
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas 77030, USA.
| | | |
Collapse
|
24
|
Abstract
Borderline personality disorder (BPD) is characterized by a broad pattern of impulsivity and suicidality. BPD usually begins in adolescence; the full clinical picture of the disorder is associated with developmental increases in impulsivity. However, BPD also has childhood precursors. The developmental pathways are similar to those found in other impulsive spectrum disorders, but children who later develop BPD probably have both externalizing and internalizing symptoms. Research in this area has made use of retrospective data from adults, prospective data from community studies, follow-up studies from children at risk, as well as research on "borderline pathology of childhood" (a condition with symptoms similar to adult BPD). Existing evidence suggests that both temperamental and environmental risk factors play a role in the development of the behavioral patterns associated with the disorder. These pathways also help account for the life course and outcome of BPD in adulthood.
Collapse
Affiliation(s)
- Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, 4333 Chemin de la Cote Ste. Catherine, Montréal, Québec, Canada.
| |
Collapse
|
25
|
Houston RJ, Ceballos NA, Hesselbrock VM, Bauer LO. Borderline personality disorder features in adolescent girls: P300 evidence of altered brain maturation. Clin Neurophysiol 2005; 116:1424-32. [PMID: 15978505 DOI: 10.1016/j.clinph.2005.01.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Revised: 12/31/2004] [Accepted: 01/20/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine brain maturation in adolescent girls with borderline personality disorder (BPD) features using the P300 event-related potential. METHODS One hundred twenty-three girls, aged 14-19 yrs, were assigned to one of 4 groups formed by the crossing of BPD features (vs. > or =5 BPD criteria) and median age (vs. >16.5 yrs). P300 responses were measured while subjects performed a complex visual oddball task. RESULTS ANCOVAs of P300 amplitude-adjusting for variability associated with comorbid conduct disorder and depression symptoms--revealed a significant interaction. Among subjects without BPD features, aging was associated with the normal reduction in visual P300 amplitude. Among subjects with BPD features, there were no age-related changes. Additional analyses, which tested the effects of BPD features across the full age range, supported these findings. CONCLUSIONS The present findings suggest abnormal brain maturation among adolescent girls exhibiting features of BPD. SIGNIFICANCE These results support a hypothesis of altered brain maturation in adolescents exhibiting BPD features at an early age. It is suggested that measures of brain maturation obtained during adolescence may improve our ability to predict BPD and comorbid disorders in adulthood.
Collapse
Affiliation(s)
- Rebecca J Houston
- Research Institute on Addictions/State University of New York at Buffalo, 1021 Main Street, Buffalo, NY 14203, USA.
| | | | | | | |
Collapse
|
26
|
Chanen AM, Jackson HJ, McGorry PD, Allot KA, Clarkson V, Yuen HP. Two-year stability of personality disorder in older adolescent outpatients. J Pers Disord 2004; 18:526-41. [PMID: 15615665 DOI: 10.1521/pedi.18.6.526.54798] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The 2-year stability of categorical and dimensional personality disorder (PD) in an older adolescent psychiatric outpatient sample was examined. One hundred and one 15-18-year-old participants were assessed using the Structured Clinical Interview for DSM Axis II Disorders (SCID-II) at baseline and 97 were re-interviewed, face-to-face, at 2 years. Of those with a categorical PD diagnosis at baseline, 74% still met criteria for a PD at follow-up, with marked gender differences (83% of females and 56% of males). Kappa for specific PDs was low for all except antisocial. Rank order and mean level dimensional stability ranged from high (antisocial, schizoid) to moderate (borderline, histrionic, schizotypal) to low (other PDs), with no decline in PD scores over the 2 years. There was no substantial influence upon stability of dimensional PD from the presence of Axis I disorder at baseline or from outpatient or inpatient treatment. However, categorical PD endured in 100% of those receiving inpatient care. The study supports that, in late teenage outpatients, the 2-year stability of the global category of PD is high and the stability of dimensionally rated PD appears to be similar to that found in young adults in a variety of settings, especially for some cluster A and B PDs. Diagnosis and early intervention appears to be justified in this age group.
Collapse
Affiliation(s)
- Andrew M Chanen
- ORYGEN Research Centre, Department of Psychiatry, University of Melbourne.
| | | | | | | | | | | |
Collapse
|
27
|
Approche neurobiologique des traits tempéramentaux associés aux troubles de personnalité. ANNALES MEDICO-PSYCHOLOGIQUES 2004. [DOI: 10.1016/j.amp.2004.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
28
|
Crawford TN, Cohen P, Johnson JG, Sneed JR, Brook JS. The Course and Psychosocial Correlates of Personality Disorder Symptoms in Adolescence: Erikson's Developmental Theory Revisited. J Youth Adolesc 2004. [DOI: 10.1023/b:joyo.0000037631.87018.9d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
29
|
Gretton HM, Hare RD, Catchpole REH. Psychopathy and Offending From Adolescence to Adulthood: A 10-Year Follow-Up. J Consult Clin Psychol 2004; 72:636-45. [PMID: 15301648 DOI: 10.1037/0022-006x.72.4.636] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the predictive validity of the Hare Psychopathy Checklist: Youth Version (PCL:YV) from adolescence to early adulthood. The authors coded the PCL:YV using file information and collected criminal record information over a 10-year follow-up period on 157 boys, ages 12 through 18, referred to Youth Forensic Psychiatric Services for assessment in 1986. The risk for violence into early adulthood was greater among those with high PCL:YV scores than among those with low scores, even after controlling for conduct disorder, age at first offence, and history of violent and nonviolent offending. These results indicate that the PCL:YV provides meaningful information about young offenders' risk for violence into early adulthood. Clinical implications are discussed, with reference to pertinent ethical issues.
Collapse
|
30
|
Houston RJ, Bauer LO, Hesselbrock VM. Effects of borderline personality disorder features and a family history of alcohol or drug dependence on P300 in adolescents. Int J Psychophysiol 2004; 53:57-70. [PMID: 15172136 DOI: 10.1016/j.ijpsycho.2004.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2003] [Revised: 02/05/2004] [Accepted: 02/05/2004] [Indexed: 10/26/2022]
Abstract
Decrements in P300 amplitude have been associated with familial risk for alcoholism as well as several other psychiatric disorders characterized by disinhibited behavior. The present study examined the P300 in relation to Borderline Personality Disorder (BPD) features in adolescents with a paternal history of alcohol or drug dependence. One hundred and seventy-five males and females, aged 14-20, were assigned to groups based on BPD features (BPD+ vs. BPD-), family history of substance dependence (negative FH-, alcohol FHA, drug FHD) and gender. BPD features were assessed using the Structured Clinical Interview for the DSM-III-R questionnaire. P300 ERPs were recorded while each subject performed the Stroop color-word compatibility test. Repeated measures analyses, which included Conduct Disorder and Depression symptoms as covariates, indicated a significant reduction in P300 amplitude in the BPD+ group. There were no significant effects of FH or gender on P300 amplitude. These results document the presence of neurophysiological abnormalities associated with BPD features in an adolescent sample. This effect appeared to be independent of a family history of alcohol or substance dependence. These findings suggest that BPD symptoms during adolescence are relevant to the examination of the physiological antecedents of those forms of adult psychopathology characterized by behavioral disinhibition, including alcohol and drug dependence.
Collapse
Affiliation(s)
- Rebecca J Houston
- Alcohol Research Center, Department of Psychiatry, MC-2103, University of Connecticut Health Center, Farmington, CT 06030-2103, USA.
| | | | | |
Collapse
|
31
|
Crawford TN, Cohen P, Brook JS. Dramatic-erratic personality disorder symptoms: II. Developmental pathways from early adolescence to adulthood. J Pers Disord 2001; 15:336-50. [PMID: 11556700 DOI: 10.1521/pedi.15.4.336.19185] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined the relationship over time between Cluster B personality disorder symptoms (borderline, histrionic, and narcissistic symptoms) and comorbid internalizing and externalizing symptoms in a community sample of 407 adolescents. Cross-lagged longitudinal models tested (a) the hypothesis that Cluster B symptoms reflect primary disturbances that give rise to co-occurring internalizing and externalizing symptoms; and (b) the alternative hypothesis that these Axis I symptom clusters reflect primary problems that interfere with normal personality development. Internalizing and externalizing symptoms each predicted subsequent Cluster B symptoms in girls, although these effects occurred only at specific developmental stages. Cluster B symptoms in boys and girls at ages 10 to 14 years predicted externalizing symptoms two years later. Instead of clearly supporting one hypothesis over the other, longitudinal models suggested gender-specific developmental effects that were partially consistent with both hypotheses.
Collapse
|