The Relations Between Identity Disturbances, Borderline Features, Internalizing Disorders, and Suicidality in Inpatient Adolescents

Psychosocial Identity, Intimacy and Suicidality in Young Adults

OBJECTIVE

Suicidality in young adults is a serious and growing clinical and social problem. The theory of psychosocial ego development assumes that identity and intimacy are two key factors for adaptation and vulnerability in early adulthood. The aim of the present study was to test whether psychosocial identity and intimacy are related to suicidality in young adults, even when controlling for confounding variables (depressive symptoms, sex, age, health and economic assessment, religious commitment, and pandemic-related distress).

METHOD

Respondents aged 18-25 (n = 607) completed the Identity-Confusion and Intimacy-Isolation subscales from the Modified Erikson Psychosocial Stage Inventory, as well as the Patient Health Questionnaire-9, the Suicidal Behaviors Questionnaire-Revised and answered questions about the pandemic-related distress and various sociodemographic factors.

RESULTS

At the level of bivariate analyses, both identity and intimacy were negatively associated with suicidal risk in the overall sample and with the frequency of suicidal ideation in the suicide risk subsample (n = 242). Weaker identity, but not intimacy, was associated with belonging to a suicide risk group in multivariable logistic regression. Moreover, ordinal regression showed that, in the subgroup with suicide risk, identity was negatively associated with the frequency of suicidal thoughts.

CONCLUSIONS

Identity is a negative correlate of suicidality in young adults. Identity-focused therapy may be a promising target for intervention in suicidal young adults.

Network structure of adolescent social, emotional, and behavioral difficulties and their differential relationships with suicidality

BACKGROUND

Social, emotional, and behavioral difficulties (SEBDs) tend to develop during adolescence. Their presence and especially co-occurrence induce numerous disrupting consequences, including suicidality. A recently developed network analysis is suitable to investigate the symptom-level structure of comorbid psychopathology. Rather than pairwise comorbidity networks, the current study investigated a comprehensive network of SEBDs at the symptom level and explored the differential relationships between symptoms of SEBDs and suicidality.

METHODS

Recruited from four public schools in China, a sample of adolescents (N = 6974, mean age = 15.84, 50.1% boys) were assessed with the Strengths and Difficulties Questionnaire (SDQ) and one suicidality-related item. The cross-sectional network structure of the SEBD symptoms was investigated. The differential associations between individual symptoms of SEBDs and suicidality were also explored with a relative importance analysis.

RESULTS

The results showed that constantly fidgeting, worry a lot, unhappy, down-hearted, tearful, and easily scared emerged as the most central symptoms in the network of SEBDs. Worry a lot, constantly fidgeting, lose my temper, and being bullied served as bridge symptoms, connecting various domains of SEBDs. In addition, the centrality of symptoms was positively associated with the variance shared with suicidality, with worry a lot and unhappy, down-hearted, and tearful explaining a large portion of the variance of suicidality.

CONCLUSIONS

Taken together, the results were indicative of close connections among emotional, hyperactivity-inattention, peer, and conduct aspects of adolescent mental health difficulties, as well as the central role of emotional difficulties in the SEBDs network.

Mental Health of Transgender Youth: A Comparison of Assigned Female at Birth and Assigned Male at Birth Individuals

Gender dysphoric adolescents report a gender identity which is incongruent with their assigned sex at birth, whereby the experienced incongruence is accompanied by clinically relevant distress. The aim of the study was to assess and compare the mental health of transgender youth by assigned sex at birth. A total of n = 49 adolescents (n = 29 assigned females at birth, n = 20 assigned male at birth) aged 12 to 18 years with the diagnosis of gender dysphoria according to DSM-5 were included in the study. The adolescents underwent a psychological assessment in a child and adolescent psychiatry outpatient department prior to starting gender-affirming medical treatment, completing relevant mental health questionnaires. Although no differences were found in psychiatric disorders, more externalizing problems above the clinical threshold were reported by parents in assigned female at birth (AFAB) adolescents. On the other hand, internalizing problems, both in general and within the clinical range, were found to be more prevalent in assigned male at birth (AMAB) adolescents, as indicated by self-report. Our results suggest that a comprehensive assessment of mental health in gender dysphoric adolescents is crucial for understanding the diverse range of challenges they may face and tailoring appropriate interventions to address their specific needs.

Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder

Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.

The role of sense of coherence and loneliness in borderline personality disorder traits: a longitudinal twin study

BACKGROUND

Borderline personality disorder (BPD) implies having problems with identity and relations with other people. However, not much is known about whether these indications of BPD are present in adolescence, i.e., before personality disorders usually are diagnosed. In this study, we examined the prediction of an aspect of identity (i.e., sense of coherence [SOC]) and social relations (i.e., perceived loneliness) throughout adolescence on BPD traits in young adulthood. In addition, we examined to what degree the predictive ability could be attributed to genetic and environmental factors. We also examined whether life events in adolescence were related to BPD traits.

METHODS

Three thousand three hundred ninety-one twins, consisting of seven national birth cohorts from Norway, participated in the study. SOC, loneliness and life events were measured three times throughout adolescence with self-report questionnaires, with 2 years in between measurements. BPD traits were measured at the end of adolescence around the age of 19 with a structured interview. Regression analyses were performed to examine the prediction of SOC, loneliness and life events on BPD traits. Cholesky decomposition models were then used to determine to what degree the associations were due to genetic and environmental influences.

RESULTS

The prediction of SOC and loneliness on BPD traits increased from R = .25 (when measured 6 years prior to the assessment of BPD traits) to R = .45 (when measured shortly before the assessment of BPD traits). In addition, negative life events considered dependent on a person's behavior were related to BPD traits. Negative independent and positive dependent life events did not contribute to the prediction of BPD traits. Cholesky decomposition models showed that SOC and loneliness were associated with BPD traits mainly due to shared genetic influences (i.e., the proportion due to genetic influences ranged from 71 to 86%). Adding negative dependent life events to the prediction of BPD traits did not change these percentages.

CONCLUSIONS

These findings indicate that the weaker SOC, the stronger feelings of loneliness, and the negative life events associated with BPD traits are mainly consequences of the genetic aspects of BPD traits, rather than having direct effects on levels of BPD symptoms.

Associations between symptoms of borderline personality disorder and suicidality in inpatient adolescents: The significance of identity disturbance

Several studies report that borderline personality disorder (BPD) is a risk factor for suicidality in adults. However, this issue requires further research in adolescents, as it is not clear which individual BPD symptoms are significant correlates of suicidality in this age group. The main aim of the current study was to test which symptoms of BPD are associated with suicidality in adolescent inpatients, even when controlling for age, gender, and depressive symptoms. Inpatient adolescents (N = 339) aged 12-17 years completed the Childhood Interview for DSM-IV Borderline Personality Disorder, the Beck Depression Inventory-II, the Modified Scale for Suicidal Ideation, and reported their number of lifetime suicide attempts. Multivariable regression analyses showed that, after controlling for confounding variables, overall BPD symptom severity was positively related to suicidal ideation and suicide attempts. Of the individual BPD symptoms, identity disturbance, chronic emptiness, avoid abandonment, and transient paranoia were the most robust correlates of suicidal ideation intensity, and only identity disturbance was associated with the number of lifetime suicide attempts. To assess the risk of suicidality in youth, it is essential to assess for BPD symptoms; it is important to focus on adolescents' subjective feelings to assess the severity of identity disturbance and chronic emptiness.