The Love Problem of a Student-Revisited: A Psycho-Ethical Map for Cases of Anima Projection

In its typical form, an "anima projection" is a psychic experience in which a heterosexual man is caught up by an intense, almost magical attraction for a woman. What sets these numinous experiences apart from a common "crush" is a pattern of specific phenomenological characteristics. Anima projections are particularly common in late adolescence and early adulthood, when they can cause a deep sense of disorientation. Little education exists for young men on how to deal with these experiences and to actualize the developmental opportunity that underlies them. In this paper, I frame anima projections as an ethical problem and outline a psycho-ethical "map" that is intended for use by disoriented young men, or by any practitioner who may be tasked with helping them navigate this challenge along the path of individuation. The map considers four solutions to the love problem: the "concretistic-literal", the "fearful-avoidant", the "rational-depressive", and the "transitional-developmental" solution, and indicates the latter as the one that is conducive to optimal psychic development. Although developed with a focus on young men, the map may apply to other relations based on projection, regardless of age, sex, gender, or sexual orientation.

[Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different?]

Case Report of a 14-Year-Old Girl with Addison's Disease Under Initial Presumptive Diagnosis of Anorexia Nervosa: Confusingly Similar and Yet so Different? Abstract: Objective: Primary adrenal insufficiency (Addison's disease) is a rare differential diagnosis of anorexia nervosa. This case report presents important differential diagnostic aspects. Methods: We prepared a case report of a 14-year-old female patient according to the CARE guidelines, taking the patient's and the child's parents' view into consideration. Results: The diagnosis of primary adrenocortical insufficiency was reached using specific laboratory diagnostics approximately 9 months after the onset of symptoms, including sudden body weight loss. Significant differential diagnostic aspects were the absence of a body schema disorder and skin hyperpigmentation prominent in the physical examination. The patient experienced a high psychosocial burden because of the unclear diagnosis over 9 months. The diagnosis and substitution therapy with hydrocortisone led to a rapid improvement of the physical and psychological symptoms. Conclusions: This case report emphasizes the importance of a thorough somatic differential diagnosis in the context of a suspected anorexia nervosa.

[Depressive Disorders in Adolescence: Current State of Studies Concerning the Microbiota-Gut-Brain Axis]

Depressive Disorders in Adolescence: Current State of Studies Concerning the Microbiota-Gut-Brain Axis Abstract. Depressive disorders increase during adolescence and often lead to significant impairment in affected individuals - despite treatment. Current research efforts aim to further investigate the pathophysiology of depression, considering the influence of gut microbiota on the gut-brain axis. The present narrative review outlines the current state of studies of the microbiota-gut-brain axis in depressive disorders as well as the direct and indirect interactions in adolescence. Besides providing promising results from animal studies, studies on the microbiota-gut-brain axis in adults suffering from depressive disorders are growing steadily. In depressed adolescents, however, the study situation is still marginal, making a recommendation for the supplementation of probiotics and prebiotics in depressed children and adolescents impossible according to the current state of research. Against the background of a very limited number of studies involving adolescents with depressive disorders, the interactive role of the microbiota-gut-brain axis in adolescent development should receive special attention in future research projects.

Practitioner Review: Signposts for Enhancing Cognitive-Behavioral Therapy for School Refusal in Adolescence

Factors associated with adolescent development influence the occurrence and presentation of school refusal (SR). Cognitive-behavioral therapy (CBT) manuals for the treatment of SR account for these developmental issues to varying degrees. Some multimodal treatments aim to address the complexity of adolescent SR by incorporating interventions alongside CBT, such as medication, inpatient treatment, and educational support in a special setting. However, CBT manuals and multimodal treatments appear to fail to help approximately one-third to two-thirds of adolescents, with respect to achieving regular school attendance. This paper provides an overview of suggestions in the literature for improving treatment for SR, with a focus on adolescent SR. Seven signposts emerge from the literature, namely, increased number or frequency of sessions, greater attention to social anxiety disorder and social functioning, greater attention to depression, greater attention to emotion regulation, careful consideration of the role of parents, greater attention to parent-adolescent communication and problem-solving, and the use of alternative educational settings. Professionals may find these signposts helpful when planning and delivering treatment for SR in adolescents. Research is needed to determine the benefit of including one or more of these adaptations alongside an existing SR treatment.

[Contraceptive Counseling: The Medical Toolbox Must Include the Full Range of Reversible Contraceptive Methods Also for Adolescent Women]

Contraceptive Counseling: The Medical Toolbox Must Include the Full Range of Reversible Contraceptive Methods Also for Adolescent Women Abstract. When counselling adolescents, empathy and age-appropriate information on medical confidentiality are important. Addressing individual needs and wishes enables the targeted use of the necessary information and resources and is the best guarantee for successful contraception over time. The goal is to make informed decisions and to have a positive experience of successfully protected sexual and reproductive health. The range of suitable contraceptive options is very broad. To make the most of this potential, all methods should be addressed with their advantages and disadvantages, including information on sexually transmitted infections and protection against them. Concerns and questions should be answered comprehensively and openly, and the experiences with sexuality described should be approached without prejudice. Often this is also an opportunity to talk about experienced situations of sexual assault.

[Transition-oriented patient education program for adolescents and young adults with ADHD]

Transition-oriented patient education program for adolescents and young adults with ADHD Abstract. Background: The transition from child- to adult-centered treatment includes numerous challenges in the treatment of chronic disorders. This process can be further complicated by disease-specific characteristics of attention-deficit/hyperactivity disorders (ADHD). This secondary analysis evaluated a transition workshop in individuals with ADHD. Methods: In total, 56 adolescents and young adults with ADHD (age M = 17.3 years, SD = 1.1; 17.9 % female) and their parents were quasi-randomly assigned to a control group (CG, n = 28) or an intervention group (IG, n = 28). The CG received regular medical care, whereas the IG additionally participated in a one-and-a-half-day transition workshop (ModuS-T). Before and 4 weeks after the intervention, transition competence was assessed with the Transition Competence Scale (TKS), patient activation with the Patient Activation Measure 13 for Adolescents (PAM® 13), and satisfaction with care with the Patient Satisfaction Questionnaire (ZUF-8). Results: The IG showed significantly improved transition competence (p ≤ .001) compared to the CG. There was no significant intervention effect in terms of patient activation (p = .194). Overall, the IG was highly satisfied with the workshop. Discussion: To date, transition workshops have been evaluated predominantly in individuals with chronic somatic disorders. This secondary analysis indicates that a generic workshop is also associated with improved transition competence and high satisfaction in individuals with chronic mental disorders. The integration of such approaches into routine care needs to be discussed.

Developmental Issues Associated with Adolescent School Refusal and Cognitive-Behavioral Therapy Manuals

It is important to consider developmental issues when addressing school refusal (SR) in adolescence. Referral rates appear to be higher among adolescents relative to children, and treatment appears to be less effective among adolescents. This paper provides an in-depth review of developmental issues associated with adolescent SR and treatment via cognitive-behavioral therapy (CBT). It begins by considering the reasons for the higher referral and poorer treatment outcomes, including the higher level of absenteeism in adolescence, higher rates of concurrent social anxiety disorder and depressive disorder, and the developmental challenges inherent to adolescence. Such challenges include increased academic and social demands in the secondary-school environment, and increasing autonomy which may contribute to family conflict. These developmental issues may potentiate and exacerbate an adolescent's difficulty attending school, make it difficult for families to cope, and complicate practitioners' efforts to provide effective treatment for SR. Further, the review describes CBT manuals for SR and the extent to which they are developmentally sensitive. There are five CBT manuals, which vary in their sensitivity to developmental issues. Various multimodal treatments employ interventions in addition to CBT, such as medication or inpatient treatment, to address the complexity of SR in adolescence. Nevertheless, nonresponse to treatment for adolescent SR ranges from one-third to two-thirds of youths. Attention thus needs to be given to ways of improving treatment outcomes.

[Substance Use, Resulting Disorders, and Collateral Mental Disorders Among Adolescents in a Special Outpatient Institutions for Addictions]

Substance Use, Resulting Disorders, and Collateral Mental Disorders Among Adolescents in a Special Outpatient Institutions for Addictions Abstract. Objective: Only few clinics offer the outpatient treatment of substance use disorders (SUDs) among adolescents. Therefore, only limited data describe substance use patterns, SUDs, and co-occurring psychiatric disorders characteristic of adolescents who present in such outpatient clinics specialized in the treatment of SUDs. Method: Via interview we collected data from n = 201 patients between 12 and 19 years concerning their substance use, SUDs, and current co-occurring psychiatric disorders. We created descriptive presentation of data regarding use patterns, SUDs, and co-occurring disorders divided by sex and current age. Results: Tobacco (88 %) and cannabis (86 %) were the most frequently used substances. 67 % of all patients presented with more than one SUD, cannabis use disorder being the most prevalent one (84 %). 72 % presented with at least one co-occurring disorder, with conduct disorders (40 %), attention deficit (hyperactivity) disorders (21 %), and depressive disorders (18 %) being the most frequent ones. Conclusions: Adolescent SUD patients often present with co-occurring psychiatric disorders. Institutions for adolescent SUD treatment should also focus on treating co-occurring conduct disorders, depression, and attention deficit disorders.

[A Multidimensional Assessment of Emotion Regulation in Adolescent Non-Suicidal Self-Injury]

The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.

[Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A]

This study examines whether transference-focused psychotherapy for adolescents (TFP-A) in a dayclinic setting increases the capability to regulate affects and decreases self-destructive behavior in adolescents with borderline personality organization in comparison to treatment as usual (TAU). A total of 120 adolescents consecutively presenting to the dayclinic were allocated to either TFP-A or TAU. They were assessed for aggression, irritability, depression, self-harm, internalizing behavior and pathological personality traits at baseline and after twelve weeks. TFP-A was more effective than TAU in reducing self-harm. Aggression and irritability was improved within the treatment group. These results can be explained by an improvement in affect regulation through a treatment with TFP-A in a dayclinic setting. Further research is necessary in order to assess whether TFP-A reduces self-harm, aggressive behavior and irritability from a long-term perspective and whether these exploratory results can be replicated in independent samples.

Gender detransition: a case study

Within the last decade, there has been a sharp global rise in the number of young people identifying as transgender. More recently, there appears to be an increase in the numbers of young people detransitioning or returning to identifying with their natal sex after pursuing medical transition. A case is presented of a young woman who pursued a gender transition and returned to identifying as female after almost two years on testosterone. The author considers and critiques the affirmative model of care for gender dysphoric youth in light of this case.

[Suicides Among Adolescents in a Major German City]

Suicides Among Adolescents in a Major German City Abstract. Objective: Adolescent suicide is a major contributor to the overall mortality in this age group. This study examined sex and age differences in suicide methods. Method: The investigation is based on death certificates from the years 1996 to 2019 of the city of Leipzig and includes all suicides in the age group under 25 years. The impact of sex and age on the method and location of suicide was examined using chi square statistics. Moreover, we verified the association between suicides and death by drug overdose through statistical regression. Results: 140 suicides were included in the study. The suicide methods differed between the age groups (χ^² = 17,878; p = .022). Individuals under 21 years of age committed suicide almost exclusively by strangulation, jumping from heights, railway suicide, or deliberate intoxication. With the onset of early adulthood, the spectrum of methods expanded. Suicide methods were also different between the sexes (χ^² = 35,166; p < .001): Male adolescents preferred highly lethal methods such as strangulation, whereas in female adolescents intoxication was the leading method of suicide, with a predominance of antidepressants. The annual rates of suicide and death by drug overdose were found to correlate (Pearson correlation = 0,571, p = .004). Minors (χ² = 3.125, p = .077) tended to avoid their own residential environment as a place of suicides compared to adults. Conclusion: When assessing the individual suicide risk and weighing safeguarding measures in clinical practice, the differences shown in the choice of methods should be taken into account.

Adolescents coping with the COVID-19 pandemic: 'every day is like another Sunday'

COVID‐19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in‐person connection and immediate non‐verbal cues. The public health restrictions put in place to manage COVID‐19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.

Medication Adherence in Adolescents with Psychiatric Disorders

Objective: This study investigates whether adolescents' adherence to psychotropic medication is associated with demographic and socioeconomic factors, and to what extent parents' assessments of their offspring's attitudes toward treatment correspond with the adolescents' self-report. Methods: This study is part of the multicenter SEMA study (Subjective Experience and Medication Adherence in Adolescents with Psychiatric Disorders). Adolescents' subjective attitudes toward medication and their adherence were assessed using the patient and parent versions of the QATT (Questionnaire on Attitudes Toward Treatment) and the MARS (Medication Adherence Rating Scale). Furthermore, we collected socioeconomic and demographic data. Results: Of the n = 75 adolescents included in the study, n = 45 (60 %) were classified as completely adherent. Patients receiving monotherapy were more often completely adherent than those receiving a combination of different medications. There was no statistically significant association between adherence and demographic or socioeconomic factors. Consensus between adolescents and their parents regarding adolescents' attitudes toward treatment ranged from slight (κ = 0.157) to fair (κ = 0.205). Conclusion: Incomplete medication adherence in adolescents with psychiatric disorders is a common phenomenon and still poorly understood. Demographic and socioeconomic factors do not seem to be relevant in this respect. However, adolescents' subjective attitudes towards medication, which parents are presumably unable to adequately assess, warrant more careful consideration in future research.

The landscapes of minus. Hatred, adolescence and the paradoxes of growth

This paper explores Bion's theory of links, L, H, K (Love, Hate and Knowledge) and their minus counterparts, -L, -H, -K, which are not conceivable as simply opposite to or as a lack of L, H, K. Rather, they correspond to a way of experiencing Love, Hatred and Knowledge in terms of absoluteness, and in terms of a radical impossibility of acknowledging loss, relativeness and absence. The theory of links is also examined in its evolution towards the conceptualization of three types of container/contained configurations (commensal, symbiotic and parasitic). These Bionian models are compared and referred to the way Jung articulates the coexistence of 'good' and 'evil', and the paradoxical nature of mental functioning in relation to the individuation process. The images taken from the Rosarium Philosophorum, particularly the Fons Mercurialis, examined by Jung in 'The psychology of the transference' (1946), are explored in the paper. Theory is examined with a particular focus on the adolescent mind and its dramatic phenomenology. Two excerpts taken from the analytic work with a mid-adolescent female patient and a late-adolescent male patient are presented to describe minus-Hate as a form of absolute love, and minus-Love as a form of absolute hatred.

[Associations Between Personality Structure, Unconscious Conflicts, and Defense Styles in Adolescence]

Associations Between Personality Structure, Unconscious Conflicts, and Defense Styles in Adolescence According to the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence, associations between personality structure, unconscious conflicts, and defense styles are postulated. So far, an empirical investigation of these associations in mentally healthy adolescents is missing. The present study aims to contribute to the understanding of unconscious conflicts as well as the unconscious defense of conflicts by elucidating intrapersonal factors within a normative sample. Furthermore, the aim of this study is to analyse the extent to which sex, age, and socioeconomic status are related to personality structure, unconscious conflicts, and defense styles. A total of 175 adolescents (M_age = 16.98 ± 1.83) participated in the study. Measurement instruments were the Structure and the Conflict Questionnaire of the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence as well as the Defense Style Questionnaire for Adolescents and Young Adults. Sex-specific differences were found for the passive identity conflict. Regarding the personality structure, unconscious conflicts or defense styles, associations with age or socioeconomic status of adolescents were not found. The associations between personality structure, unconscious conflicts, and defense styles as postulated by OPD-CA-2 were empirically proven regarding the passive self-worth, guilt, and identity conflict as well as the active guilt conflict. Overall, this study indicates the low presence of unconscious conflicts in mentally healthy adolescents and the possibility of elucidating these conflicts by means of personality structure and defense styles.

["If One Feels Better Like That …"]

"If One Feels Better Like That …". Adolescent Sibling Relationship in the Context of Transgender Development A transgender development in youth can influence the relationship of concerned youth and their siblings. While in most surveys, the focus lies on transgender adolescents, both sides shall be interviewed here to capture the situation of siblings and to relate the results. For this purpose, guide interviews with ten transgender adolescents and twelve of their siblings were analysed in accordance to Grounded Theory. In most cases, participants were satisfied with the sibling relationship. After the coming-out of the transgender adolescent they showed both positive and negative reactions that, however, changed to respect and acceptance by time without exception. Doubt, compassion and grief were short lived and often replaced by joy for the transgender adolescent. Transgender youth were mostly satisfied with the reaction of their sibling though the amount of support varied. The time of coming-out and transition often led to an improvement in sibling relationship, more closeness and family cohesion. In general, siblings seem to be immediately concerned by transgenderism in adolescence. In clinical practice, they should thus be included from the beginning. By taking into account their situation, negative developments can be prevented, and the sibling relationship become usable as a resource.

[Transition psychiatry: attention deficit/hyperactivity disorder]

Transition psychiatry: attention deficit/hyperactivity disorder Abstract. Attention deficit/hyperactivity disorder affects 5 % of all children and adolescents and 2-3 % of all adults. It is thus one of the most frequent neurodevelopmental disorders, frequently associated with comorbid disorders and multiple functional impairments. Administrative data indicate that many patients with ADHD are at a great risk for treatment discontinuation during the transition to adulthood despite persistent symptomatology and functional impairment. The article addresses potential consequences for optimizing ADHD treatment during this transition.

[Borderline Personality Disorders]

Borderline Personality Disorders Abstract. Within the framework of the German task force "Transitional Psychiatry" (DGKJP and DGPPN), a group of experts discussed the significance of adolescence for the mental healthcare of Borderline Personality Disorder (BPD) in Germany. They identified particular gaps and problems within the following areas: early detection, access to specific outpatient psychotherapy, prolonged inpatient treatment, and polypharmacy. The authors then describe various recommendations and demands regarding the generation and dissemination of knowledge about BPD as well as potential adaptations within the German healthcare system.

[Identity - An Illusion? Self Development in Adolescence]

Identity - An Illusion? Self Development in Adolescence With support from their social environment, five out of six young people progress through adolescent development relatively well, while approximately 15 % are at risk of developing psychological problems (Kaess, Ghinea, Fischer-Waldschmidt, Resch, 2017). Those who cannot cope with the challenges of society and who do not have a safe space in the family or among friends to deal with worries and adjustment issues may attempt to stabilize their identity and self-esteem through risk-taking behavior (Kaess et al., 2017). Addictive behavior, e. g. substance abuse or extreme media consumption, may be an expression of adolescents' desire to assert and define their own identity - and not only to anesthetize themselves and forget their troubles. The "Who am I?" question in addictive behavior appears to be closely connected with consumption. The issue of identity will play a very important role for future generations of youth. The following overview, based on scientific findings, examines identity development in adolescence, the connection between identity and risk-taking behavior, and the connection between identity and zeitgeist.

[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.

[Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ) in Youth: First Results on Reliability and Validity]

Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ) in Youth: First Results on Reliability and Validity The OPD structure axis questionnaire (OPD-SQ) demonstrated good empirical findings and usability in therapeutic work. Therefore, the aim of this study was to verify the OPD-SQ for an adolescent sample in order to further implement the questionnaire as an economic instrument in clinical childhood and adolescence psychiatry routine. The overall sample consisted of 180 adolescent inpatients (72.8 % female) and 152 pupils (57.9 % female). In order to test reliability, Cronbach's alpha and discriminatory power were assessed. To test validity, YSR11-18 data was collected for the overall sample, and further data (AIDA, LoPF Q12-18, SKID-II, WISC-IV) was collected for the inpatient-sample. Cronbach's alpha was satisfactory for overall OPD-SQ, and all dimensions and sub-dimensions. The differences in mean values between inpatients and pupils were as expected. When controlled for overall symptom severity, gender differences lost significance. Adolescents with one or more SCID-II diagnoses had significantly lower psychic structure. Both construct-related questionnaires (AIDA, LoPF Q12-18) correlated high with OPD-SQ, no correlations were found for psychic structure and intelligence. OPD-SQ proved to be well applicable for the use on adolescents and can be implemented as an economic instrument for the measure of psychic structure in clinical adolescent psychiatry routine.

Internet- and Mobile-Based Interventions for Mental and Somatic Conditions in Children and Adolescents

This meta-review integrates the current meta-analysis literature on the efficacy of internet- and mobile-based interventions (IMIs) for mental disorders and somatic diseases in children and adolescents. Further, it summarizes the moderators of treatment effects in this age group. Using a systematic literature search of PsycINFO and MEDLINE/PubMed, we identified eight meta-analyses (N = 8,417) that met all inclusion criteria. Current meta-analytical evidence of IMIs exists for depression (range of standardized mean differences, SMDs = .16 to .76; 95 % CI: -.12 to 1.12; k = 3 meta-analyses), anxiety (SMDs = .30 to 1.4; 95 % CI: -.53 to 2.44; k = 5) and chronic pain (SMD = .41; 95 % CI: .07 to .74; k = 1) with predominantly nonactive control conditions (waiting-list; placebo). The effect size for IMIs across mental disorders reported in one meta-analysis is SMD = 1.27 (95 % CI: .96 to 1.59; k = 1), the effect size of IMIs for different somatic conditions is SMD = .49 (95 % CI: .33 to .64; k = 1). Moderators of treatment effects are age (k = 3), symptom severity (k = 1), and source of outcome assessment (k = 1). Quality ratings with the AMSTAR-2-checklist indicate acceptable methodological rigor of meta-analyses included. Taken together, this meta-review suggests that IMIs are efficacious in some health conditions in youths, with evidence existing primarily for depression and anxiety so far. The findings point to the potential of IMIs to augment evidence based mental healthcare for children and adolescents.

[Progress and challenges in the analysis of big data in social media of adolescents]

Progress and challenges in the analysis of big data in social media of adolescents Abstract. Social media are ubiquitous today, and adolescents use them to express their thoughts, feelings, and behaviours. New interdisciplinary methods allow the automatic analysis of the massive amounts of data (big data) available on social networking websites using machine-learning tools to detect indicators of mental-health problems and disorders by identifying differences with common activity and communication patterns. This review first introduces the concept and potential fields of applications of big data in social media. It then discusses the first studies that used big data analyses and detected mental-health problems by identifying differences in the structure of social networks, in the use of certain words, and in the communication of opinions and sentiments. Future studies employing several assessment points could use longitudinal mediation analysis to model intraindividual changes in order to understand when and through which mechanisms social media use has an impact on mental health. Furthermore, future studies should include additional mental disorders, various sources of information, a broader age range, and additional social-networking websites to develop more precise models for the early detection of mental disorders. This would enable the development of personalised intervention programs to promote mental health and resilience in adolescents.

[AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders]

AIT (Adolescent Identity Treatment) - an Integrative Treatment Model for the Treatment of Personality Disorders Personality disorders are patterns of maladaptive personality traits that have an impact on the individual throughout the life span. Borderline Personality Disorder (BPD) is a very severe, but treatable mental disorder. Identity disturbance is seen as the central construct for detecting severe personality pathology - and, most notably, borderline personality disorder - in adults and adolescents. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning whereas identity diffusion is viewed as a lack of integration of the concept of the self and significant others. It is seen as the basis for subsequent personality pathology, including that of borderline personality disorder. Although BPD has its onset in adolescence and emerging adulthood the diagnosis is often delayed. In most cases, specific treatment is only offered late in the course of the disorder and to relatively few individuals. Adolescent Identity Treatment (AIT) is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, a behavior-oriented homeplan and intensive family work is part of AIT.

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Zusammenfassung. Zusammenfassung: Die Medialisierung der Welt verändert Beziehungs- und Individuationsprozesse von Kindern und Jugendlichen rasant. Dies wirkt sich auf die schulischen Leistungen, auf Bewältigung von Entwicklungsaufgaben wie die Nähe-Distanz- und Affektregulation sowie den Umgang mit aggressiven Impulsen und sexuellen Bedürfnissen aus. Da der Einfluss der neuesten Medien nicht nur auf internetabhängige, sondern auf alle Kinder und Jugendlichen immens ist, kommen Ärztinnen und Ärzte nicht umhin, sich mit den Auswirkungen der digitalen Formate und Inhalte zu beschäftigen. Typologien von Spielern und von pathologischem Verhalten sind eine gute Orientierung. Sie werden ergänzt durch eine entwicklungspsychiatrisch fundierte und mediensoziologische Klassifikation von Spieltypen und eine übliche entwicklungspsychiatrische Diagnostik. Beratung und Therapie erfolgen je nach Schwere, Komorbidität, Spielverhalten und sozialer Einschränkung.

[Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder]

Mentalization Based Treatment of an Adolescent Girl with Conduct Disorder This paper will give a short overview on the theoretical concept of mentalization and its specific characteristics in adolescence. A previous study on Mentalization based treatment for adolescents (MBT-A) demonstrated the effectiveness of MBT-A for the treatment of adolescents with symptoms of deliberate self-harm (Rossouw u. Fonagy, 2012). Based on the results of this study Taubner, Gablonski, Sevecke, and Volkert (in preparation) developed a manual for mentalization based treatment for adolescents with conduct disorders (MBT-CD). This manual represents the foundation for a future study on the efficacy of the MBT-A for this specific disorder in young people. The present case report demonstrates the application of specific MBT interventions, as well as the therapeutic course over one year in a 16-year old girl who fulfilled all criteria of a conduct disorder. During the course of treatment, the de-escalating relationship-oriented therapeutic approach can be considered as a great strength of MBT-A, especially for patients with conduct disorders. The clinical picture, as well as the psychological assessment, showed a positive progress over the course of treatment. Despite frequent escalations, forced placements due to acute endangerment of self and others, and a precarious situation with the patient's place of residence towards the end of therapy, MBT-A treatment enabled the patient to continually use the evolved mentalizing capabilities as a resource.

[A pilot study on the specificity of body image disturbance in anorexia nervosa]

OBJECTIVE

Body image disturbance (BID) is a central feature of anorexia nervosa (AN), but evidence for bodily-related disorders also exists for patients with cystic fibrosis (CF), who are frequently underweight. A comparison of BID in patients with AN, CF and controls serves to clarify the specificity of BID for AN.

METHOD

22 patients with AN, 10 patients with CF, and 23 controls were tested with regard to perceptual and cognitive-affective components of BID. Further data concerning eating-disorder-related psychopathology were assessed.

RESULTS

BID occurred in all patients with AN. Patients with CF perceived themselves as thinner than the controls did, and three of them exhibited BID. Patients with AN and CF did not differ regarding body satisfaction, and only controls showed higher satisfaction than patients with CF. Patients with AN and CF differed on desire for thinness, dissatisfaction with their body, and interoceptive awareness, with higher scores occurring in patients with AN.

CONCLUSIONS

Our pilot study reveals no severe psychopathology concerning body image in patients with CF. However, we did observe a general body dissatisfaction among these patients, probably associated with their being underweight. BID still seems to be a central diagnostic criterion for AN and should be carefully considered during therapeutic interventions.

[The dimensional-categorical hybrid model of personality disorders in DSM-5 from an adolescent psychiatric perspective - criticism and critical outlook]

By applying the dimensional-categorical hybrid model, Chapter III of the DSM-5 proposes a central innovation in the classification of personality disorders, the aim being a reduction of comorbidity and improvement of the construct as well as the discremental validity and stability of the diagnosis. The well-known categorical classification of personality disorders in Chapter II, however, remains valid. Based on the hybrid model the essential aspects of a personality disorders are as follows: the dimensional assessment of levels of personality functioning regarding disturbances in self (identity and self-direction) and interpersonal (empathy and intimacy) aspects on the one hand, and the existence of pathological personality traits on the other. Beside five higher-order traits, 25 specific trait facets are described. Moreover, a reduction in the number of personality disorder types is proposed, reflecting six instead of ten categories which are empirically best validated. The abandoned age limitation for the assessment of a personality disorder in Chapter III can be regarded as a clear statement with respect to the possibility and necessity of diagnosing and treating personality pathology in adolescence. By presenting an additional dimensional approach with a detailed description of personality functioning as well as specific pathological personality traits, the new hybrid model seems to principally be a useful approach for clinical purposes as well as research questions.