The relative importance of identity status interview components: replication and extension

The present study partially replicates and extends the work of Rogow et al. (1983) in probing the relative importance of Ego Identity Status Interview components for both sexes. Eighty female and sixty male students attending a New Zealand university were given the Ego Identity Status Interview with identity components of occupation, religion, politics, and sex role beliefs presented in counterbalanced order. Subjects were then asked to rank components in order of importance to their sense of identity and additional identity contents were explored through open-ended questions. This investigation revealed few sex differences in terms of number of content areas having a common rating, hit rates between single or paired content areas and overall identity ratings, rank order for importance of identity contents, or reported areas of additional identity concerns. In support of Rogow findings, this study suggests that identity not be viewed as a unitary structure and encourages the reporting of both component and overall identity status ratings to allow a more comprehensive means of researching the identity formation process. In general, the identity status approach provides a useful model for clinical research of ego synthesis in late adolescence.     

Brief psychotherapy in late adolescence: a psychodynamic and developmental approach

Four cases were discussed in which college students presented themselves in crisis for psychiatric treatment; each was dealing with a normal developmental crisis of late adolescence centering around separation-individuation issues. A type of brief psychotherapy was described which maintained the focus on the primary dynamic conflict and promoted ego development by interpreting the unconscious intrapsychic conflict. The incestuous, aggressive, and regressive themes were explored, and defenses were actively interpreted whenever they interfered with the awareness of autonomous strivings consistent with the ego ideal. Although other authors have emphasized the necessity of establishing a contract early which specifies the number of visits, we have emphasized the importance of maintaining strict therapeutic neutrality, especially regarding the duration of treatment with late adolescents. We view this as an important cornerstone of technique in assisting the healthy late adolescent in his quest for increasing autonomy, ego-ideal integration and ego mastery.     

Separation anxiety and overanxious disorders: relations to age and level of psychosocial maturity.

OBJECTIVE: To study the developmental underpinnings of age trends in the prevalence of separation anxiety disorder (SAD) and overanxious disorder (OAD) in children and adolescents. METHOD: The sample consisted of 118 children and adolescents (aged 8-18 years) with SAD or OAD, who were referred to an outpatient psychiatric clinic. Anxiety disorders were assessed with Silverman and Nelles' Anxiety Disorders Interview Schedule for Children; level of psychosocial development was conceptualized and assessed by means of Jane Loevinger's model and measure of ego development. Logistic regression analyses were applied to study the extent to which age and level of ego development were related to the presence of SAD or OAD. RESULTS: Level of ego development was the strongest predictor of group membership (SAD versus OAD). Although age was a strong predictor as well, the age effect became insignificant after ego level had been entered into the regression equation. As predicted, SAD was related primarily to the Impulsive ego level, whereas OAD was related mostly to the Conformist ego level. The comorbid condition (SAD and OAD) fell squarely in between the 2 "pure" groups, both in terms of age and ego level. The results were controlled for possibly confounding variables, such as gender, IQ, and socioeconomic status. CONCLUSIONS: The presence of SAD and OAD appears to be related to specific levels of psychosocial maturity, irrespective of age.     

Adolescent sex-role orientation and ego identity

This study investigated the relationship between sex-role development and ego development in a sample of 9th-12th grade Anglo-American and Mexican-American students attending high school in a southwestern state. All students were administered: (a) the Extended Objective Measure of Ego Identity Status (Grotevant and Adams, 1984) as a measure of ego development (i.e., diffusion, foreclosure, moratorium, and identity achievement), and (b) the Personal Attributes Questionnaire Short Form (Spence, Helmreich and Stapp, 1975) as a measure of masculinity and femininity. Results indicated no ethnic differences in the relationship between ego identity and masculinity/femininity. Adolescents who were identity achieved on ideological identity formation had significantly higher levels of masculinity than did moratorium, foreclosed, and diffused individuals. For interpersonal identity, identity achieved adolescents had higher levels of both masculinity and femininity than did individuals who were foreclosed, diffused, or in moratorium. Discussion centered on these results in light of the additional finding that there was little shared variance (eta2) between masculinity, femininity and ego identity.     

Adolescent suicidality: a clinical-developmental approach

This study investigates the relation of ego development, age, gender, and diagnosis to suicidality among 219 adolescent psychiatric inpatients. Using the Diagnostic Interview Schedule for Children, adolescents were classified as suicide attempters or as nonsuicidal and were categorized into three diagnostic groups: affective disorder, conduct disorder, or mixed conduct-affective disorder. Ego development measurement was used to assess developmental maturity. Chi-square analyses demonstrated a relation between suicide attempts and developmental complexity. Attempters were more likely to be diagnosed with affective or mixed conduct-affective disorders and to be girls. Suicidality was not associated with age in this sample. Log-linear analyses demonstrated the interplay of known suicide risk factors with the important new dimension of developmental level.     

Personality disorders in recent-onset bipolar disorder

The frequency and types of DSM-III personality disorders (PDs) were investigated in a sample of 26 recent-onset bipolar-disordered (BD) patients. Results showed that 62% of BD patients had PDs according to the Structured Interview for DSM-III Personality Disorders (SIDP). The most frequently diagnosed PDs were the histrionic, borderline, passive-aggressive, and antisocial categories. A comparison between the BD patients and a sample of 35 recent-onset schizophrenic patients showed significant differences for two PDs. Schizotypal PD was more frequently diagnosed in the schizophrenic group, while the BD group had a higher frequency of histrionic PD.     

Self-reported strengths and difficulties in a large Norwegian population 10–19 years

This study reports young people’s assessment of own problems and strengths from a Norwegian survey (n=29,631, age range 10–19), based on the self-report version of the Strengths and Difficulties Questionnaire (response rate 84.3%). Differences according to the age and gender are illuminated. Girls reported most emotional problems and boys most conduct and peer problems. Compared to other countries, Norwegian adolescents reported more hyperactive behaviour. Total problem scores were highest in early-adolescence for boys (Mean=10.8, SD=6.1), and for girls it is in late adolescence (Mean 11.3, SD=5.2). One third of the subjects reported at least minor perceived difficulties. All symptom scales were strongly associated with perceived difficulties, impact and burden to others (P<0.001) with significant gender and age effects. Impact scores were included in the estimate of possible caseness. Combining symptom scores and impact scores, 3.7% of the sample was defined as a high risk group, while 8.8% needed special attention from mental health services. The results also suggested that SDQ could be a valuable screening instrument for older adolescents.     

Trauma and dissociation in delinquent adolescents

OBJECTIVES: To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms. METHOD: Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). RESULTS: In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation. CONCLUSIONS: This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.     

Observations of a small sample of adolescents experiencing an at-risk mental state (ARMS) for psychosis

Some commentaries express concern that the At-Risk Mental State (ARMS) designation can be stigmatizing and induce a lasting sense of personal fragility. However, no studies have actually explored the personal perspectives of those so categorized. The purpose of this study was to explore how adolescents with an ARMS label understand and experience their condition medically and personally. Six participants receiving an ARMS diagnosis were interviewed and the data analyzed using interpretative phenomenological analysis. Three superordinate themes emerged: "It is better to say it," "How others would take me," and "Just to have somebody to talk to." The participants' experiences of being labeled were generally positive with limited instances of stigmatization by family and friends. Like most psychiatric diagnoses, the ARMS label has the potential to generate stigma. In practice, however, this sample of young people appeared to respect being told about the condition and to value the opportunity of talking about their experiences with mental health professionals and significant others.     

Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia

OBJECTIVE: A pilot study to evaluate the efficacy of a cognitive-behavioral group therapy program for adolescents with social phobia, simplified both in terms of time and labor intensity from a previously studied program (Social Effectiveness Therapy for Children and Adolescents) to be more appropriate for a community outpatient psychiatric setting. METHOD: Twelve adolescents with social phobia (ages 13-18), diagnosed by DSM-IV criteria and confirmed with Anxiety Disorders Interview Schedule for Children assessment, were randomly assigned to treatment (n=6) and waitlist (n=6) groups. The waitlist group was subsequently treated, and results were included in the data analysis. Assessments, including Anxiety Disorders Interview Schedule for Children interviews and self-report Social Phobia and Anxiety Inventory and Beck Depression Inventory II questionnaires, were performed at baseline and immediately after treatment or waitlist. RESULTS: All subjects completed the treatment program. Compared with the waitlist group, treated subjects showed significantly greater improvement in both examiner-evaluated (Anxiety Disorders Interview Schedule for Children) and self-reported (Social Phobia and Anxiety Inventory) symptoms of social anxiety (effect sizes [d], 1.63 and 0.85, respectively). No significant change was seen in Beck Depression Inventory II scores for treatment or waitlist groups. CONCLUSIONS: This study provides support for the use of simplified cognitive-behavioral interventions for adolescents with social phobia that are practical for community psychiatric settings.     

Dynamics of perceived parenting and identity formation in late adolescence

Identity formation is a dynamic process of person-context interactions, and part of this context are parents, even in late adolescence. Several theories on parent-adolescent relationships share the idea that parents influence the process of identity formation. However, up to now, empirical evidence, particularly longitudinal evidence for this link is limited. Therefore, this study aims to examine short-term changes in parenting and identity formation during late adolescence and to test the transactional process involved. Moreover, we focused on gender differences. Late adolescents were measured twice with a 1-year interval. Analyses using latent change models largely showed that parenting predicted the explorative phases of identity formation (i.e., exploration in breadth and commitment making), while evaluative phases of identity formation (i.e., exploration in depth and commitment identification) predicted more supportive parenting. Gender differences emerged, with respect to both parents' and adolescents' gender. These results clearly show that parenting and identity formation are dynamically interlinked, and underscore that parents keep being an important source of socialization for their developing children, even in late adolescence.     

Neural correlates of the self‐concept in adolescence—A focus on the significance of friends

The formation of a coherent and unified self‐concept represents a key developmental stage during adolescence. Imaging studies on self‐referential processing in adolescents are rare, and it is not clear whether neural structures involved in self‐reflection are also involved in reflections of familiar others. In the current study, 41 adolescents were asked to make judgments about trait adjectives during functional magnetic resonance imaging (fMRI): they had to indicate whether the word describes themselves, their friends, their teachers or politicians. Findings indicate a greater overlap in neural networks for responses to self‐ and friend‐related judgments compared to teachers and politicians. In particular, classic self‐reference structures such as the ventromedial prefrontal cortex and medial posterior parietal cortex also exhibited higher activation to judgments about friends. In contrast, brain responses towards judgments of teachers (familiar others) compared to politicians (unfamiliar others) did not significantly differ. Results support behavioral findings of a greater relevance of friends for the development of a self‐concept during adolescence and indicate underlying functional brain processes. Hum Brain Mapp 38:987–996, 2017. © 2016 Wiley Periodicals, Inc.     

The relationships among caregiver and adolescent identity status, identity distress and psychological adjustment

The present study addresses the relationships of caregiver identity status on their adolescent children's identity distress and psychological symptom severity among a sample of adolescents (age 12-19) in treatment at a community mental health center (N?=?60 caregiver-child dyads). A significant proportion of caregivers (10%) and their adolescent children (21.7%) met DSM-IV criteria for Identity Problem. Caregiver identity commitment, significantly predicted adolescent identity distress over and above the adolescents' identity variables, while caregiver identity exploration significantly predicted adolescent psychological symptom severity. These findings and implications are discussed in further detail.     

Brief report: Benefit finding and identity processes in type 1 diabetes: Prospective associations throughout adolescence

Identity formation constitutes a core developmental task during adolescence, but may be challenged when having a chronic illness such as type 1 diabetes. The present study examined whether viewing positive benefits to one's diabetes across adolescence was related to greater identity exploration and commitment later in time. A total of 55 adolescents (10–14 years; 47% female) with type 1 diabetes participated in a six-wave study spanning 3 years (with six-month measurement intervals). Through latent growth curve modeling, Time 6 identity scores were regressed on intercept and slope terms of benefit finding through Times 1–4, simultaneously controlling for demographic and clinical variables. Identity exploration (but not commitment) at Time 6 was positively predicted by the intercept and slope of benefit finding: adolescents who find benefits in diabetes are more inclined to explore different alternatives later on in adolescence. Benefit finding may constitute a resource facilitating identity formation in adolescents with diabetes.     

Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents

The frequency, comorbidity, and psychosocial impairment of anxiety disorders among German adolescents was estimated from a survey of 1,035 students aged 12-17 years. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, using the computerized Munich version of the Composite International Diagnostic Interview. Anxiety disorders occurred frequently in our sample of adolescents, with a rate of 18.6%. When considering the subtypes of anxiety disorders, phobia was the most common. Posttraumatic stress disorder and obsessive-compulsive disorder occurred less frequently with rates below 2%. Panic disorder and generalized anxiety disorder were the least common, with rates well below 1%. Anxiety disorders were significantly higher in girls than in boys, and that the rates increased with age. Comorbidity occurs quite frequently, both within the anxiety disorders and also with other psychiatric disorders. The most common pattern of comorbidity was that of anxiety and depressive disorders. Although a high number of anxiety cases were psychosocially impaired, at least during the worst episode of their disorders, only a few of them sought treatment for their problems. We conclude by discussing some research priorities in the area of anxiety disorders in children and adolescents.     

Depressive symptoms in children and adolescents with dysthymic disorder

This report examines clinical features of 'pure' dysthymic disorder (DD, without superimposed major depressive disorder, MDD) in a sample of children and adolescents. Profiles of symptomatology and comorbidity as a function of age and gender are described. The sample consisted of 48 subjects (22 males, 26 females, age range 7-18 years, mean age 12.1 years) screened from consecutively referred children and adolescents. All subjects were comprehensively diagnosed with structured diagnostic interviews (Schedule for Affective Disorders and Schizophrenia for School Age, Diagnostic Interview for Children and Adolescents-Revised), according to DSM-IV criteria. Depressed mood, irritability, loss of energy and fatigue, guilt and low self-esteem were present in more than 70% of the subjects. Differences in symptomatic profile between males and females were not significant. Children showed less symptoms than adolescents, but the symptomatic profile was comparable (only anhedonia was significantly more frequent in adolescents). Anxiety disorders were more commonly comorbid with DD, especially separation anxiety disorder in children (33%) and generalised anxiety disorder in adolescents (67%). Externalising disorders were less frequently represented in our sample (14%). An early diagnosis of 'pure' DD before the first episode of MDD is crucial for a timely intervention.     

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers’ Views of the Role of Technology and Web-Based Resources

This mixed-methods study assessed providers’ views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.     

Bullying, depression, and suicidality in adolescents

OBJECTIVE: To assess the association between bullying behavior and depression, suicidal ideation, and suicide attempts among adolescents. METHOD: A self-report survey was completed by 9th- through 12th-grade students (n = 2342) in six New York State high schools from 2002 through 2004. Regression analyses were conducted to examine the association between being victimized and bullying others with depression, ideation, and attempts. RESULTS: Approximately 9% of the sample reported being victimized frequently, and 13% reported bullying others frequently. Frequent exposure to victimization or bullying others was related to high risks of depression, ideation, and suicide attempts compared with adolescents not involved in bullying behavior. Infrequent involvement in bullying behavior also was related to increased risk of depression and suicidality, particularly among girls. The findings indicate that both victims and bullies are at high risk and that the most troubled adolescents are those who are both victims and bullies. Psychopathology was associated with bullying behavior both in and away from school. CONCLUSIONS: Victimization and bullying are potential risk factors for adolescent depression and suicidality. In evaluations of students involved in bullying behavior, it is important to assess depression and suicidality.