The classification of disturbed personality functioning in early adolescence

This study describes disturbed personality functioning in early adolescence. A non-clinical sample of 63 thirteen year olds underwent a semi-structured psychiatric interview as part of a longitudinal study investigating the relationship between competence in personality functioning and development. The presence of personality disturbance was determined by two psychiatrists who rated the adolescents on a personality functions scale. The raters then described the type of disturbance using Axis II of DSM-III as a guideline. Forty-six percent of the sample were found to have some degree of disturbed personality functioning. Of these, over one-half fell into a cluster comprised of avoidant, dependent, compulsive, or passive-aggressive types, while another third were characterized by antisocial tendencies. Severity of disturbance was not related to type of disturbance. Ratings of behaviour by teachers and parents supported the division of subjects with personality dysfunction into two broad groups: an anxious, fearful, "quiet" cluster; and a group of more "acting out", disturbing individuals. However, parents and teachers could not distinguish the "quiet" group from teenagers who were free of disturbed personality functioning. These data indicate that it is possible to classify a segment of a non-clinical population of young adolescents who had personality dysfunction using Axis II of DSM-III as a guideline. Furthermore, such a group of teenagers is not homogeneous. They distribute themselves into internalizing and externalizing clusters.     

Personality disorders in adolescence. A pilot study on classification and early course

72 case histories of former adolescent psychiatric inpatients diagnosed on discharge as suffering from a personality disorder were evaluated. It was possible to re-examine 33 (46%) of them. The discharge diagnosis was made according to ICD 9, the follow-up diagnosis according to ICD 10 and DSM-III-R. Depending on the instrument and criterion, 40% to 87.9% of the discharge diagnoses made could be confirmed after an average follow-up period of 3.4 years. Only in 12.1% of the cases there was no personality disorder established. There was no indication of any change of diagnosis to other psychiatric disorders. The re-diagnosis rates obtained are thus similar to those for adults. The classifications of ICD 10 and DSM-III-R corresponded much better than those of ICD 9 to clinical reality. The classification systems and assessment instruments that have normally been verified only for adults thus also seem suitable for use among adolescents. In both adolescents and adults the avoidant personality disorder is a particularly frequent subtype. However, the current study was unable to resolve the question of what the decisive criteria should be in the case of competing definitions such as puberty crisis, personality development disorder, personality disorder and emotional or affective disorder. This issue requires further investigation.     

Personality strengths in adolescence and decreased risk of developing mental health problems in early adulthood

The aim of this study was to investigate whether personality strengths during adolescence are associated with decreased risk of developing psychiatric disorders, educational or occupational problems, violent or criminal behaviors, and interpersonal difficulties during early adulthood. A representative community sample of 688 mothers from upstate New York and their offspring was interviewed in the period of 1985-1986 (mean offspring age = 16 years) and in that of 1991-1993 (mean offspring age = 22 years). Results showed that youths with numerous personality strengths at the mean age of 16 years were at a decreased risk of developing psychiatric disorders, educational and occupational problems, interpersonal difficulties, and criminal behaviors at the mean age of 22 years. These associations remained significant after controlling for age, sex, socioeconomic status, verbal intelligence, preexisting psychiatric disorders, and corresponding problems at the mean age of 16 years. Although youths with fewer personality strengths who experienced numerous stressful events were at elevated risk of developing psychiatric disorders during early adulthood, those with a higher number of personality strengths at the mean age of 16 years did not share this vulnerability. We conclude that personality strengths during adolescence may contribute to a decreased risk of developing a wide range of adverse outcomes during early adulthood. Systematic evaluation of character strengths may improve the clinical assessment of adolescents.     

Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative

OBJECTIVE: The study of personality pathology in adolescence is in its infancy. This article examined the applicability and limits of DSM-IV axis II personality disorder diagnoses in adolescents, assessed the validity of a method for assessing adolescent personality pathology, and began to develop an empirically grounded classification. METHOD: A total of 296 randomly selected clinicians described a patient age 14-18 in treatment for maladaptive personality patterns using axis II ratings scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A), a Q-sort instrument for assessing adolescent personality pathology. After examining the nature and frequency of axis II disorders in the sample, the authors used Q-factor analysis to identify naturally occurring groupings of patients on the basis of shared personality features. RESULTS: Axis II diagnoses in adolescents resembled those in adults, although application of DSM-IV criteria appeared to overdiagnose antisocial and avoidant personality disorder in adolescents. Q analysis with the SWAP-200-A isolated five personality disorders (antisocial-psychopathic, emotionally dysregulated, avoidant-constricted, narcissistic, and histrionic) and one personality style. Patients' dimensional scores on each diagnostic prototype showed predictable associations with ratings of current axis II disorders, measures of adaptive functioning, and symptoms assessed with the Child Behavior Checklist. CONCLUSIONS: With some exceptions, personality pathology in adolescence resembles that in adults and is diagnosable in adolescents ages 14-18. Categories and criteria developed for adults may not be the optimal way of diagnosing adolescents. Data from samples of adolescents may prove useful in developing an empirically and clinically grounded classification of personality pathology in adolescents.     

Personality and predictions of psychosis in adolescence

This paper reviews the major epidemiologic studies of childhood and adolescent social, behavioral, and personality abnormalities in schizophrenia. Social abnormalities, behavioral impairments, and abnormal personality are already evident in the premorbid stage of the disorder. These abnormalities are not secondary to psychotic symptoms, intellectual impairments, or socioeconomic status, and may therefore act as risk factors for schizophrenia. Nevertheless, low specificity of these associations and poor predictive value make it difficult, at this point, to utilize such markers for early detection or prevention.     

Personality, functioning and symptomatology

A random sample of 200 people selected from urban and rural communities wasassessed using structured interview schedules to measure the prevalence of personality disorder and psychiatric illness and their relation to social functioning. Explosive personality disorder was the most prevalent type of abnormal personality. Social functioning was significantly worse in those with personality disorder than those with normal personality but there was no difference between the various diagnostic categories of abnormal personality. Social functioning differed between some PSE diagnostic categories. An assessment was made of the variables contributing to mean social functioning score, of the interactions between them, and of the correlation between social functioning symptomatology.     

Diverse aspects of dating: associations with psychosocial functioning from early to middle adolescence

Theories imply that some aspects of adolescent dating behavior will be associated with individuals' positive psychosocial functioning, while other aspects will be associated with problems. This study addressed associations between diverse aspects of dating at age 16 and: (1) individual and social functioning at age 12 and at age 16; and (2) change in psychosocial functioning from age 12 to age 16. Controlling for physical maturity, overinvolvement in dating at age 16 was associated with poorer psychosocial functioning in early and middle adolescence and also predicted declines in functioning between the two ages. Level of dating experience and quality of romantic relationships were associated with social adaptation at age 16, especially in the friendship and dating domains.     

The relation between self-concept and social functioning in adolescence

A model of the relation between self-concept and internalizing and externalizing problem behaviours in adolescence, with the self-concept influencing problem behaviours (S-->IE), was assessed using a sample of 277 Swedish adolescents. The model was tested in a path analysis with data from Youth Self Report (YSR) and Structural Analysis of Social Behaviour (SASB) questionnaires. Consistent with the model, a positive self-concept was found to be the most important factor for adjustment and for protection against common problem behaviour. A negative self-concept combined with female gender were risk factors for internalized problems. Self-control had only a direct effect on externalizing behaviour for boys. Adolescents of 15, 16 years of age had a stronger relationship between a negative self-concept and externalizing problem behaviour than younger and older adolescents. Internalizing problem behaviours such as anxiety and depression predicted aggressive and delinquent behaviour. These findings highlight the importance of promoting of a positive self-concept in every adolescent in various psychosocial contexts.     

Depersonalization in early adolescence

Depersonalization is a comparatively rare disease in the psychiatric field. Particularly, its occurrence in early adolescence or even before seems to be quite uncommon. We have observed 120 cases of depersonalization, of which only 16 cases had their onset before the age of 15. Among them, we will present here 6 cases for which a detailed observation was available. It is very difficult for these minors to put their feeling into verbal expressions because the experience of depersonalization is a "negative symptom." Adult patients can explain metaphorically how they feel. However, children can use only similes. Therefore, in the case of depersonalization, children have more difficulty in expressing their feeling than adults. This might cause to clinically overlook depersonalization in children. Even in our observation of the cases reported here, we found after a while that their complaints actually meant experiences of depersonalization, although their explanations were at first obscure. These 6 cases showed common personality traits that they are passive in interpersonal relationship and that they easily become frustrated or hold a sense of inferiority even at trifles.     

The link between emotion identification skills and socio-emotional functioning in early adolescence: a 1-year longitudinal study

Amongst adults, low emotion identification skill (EIS) relates to poor emotion regulation strategies, higher rates of anxiety and depression, and higher rates of somatic illness and disease [Taylor, G. J., & Bagby, R. M. (2004). New trends in alexithymia research. Psychotherapy and Psychosomatics, 73, 68-77]. Little research has examined EIS in adolescence and, in particular, the longitudinal impact of EIS on social support and affective experience. Six hundred and sixty-seven high school students completed measures of EIS, social support and positive and negative affects in Grade 8, and again in Grade 9. Repeated measure ANOVAS revealed that negative affect increased and positive affect decreased from Grades 8 to 9. Structural equation modelling revealed that low EIS predicted increases in fear, decreases in positive affect, and decreases in the quality and quantity of social support. Amongst boys, low EIS also predicted increases in sadness. We discuss the implications of these findings for early prevention programmes.     

A longitudinal twin study on IQ, executive functioning, and attention problems during childhood and early adolescence

Variation in human behavior may be caused by differences in genotype and by non-genetic differences ("environment") between individuals. The relative contributions of genotype (G) and environment (E) to phenotypic variation can be assessed with the classical twin design. We illustrate this approach with longitudinal data collected in 5 and 12-year-old Dutch twins. At age 5 data on cognitive abilities as assessed with a standard intelligence test (IQ), working memory, selective and sustained attention, and attention problems were collected in 237 twin pairs. Seven years later, 172 twin pairs participated again when they were 12 years old and underwent a similar protocol. Results showed that variation in all phenotypes was influenced by genetic factors. For IQ the heritability estimates increased from 30% at age 5, to 80% at age 12. For executive functioning performance genetic factors accounted for around 50% of the variance at both ages. Attention problems showed high heritabilities (above 60%) at both ages, for maternal and teacher ratings. Longitudinal analyses revealed that executive functioning during childhood was weakly correlated with IQ scores at age 12. Attention problems during childhood, as rated by the mother and the teacher were stronger predictors (r = -0.28 and -0.36, respectively). This association could be attributed to a partly overlapping set of genes influencing attention problems at age 5 and IQ at age 12. IQ performance at age 5 was the best predictor of IQ at age 12. IQ at both ages was influenced by the same genes, whose influence was amplified during development.     

Personality,perceived parental rejection and problem behavior in adolescence

BACKGROUND: It has been well documented that adolescents run a heightened risk for developing depression and aggression when they feel rejected by their parents and that parental rejection has different effects for gender in developing depression and aggression. Whether personality in combination with gender plays a role in the association between parental rejection, depression and aggression has not yet received much attention. METHOD: This was a cross-sectional study using data from the Conflict and Management of Relationships study (CONAMORE). A total of 1142 early and middle adolescents completed questionnaires about parental rejection, depression, aggression and personality. The associations between the variables were tested in multi-group moderation models using structural equation modeling. RESULTS: Perceived parental rejection was associated with depression and aggression in most of the combined personality type and gender groups. Personality type and gender moderated the associations between perceived parental rejection, depression and aggression. Several clear differences between the combined personality type and gender groups were found on these associations. CONCLUSION: Several clear moderating effects of the personality type x gender groups were found on associations between perceived parental rejection, depression and aggression. Future research should focus on these specific combinations instead of using either personality types or gender separately.     

Preference for outdoor play during early adolescence.

The present study examined the extent to which boys' and girls' preference for outdoor, vigorous activity changed as they became socialized to middle school. A sample of 133 boys and girls were studied for one year: those just beginning middle school (sixth graders) and those with one year experience (seventh grade). Measures of children's preference for the playground, the duration of their stay outdoors, and behaviors while outdoors were obtained through direct observational methods. Additionally, teachers' rated children's level of achievement, physical attractiveness, and facility in games. Children also rated each other in terms of dominance status. Results indicated that boys', compared to girls', preference to play outdoors existed only in sixth grade. Factor analyses indicated that three factors described these children: Teachers' Choice, Active Female Oriented, and Outdoor Male Oriented. All three factors varied as children progressed through middle school. Results are discussed in terms of life course developmental theory.     

Differences between older and younger adults with Borderline Personality Disorder on clinical presentation and impairment

Background

Borderline Personality Disorder (BPD) is well-known to be a clinically severe and impairing diagnosis. Research shows that BPD symptoms decrease in severity over time. However, a subset of patients with BPD continue to meet criteria for the disorder in older adulthood. Little is known about this subset. Perception of BPD as a young-person's diagnosis could lead to under recognition in older patients. As such, the objective of the present report is to provide the first direct comparison between older and younger adults with BPD on demographics, clinical presentation, and functional impairment.

Method

Over 3000 psychiatric outpatients were evaluated with semi-structured diagnostic interviews. Forty-six older adults (age 45–68) and 97 younger adults (age 18–25) met criteria for BPD.

Results

Both groups reported high levels of functional impairment and Axis I comorbidity. Older adults were more likely to endorse chronic emptiness, and less likely to endorse impulsivity, self-harm, and affective instability. Older adults also reported fewer substance use disorders, more lifetime hospitalizations and higher social impairment.

Conclusion

Older adults with BPD had a significantly different clinical presentation from younger adults with BPD, including differences in likelihood of endorsing specific BPD criteria, social impairment, and comorbid substance use. It is important to assess less prototypic features of BPD to avoid overlooking borderline personality features in this population.     

Personality disorder symptomatology and neuropsychological functioning in closed head injury

Despite an emerging literature characterizing the neuropsychological profiles of borderline, antisocial, and schizotypal personality disorders, relations between personality disorder traits and neurocognitive domains remain unknown. The authors examined associations among Millon Clinical Multiaxial Inventory-III personality disorder scales and eight neuropsychological domains in 161 patients referred for neuropsychological evaluation following closed head injury. Most personality disorder scales were associated with some decrement in cognitive function, particularly speeded processing, executive function, and language, while histrionic and narcissistic scales had positive relations with neuropsychological functioning. Results suggest that many personality disorder traits are related to neurocognitive function, particularly those functions subserved by frontal and temporal regions.