Recent extensions of mentalization theory have included the hypothesis that a reduced capacity for epistemic trust in the context of attachment relationships may represent a core vulnerability for ...the development of borderline personality disorder (BPD). The first aim of the current study was to explore empirical relationships between epistemic trust and symptoms of BPD. The second aim was to explore the effect of epistemic trust on treatment response.
Data were collected from 322 inpatient adolescents. The Inventory of Parent and Peer Attachment (IPPA) trust in mother and father subscales were used to approximate epistemic trust in the absence of a validated measure. A multimodal approach was used to measure BPD including self-report, parent-report, and interviewer ratings. Regression analyses were performed to explore the relationship between IPPA trust scores and measures of BPD. Mixed-design analyses of variance were conducted to evaluate whether self-reported parent trust at admission influenced progress in treatment.
As hypothesized, results indicated that reduced IPPA trust in parents correlated with BPD symptoms across various measures. Levels of IPPA trust in parents at admission did not moderate a reduction in BPD symptoms over the course of treatment.
This study provides support for the theoretical association between deficits in epistemic trust and BPD while also highlighting the need for a validated measure of epistemic trust. Although parent trust at admission did not moderate a reduction in BPD symptoms over the course of treatment, this result may suggest that progress in treatment, and perhaps the ability to cultivate trust in the treatment setting and providers, may not be overly determined by levels of parent trust.
Abstract
Background
Observational assessments of parent-adolescent conflict can guide interventions to prevent and reduce conflict and mental health problems. The authors identified the Observing ...Mediational Interactions (OMI) as a particularly useful coding system for examining parent-adolescent conflict. The OMI is the observational measure used in the Mediational Intervention for Sensitizing Caregivers (MISC) and quantifies emotional (attachment-based) and cognitive (learning-based) behaviors during caregiver-child interactions.
Objective
The overall aim of the current study was to tailor and evaluate the OMI specifically for observing conflict interactions.
Method
Conflict discussions between 56 clinical youth aged 10-15 years and their mothers were coded using the OMI. Reliability, construct validity, and associations with affect following the conflict discussion were examined.
Results
Analyses revealed that the OMI demonstrated adequate internal consistency, interrater reliability, and construct validity in terms of associations with an alternate observational measure and parent-reported family functioning and stress. Additionally, mothers who engaged in fewer negative parenting behaviors reported greater positive affect following the conflict discussion, controlling for baseline affect.
Conclusions
Taken together, findings support the use of the OMI in future studies. While further research should attempt to extend findings to other populations and settings and elaborate the coding instructions as needed, researchers can use the OMI to inform ongoing adaptations of MISC and identify targets for prevention and intervention more broadly.
The prevalence of pathological gambling among college students is increasing. Few studies have directly examined the relation between reward processing and gambling severity while concurrently ...examining the effects of co-occurring negative affect in this at risk population. This study used Structural Equation Modeling (SEM) techniques to analyze results from an online survey of 352 female and 96 male students age 18–25. Participants completed measures of past year gambling behavior and severity of gambling problems using the Canadian Problem Gambling Index and the Problem Gambling Severity Index. Negative affect and reward processing were measured by the 21-item version of the Depression, Anxiety, and Stress Scales and the Behavioral Inhibition System and Behavioral Activation System (BIS/BAS) scales, respectively. Thirty-five percent of participants reported gambling in the previous 12 months, and 11% had gambling severity scores indicative of “moderate-risk” or “problem gambling.” Gambling severity was associated with negative affect. Negative affect, in turn, was correlated with the unitary BIS scale and inversely associated with the BAS reward responsiveness scale. Reward responsiveness was also inversely associated with gambling severity. In the SEM models, the association between reward responsiveness and gambling severity was mediated by negative affect among males but not among females. Potential explanations for these findings and their implications for addressing problem gambling are discussed.
This commentary critically evaluates the usefulness of the standards employed by Gunderson et al. (2018) for theory evaluation and comparison and calls into question their adequacy, based both on the ...lack of scientific evidence supporting the assertions these standards imply and on the availability of alternative standard for theory evaluation and comparison. In so doing, the commentary calls for a redefinition of "borderlineness" as well as the use of standard criteria for theory evaluation and comparison.
Objective: A social-cognitive perspective on posttraumatic stress disorder (PTSD) has been proposed and posits that impaired social cognition, rooted in attachment insecurity, plays a role in the ...development of PTSD. Support for the role of impaired social cognition in PTSD has been found in adults, but the social-cognitive perspective on PTSD has not been examined in adolescents. This study sought to explore differences in social cognition and PTSD on the basis of attachment security, and it examined social cognition as a mediator in the relation between attachment security and PTSD and with regard to PTSD symptom change during inpatient treatment. Method: We recruited 142 adolescents from an inpatient psychiatric hospital, where adolescents and their parents completed assessments at admission and discharge. Results: Adolescents with a secure attachment demonstrated better social-cognitive skills than did those with an insecure attachment. Social cognition mediated the relation between adolescents' maternal attachment representations and PTSD at admission across 3 self- and parent-report measures. Social cognition also mediated the relation between adolescents' maternal attachment representations at admission and PTSD treatment outcome. Conclusion: This study provides the 1st support for the application of Sharp, Fonagy, and Allen's (2012) social-cognitive perspective of PTSD to adolescents by showing a link between clinically significant symptoms of PTSD and attachment security through social-cognitive impairment. Findings indicate that improvement in PTSD during medium-stay inpatient treatment is partially driven by baseline attachment security and social-cognitive abilities, highlighting the potential of social-cognitive skills as important targets of clinical intervention among adolescents with PTSD.
•Personality pathology onsets in adolescence.•Personality pathology is moderately stable in adolescence.•Personality pathology is preceded by internalizing and externalizing disorders.•Personality ...pathology remains comorbid with internalizing and externalizing pathology throughout development.•Personality pathology emerges as maladaptive self-other relatedness from normative adolescent identity development.
There is mounting evidence that personality pathology, in particular, borderline pathology is a valid and reliable construct in adolescence, with prevalence, phenomenology, stability and risk factors similar to that of adult borderline personality disorder. Scientific evidence also delineates a marked separation of course and outcome of adolescent borderline personality disorder from other disorders and supports the efficacy of disorder-specific treatment. The current article addresses recent findings in these areas which point to adolescence as a sensitive period for the development for personality pathology. A conceptual model of psychopathology is presented wherein personality pathology is described as a qualitatively different level of psychopathology in the form of maladaptive self-other relatedness that is developmentally tied to identity formation in adolescence.
Background Research on parent-level factors linked to adolescent attachment security would inform interventions to prevent or reduce youth psychopathology and other negative outcomes. The current ...study examined one relevant parent-level variable: maternal interpersonal problems. Interpersonal problems, a key characteristic of personality pathology, are well described by the interpersonal circumplex (IPC) and have been shown to be associated with maladaptive adult attachment in close/romantic relationships; however, studies have not examined relationships with offspring attachment. Therefore, the first aim of the current study was to examine the relationship between maternal interpersonal problems and adolescent attachment insecurity. Based on previous evidence that parents' recalled bonding with caregivers is associated with the quality of bonding and attachment with offspring, the second aim was to examine whether mothers' recalled bonding with their own mothers partially explained this relationship. Methods Participants included 351 psychiatric inpatient adolescents (M.sub.age = 15.26, 64.1% female) and their biological mothers. Logistic regressions tested whether maternal interpersonal problems were associated with Child Attachment Interview classifications (secure vs. insecure; secure vs. preoccupied vs. dismissing; not disorganized vs. disorganized). A mediation model (N = 210) tested whether the relationship between maternal interpersonal problems and adolescent attachment was mediated by the mother's recalled maternal bonding. Results Maternal interpersonal problems were associated with insecure (vs. secure), dismissing (vs. secure), and preoccupied (vs. secure) attachment. There was no significant relationship between maternal interpersonal problems and disorganized attachment. Mediation analyses showed that maternal interpersonal problems were indirectly related to adolescent attachment security via the mother's recalled maternal care, though only a small amount of variance (7%) in adolescent offspring attachment was accounted for by the model. Conclusions Results provide the first evidence that maternal interpersonal problems are associated with higher likelihood of insecure attachment in adolescents. Therefore, researchers could consider drawing upon the IPC literature to further examine mechanisms of intergenerational risk and to tailor interventions aimed to improve parent-child relations and attachment. Additionally, findings highlight the mediating role of the mothers' recalled experiences with caregivers in the transmission of risk, suggesting attachment-based or mentalization-based interventions may be helpful for mothers with interpersonal problems and personality pathology. Keywords: Interpersonal problems, Attachment, Intergenerational transmission, Adolescent attachment
Adolescents with features of borderline personality disorder (BPD) may experience deficits in interpersonal trust; however, a simultaneous comparison of interpersonal trust among adolescents with ...BPD, other psychiatric disorders, and no psychiatric conditions (healthy controls) has never been conducted.
The aims of this study were to 1) explore differences in interpersonal trust (emotional trust, honesty beliefs, and reliability beliefs) between these three groups, and 2) examine the incremental value of BPD features in association with interpersonal trust over and above internalizing and externalizing.
Adolescents (
= 445, 67.9% female,
= 15.13) recruited from two psychiatric hospitals (psychiatric sample, n = 280) and community organizations (healthy sample, n = 165) completed measures of BPD features, interpersonal trust, and internalizing and externalizing psychopathology. Psychiatric adolescents also completed an interview assessing BPD (n = 83 BPD). ANCOVA and hierarchical linear regression were used for analyses.
Emotional trust differed significantly across all three groups, with the lowest level of emotional trust in adolescents with BPD. Reliability was also lower in the two psychiatric groups relative to healthy controls. BPD features were significantly, inversely associated with emotional trust and reliability beliefs when controlling for internalizing and externalizing pathology. Post-hoc analyses testing specificity of the three forms of trust found that lower emotional trust predicted BPD diagnosis over and above the other two forms of trust.
Findings highlight emotional trust as a correlate and important target of intervention for adolescents with BPD, and add to knowledge on interpersonal trust deficits for adolescents with psychiatric disorders more broadly.
Extant literature indicates that Borderline Personality Disorder (BPD) may be reliably assessed in adolescence. Sharp and colleagues' (2011) suggested that mentalization could be an important early ...target for intervention in BPD adolescents and showed that hypermentalizing may represent an important marker to distinguish emerging BPD from adolescent turmoil. We aimed at testing if both dimensionally-assessed and categorically-diagnosed BPD was selectively associated with hypermentalizing errors on the Movie for the Assessment of Social Cognition (MASC) task in Italian adolescent inpatients and community adolescents.
The sample was composed of 58 Italian adolescents who were consecutively admitted to an adolescent psychiatry unit in Rome, Italy. BPD was assessed using the Structured Clinical Interview for
Personality Disorders (SCID-5-PD); the MASC task was used to assess mentalizing. Findings supported the hypothesis of a specific link between BPD features and hypermentalizing in adolescent inpatients. Both dimensionally-assessed and categorically-assessed BPD showed significant and non-negligible associations with hypermentalizing. The overall performance on the MASC task significantly discriminated BPD adolescents from Italian community-dwelling adolescents.
Our findings supported the hypothesis that specific deficits in mentalization-namely, hypermentalizing-may play a crucial role in the developmental pathway leading to emerging BPD in adolescence.
Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed ...patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians' emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician's subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.
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