Over the last 15 years, controversy over the construct of adolescent personality disorder has largely been laid to rest because of accumulating empirical evidence in support of its construct ...validity. In this article, four conclusions that can be drawn from recent literature on borderline disorder in adolescents are discussed, with the ultimate goal of building an argument to support the idea that adolescence is a sensitive period for the development of personality disorder.
Identity integration, as opposed to identity diffusion, has been associated with greater self-esteem, meaning in life, and functioning. Trauma may have negative effects on identity; however, few ...studies have examined trauma and identity among adolescents, particularly those with psychiatric disorders. Moreover, factors that may promote healthy identity in adolescents who have experienced trauma have not been identified. This study aimed to test associations between childhood maltreatment and identity diffusion among adolescents with psychiatric disorders, and evaluated reflective function (RF) as a mediator of these associations.
107 adolescents (Mage = 15.36, 75.7% female) who were inpatient at a psychiatric hospital in the United States completed self-report measures of childhood maltreatment (physical, sexual, and emotional abuse; physical and emotional neglect; total maltreatment), identity diffusion, and RF. Path analysis was used to test two models of the relations between childhood maltreatment, RF, and identity diffusion.
Total maltreatment and all forms of maltreatment except physical abuse were significantly associated with identity diffusion at the bivariate level. In path analysis (Model 1), emotional and physical neglect were directly associated with identity diffusion, and RF mediated the association between emotional abuse and identity diffusion. In Model 2, RF partially mediated the association between overall level of maltreatment and identity diffusion.
Emotional abuse, emotional neglect, physical neglect, and total combined maltreatment exposure may be risk factors for adolescent identity diffusion. Targeting RF may help to build healthy identity among adolescents with symptoms of psychiatric disorders who have experienced maltreatment, particularly emotional abuse.
The Barratt Impulsivity Scale (BIS), a 30-item self-report measure, is one of the most commonly used scales for the assessment of the personality construct of impulsiveness. It has recently marked 50 ...years of use in research and clinical settings. The current BIS-11 is held to measure 3 theoretical subtraits, namely, attentional, motor, and non-planning impulsiveness. We evaluated the factor structure of the BIS using full information item bifactor analysis for Likert-type items. We found no evidence supporting the 3-factor model. In fact, half of the items do not share any relation with other items and do not form any factor. In light of this, we introduce a unidimensional Barratt Impulsiveness Scale-Brief (BIS-Brief) that includes 8 of the original BIS-11 items. Next, we present evidence of construct validity comparing scores obtained with the BIS-Brief against the original BIS total scores using data from (a) a community sample of borderline personality patients and normal controls, (b) a forensic sample, and (c) an inpatient sample of young adults and adolescents. We demonstrated similar indices of construct validity that is observed for the BIS-11 total score with the BIS-Brief score. Use of the BIS-Brief in clinical assessment settings and large epidemiological studies of psychiatric disorders will reduce the burden on respondents without loss of information.
Five versions of the Interpersonal Needs Questionnaire (INQ), a self‐report measure of perceived burdensomeness and thwarted belongingness, have been used in recent studies (including 10‐, 12‐, 15‐, ...18‐, and 25‐items). Findings regarding the associations between perceived burdensomeness, thwarted belongingness, and suicidal ideation using different versions have been mixed, potentially due to differences in measurement scales. This study evaluated factor structure, internal consistency, and concurrent predictive validity of these five versions in three samples. Samples 1 and 2 were comprised of 449 and 218 undergraduates, respectively; Sample 3 included 114 adolescent psychiatric inpatients. All versions demonstrated acceptable internal consistency. The 10‐item version and 15‐item version demonstrated the best, most consistent model fit in confirmatory factor analyses. Both perceived burdensomeness and thwarted belongingness consistently predicted concurrent suicidal ideation on the 10‐item INQ only. Future research should consider using the 15‐item or 10‐item versions.
•Sexual abuse and physical neglect have an indirect effect on greater suicidal ideation via generalized guilt and depressive symptoms.•Physical abuse has an indirect effect on greater suicidal ...ideation via generalized guilt and shame and depressive symptoms.•Emotional neglect has an indirect effect on greater suicidal ideation via depressive symptoms.
Previous studies demonstrated positive relations between various forms of maltreatment and suicidal ideation in youth; however, mechanisms underlying these relationships are not well understood. We propose that the experience of maltreatment in childhood may lead to high levels of generalized guilt and shame, resulting in an increase of depressive symptoms and suicidal thoughts in adolescents. The aim of the current study was to test our model of relations between these constructs using path analysis.
112 inpatient adolescents aged 12-17 years completed the Childhood Trauma Questionnaire to measure various types of maltreatment, the Personal Feelings Questionnaire to evaluate generalized guilt and shame, the Beck Depression Inventory-II to assess depressive symptoms, and the Columbia-Suicide Severity Rating Scale to assess suicidal ideation.
Findings partly confirmed the theoretical model. Indirect positive effects of sexual and emotional abuse, as well as emotional and physical neglect on suicidal ideation via generalized self-conscious emotion and/or depression were demonstrated. In contrast to our predictions, indirect negative effects of physical abuse on suicidal thoughts via generalized guilt and shame and depression were found.
Sample characterized by predominately Caucasian inpatient adolescents from financially stable and well-educated environments, over-reliance on self-report measures and the lack of a longitudinal design were main limitations of the study.
The study provides novel information on the potential mechanisms underlying the association between childhood maltreatment and suicidal ideation in adolescents. Generalized guilt and/or shame could be possible targets for interventions for victims of some forms of maltreatment to reduce depressive symptoms and suicidal ideation.
Objective: Dysfunctions in both emotion regulation and social cognition (understanding behavior in mental state terms, theory of mind or mentalizing) have been proposed as explanations for ...disturbances of interpersonal behavior in borderline personality disorder (BPD). This study aimed to examine mentalizing in adolescents with emerging BPD from a dimensional and categorical point of view, controlling for gender, age, Axis I and Axis II symptoms, and to explore the mediating role of emotion regulation in the relation between theory of mind and borderline traits. Method: The newly developed Movie for the Assessment of Social Cognition (MASC) was administered alongside self-report measures of emotion regulation and psychopathology to 111 adolescent inpatients between the ages of 12 to 17 (mean age = 15.5 years; SD = 1.44 years). For categorical analyses borderline diagnosis was determined through semi-structured clinical interview, which showed that 23% of the sample met criteria for BPD. Results: Findings suggest a relationship between borderline traits and "hypermentalizing" (excessive, inaccurate mentalizing) independent of age, gender, externalizing, internalizing and psychopathy symptoms. The relation between hypermentalizing and BPD traits was partially mediated by difficulties in emotion regulation, accounting for 43.5% of the hypermentalizing to BPD path. Conclusions: Results suggest that in adolescents with borderline personality features the loss of mentalization is more apparent in the emergence of unusual alternative strategies (hypermentalizing) than in the loss of the capacity per se (no mentalizing or undermentalizing). Moreover, for the first time, empirical evidence is provided to support the notion that mentalizing exerts its influence on borderline traits through the mediating role of emotion dysregulation. (Contains 1 figure and 3 tables.)
To sustain or repair cooperation during a social exchange, adaptive creatures must understand social gestures and the consequences when shared expectations about fair exchange are violated by ...accident or intent. We recruited 55 individuals afflicted with borderline personality disorder (BPD) to play a multiround economic exchange game with healthy partners. Behaviorally, individuals with BPD showed a profound incapacity to maintain cooperation, and were impaired in their ability to repair broken cooperation on the basis of a quantitative measure of coaxing. Neurally, activity in the anterior insula, a region known to respond to norm violations across affective, interoceptive, economic, and social dimensions, strongly differentiated healthy participants from individuals with BPD. Healthy subjects showed a strong linear relation between anterior insula response and both magnitude of monetary offer received from their partner (input) and the amount of money repaid to their partner (output). In stark contrast, activity in the anterior insula of BPD participants was related only to the magnitude of repayment sent back to their partner (output), not to the magnitude of offers received (input). These neural and behavioral data suggest that norms used in perception of social gestures are pathologically perturbed or missing altogether among individuals with BPD. This game-theoretic approach to psychopathology may open doors to new ways of characterizing and studying a range of mental illnesses.
Studies of individual attachment features have linked insecure attachment to intimate partner violence (IPV), but these studies have neither taken into account couple-level factors nor evidence of ...high rates of dual-partner perpetration. The current study examined three forms of IPV as a function of both partners’ adult attachment characteristics in order to better understand the maintenance of relationship violence by using a dyadic statistical design. Heterosexual couples (
n
= 163) were recruited from the community. Results suggest that one’s own attachment avoidance and a partner’s attachment avoidance and anxiety was associated with perpetration of physical assault. Similarly, one’s own attachment avoidance and a partner’s attachment avoidance and anxiety was associated with perpetration of psychological aggression. Attachment anxiety influenced one’s own perpetration of sexual coercion and their partner’s perpetration. Thus, functional analysis of violence in terms of attachment and risk regulation may afford targeted interventions to certain types of couples.
Level of Personality Functioning (LPF) represents the entry criterion (Criterion A) of the Alternative Model for Personality Disorders (AMPD) in the fifth edition of the
Diagnostic and Statistical ...Manual of Mental Disorders
(DSM-5). It is defined as a dimensional general severity criterion common to all personality disorders and conceptually independent of personality types or traits, and it represents maladaptive self (identity and self-direction) and interpersonal (empathy and intimacy) functioning. We review the history, measurement, and significance of LPF. We show that the inclusion of LPF in the AMPD is well justified if it is defined as a general adaptive failure of a subjective intrapsychic system needed to fulfill adult life tasks. If so defined, LPF distinguishes itself from maladaptive traits (Criterion B of the AMPD) and captures the contribution humans make as agentic authors to the interpretation and management of the self. While Criterion B maladaptive traits provide important descriptive nuance to manifestations of personality pathology, maladaptive LPF is conditional to the diagnosis of personality disorder.
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