The purpose of this study was to examine the relationship between various adverse childhood experiences, alexithymia, and dissociation in predicting nonsuicidal self-injury (NSSI) in an inpatient sample of female adolescents. Seventy-two adolescents (aged 14-18 years) with NSSI disorder (n=46) or mental disorders without NSSI (n=26) completed diagnostic interviews and self-report measures to assess NSSI disorder according to the DSM-5 criteria, childhood maltreatment, alexithymia, and dissociation. Alexithymia and dissociation were highly prevalent in both study groups. Multivariate logistic regression analyses indicated that only alexithymia was a significant predictor for NSSI, whereas childhood maltreatment and dissociation had no predictive influence. The association between alexithymia and NSSI emphasizes the significance of emotion regulation training for female adolescents with NSSI. Efforts to reduce NSSI behavior should therefore foster skills to heighten the perception and recognition of one's own emotions.

Background: Professional caregivers working in child and youth welfare institutions are frequently faced with the complex mental health issues, emotional needs and challenging coping strategies of clients with cumulated traumatic experiences, leaving them prone to developing high levels of stress, burn-out and compassion fatigue. Trauma-informed care (TIC) is a milieu-therapeutic approach that aims to promote the self-efficacy and self-care of youth welfare staff by guiding them to a better understanding of their own and their clients' stress symptoms and countertransference. Despite increasing efforts to implement TIC practices, and more widespread recognition of their value in youth welfare systems, there is a lack of studies evaluating the effectiveness of this approach. The aim of this study was to assess the effects of TIC practices in youth welfare institutions on both the physiological stress of staff members and clients' physical aggression towards their caregivers. . Methods:Data was obtained from a longitudinal study investigating the effectiveness of TIC in 14 residential youth welfare institutions. Our sample consisted of 47 youth welfare employees (66.0% female) aged from 23 to 60 years (M = 37.4, SD = 10.4 years). Hair cortisol concentration (HCC) and occurrences of client physical aggression were assessed at four annual measurement time points (T1 to T4). Results: Participants in five institutions employing TIC practices (intervention group) showed significantly lower HCC at T4 than staff members from institutions who did not receive training in TIC (control group), indicating reduced physiological stress levels. At T4, the intervention group reported significantly less physical aggression than the control group.Conclusions: TIC might be a promising approach for reducing the emotional burden of employees and institutions should invest in training their staff in TIC practices. More research is necessary, to investigate the benefits and efficacy of TIC, both to youths and staff members, and to foster a better understanding of which specific factors may contribute to stress reduction.

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Nonsuicidal self-injury (NSSI) is a frequent phenomenon in adolescents, however there is a lack of studies on the prevalence of NSSI in adolescents placed in youth welfare and juvenile justice group homes. The goal of the present study is to investigate the prevalence rates of NSSI and mental disorders in adolescents living in the youth welfare system, as well as how occasional and repetitive NSSI differ with respect to mental disorders, suicidality, and gender. The sample consisted of 397 adolescents aged 12 to19 years (mean age = 15.98, SD = 1.77, 65.7% male) placed in youth welfare and juvenile justice group homes. NSSI, suicidality, and mental disorders were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia (K-SADS-PL). Lifetime prevalence rates of occasional and repetitive NSSI were 21.9% and 18.4%, respectively and 85.6% of the sample endorsed a lifetime mental disorder. Occasional and repetitive NSSI were significantly associated with depressive, conduct, and substance use disorders (d = 0.50-0.67) among both genders. Prevalence rates of repetitive NSSI in youth welfare and juvenile justice institutions are higher than in the general population and males who engage in NSSI are at particularly high risk of suicidality. Due to the high prevalence of NSSI and its related problems, NSSI should be routinely assessed in this vulnerable population and staff should be trained in recognizing and handling NSSI as well as supporting adolescents in improving their emotion regulation skills.

BackgroundAdolescents’ nonsuicidal self-injury (NSSI) leads to distress that affects the whole family system, and siblings are reported to suffer from disrupted family communication and functioning. So far, no studies have examined the quality of relationships between adolescents with NSSI and their siblings. The aim of the present study was to examine the sibling relationship quality of adolescents with NSSI, adolescents with other mental disorders without NSSI (clinical controls, CC), and adolescents without current or past experience of mental disorders (nonclinical controls, NC).Methods139 female adolescents aged 13–20 years (mean age = 16.18 years, SD = 1.62, NSSI: n = 56, CC: n = 33, NC: n = 50) and 73 siblings aged 10–28 years (mean age = 16.88 years, SD = 4.02, 60.3% female) participated. Self-report measures were used to assess psychopathology and sibling relationship quality.ResultsSiblings reported a wide range of negative emotional and familial consequences, such as feeling left alone with their sister’s issues or a distressing family situation, as a result of their sister’s NSSI. Siblings of adolescents with NSSI experienced significantly more coercion in the relationship with their sister compared to CC (d = 1.08) and NC (d = 0.67) siblings, indicating an imbalance of dominance and control in their relationship. Further, adolescents with NSSI reported significantly less warmth and empathy in the sibling relationship and higher rivalry scores between their siblings and themselves than NC adolescents, suggesting higher levels of parental favoritism among parents of adolescents with NSSI compared to NC parents (d = 0.93). Among siblings of adolescents with NSSI, high levels of warmth, conflict, and empathy were significantly associated with internalizing problems. For adolescents with NSSI a significant association was found between internalizing problems and coercion and externalizing problems and similarity.ConclusionsGiven the negative impact of NSSI on siblings’ emotional well-being and family life, efforts should be made to offer siblings psychoeducation and support to help them cope with the emotional and familial consequences of their sister’s NSSI. Given adequate support, siblings can in turn be a source of emotional support for their sister.

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<b><i>Introduction:</i></b> Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). <b><i>Methods:</i></b> With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. <b><i>Results:</i></b> The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. <b><i>Conclusions:</i></b> The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.

Zusammenfassung. Obwohl Angststörungen (AS) häufig komorbid mit einer Störung des Sozialverhaltens (SSV) auftreten, wurde diese Komorbidität in der Forschung weitgehend vernachlässigt. Komorbide AS wirken sich in Studien sowohl positiv als auch negativ auf den Verlauf einer SSV aus. Diese Studie zielt darauf ab, Heranwachsende mit einer SSV mit und ohne AS hinsichtlich psychischer Belastung, traumatischen Erlebnissen, psychopathischen Persönlichkeitstraits und Legalbewährung zu untersuchen. 207 Heranwachsende mit einer SSV (9 – 25 Jahre; 73.4 % männlich; SSV: N = 180, SSV und AS: N = 27), die zum Zeitpunkt der Untersuchung in Jugendhilfeeinrichtungen lebten, konnten eingeschlossen werden. Es wurden strukturierte klinische Interviews und eine psychometrische Testbatterie eingesetzt. Die Resultate zeigen, dass die Gruppe mit SSV und AS signifikant weniger externalisierende und mehr internalisierende Symptome sowie traumatische Erlebnisse aufweisen. Bezüglich psychopathischer Persönlichkeitsmerkmale und Verurteilungen (>50 % in beiden Gruppen) ergaben sich keine signifikanten Gruppenunterschiede. Die Ergebnisse legen nahe, dass die Ausprägung der SSV für die Kriminalitätsentwicklung bedeutsamer und die spezifische Komorbidität von AS aber doch ätiologisch und symptomatisch von großem Interesse ist. Diese sollte deshalb mit Längsschnittstudien und Therapieprozessanalysen intensiver beforscht werden.