An Empirically Derived Classification of Adolescent Personality Disorders

Westen, Drew; DeFife, Jared A.; Malone, Johanna C.; DiLallo, John

doi:10.1016/j.jaac.2013.12.030

Cited by 30 publications

(43 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, although to date there are no official developmentally focused criteria for BPD, current psychiatric classification systems imply that personality disorder categories (including BPD) can be applied to children and young people in cases where the maladaptive personality traits appear to be pervasive and persistent (at least 1 year), and are considered unlikely to be limited to a particular developmental stage [12, p. 647, 13, p. 123]. Moreover, recent reviews have concluded that the reliability and validity of the diagnosis of BPD in at least middle-to-late adolescence is comparable to that in adulthood [8,[14][15][16]. In line with this, several national treatment guidelines [17][18][19][20][21] acknowledge that diagnosing BPD is now justified and practical in adolescence.…”

Section: Phenomenology Of Borderline Personality Disorders In Adolescmentioning

confidence: 99%

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

Fonagy

Speranza

Luyten

et al. 2015

Eur Child Adolesc Psychiatry

129

View full text Add to dashboard Cite

Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.

show abstract

Section: Phenomenology Of Borderline Personality Disorders In Adolescmentioning

confidence: 99%

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

Fonagy

Speranza

Luyten

et al. 2015

Eur Child Adolesc Psychiatry

129

View full text Add to dashboard Cite

show abstract

“…Overall, all patients tend to actualize in the therapeutic relationship the repetitive and dysfunctional interpersonal patterns that are ubiquitous in their real-life relationships. Narcissistically grandiose individuals-both adults and adolescents-tend to be aggressive towards the clinician, making contemptuous comments, devaluing or ignoring the clinician's interventions, or exerting omnipotent control to affirm their self-centeredness and grandiose illusion of self-sufficiency (e.g., P. F. Kernberg et al, 2000;Tanzilli, Colli, Gualco, & Lingiardi, 2018;Westen, DeFife, Malone, & DiLallo, 2014). Vulnerable patients tend to be interpersonally detached and aloof in therapy, disavowing the need for closeness; at the same time, they have to receive attention and admiration from their clinicians (Ogrodniczuk & Kealy, 2013).…”

mentioning

confidence: 99%

“…The present study sought to extend this knowledge in the context of adolescent treatment by investigating therapists' emotional responses to and therapeutic alliance with adolescent NPD patients using narcissistic subtypes that were empirically derived from the Shedler-Westen Assessment Procedure, Version II (SWAP-II; Russ et al, 2008;Westen, Shedler, Bradley, & DeFife, 2012). This is the first study to have used these personality subtypes in a clinical adolescent population applying the SWAP-II for adolescents (SWAP-II-A; DeFife et al, 2013;Westen et al, 2014), and it provided preliminary data on the validity of this approach to narcissistic pathology within a sample of young persons. Moreover, use of the SWAP-II-A-an instrument that provides a comprehensive assessment of adolescent patient personality and psychological functioning, quantifying clinical observations-also offered us the opportunity to not rely on commonly employed self-report measures of narcissism.…”

mentioning

confidence: 99%

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

Tanzilli

Gualco²

2020

Journal of Personality Disorders

View full text Add to dashboard Cite

This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.

show abstract

“…Research, however, shows that the reliability and validity of the diagnosis of BPD in adolescence is comparable to that in adulthood Kaess, Brunner, & Chanen, 2014;Miller, Muehlenkamp, & Jacobson, 2008;Westen, DeFife, Malone, & DiLallo, 2014).…”

Section: Mentalization-based Treatmentmentioning

confidence: 97%

Mentalization-based treatment for borderline personality disorder in adults and adolescents: For whom, when, and how?

Feenstra

Luyten

Bales

2017

Bulletin of the Menninger Clinic

View full text Add to dashboard Cite

Borderline personality disorder (BPD) is common in clinical practice. Psychotherapy is the treatment of choice, and mentalization-based treatment (MBT) is one of the empirically supported treatments that are currently available. For adults, two variants of MBT (MBT day hospital [MBT-DH] and MBT intensive outpatient [MBT-IOP]) have been developed and empirically evaluated. The authors review research on the development, efficacy, and implementation of MBT. In conclusion, the authors focus on the implementation of treatment programs for BPD patients. Although there are now different effective treatments, their implementation in routine clinical practice has proven to be much more complex than initially thought. In addition, treatments such as MBT are multimodal and long term. Both societal pressures to increase the cost-effectiveness of treatments and new theoretical insights into the role of social learning and salutogenesis in the development of BPD force a reconsideration of some assumptions concerning the nature of treatment for individuals with BPD.

show abstract

An Empirically Derived Classification of Adolescent Personality Disorders

Cited by 30 publications

References 61 publications

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

Mentalization-based treatment for borderline personality disorder in adults and adolescents: For whom, when, and how?

Contact Info

Product

Resources

About