Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders

Abstract

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the <i>Psychodynamic Diagnostic Manual</i> - third edition

“…The present study aimed to investigate the presence of personality subtypes in adolescent patients with DD according to the PDM-2 theoretical-clinical framework. Consistent with previous research (Feenstra et al , 2011 ; Gander et al , 2023 ), this investigation seems to confirm our first hypothesis, empirically supporting the great complexity in personality functioning of patients within this specific diagnostic grouping. Notably, in line with some investigations conducted on both adult and youth populations (Friborg et al ., 2014 ; Huprich et al , 2014 , Rost et al ., 2018 ; Westen et al , 2014 ), young depressed patients (compared with those with other clinical conditions) exhibited more maladaptive and clinically relevant traits of the emerging disorders of depressive, anxious-avoidant, narcissistic and borderline personality ( Table 1 ).…”

“…Despite the stability of personality pathology in young populations remains a contentious issue, the PDM grounds its diagnostic approach on the basis of a large body of scientific studies suggesting that specific maladaptive features of personality may be clearly identified in this developmental stage (Chanen, 2022 ; Lingiardi & McWilliams, 2017 ; Westen et al , 2014 ). Evidence has indicated that DD are strongly associated with personality disorders (mostly, clusters B and C) in adolescence (Feenstra et al ., 2011 ; Gander et al ., 2023 ; Ha et al ., 2014 ; Rost et al ., 2018 ; Westen et al ., 2014 ), and this comorbidity exerts a significant influence on prognosis and treatment outcomes (Strandholm et al ., 2014 ). Notably, young depressed patients often receive a diagnosis of borderline, dependent, avoidant, obsessive-compulsive, and depressive personality disorders (Feenstra et al ., 2011 ; Zanarini et al ., 2004 ).…”

“…Notably, the present research aimed at exploring: i) specific emerging personality disorders (or, in other terms, subtypes) among young patients with DD compared to those with other psychopathological diagnoses. In line with the few empirical investigations in the field (Feenstra et al ., 2011 ; Gander et al , 2023 ), it was expected that these adolescents would show more pervasive and rigid characteristics of depressive, borderline, dependent, and avoidant personality pathology; ii) the associations between patients’ personality subtypes and their overall mental functioning and personality organization. Consistent with some clinical and empirical contributions (Kernberg, 1984 ; Westen et al ., 2014 ), it was expected that more severe personality disorders would exhibit worse levels of impairments in several psychological domains; iii) the relationship between patients’ personality subtypes and therapists’ emotional responses, regardless of the effect of depressive symptoms.…”