[Associations between Personality Structure, Psychodynamic Conflicts and Defense Styles in Adolescents with Mental Health Problems]. / Die Zusammenhänge von psychischer Struktur, psychodynamischen Konflikten und Abwehrstilen bei Adoleszenten mit psychischen Beschwerden.

OBJECTIVES: An exploration of the interrelationships between central psychodynamic constructs in adolescents with mental health problems was conducted. METHODS: 230 adolescents (Mage=18.0±1.9) were assessed using the Structure and the Conflict Questionnaire of the Operationalized Psychodynamic Diagnosis System in Childhood and Adolescence and the Defense Style Questionnaire for Adolescents. RESULTS: Controlling for the influence of gender, age, and socioeconomic status, low to moderate associations were revealed between increased psychodynamic conflict levels and immature defense styles (r=0.20 to 0.39, p<0.05 to 0.001) as wells as deficits in the personality structure and increased psychodynamic conflict levels (r=0.15 to 0.55, p<0.05 to p<0.001) or immature defense styles (r=0.30 to 0.69, p<0.001). Psychodynamic conflicts as well as defense styles could be predicted by the structural dimensions as well as age and sex (R2=0 .04 to 0.49, p<0.05 to 0.001). CONCLUSIONS: Theory-compliant correlations were demonstrated. The findings are particularly relevant against the background of the revision of the classification of personality functioning (ICD-11) in childhood and adolescence.

Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems.

The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.

Differences and similarities in personality functioning across different types of eating disorders.

Objective: The classification of anorexia nervosa (AN) into subtypes is relevant due to their different symptomatology. However, subtypes (restricting type: AN-R; purging type: AN-P) differ also in terms of their personality functioning. Knowledge about these differences would allow for better treatment stratification. A pilot study indicated differences in structural abilities that can be assessed by the operationalized psychodynamic diagnosis (OPD) system. The aim of this study was therefore to systematically explore differences in personality functioning and personality between the two AN subtypes and bulimia nervosa (BN) using three personality (functioning) constructs. Methods: A total of N = 110 inpatients with AN-R (n = 28), AN-P (n = 40), or BN (n = 42) were recruited in three clinics for psychosomatic medicine. Assignment to the three groups was performed using a comprehensive questionnaire validated for diagnostic purposes (Munich-ED-Quest). Personality functioning was examined using OPD Structure Questionnaire (OPD-SQ), personality by using the Personality Inventory for DSM-5-Brief Form and Big Five Inventory-10. (M)ANOVAs were used to examine differences across eating disorder groups. In addition, correlation and regression analyses were conducted. Results: We observed differences on several sub- and main scales of the OPD-SQ. Whereas patients with BN showed the lowest levels, AN-R patients displayed the highest levels of personality functioning. On some sub- and main scales, such as "affect tolerance," the subtypes of AN differed from BN, whereas on the scale "affect differentiation," AN-R, differed from the other two groups. The total eating disorder pathology score of the Munich-ED-Quest best predicted overall personality structure [stand. ß = 0.650; t(104) = 6.666; p < 0.001] and self-regulation [stand. ß = 0.449; t(104) = 3.628; p < 0.001]. Discussion: Our findings confirm most of the results of the pilot study. These findings can facilitate the development of stratified treatment approaches for eating disorders.

An Empirical Investigation of Psychodynamic Conflicts in Stable Couples.

Introduction: Previous investigations have shown that stressful and pathological developments in couple relationships can be psychodynamically explained by rigid unconscious couple collusions. This manuscript presents and discusses the findings of a pilot study in which the psychodynamic conflicts of stable and "functioning" couples were empirically explored. Methods: We studied 116 couples (N = 232) who were currently married or in a steady relationship, had at least one child together, and showed no signs of mental disorders. Psychodynamic conflicts were measured using the OPD Conflict Questionnaire, and the Patient Health Questionnaire was used to screen for mental disorders. Results: Significant differences in the mean scores of psychodynamic conflicts between mothers and fathers appeared in the individuation versus dependency conflict, the self-worth conflict, and the guilt conflict. The maternal and paternal self-worth conflicts were associated with their socio-economic status. Parent couples mainly showed positive associations in the same coping modes and correlations between different conflict topics. Discussion: Our results provide initial insights into the psychodynamic conflicts of mothers and fathers from a nonclinical population and indicate that healthy and stable couple relationships are characterized by concordant and health-promoting ways of dealing with inner conflicts. Future longitudinal studies are needed to understand the influences of psychodynamic conflicts on the formation and maintenance of well-functioning and lasting relationships between couples.

Defense Mechanisms Reloaded in the Light of Impaired Personality Functioning: An Attempt of Clarification and Simplification Resulting in the DSQ-22-A for Adolescents.

With the upcoming ICD-11, the diagnostic guidelines for personality disorders will change fundamentally to a dimensional severity concept, including the evaluation of several domains of personality functioning. Moreover, the lifetime perspective will allow this diagnosis even in early adolescence, providing the opportunity for early detection and intervention. In psychodynamic understanding, defense mechanisms are considered to be a part of the "personality structure", which is one axis in the related diagnostic system (OPD) and showed great similarities to the concept of personality functioning. The most common inventory to assess defense mechanisms is the Defense Style Questionnaire, especially the DSQ-40, which has unfortunately not been specifically adapted to younger ages yet. Using an age-adapted version of the DSQ-40 with simplified formulations, a thorough empirical item analyses and selection was performed, including a face-validity check of the items by experienced therapists and assessments for item correlations, factor structure, reliability, construct and clinical validity in a german clinical and school sample containing 396 adolescents. Though several improvements, similar problems as reported for the adult DSQ versions concerning face-validity and coherence of the item pairs (2-item-method) to represent the single defense mechanisms were obtained. Thus, not all item pairs could be kept and a shortened version DSQ-22-A for adolescents with good psychometric properties was build. The three resulting defense categories adaptive, neurotic and maladaptive showed acceptable scale reliabilities (0.63, 0.56, 0.68), sound factor structure and convincing convergent and clinical validity in terms of highly significant correlations with impaired personality structure according to the OPD-CA2-SQ as well as with PHQ-D depression and somatic symptoms, especially for the maladaptive defense category (0.75, 0.44, 0.34). Likewise, the maladaptive defense category differed highly significant (p = 0.000) and with a large effect size of d = 0.9 standard deviations between adolescents from the school and the clinical sample. The DSQ-22-A can be recommended for use in adolescents for research, diagnostics and therapy planning, especially with regard to personality functioning and structure. Possible fundamental changes concerning some basic operationalization's of the defense mechanisms and the 2-item-method were suggested for international discussion.

Applying Item Response Theory to the OPD Structure Questionnaire: Identification of a Unidimensional Core Construct and Feasibility of Computer Adaptive Testing.

Recent developments in the dimensional assessment of personality functioning have made the implementation of latent measurement models increasingly attractive. In this study, we applied item response theory (IRT) to a well-established personality functioning instrument (the OPD Structure Questionnaire) to identify a unidimensional latent trait and to evaluate the feasibility of computer adaptive testing (CAT). We hypothesized that the use of IRT could reduce the test burden - compared to a fixed short form - while maintaining high precision over a wide range of the latent trait. The OPD-SQ was collected from 1235 patients in a psychosomatic clinic. IRT assumptions were fulfilled. A 9-factor model yielded sufficient fit and unidimensionality in exploratory factor analysis with bifactor rotation. Items were iteratively reduced, and a graded-response IRT model was fitted to the data. Simulations showed that a CAT with approximately 7 items was able to capture an OPD-SQ global severity score with an accuracy similar to that of a fixed 12-item short form. The final item bank and CAT yielded satisfactory content validity. Strong correlations with depression and anxiety replicated previous results on the OPD-SQ. We concluded that IRT applications could be useful to reduce the test burden of personality functioning instruments.

[Associations Between Personality Structure, Unconscious Conflicts, and Defense Styles in Adolescence]. / Psychische Struktur, intrapsychische Konflikte und Abwehrstile in der Adoleszenz.

Associations Between Personality Structure, Unconscious Conflicts, and Defense Styles in Adolescence According to the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence, associations between personality structure, unconscious conflicts, and defense styles are postulated. So far, an empirical investigation of these associations in mentally healthy adolescents is missing. The present study aims to contribute to the understanding of unconscious conflicts as well as the unconscious defense of conflicts by elucidating intrapersonal factors within a normative sample. Furthermore, the aim of this study is to analyse the extent to which sex, age, and socioeconomic status are related to personality structure, unconscious conflicts, and defense styles. A total of 175 adolescents (Mage = 16.98 ± 1.83) participated in the study. Measurement instruments were the Structure and the Conflict Questionnaire of the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence as well as the Defense Style Questionnaire for Adolescents and Young Adults. Sex-specific differences were found for the passive identity conflict. Regarding the personality structure, unconscious conflicts or defense styles, associations with age or socioeconomic status of adolescents were not found. The associations between personality structure, unconscious conflicts, and defense styles as postulated by OPD-CA-2 were empirically proven regarding the passive self-worth, guilt, and identity conflict as well as the active guilt conflict. Overall, this study indicates the low presence of unconscious conflicts in mentally healthy adolescents and the possibility of elucidating these conflicts by means of personality structure and defense styles.

Body mass index and self-reported body image in German adolescents.

BACKGROUND: Despite knowledge about eating disorder symptoms in children and adolescents in the general population, relatively little is known about self-reported and sex-specific eating-disorder-related psychopathology, as well as its specific correlates. METHODS: 880 German school-attending adolescents (15.4 ± 2.2 years) and 30 female patients with AN (16.2 ± 1.6 years) were studied. All participants completed the Eating Disorder Inventory-2 and a Body Image Questionnaire. RESULTS: There were more overweight males than females (15.2% vs 10.1%, p < 0.001), but more females with underweight than males (6.2% vs. 2.5%, p < .001). Negative body evaluations (p < .001) and dissatisfaction (p < .001) were significantly more frequent in females. Compared to underweight female patients with AN, underweight school-attending females had less negative body evaluations (p < .001) and lower scores on 5 of the 11 EDI-2 subscales (p < .001; p < .05). CONCLUSIONS: Males were more overweight than females, females more underweight. Body image was more important to female than to male youth, yet without reaching pathological values when compared to female patients with AN. Complex emotional and cognitive challenges seem to be a representative factor for eating pathology rather than simply being underweight. These aspects may be relevant for the shift from a thinness-related focus in girls in the general population to the development of an eating disorder.

[Parental evaluation of behavioral problems in children with developmental language disorder]. / Elterliche Wahrnehmung von Verhaltensauffälligkeiten bei Kindern mit spezifischer Sprachentwicklungsstörung.

Parental evaluation of behavioral problems in children with developmental language disorder Abstract. Objective: Children with developmental language disorder (DLD) often suffer from problems in everyday communication and react with social withdrawal or oppositional behavior. In light of the lack of studies in preschool children regarding this topic, the present study analyzes the occurrence of behavioral problems in children with DLD aged 4;0 to 5;11 years. Furthermore, we assessed differences in parental perception regarding their child's behavior. Methods: This monolingual, Caucasian study sample consisted of 30 children with DLD and 40 healthy controls. The groups were matched for nonverbal IQ and socioeconomic status. All children were examined for their language proficiency level. The Child Behavior Checklist was used to detect behavioral problems. Results: The study revealed significant differences between children with DLD and the control group on several syndrome scales including the total problem scale. Children with DLD always showed more severe symptoms and also reached T-scores in clinical range (≥64) significantly more often. The parental perception did not differ. Conclusions: The results indicate the presence of behavioral problems in children with DLD already in preschool age. In particular, we found social problems, attention problems, and internalizing disorders.

[Effects of Bilingualism on Cognitive Functions in Early Childhood]. / Auswirkungen von Bilingualität auf kognitive Funktionen im Vorschulalter.

Effects of Bilingualism on Cognitive Functions in Early Childhood Studies have revealed advantages in cognitive functions among children with bilingualism. In this study we investigate cognitive functions in monolingual and bilingual preschool children taking socioeconomic status into account. The study population consists of 40 monolingual (German) children (Mage = 5.0 ± 0.4) and 23 bilingual (German/English) children (Mage = 5.1 ± 0.6). A neuropsychological test battery was conducted. The analyses revealed better performance for bilingual children. However, significant group differences were only found with respect to phonological short-term memory. Controlling for socioeconomic status, intelligence and balanced bilingualism, only slight advantages in cognitive performance were found for bilingual children. Due to high socioeconomic status in both groups, we suppose a ceiling effect. Children's development might be extensively promoted in upper class families and therefore bilingualism may not have additional impact on cognitive functions in these children.

Psychiatric Disorders and Personality Styles in Mothers of Female Adolescent Patients with Eating Disorders.

OBJECTIVE: To provide further insight into the presently poorly understood role of familial psychopathology in the development of eating disorders (ED). METHOD: The present study assesses psychiatric and personality disorders listed on Axis I and II of the DSM-IV in 27 mothers of adolescent patients with anorexia (AN mothers) and 14 bulimia nervosa (BN mothers) as well as 22 mentally healthy girls (CG mothers) on a categorical level. Furthermore, we conducted a dimensional diagnostic regarding personality styles and personality traits. RESULTS: AN and BN mothers showed increased rates of Axis I disorders, especially affective, substance use, and anxiety disorders. Differences on Axis II did not reach statistical significance. However, BN mothers showed higher occurrences of paranoid, negativistic, and schizotypal personality styles compared to the other groups. BN mothers further showed higher occurrences than CG mothers of the personality traits excitability, aggressiveness, physical complaints, openness, and emotionality. AN mothers differed significantly from CG mothers on the scale demands. CONCLUSIONS: Increased occurrence of psychopathology on both categorical and dimensional levels in mothers of patients with AN and BN supports the assumption of a familial accumulation of psychopathology in ED. Longitudinal studies and genetic analyses should clarify a possible cause-effect relationship and interactions between familial dynamics and adolescent ED.

Cognitive functions in preschool children with specific language impairment.

OBJECTIVE: A growing body of research has focused on executive functions in children with specific language impairment (SLI). However, results show limited convergence, particularly in preschool age. The current neuropsychological study compared performance of cognitive functions focused on executive components and working memory in preschool children with SLI to typically developing controls. METHOD: Performance on the measures cognitive flexibility, inhibition, processing speed and phonological short-term memory was assessed. The monolingual, Caucasian study sample consisted of 30 children with SLI (Mage = 63.3 months, SD = 4.3 months) and 30 healthy controls (Mage = 62.2 months, SD = 3.7 months). Groups were matched for age and nonverbal IQ. Socioeconomic status of the participating families was included. RESULTS: Children with SLI had significantly poorer abilities of phonological short-term memory than matched controls. A tendency of poorer abilities in the SLI group was found for inhibition and processing speed. CONCLUSIONS: We confirmed phonological short-term memory to be a reliable marker of SLI in preschoolers. Our results do not give definite support for impaired executive function in SLI, possibly owing to limited sensitivity of test instruments in this age group. We argue for a standardization of executive function tests for research use.

Cognitive Function in Adolescent Patients with Anorexia Nervosa and Unipolar Affective Disorders.

Studies have shown impairments in cognitive function among adult patients with anorexia nervosa (AN) and affective disorders (AD). The association between cognitive dysfunctions, AN and AD as well as the specificity for these psychiatric diagnoses remains unclear. Therefore, we examined cognitive flexibility and processing speed in 47 female adolescent patients with AN, 21 female adolescent patients with unipolar affective disorders and 48 female healthy adolescents. All participants completed a neuropsychological test battery. There were no significant group differences regarding cognitive function, except for psychomotor processing speed with poorer performance in patients with AN. A further analysis revealed that all groups performed with the normal range, although patients with AN were over represented in the poorest performing quartile. We found no severe cognitive impairments in either patient group. Nevertheless, belonging to the AN group contributed significantly to poor performances in neuropsychological tasks. Therefore, we conclude that the risk for cognitive impairments is slightly higher for patients with AN.

The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa.

INTRODUCTION: Little is known about the contribution of impulsivity, inattention and comorbid attention deficit/hyperactivity disorder (ADHD) in the development and maintenance of bulimia nervosa (BN). In particular, their specific contribution to disordered eating symptoms and whether they have additive effects to the general psychopathological burden remains unclear. METHODS: Fifty-seven female patients seeking treatment for BN and 40 healthy controls completed diagnostic questionnaires and interviews that investigated: a) ADHD, b) impulsivity, c) eating disorders and d) general psychopathology. Attentional processes and impulsivity were assessed by a comprehensive computer-based neuropsychological battery. RESULTS: Twenty-one percent of patients with BN met the clinical cut-off for previous childhood ADHD compared to 2.5% of healthy controls. Adult ADHD according to DSM IV was also more prevalent in patients with BN, with an odds ratio of 4.2. Patients with BN and previous childhood ADHD were more impulsive and inattentive than patients with BN alone. These patients also displayed more severely disordered eating patterns and more general psychopathological symptoms compared with those without ADHD. Severity of eating disorder symptoms was better explained by inattentiveness than by either impulsivity or hyperactivity. DISCUSSION: Our data suggest an elevated rate of former childhood and current ADHD-symptoms in treatment-seeking patients with BN. Stronger impulsivity and inattention associated with more severe neuropsychological deficits and eating disorder symptoms indicate an additive risk that is clinically relevant for these patients. Thus, clinicians should identify comorbid patients who might profit from additional ADHD-specific treatments.

Cognitive flexibility and Agouti-related protein in adolescent patients with anorexia nervosa.

INTRODUCTION: Cognitive flexibility and the flexible learning and relearning of stimulus-reward-associations are important for decision-making and goal-directed behavior. Studies on patients with anorexia nervosa (AN) have shown difficulties in cognitive functions associated with malnutrition and extreme underweight. However, to date we find a lack of neuropsychological studies on cognitive flexibility among adolescent patients with AN. Furthermore, the underlying biological mechanisms remain unclear. Therefore, we aim to examine cognitive functions, especially reward association learning, as a measure of cognitive flexibility in adolescent patients with AN and investigate the relationship between Agouti-related protein (AGRP) and cognitive functions. METHODS: The study population consists of 30 patients with AN (M(age)=16.2 ± 1.2) and a healthy control group (CG) of 28 female adolescents (M(age)=16.3 ± 1.3). All subjects completed a neuropsychological test battery including the probabilistic Object Reversal Task, the Digit Symbol Test and the Trail Making Test. Patients with AN were explored before and after weight gain, the CG initially and after 3 months. RESULTS: Subtle deficits in cognitive flexibility were found in patients with AN compared to the CG. After weight gain, the AN group improved relative to their baseline values in most of the variables but did not reach CG values. They still showed slight impairments. Moreover the study revealed a clear association between AGRP levels and cognitive flexibility. DISCUSSION: Cognitive flexibility plays an important role in AN and may be modulated by abnormal levels of the appetite-regulating peptide AGRP. Even subtle impairments in cognitive flexibility can be relevant for the ability to fully engage in therapy and therefore may hinder a prosperous treatment.