Identity synthesis and confusion in early to late adolescents: Age trends, gender differences, and associations with depressive symptoms.

INTRODUCTION: Research on identity development has primarily studied over-time trends in identity status change and exploration and commitment processes among late adolescents and emerging adults. Identity development in early and mid-adolescents has generally been overlooked. Hence, little is known about how a sense of identity synthesis and confusion evolves from early to late adolescence for boys and girls. METHODS: The present cross-sectional study examined gender-moderated age trends in identity synthesis and confusion from ages 12 to 25 among 5860 Belgian adolescents (56.1% girls; Mage = 16.09). In addition, using a subsample of 2782 participants, we investigated associations of identity synthesis and confusion with depressive symptoms in early, mid-, and late adolescents. RESULTS: Mean scores on identity synthesis decreased from ages 12 to 15, subsequently increased from ages 15 to 23, and decreased again later on. Mean scores on identity confusion followed a parallel but opposite cubic trend. Gender differences in these age trends were dependent upon the developmental period. For all age groups, identity synthesis scores were negatively associated with depressive symptoms, whereas positive associations emerged between identity confusion and depressive symptoms. CONCLUSIONS: From 12 to 25 years old, individuals experience an increasing sense of identity synthesis and less identity confusion, despite fluctuations that appear to be dependent upon the developmental period. Identity synthesis and confusion seem to be strongly negatively and positively associated with depressive symptoms in early, mid-, and late adolescents.

Trauma and self-harming behaviors in high school students: The mediating role of identity formation.

INTRODUCTION: This study investigated the link between trauma and self-harming behaviors in South African high school students, and examined the mediating role of identity formation. Traumatic experiences have been commonly associated with self-harming behaviors in adolescents. However, research addressing this association in non-Western countries is limited. METHODS: A total of 552 South African high school students aged 13-21 (60.4% female; Mage = 16 years) were included in the study. Students completed self-report questionnaires on traumatic experiences, identity formation, and self-harming behaviors (disturbed eating behaviors and suicidal thoughts and behaviors). RESULTS: Structural equation modelling indicated that the association between traumatic experiences and self-harming behaviors was partially mediated by identity formation. Traumatic experiences were associated with more identity diffusion, bulimia, and suicidal thoughts and behaviors. Identity diffusion, in turn, was associated with more drive for thinness, bulimia, body dissatisfaction, and suicidal thoughts and behaviors. Identity consolidation was positively associated with drive for thinness and negatively with body dissatisfaction and suicidal thoughts and behaviors. No moderation effects by gender or age were found. CONCLUSIONS: Traumatic experiences were associated with higher levels of identity diffusion, which, in turn, were associated with more self-harming behaviors in South African high school students. These findings suggest the importance of focusing on identity diffusion in prevention and intervention programs targeting self-harming behaviors.

Identity formation in adolescents and emerging adults with type 1 diabetes.

The present study investigated identity formation in adolescents and emerging adults with type 1 diabetes and its relation to psychological and diabetes-specific functioning. As diabetes management is especially challenging in these life periods, identity problems may not only hamper psychological adjustment, but could also impact diabetes management. A total of 431 patients were 1:1 matched with control participants, based on age, gender, and context (student, employed, other). To investigate identity types or statuses, cluster analysis on different identity processes was conducted, resulting in six statuses. Patients in foreclosure and achievement (both characterized by strong identity commitments) presented with the most adaptive functioning. Patients in troubled diffusion and moratorium (both characterized by a maladaptive type of exploration) showed the least adaptive scores on well-being, diabetes-specific problems, treatment adherence, and illness-perceptions. The present study underscores the importance of assessing identity issues in youth with type 1 diabetes.

Eating Disorder Symptomatology in Adolescent Boys and Girls: Identifying Distinct Developmental Trajectory Classes.

Eating disorder symptomatology is highly prevalent in adolescence and is regarded one of the most important precursors of clinical eating disorders. The present longitudinal study examined the development of eating disorder symptomatology in adolescents over two years. At Time 1,528 high school students filled out self-report questionnaires (50.5% female; Mage = 15 years). Multivariate latent growth curve modeling and latent class growth analyses were performed to model latent trajectories and to identify latent trajectory classes. Stable trajectories of drive for thinness and body dissatisfaction were found, whereas bulimia and BMI increased over time. Important gender differences pointed to girls experiencing more eating disorder symptoms at each time point. Additionally, more diverse trajectory classes were found in girls than in boys. Finally, classes with the most eating disorder symptoms also experienced the most problems in identity development, internalizing symptoms, and the least effortful control. The present study underscores the importance of identifying vulnerable adolescents that experience greater eating disorder symptomatology, as they also seem to experience the worst psychosocial development.

Identity statuses in prebariatric patients with obesity: Associations with eating disorder symptoms, psychological complaints, and coping behaviour?

OBJECTIVE: In the present study, we focused on the associations between identity processes/statuses and eating and general psychopathology and coping in prebariatric patients suffering from morbid obesity. METHOD: Our sample consisted of 369 prebariatric patients (68.8% female) who filled out self-report questionnaires to assess identity processes, eating and general psychopathology, and coping. RESULTS: Concerning identity processes, ruminative exploration was positively related to eating-related and general psychopathology and maladaptive coping, whereas commitment processes were protective against psychopathology and maladaptive coping. Based on cluster analyses, we identified five identity statuses, being achievement, foreclosure, moratorium, diffusion, and an undifferentiated status, showing some heterogeneity within the prebariatric patient group. Patients in the diffused and moratorium statuses reported more eating and general psychopathology and more maladaptive coping compared with prebariatric patients of the other statuses. CONCLUSIONS: Given the clinical vulnerability to psychopathology of patients in the moratorium and diffused statuses, it would be advisable to increase the psychological help in their prebariatric and postbariatric trajectories.

Identity Structure and Processes in Adolescence: Examining the Directionality of Between- and Within-Person Associations.

Developing a stable and coherent identity structure (i.e., a synthesized sense of self that can support self-directed decision making) represents a lifelong task. A person's identity structure is continually revised through ongoing processes of identity exploration and commitment. However, longitudinal studies linking identity structure to identity processes are largely lacking. The present three-wave longitudinal study among 530 Flemish high school students [50.6% female; Mage = 15; SD = 1.85; age range = 11-19 years] examined the directionality of both between- and within-person associations linking identity synthesis and confusion to identity exploration and commitment processes. Between-person cross-lagged models indicated that adolescents who scored high on identity synthesis relative to their peers also scored high on proactive exploration and commitment processes, and low on ruminative exploration one year later, again relative to their peers. Adolescents who scored high on identity confusion relative to their peers also scored high on ruminative exploration one year later, again relative to their peers. With respect to effects of identity processes on identity structure, adolescents who scored high on identification with commitment relative to their peers also scored low on identity confusion one year later. Within-person cross-lagged models indicated that, when adolescents scored high on identity synthesis relative to their own average score, they reported increased proactive exploration processes one year later. In general, reaching a degree of identity synthesis appears to represent a prerequisite for proactive identity exploration at both the between- and within-person levels.

Correction: Identity Statuses Throughout Adolescence and Emerging Adulthood: A Large-scale Study into Gender, Age, and Contextual Differences.

[This corrects the article on p. 32 in vol. 57.].

Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder.

Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD) features are common in patients with eating disorders (ED), yet little is known regarding the clinical presentation of ED patients who present with NSSI with and without BPD. The current study compared self-injurious, female ED inpatients with (n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported clinical features. Results suggest that ED patients with NSSI+BPD differ from those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug or medication abuse, internalizing/externalizing psychopathology, interpersonal problems, and coping strategies, with the NSSI+BPD group demonstrating more impairment in each of these domains. Despite these differences in clinical presentation, however, groups did not differ in NSSI features. In sum, while self-injurious ED patients may present with similar NSSI behavior regardless of BPD diagnosis, those with NSS+BPD represent a group with much higher clinical complexity and greater treatment needs.

Identity Processes and Statuses in Patients with and without Eating Disorders.

Problems with identity formation are associated with a range of psychiatric disorders. Yet, the mechanisms underlying such problems and how they are refined into specific diagnostic presentations require further investigation. The present study investigated identity processes among 123 women with eating disorders (ED) and age-matched community controls via a newly developed identity model. Several clinical outcome variables were assessed. Patients with ED scored lower on committing to and identifying with identity-related choices and scored higher on maladaptive or ruminative exploration, identity diffusion and identity disorder. They also experienced less identity achievement as compared with controls. The identity disorder status was associated with the highest scores on anxiety, depression, borderline personality disorder symptoms, and non-suicidal self-injury and the lowest scores on need satisfaction. Results indicate that patients with ED experience more identity problems than community controls and those captured by an identity disorder status experience the most problematic psychosocial functioning. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Identity Statuses throughout Adolescence and Emerging Adulthood: A Large-Scale Study into Gender, Age, and Contextual Differences.

Identity formation constitutes a core developmental task during adolescence and emerging adulthood. However, it remains unclear how identity formation may vary across age, gender, and context (education vs. employment) in these developmental periods. The present study used a recently developed model to examine identity statuses or types in a sample of 7,906 Flemish individuals (14-30 years old; 64% female). As expected, achievement, foreclosure, moratorium, carefree diffusion, troubled diffusion, and an undifferentiated status emerged through cluster analysis. Women were overrepresented in the moratorium status (characterized by high exploration), whereas men were mainly situated in foreclosure and carefree diffusion statuses (both characterized by low exploration, but individuals in foreclosure having strong identity commitments as well). Individuals in the carefree and troubled diffusion statuses, which represent the least adaptive statuses, were youngest. High school students were overrepresented in the diffusion statuses and college students were mostly present in achievement (representing the most mature status) and moratorium. Finally, employed individuals were overrepresented in foreclosure, whereas unemployed individuals were mainly situated in troubled diffusion. In sum, the present study systematically examined relationships between empirically-identified identity statuses and socio-demographic variables in a large-scale sample, generating important information on age, gender, and contextual differences in identity.

Brief report: Benefit finding and identity processes in type 1 diabetes: Prospective associations throughout adolescence.

Identity formation constitutes a core developmental task during adolescence, but may be challenged when having a chronic illness such as type 1 diabetes. The present study examined whether viewing positive benefits to one's diabetes across adolescence was related to greater identity exploration and commitment later in time. A total of 55 adolescents (10-14 years; 47% female) with type 1 diabetes participated in a six-wave study spanning 3 years (with six-month measurement intervals). Through latent growth curve modeling, Time 6 identity scores were regressed on intercept and slope terms of benefit finding through Times 1-4, simultaneously controlling for demographic and clinical variables. Identity exploration (but not commitment) at Time 6 was positively predicted by the intercept and slope of benefit finding: adolescents who find benefits in diabetes are more inclined to explore different alternatives later on in adolescence. Benefit finding may constitute a resource facilitating identity formation in adolescents with diabetes.

Identity Functioning in Patients with an Eating Disorder: Developmental Trajectories throughout Treatment.

Increasing research has indicated a strong association between identity functioning and eating disorder (ED) symptomatology. However, a detailed investigation of identity throughout ED treatment is lacking. The present longitudinal study examined identity in inpatients with an ED and explored its simultaneous change with ED symptomatology throughout treatment. A total of 225 female patients completed questionnaires at admission. From these 225 patients participating at admission (Wave 1), 110 also participated in at least one additional measurement wave, with 43.64% (n = 48) participating at admission and during treatment, 16.36% (n = 18) participating at admission and at discharge, and 40% (n = 44) participating at admission, during treatment and at discharge. Questionnaires on identity synthesis, identity confusion, identity processes, and ED symptomatology were completed. Latent growth curve modeling was used to address the research questions. Throughout treatment, a decrease in identity confusion and an increase in identity synthesis and adaptive identity processes were found. Accordingly, increases in identity synthesis and identification with commitment were related to general decreases in the drive for thinness and body dissatisfaction. Similarly, such decreases in ED symptoms were related to general decreases in identity confusion and ruminative exploration. The present study points to an increase in identity functioning throughout treatment, and longitudinal associations between identity functioning and ED symptomatology were found. Helping patients to decrease their ruminative exploration and to increase their identification with previously made life commitments and treating body/weight concerns could both be helpful in ED treatment.

Identity formation in adolescent and emerging adult cancer survivors: a differentiated perspective and associations with psychosocial functioning.

OBJECTIVE: Identity formation was investigated in adolescent and emerging adult cancer survivors from a (neo-)Eriksonian perspective by comparing survivors to control participants. In survivors, associations between identity and clinical/demographical variables and general and illness-specific functioning were investigated. DESIGN: Childhood cancer survivors (n = 125; Mage: 19.54; 47% male) were matched on age and gender with healthy controls (2:1). MAIN OUTCOME MEASURES: All participants completed identity questionnaires. Survivors reported on demographics, well-being (depressive symptoms, life satisfaction, physical functioning), and illness-specific experiences (PTSS, illness centrality, cancer self-identity, benefit finding, cancer-related worries). Medical records provided clinical information. RESULTS: Survivors did not differ from controls on identity synthesis or confusion or on the identity statuses resulting from cluster analysis on the identity dimensions (achievement, foreclosure, moratorium, diffusion). Identity synthesis related to better well-being and illness experiences, whereas confusion related to worse well-being and illness experiences. Youth in moratorium and diffusion reported lower well-being and more negative illness experiences. Associations between identity and demographical and clinical characteristics were inconsistent. CONCLUSIONS: This study revealed no significant differences in identity formation between cancer survivors and controls. However, survivors who struggle in their identity quest should be identified as they are at risk for poorer well-being and negative illness experiences.

What matters most to patients with multiple myeloma? A Pan-European patient preference study.

Introduction: Given the rapid increase in novel treatments for patients with multiple myeloma (MM), this patient preference study aimed to establish which treatment attributes matter most to MM patients and evaluate discrete choice experiment (DCE) and swing weighting (SW) as two elicitation methods for quantifying patients' preferences. Methods: A survey incorporating DCE and SW was disseminated among European MM patients. The survey included attributes and levels informed by a previous qualitative study with 24 MM patients. Latent class and mixed logit models were used to estimate the DCE attribute weights and descriptive analyses were performed to derive SW weights. MM patients and patient organisations provided extensive feedback during survey development. Results: 393 MM patients across 21 countries completed the survey (M years since diagnosis=6; M previous therapies=3). Significant differences (p<.01) between participants' attribute weights were revealed depending on participants' prior therapy experience, and their experience with side-effects and symptoms. Multivariate analyses showed that participants across the three MM patient classes identified via the latent class model differed regarding their past number of therapies (F=4.772, p=.009). Patients with the most treatments (class 1) and those with the least treatments (class 3) attached more value to life expectancy versus quality of life-related attributes such as pain, mobility and thinking problems. Conversely, patients with intermediary treatment experience (class 2) attached more value to quality of life-related attributes versus life expectancy. Participants highlighted the difficulty of trading-off between life expectancy and quality of life and between physical and mental health. Participants expressed a need for greater psychological support to cope with their symptoms, treatment side-effects, and uncertainties. With respect to patients' preferences for the DCE or SW questions, 42% had no preference, 32% preferred DCE, and 25% preferred SW. Conclusions: Quality of life-related attributes affecting MM patients' physical, mental and psychological health such as pain, mobility and thinking problems were considered very important to MM patients, next to life expectancy. This underscores a need to include such attributes in decision-making by healthcare stakeholders involved in MM drug development, evidence generation, evaluation, and clinical practice. This study highlights DCE as the preferred methodology for understanding relative attribute weights from a patient's perspective.

Identity Functioning and Eating Disorder Symptomatology: The Role of Cognitive Emotion Regulation Strategies.

Introduction: Adolescence is the most critical life period for the development of eating disorder (ED) symptomatology. Although problems in identity functioning and emotion dysregulation have been proven important risk and maintaining factors of ED symptomatology, they have never been integrated in a longitudinal study. Methods: The present study is part of the Longitudinal Identity research in Adolescence (LIA)-study and aimed to uncover the temporal interplay between identity functioning, cognitive emotion regulation, and ED symptomatology in adolescence. A total of 2,162 community adolescents (Time 1: 54% female; M age = 14.58, SD = 1.88, range = 10-21 years) participated at three measurement points with 1-year intervals. They reported on identity functioning (identity synthesis and identity confusion), cognitive emotion regulation (rumination, catastrophizing, and positive reappraisal), and ED symptomatology (drive for thinness and bulimia symptoms). Results: Cross-lagged paths could be fixed for boys and girls and showed bidirectional associations between both dimensions of identity functioning and both rumination and catastrophizing over time. Similarly, these maladaptive cognitive emotion regulation strategies were bidirectionally related to ED symptomatology over time. Finally, indirect pathways pointed to bidirectional associations between both dimensions of identity functioning and bulimia symptoms through rumination and catastrophizing. Only unidirectional associations emerged for drive for thinness and almost no cross-lagged associations were found with positive reappraisal. Conclusion: The present study demonstrates that identity confusion may contribute to the development of ED symptomatology in adolescence through cognitive emotion dysregulation. It also reveals that these ED symptoms hamper identity development through emotion dysregulation. These results stress the importance of targeting both identity functioning and cognitive emotion regulation in the prevention and intervention of ED symptoms.

Body Dissatisfaction as a Mediator between Identity Formation and Eating Disorder Symptomatology in Adolescents and Emerging Adults.

OBJECTIVE: Eating disorder symptomatology generally develops during adolescence and emerging adulthood. Previous research has focused on the role of identity formation or body image in the development of eating disorder symptomatology, but integrative work is lacking. For this reason, the present cross-sectional study examined the mediating role of body dissatisfaction in the relation between identity formation and eating disorder symptomatology. METHOD: The sample comprised 659 participants between 15 and 30 years old (68.9% females; Mage = 19.44; SDage = 3.99). All participants completed self-report measures on identity (Self-concept and Identity Measure), body dissatisfaction (the Body Image Feelings and Attitudes subscale of the Body Investment Scale and the Body Dissatisfaction subscale of the Eating Disorder Inventory-3), and eating disorder symptomatology (Eating Disorder Inventory-3). Latent variable modeling from a structural equation modeling approach was used. RESULTS: First, identity formation significantly predicted eating disorder symptomatology. Additionally, indirect effects were found linking identity formation to eating disorder symptomatology through the mechanism of body dissatisfaction. No significant differences between males and females or between adolescents and emerging adults on direct or indirect effects were found. CONCLUSION: The present study indicated that body dissatisfaction mediated the relationship between identity formation and eating disorder symptomatology during mid-to-late adolescence and emerging adulthood. Provided that the present findings can be replicated in a future longitudinal study, they demonstrate that both identity formation and body dissatisfaction should be taken into account in prevention and intervention programs targeting eating disorder symptomatology.

Non-Suicidal Self-Injury and Pathological Buying in Community Adults and Patients with Eating Disorders: Associations with Reactive and Regulative Temperament.

The present study investigated the (co-)occurrence of non-suicidal self-injury (NSSI) and pathological buying (PB) and their associations with reactive/regulative temperament in a sample of female patients with eating disorders (ED) and in a sample of community adults. Our samples consisted of 254 community adults (48.8% female) and 60 female patients with ED. All participants filled out self-report questionnaires to assess NSSI, PB, and reactive/regulative temperament. Prevalence rates of NSSI and PB were respectively 14.5% and 4.8% for community women, 13.1% and 1.5% for community men, and 36.7% and 10% for female patients with ED. Only for community women, NSSI was positively related to PB. NSSI was negatively related to self-regulation in community men and women. Additionally, NSSI was negatively predicted by BAS reactivity in the clinical sample and by the interaction of BAS reactivity and self-regulation in community men. PB was predicted by low self-regulation in the three groups. Additionally, PB was positively predicted by BAS reactivity and by the interaction of BAS reactivity and self-regulation in community women. These findings indicated group differences in the (co-)occurrence of NSSI and PB and in their associations with underlying temperamental characteristics between individuals with and without ED.

Temperament and Character Traits of Female Eating Disorder Patients with(out) Non-Suicidal Self-Injury.

Eating disorder (ED) patients show alarmingly high prevalence rates of Non-Suicidal Self-Injury (NSSI). Adolescents seem to be particularly at risk, as EDs and NSSI both have their onset in mid-adolescence. It has been suggested that personality could be a transdiagnostic mechanism underlying both EDs and NSSI. However, little attention has been given to adolescent clinical samples compared to adult and/or community samples. Therefore, the current study investigated the role of personality in a sample of 189 female inpatients with an ED (M = 15.93, SD = 0.98). Our results confirmed the high prevalence of NSSI in EDs, specifically in patients with bingeing/purging behaviours (ED-BP). Temperamental differences were found between ED-BP and the restrictive ED subtype (ED-R). Namely, ED-BP patients showed more harm avoidance and less self-directedness compared to ED-R. Temperamental differences were found in NSSI as well, regardless of ED subtype: ED patients who had engaged in NSSI during their lifetime reported less self-directedness and more harm avoidance. Interestingly, only ED patients who recently engaged in NSSI showed less novelty seeking. These temperamental profiles should be recognised as key mechanisms in the treatment of adolescent ED patients with and without NSSI.

Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study.

OBJECTIVE: Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults. RESEARCH DESIGN AND METHODS: Three hundred youth (16-28 years old) with type 1 diabetes participated in a two-wave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA1c values were obtained from physicians. Mixed ANOVA and cross-lagged analysis were used to examine prospective changes and directionality of effects, respectively. RESULTS: Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found. CONCLUSIONS: This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time.

Identity processes and clusters in individuals with and without pathological buying.

The present study investigated the association between pathological buying (PB) and identity processes and clusters. Forty-one patients with PB and 41 gender/age-matched controls (73% females) filled out the Dimensions of Identity Development Scale (DIDS), the Pathological Buying Screener, and self-report questionnaires to assess comorbid psychopathology, such as depressive symptoms, pathological internet shopping, and hoarding (excluding acquisition). Patients with PB reported significantly higher scores on ruminative exploration and lower scores on identity commitment processes compared to healthy controls. In the total sample, as well as in the PB sample, we identified four identity clusters: troubled diffusion, moratorium, foreclosure, and achievement, similar to Marcia's identity statuses. Patients with PB were overrepresented in the troubled diffusion cluster and less represented in the foreclosure and achievement clusters. Patients with PB in the troubled diffusion cluster scored significantly higher on PB, pathological internet shopping, hoarding, and depressive symptoms as compared to patients with PB in the other clusters. Based on these findings, we can conclude that patients with identity diffusion report more severe PB and related comorbid symptomatology. PB and related symptoms may be considered as coping strategies to deal with identity-related issues.