Personality Disorder in Adolescent Patients with Anorexia Nervosa.

OBJECTIVE: Anorexia nervosa (AN) is a highly debilitating disease which frequently results in chronification and often originates in adolescence. Personality traits have been associated with the onset and maintenance of AN; moreover, study results indicated a worse treatment outcome in patients with AN and comorbid personality disorder (PD). However, research on PD in adolescent AN is scarce. METHODS: The sample consists of 73 female adolescent patients with AN. We investigated comorbid PD and AN symptom severity performing the International Personality Disorder Examination (IPDE) and the Eating Disorder Inventory 2 (EDI-2). RESULTS: Almost a third (27.4%) of all participants were diagnosed with comorbid PD. They had significantly higher EDI-2 total scores reflecting overall stronger symptom severity, as well as significantly higher scores in the subscales "ineffectiveness," "interpersonal distrust," "interoceptive awareness," "asceticism," "impulse regulation," and "social insecurity." CONCLUSION: PD is an important and frequent comorbid condition in adolescent AN and should be addressed in diagnostic and treatment planning. Early diagnosis of comorbidity could have an impact on choosing specialized treatment for adolescents with AN and PD in order to enhance the outcome.

[Implications on the Diagnosis and Treatment of Narcissistic Personality Pathology in Adolescents Based on the Sequelae of the Covid-19 Pandemic]. / Implikationen für die Diagnostik und Behandlung der narzisstischen Persönlichkeitspathologie bei Jugendlichen in Folge der COVID-19-Pandemie.

The COVID-19 pandemic caused more adolescents with a pathological narcissistic personality to seek clinical as well as psychotherapeutic treatment due to suicidal crises, breakdown of social functioning and inability to continue school attendance. Recent study results show that youth with personality disorders (pd) had more trouble returning to school and to everyday life following pandemic related closures of schools. In a sample of adolescent patients with pd who were treated with transference focused psychotherapy (TFP-A) in a day-clinic programsignificantlymore juveniles remained absent fromschool during the pandemic then pre-pandemic. Only 42 % of the adolescents from the pandemic-group returned to school as a result of the treatment in comparison to 53%of the juvenile patients who returned to school after being treated before the pandemic. This might be explained by the specific effect the pandemic had on adolescents with narcissistic pd and their problem with being treated. Unfortunately, there is still hesitance in diagnosing and investigating narcissistic personality pathology in adolescence despite the knowledge that the early diagnosis and specified treatment could prevent unfavorable pathways and chronification of their severe problems. Changes in the conceptualization of pd in ICD-11 and DSM-5 enable a differentiated diagnosis beginning in late childhood. Furthermore, there are specialized manualized treatment approaches for adolescents with pd. This paper aims at illustrating the specific characteristics of narcissistic pd in youth as well as describing the symptom aggravation following the pandemic. It also points out the possibilities of a modified specialized treatment approach based on transference focused psychotherapy. Further research is needed to improve diagnostic and therapeutic modifications for juveniles with pd.

[Reduction of Non-Suicidal Self-Injury (NSSI) in Adolescents with Borderline Personality Organization Treated with TFP-A]. / Reduktion selbstverletzenden Verhaltens bei Jugendlichen mit Borderline-Persönlichkeitsorganisation mittels der übertragungsfokussierten Psychotherapie.

This study examines whether transference-focused psychotherapy for adolescents (TFP-A) in a dayclinic setting increases the capability to regulate affects and decreases self-destructive behavior in adolescents with borderline personality organization in comparison to treatment as usual (TAU). A total of 120 adolescents consecutively presenting to the dayclinic were allocated to either TFP-A or TAU. They were assessed for aggression, irritability, depression, self-harm, internalizing behavior and pathological personality traits at baseline and after twelve weeks. TFP-A was more effective than TAU in reducing self-harm. Aggression and irritability was improved within the treatment group. These results can be explained by an improvement in affect regulation through a treatment with TFP-A in a dayclinic setting. Further research is necessary in order to assess whether TFP-A reduces self-harm, aggressive behavior and irritability from a long-term perspective and whether these exploratory results can be replicated in independent samples.

[Evidence for Psychodynamic Therapy for Children and Adolescents]. / Evidenz für psychoanalytisch begründete Verfahren für Kinder und Jugendliche.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Effects of long-term psychodynamic psychotherapy on life quality in mentally disturbed children.

AbstractObjective: Long-term psychodynamic psychotherapy for children aims not only at improving symptoms but also at changing the quality of life. To our knowledge, no studies exist to date that focused on both aspects. In this paper, we investigated changes in problem behavior and health-related quality of life based on long-term psychodynamic psychotherapy with children suffering from emotional and behavioral disorders. Method: We investigated 76 children in the treatment group and analyzed pre- and post-treatment symptoms. Furthermore, we compared the outcome data with a control group of 27 children of similar age and diagnoses who received no psychotherapy, both under routine care conditions. The children included in the study were treated on average for 66 sessions. Parent and adolescent ratings on the Achenbach Scales and the Quality of Life Inventory for Adolescents were compared before and after treatment. Results: We found a highly significant improvement of internalizing symptomatology based on parent ratings with a large effect. Different from prior investigations based on short-term psychodynamic psychotherapy we found changes in quality of life with large effects. Conclusion: These findings indicate that long-term psychodynamic treatment can improve life quality in children beyond symptom change.

[Identity Diffusion Among Adolescents - Validation of the Inventory of Personality Organization in a Clinical Adolescent Sample (IPO-A)]. / Identitätsdiffusion im Jugendalter ­ Validierung eines Fragebogens zur Erfassung der Persönlichkeitsorganisation (IPO) bei klinisch behandelten Jugendlichen.

Identity Diffusion Among Adolescents - Validation of the Inventory of Personality Organization in a Clinical Adolescent Sample (IPO-A) The main objective of the current study was to analyze the psychometric properties of the German version of the Inventory of Personality Organization for Adolescents (IPO-A). The instrument consisting of 91 items is based on the theoretical structural model by Kernberg and investigates the severity of identity diffusion, reality testing and defense mechanisms in order to determine the level of personality organization. The factor structure, the internal consistency and the convergent validity was measured among 144 inpatients aged between 13 and 18 years drawn from the Child and Adolescent Psychiatry of the University Clinic of Cologne. The investigation revealed a five factor structure: identity diffusion, reality testing, defense mechanisms, aggression and instability of goals. Moreover, testing the psychometric properties of the instrument showed a high internal consistency and meaningful significant correlations with well-validated youth self-report instruments assessing personality pathology and psychopathology. Thus, the results indicate that the IPO-A can be considered to be a reliable instrument that measures personality organization and identity diffusion in adolescents with personality disorders.

[Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program]. / Übertragungsfokussierte Psychotherapie von Borderline-Jugendlichen im tagesklinischen Setting.

Transference Focused Psychotherapy for Borderline-Adolescents in a Day Clinic Treatment Program This paper focuses on the concept of transference focused psychotherapy (TFP) modified for juvenile borderline patients. Adolescents with borderline developmental personality disorder (bpd) have an essential deficit in their personality structure that leads to oscillations in their self-esteem and in a "split" perception of the world. They suffer from a variety of symptoms and severe impairments on their own and their families' quality of life. Their fragmented perception of themselves and others make relationships almost unbearable for them. Relationships are mostly marked by severe anxiety of resentment and rejection. For these patients this causes intolerable trouble at school where every day conflicts take place. Self-mutilation and suicidal thoughts often seem the only way out. By now, there is an agreement that an early specialized assessment and treatment is necessary in order to stop the typical consequences of their self-mutilative and dysfunctional behavior. Still, in contrast to adult age, empirical evidence is missing which proves the effectiveness of treating adolescent borderline patients. In this paper we present a research project on the effectiveness of transference focused psychotherapy with adolescent borderline patients (TFP-A) in a day clinic setting, combining TFP with group skills training as known from dialectic behavior therapy (DBT). Furthermore, we give first results on analyzing the effectiveness of our day clinic treatment program based on TFP-A, focusing on improving core symptoms such as affective problems, aggressive behavior against self and others and interpersonal problems.

[The dimensional-categorical hybrid model of personality disorders in DSM-5 from an adolescent psychiatric perspective - criticism and critical outlook]. / Das dimensional-kategoriale Hybridmodell für Persönlichkeits- störungen im DSM-5 aus jugendpsychiatrischer Perspektive. Kritik und klinischer Ausblick.

By applying the dimensional-categorical hybrid model, Chapter III of the DSM-5 proposes a central innovation in the classification of personality disorders, the aim being a reduction of comorbidity and improvement of the construct as well as the discremental validity and stability of the diagnosis. The well-known categorical classification of personality disorders in Chapter II, however, remains valid. Based on the hybrid model the essential aspects of a personality disorders are as follows: the dimensional assessment of levels of personality functioning regarding disturbances in self (identity and self-direction) and interpersonal (empathy and intimacy) aspects on the one hand, and the existence of pathological personality traits on the other. Beside five higher-order traits, 25 specific trait facets are described. Moreover, a reduction in the number of personality disorder types is proposed, reflecting six instead of ten categories which are empirically best validated. The abandoned age limitation for the assessment of a personality disorder in Chapter III can be regarded as a clear statement with respect to the possibility and necessity of diagnosing and treating personality pathology in adolescence. By presenting an additional dimensional approach with a detailed description of personality functioning as well as specific pathological personality traits, the new hybrid model seems to principally be a useful approach for clinical purposes as well as research questions.

[Effectiveness of psychodynamic psychotherapy in children and juveniles - results of a pilot study]. / Tiefenpsychologisch fundierte Psychotherapie bei Kindern und Jugendlichen.

QUESTION: The effectiveness of psychodynamic psychotherapy for children and adolescents has yet to be studied sufficiently in Germany. Because psychodynamic psychotherapy aims to reduce symptoms in both the short and long term - besides achieving other long-term goals - in this paper we present results focusing on whether symptoms and problem behavior can be improved within 25 h of outpatient psychodynamic psychotherapy taking place in a practice. Moreover, it addresses whether a positive change of life quality can be achieved in the same timeframe. METHOD: Thirty children and juveniles with emotional, behavioral, and adjustment disorders who had received 25 h of psychodynamic psychotherapy were investigated. Parental reports on the Child Behavior Checklist and parental and expert opinions on the DISYPS-KJ were compared before and after therapy. RESULTS: We found significant improvement on almost all measured CBCL scales, but not on the syndrome scales measured with the DISYPS. Predominantly medium-size effects were calculated. But parents did not report an improvement of general life quality of their children during the course of psychotherapy. CONCLUSIONS: Our results indicate that there is an effective reduction of childhood emotional and behavioral symptoms following psychodynamic psychotherapy. The measured timeframe, however, seems to be too short to ensure significant improvements in specific childhood disorders from both parental and expert perspectives.

[Attachment in very low birthweight infants (< 1500 g) and their mothers]. / Bindungsqualität bei sehr kleinen Frühgeborenen (< 1500 g) und ihren Müttern.

A long hospital stay, along with the worries about the survival and the possible disabilities the child might suffer from, mark the start into life of very low birth weight premature infants (VLBW). The goal of this trial was to study the stability of the attachment representations of very low birthweight infants (birthweight < 1500 g) and the accordance of the attachment representations of the children and their primary care givers. In continuation of the Kölner Frühgeborenen Studie, we measured the attachment patterns of 40 VLBW children at the age of seven and their mothers. For the children we used the Geschichtenergänzungsverfahrens zur Bindung (GEV-B) and for the mothers the Adult Attachment Projective (AAP) to determine the attachment representation. The attachment representations first corresponded to a normal distribution pattern and shifted over time to a more insecure attachment. We could not determine a significant link between the attachment patterns of the child and their mother.

[Epidemiological data on personality dimensions in the psychopathy of adolescent boys and girls - results of the Cologne GAP study]. / Epidemiologische Daten zu Persönlichkeitsdimensionen der Psychopathy bei Jungen und Mädchen.

OBJECTIVE: This paper evaluates epidemiological data on psychopathy dimensions among adolescents. METHOD: The Psychopathy Checklist Youth Version (PCL:YV) was administered to a forensic sample of 169 boys and 172 girls, to a clinical sample of 30 boys and 63 girls, and to a community sample of 119 male and 116 female pupils. Analysis was based on three different conceptualizations of psychopathy. In total 669 youths between 14 to 19 years were included in the study. RESULTS: Depending on the cutoff used, we found a psychopathy prevalence between 27 % and 63 % among the incarcerated boys, and from 7 % and 24 % among the incarcerated girls. The clinical and the community samples showed higher scores on the behavior and lower scores on the core personality dimensions. All samples indicated significantly more psychopathy dimensions in boys than in girls. CONCLUSIONS: Varying rates of prevalence are found when using different models for analyzing the PCL:YV. The extent of age-typical adolescent and antisocial behavioral dimensions represented by the Lifestyle and the Antisocial Factor inflates the total PCL:YV score without presenting increased scores in the psychopathy core dimensions. Prospectively, the two core personality dimensions of psychopathy should be studied more closely.

Attachment Representation and Emotion Recognition Ability in Children with ADHD and Their Parents: A Study Protocol.

Background: Few studies in clinical attachment research to date have examined children with an attention-deficit/hyperactivity disorder (ADHD) diagnosis. This is surprising for two reasons: first, there are a number of parallels between the behaviors of children with an insecure and disorganized attachment and the behaviors of children with an ADHD diagnosis. Second, secure attachment has a positive effect on the development of skills in areas in which children with ADHD demonstrate problems (e.g., attention span, impulse control). There are currently no findings on whether or not and how insecure and disorganized attachment and ADHD affect children's emotion recognition ability. Methods: This is a cross-sectional study, part exploratory and part hypothesis-driven in the context of basic research. A clinical sample of 5- to 10-year-old children with an ADHD diagnosis and their parents is to be compared to a non-clinical unaffected control group. Over a period of 3 years, 80 subjects and their parents are to be recruited in each group for participation in the study. Discussion: This study is the first to examine links between attachment, emotion recognition ability, and ADHD. It is also the first to include not just children with ADHD but also their mothers and fathers in its design. The findings should help reduce the research gap and generate more knowledge for family interventions in the case of ADHD.

Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity.

BACKGROUND: Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study "Mood Vibes" analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. METHODS: Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6-IL-6 and tumor necrosis factor-α-TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating "Depression Inventory for Children and Adolescents" (DIKJ). RESULTS: Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). CONCLUSIONS: The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.

[Psychopathy, temperament and antisocial behaviour in girls]. / Psychopathy-, Temperaments- und Charakterdimensionen bei inhaftierten Mädchen.

OBJECTIVE: This study addresses the question whether temperament and character differ between antisocial incarcerated girls with and without psychopathy. Furthermore, it enquires whether this model discriminates between groups with varied psychopathy symptoms. METHOD: 170 incarcerated girls aged 14 to 17 years were examined using the German version of the Junior Temperament and Character Inventory (JTCI 12-18) and the Psychopathy Checklist Youth Version (PCL:YV). On the basis of the PCL:YV scores the girls were divided into three high-scoring psychopathy groups and compared to a group without psychopathy. RESULTS: Three-quarters of the juvenile criminals did not show psychopathy; the percentage of those scoring high on the psychopathy core dimensions was only 7%. With the aid of Cloninger's model of personality, differences in the psychopathy groups as compared to the nonpsychopathy group were identified regarding the dimensions novelty seeking, reward dependence, cooperativeness and self-transcendence. However, specific relationships between individual psychopathy dimensions and the JTCI-factors could not be identified. CONCLUSIONS: The results confirm the existence of the psychopathy construct in female delinquents, though the percentage of girls with core psychopathy dimensions is very small. The differentiating temperament factors found among girls scoring high on psychopathy dimensions as opposed to girls without psychopathy indicate that psychopathy is a valid construct that can identify a specific subgroup of antisocial girls with core psychopathy symptoms.

[Diagnosis and classification of personality disorders in adolescence - how can current research findings contribute to an understanding of this construct?]. / Erfassung und Klassifikation von Persönlichkeitspathologie im Jugendalter.

OBJECTIVE: The diagnosis and classification of personality disorders in adolescence remains a controversially discussed topic. METHOD: This review reports recent research findings on the comorbidity and the diagnosis of personality disorders in adolescence and on their neurobiological and neuropsychological correlates. RESULTS: On the one hand, the latest research findings refer to the implication that personality disorders in adolescence can be reliably diagnosed with the existing instruments used in the diagnosis of adults. On the other hand, researchers criticize the lack of a youth-specific concept of assessment, which could be used as a common foundation to study this clinically so relevant disorder. CONCLUSIONS: Diagnostic as well as longitudinal studies within the scope of networks are required in order to differentiate personality disorders in adolescence from other youth-related disorders.

[The differentiation between identity crisis and identity diffusion and its impact on treatment]. / Differenzierung zwischen Identitätskrise und Identitätsdiffusion und ihre Bedeutung für die Behandlung.

The differentiation between an identity crisis, a transient phenomenon that usually results (after resolution) in a well-integrated identity with flexible and adaptive functioning, and an identity diffusion that is viewed as a basis for subsequent personality pathology, has a major impact on the selection of a treatment method. A new treatment method (Adolescent Identity Treatment, AIT), a modification of Transference Focused Psychotherapy, was developed to treat adolescents with identity diffusion in order to improve their relationships with friends, parents, and teachers and to help them acquire positive self-esteem, clarify life goals and establish a stable identity. In a case study we describe the basic approaches of AIT in assessment and treatment.

Factor structure of the Hare Psychopathy Checklist: youth version in German female and male detainees and community adolescents.

Substantial evidence exists for 3- and 4-factor models of psychopathy underlying patterns of covariation among the items of the Psychopathy Checklist-Revised (PCL-R) in diverse adult samples. Although initial studies conducted with the Psychopathy Checklist: Youth Version (PCL:YV) indicated reasonable fit for these models in incarcerated male adolescents in the United States and the United Kingdom, only one published study has addressed the factor structure of PCL:YV psychopathy in female adolescents, and no prior studies have addressed it outside of these countries. We used confirmatory factor analysis to investigate the factor structure underlying PCL:YV scores in 314 incarcerated (143 male, 171 female) and 193 in-school (99 male, 94 female) adolescents, ages 14 to 19 years. The 2-factor model provided adequate fit only for incarcerated male adolescents and the 4-factor model was problematic in all samples, but the 3-factor solution provided an adequate model in incarcerated and community male adolescents. None of the models provided consistently acceptable fit among female adolescents. Current findings provide evidence for the robustness of the 3-factor model of psychopathy in incarcerated and community male adolescent samples but raise doubts about the applicability of this model to female adolescents. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Attachment representation in mothers of children with attention deficit hyperactivity disorder.

Attachment research so far rarely has focused on attention deficit hyperactivity disorder (ADHD). This study is the first to examine the distribution of the attachment representation in mothers of children with ADHD. Considering results of clinical attachment studies we formulated the following hypothesis: the prevalence of maternal insecure and unresolved attachment representations increases with the degree of severity of children's ADHD symptoms. Therefore it is highest in mothers of children with ADHD who are treated clinically (group A). It is expressed less strongly in mothers of children with ADHD symptoms without need for clinical treatment (group B). In a control group of mothers whose children have no ADHD diagnosis (group C), there is the lowest prevalence of insecure and disorganized attachment representations. Within a period of 6 months from a total of 72 recruited children and their mothers screened according to participation criteria (e.g. ICD-10: F90 Hyperkinetic disorders), 13 mothers could be assigned to group A, 19 mothers to group B, and 19 mothers to group C. The attachment representation was assessed using the Adult Attachment Projective. To test the sequence order hypothesis we used the Jonckheere-Terpstra test (u = 3.78; p < 0.001). The increasing clinical conspicuity in the groups obviously is connected to a reduced prevalence of the autonomous attachment representations as well as to an increase of the insecure and unresolved attachment representations of the mothers. We interpret this result with respect to the treatment of children with ADHD as a vote for considering the family context as well as early intervention strategies which aim at the improvement of the quality of maternal sensitivity.

Examining relations between psychopathology and psychopathy dimensions among adolescent female and male offenders.

AIM: This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees. METHOD: We examined 91 male and 123 female adolescent detainees (aged 14-19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles. RESULTS: Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys. CONCLUSION: Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls.