Unresolved attachment and identity diffusion in adolescence.

This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.

[Effects of the COVID-19-Pandemic on the AffectiveWell-Being of Preschool Children]. / Einfluss der COVID-19-Pandemie auf das affektive Wohlbefinden von Kindergartenkindern.

The aim of this study was to determine the predictive value of corona-specific variables and post-traumatic stress symptoms associated with the COVID-19-pandemic, considering sociodemographic data and health-related quality of life, on the affective well-being of preschool children and to identify predictors of positive and negative affect. A secondary analysis of third-party assessment data by parents of three- to six-year-old preschool children from the Tyrolean COVID-19 Children's Study at two measurement time points (123 records at t1 in summer 2020; 467 records at t2 in winter 2020/21) was conducted. To answer the research question hierarchical multiple regression analyses were performed.The largest part of the variance explanation of affective well-being was explained by health-related quality of life: while self-esteem and psychological well-being were measurement-time-independent, effects of physical well-being, preschool, family, and friends were only significant in winter. Coronaspecific variables caused additional variance explanation due to subjective threat experience in winter; post-traumatic stress symptoms had an effect at both measurement-times. In times of crisis children's self-esteem, psychological well-being, and post-traumatic stress symptoms should be considered.Measurement-time-dependent results suggest that the pandemic course plays a decisive role regarding the influence on children's affective well-being. Everyday life and routines must be redefined accordingly and communicated to the children.

Attachment status is associated with grey matter recovery in adolescent anorexia nervosa: Findings from a longitudinal study.

The aim of the present study was to investigate whether grey matter (GM) reductions in acute anorexia nervosa (AN) are (i) valid for adolescents (age 14-18 years), (ii) reversible following short-term psychotherapeutic and nutritional therapy and (iii) depend on psychological components like attachment trauma. 3T MRI including a high-resolution T1 MPRAGE was performed in 22 female adolescents in the acute state of AN (age: 15.2 ± 1.2 years) and after weight restoration (duration: 2.6 ± 1 months, n = 18) and compared with 18 gender-matched healthy controls. The Adult Attachment Projective Picture System was used to classify resolved and unresolved attachment patterns. GM decreases were localized in extensive cortical areas including the insula, prefrontal and cingulate cortices as well as subcortical regions during acute AN, which partially increased after therapy with a relative sparing of the hippocampus and parahippocampal gyrus. The resolved group showed more GM recovery in regions of the left hippocampus and parahippocampal gyrus, bilateral cerebellar regions, right precuneus and adjacent cingulate cortices relative to the unresolved pattern. Structural anomalies in adolescent AN that recovered after treatment may be primarily the consequence of malnutrition, whereas several regions did not display significant recovery. Attachment status seems to influence region-specific GM recovery.

The effects of probiotics administration on the gut microbiome in adolescents with anorexia nervosa-A study protocol for a longitudinal, double-blind, randomized, placebo-controlled trial.

OBJECTIVE: Knowledge on gut-brain interaction might help to develop new therapies for patients with anorexia nervosa (AN), as severe starvation-induced changes of the microbiome (MI) do not normalise with weight gain. We examine the effects of probiotics supplementation on the gut MI in patients with AN. METHOD: This is a study protocol for a two-centre double-blind randomized-controlled trial comparing the clinical efficacy of multistrain probiotic administration in addition to treatment-as-usual compared to placebo in 60 patients with AN (13-19 years). Moreover, 60 sex- and age-matched healthy controls are included in order to record development-related changes. Assessments are conducted at baseline, discharge, 6 and 12 months after baseline. Assessments include measures of body mass index, psychopathology (including eating-disorder-related psychopathology, depression and anxiety), neuropsychological measures, serum and stool analyses. We hypothesise that probiotic administration will have positive effects on the gut microbiota and the treatment of AN by improvement of weight gain, gastrointestinal complaints and psychopathology, and reduction of inflammatory processes compared to placebo. CONCLUSIONS: If probiotics could help to normalise the MI composition, reduce inflammation and gastrointestinal discomfort and increase body weight, its administration would be a readily applicable additional component of multi-modal AN treatment.

[Nutritional Therapy in Vegans with Anorexia Nervosa from a Diaetological Point of View]. / Ernährungstherapie bei veganer Ernährung und Anorexia nervosa aus diaetologischer Sicht.

Veganism is a form of nutrition that is becoming increasingly popular. There is also a pandemic-related increase in mental illness, which often manifests itself in the form of an eating disorder among children and adolescents. Particularly challenging in nutritional therapy is anorexia nervosa in combination with veganism.There is consensus that a correctly implemented vegan diet can generally cover the daily nutritional requirements. However, this does not apply to people who are in a growth period. Therefore, this article attempts to highlight the special requirements of a vegan diet along the dietary process development.The basis is provided by a specific anamnesis as well as the elicitation of nutritional status by means of nutrition protocol and bioelectrical impedance analysis. The treatment and goal setting are influenced by the motives behind a vegan diet and further diagnoses such as orthorexia or food intolerance. Regarding the course of action, it must be clarified how an adequate vegan diet can be guaranteed and which conditions are needed to create a space where different diets can be accepted simultaneously. Withing the daily care, nutritional aspects such as the reduction of anorexia-related digestive complaints as well as the selection, quantity and preparation of vegan foods are foregrounded. This is illustrated by nutritional analyses. The objective is to achieve a high level of compliance and to ensure a sufficient nutrient supply in order to make food, as well as vegan food, enjoyable.

[An Inpatient Concept for the Treatment of Eating Disorders - How to Implement a Systemic- Family-Therapeutic Approach]. / Stationäres Konzept zur Behandlung von Essstörungen ­ Wie kann eine systemisch-familientherapeutische Haltung umgesetzt werden?

The ward for the treatment of eating disorders was reconceptualized in the context of the reopening of the Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik in Hall in Tyrol. The focus is on systemic-family-therapeutic approaches, interdisciplinarity and groups offered for adolescents and their families struggling with an eating disorder. In addition, the ward will be expanded for adolescents with obesity who also suffer from a psychological comorbidity. Transparency, personal responsibility and voluntariness are lived in a collaboration with adolescents and their families in a multimodal treatment team.

Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders.

This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.

[Conduct Disorder - An Integrative Treatment Approach with Reference to the Theoretical Concepts of Mentalization. A Case Report]. / Störungen des Sozialverhaltens ­ Ein integrativer Behandlungsansatz unter Bezugnahme auf das Konzept der Mentalisierung. Eine narrative Falldarstellung.

The present case report presents the treatment of an adolescent with a diagnosis of F 91.1 conduct disorder, childhood-onset type. The treatment refers to the theoretical concepts of trauma-, psychodrama- and mentalization based psychotherapy. Before starting treatment several test diagnostic procedures were carried out. The psychotherapy targeted at changing the representations of attachment and at a process based development of healthy self-parts in the sense of mentalization. The therapeutic relationship took on a special position. The purpose of this paper is the question of how mental processes can be promoted, developed and integrated and to find out the importance of an integrative treatment approach.

[Attachment-Related Affect Regulation of Mothers in a Psychiatric Parent-Child Ward - A Case Study]. / Bindungsbezogene Affektregulierung von Müttern einer kinderpsychiatrischen Eltern-Kind-Station ­ eine Fallstudie.

Attachment researchers propose that the term affect regulation is associated with attachment-related defensive processes resulting from attachment experiences with primary caregivers. They serve to regulate attachment-related inner states. The Adult Attachment Projective Picture System (AAP) is a reliable and valid tool to classify attachment patterns and it allows to assess these attachment-related defensive processes. It provides information about the defensive processes that help clinicians to understand complex symptoms and interaction patterns in the parent-child relationship that can be integrated into psychiatric treatment. The present case study deals with a mother of a child with a feeding disorder. We will illustrate how information on attachment-related affect regulation can successfully be integrated into psychotherapeutic intervention in a psychiatric parent-child ward.

[Validation of a German-Language Version of the Multidimensional Offline and Online Peer Victimization Scale (MOOPV) in Adolescent Students]. / Validierung der deutschsprachigen Version der Multidimensional Offline and Online Peer Victimization Scale (MOOPV) für Jugendliche an einer Schülerstichprobe.

Peer victimisation (PV) in childhood and adolescence can come along with psychological stress through the life span. Even though there exist a large number of questionnaires that measure PV, evidence of the use is often missing. Particularly instruments for capturing cyberbullying lack psychometric calculations such as factor analysis for investigating scales and data on validity and reliability. An exception constitutes the Multidimensional Offline and Online Peer Victimization Scale (MOOPV) of Sumter et al., which is only available in Dutch. This questionnaire is not medium-specifically designed, has been psychometrically properly explored, and differentiates between direct and indirect as well as online and offline PV. The present study aims to investigate the psychometric properties of the German version of the Multidimensional Offline and Online Peer Victimization Scale (MOOPV). The factor structure, validity and reliability was examined in a sample of 777 pupils aged 10-20. Confirmatory factor analysis supported the original four-factor model. The scales direct offline, indirect offline, direct online, and indirect online demonstrated high internal reliability and construct validity. The MOOPV can be used as a validated instrument in research and practice to capture PV in childhood and adolescence.

[TransIdentity - Identity Development Among Adolescent Trans*people]. / TransIdentität ­ Die Entwicklung der Identität bei transidenten Jugendlichen.

TransIdentity - Identity Development Among Adolescent Trans*people Identity development is one of the most important developmental tasks of adolescence. Adolescents whose gender identity does not correspond to the gender assigned at birth (trangender people) are also faced with this challenge, as are cis-gender adolescents of the same age. This study is the first to examine the personality function of identity in transgender adolescents. Based on the self report of a population of 69 adolescents from the outpatient unit for gender dysphoria the extent of identity diffusion measured by AIDA (Assessment of Identity Development in Adolescence) was compared with the values of the normative sample consisting of German-speaking pupils. Both the overall construct of identity diffusion and the areas of continuity and coherence showed average values in the examined young people, which speaks against pathological identity development. Nevertheless, identity diffusion was found in over a third (36 %). Most notably the aspect of stabilising relationships and roles was above average, which suggests that positive role identification from the areas of culture, family and body-self is present to a lesser extent than in the norm sample. The identity-stabilizing feeling of social anchoring appears to be impaired in the young transidents studied.

[Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality]. / Versorgungsmodelle für Kinder und Jugendliche mit Geschlechtsdysphorie: Überblick unter Berücksichtigung der österreichischen Behandlungsrealität.

Therapeutic Models for Children and Adolescents with Gender Dysphoria: Overview with Focus on Austrian Treatment Reality Young people whose experienced gender differs from their aligned sex are increasingly visible in public life as well as in the medical care system. For those children and adolescents, who can experience a high degree of suffering because of the discrepancy between aligned sex and desired gender, treatment guidelines have been developed. In this short narrative review, classification options, epidemiological data, health-care data and treatment guidelines are presented with an emphasis on the Austrian health care system.

[Multiple Substance Abuse as a Form of High Risk Behavior in Adolescence]. / Multipler Substanzmissbrauch als Variante von Hochrisikoverhalten im Jugendalter.

Multiple Substance Abuse as a Form of High Risk Behavior in Adolescence We identify multiple substance abuse as a form of high risk behavior in adolescence based on a sample of in-patient adolescents. 43 adolescents were treated for substance abuse over the course of 20 months. 70 % reported the use of three or more different drugs, with an average of 5,35 consumed substances. The most commonly abused substance was cannabis, followed by synthetic drugs such as cocaine or ecstasy. We observed a high rate of non-suicidal self-injury as a comorbidity of multiple substance abuse in our sample. 73,3 % of adolescents with high risk, multiple substance abuse fulfilled diagnostic criteria for non-suicidal self-injury.

[Prevalence and characteristics of peer victimisation in adolescent psychiatric inpatients]. / Prävalenz und Charakteristika von Mobbingerfahrungen in einer klinischen Stichprobe von Jugendlichen.

Prevalence and characteristics of peer victimisation in adolescent psychiatric inpatients Abstract. Objective: Repeated and long-lasting victimisation, as defined by bullying, represents a wide spread health hazard. The aim of the present study was to present the prevalence of bullying in adolescent psychiatric inpatients. We analysed relations between bullying and sociodemographic and psychopathological variables. Furthermore, we investigated the number and nature of bullies, feasible resources, and parental perception on bullying in adolescence. Method: In total, 128 adolescent inpatients were surveyed with a bullying questionnaire and youth self-report. In addition, their clinical symptomatology was investigated. Results: Bullying affected one third of our sample. Male and female victims showed significantly more internal problems. Girls in addition revealed more external behaviour problems. Unlike non-suicidal, self-harming behaviour, suicidal ideation and suicidal behaviour occurred significantly more in patients with bullying experience. Conclusion: A significant number of adolescent in our sample experienced bullying and associated psychological strains. This should especially be considered in child and adolescent anamnesis.

[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]. / Psychisches Strukturniveau im Jugendalter und der Zusammenhang mit späterer psychischer Erkrankung ­ eine Langzeitstudie.

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.

[Childhood Maltreatment and Non-Suicidal Self-Injury - the Impact of Emotion Regulation]. / Belastende Kindheitserfahrungen und selbstverletzendes Verhalten ­ die Rolle der Emotionsregulation.

Childhood Maltreatment and Non-Suicidal Self-Injury - the Impact of Emotion Regulation Non-suicidal self-injury (NSSI) is a common phenomenon in adolescence. Furthermore, it is often associated with maltreatment during childhood. One factor determining the relation between childhood maltreatment and NSSI is maladaptive emotion regulation strategies. The current study examines this relation in adolescent psychiatric inpatients (n = 97). Adolescents engaging in NSSI present maladaptive strategies in emotion regulation more frequently. In addition, they experienced maltreatment in childhood more often than inpatients not engaging in NSSI. Further, partial mediation was established among childhood emotional abuse and neglect, NSSI and maladaptive emotion regulation.

[Coping with Stress During Childhood and Adolescence]. / Stressbewältigung im Kindes- und Jugendalter.

Coping with Stress During Childhood and Adolescence Humans already start to show stress responses on a physical and mental level in early childhood. Numerous studies have demonstrated age- and gender-related differences in experiencing and managing stress. During the transitional period of adolescence young people often experience higher stress-levels. This might lead to a higher vulnerability for maladaptive stress responses. In other words, adolescents who do not have adequate coping strategies to deal with the developmental challenges of puberty might be at risk for later physical and mental symptoms. On the other hand, adequate coping strategies represent a protective factor. Therefore, education and prevention in home and school settings are of particular relevance for adolescent age groups.

Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode.

For the first time, the present study investigates disorder-specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one-way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment-related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.

Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD.

Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.

[Identity - An Illusion? Self Development in Adolescence]. / Identität ­ Eine Illusion? Selbstentwicklung in der Adoleszenz.

Identity - An Illusion? Self Development in Adolescence With support from their social environment, five out of six young people progress through adolescent development relatively well, while approximately 15 % are at risk of developing psychological problems (Kaess, Ghinea, Fischer-Waldschmidt, Resch, 2017). Those who cannot cope with the challenges of society and who do not have a safe space in the family or among friends to deal with worries and adjustment issues may attempt to stabilize their identity and self-esteem through risk-taking behavior (Kaess et al., 2017). Addictive behavior, e. g. substance abuse or extreme media consumption, may be an expression of adolescents' desire to assert and define their own identity - and not only to anesthetize themselves and forget their troubles. The "Who am I?" question in addictive behavior appears to be closely connected with consumption. The issue of identity will play a very important role for future generations of youth. The following overview, based on scientific findings, examines identity development in adolescence, the connection between identity and risk-taking behavior, and the connection between identity and zeitgeist.