Ego development, self-perception, and self-complexity in adolescence: a study of female psychiatric inpatients.

A study of two groups of female psychiatric inpatients, differing in level of ego development, explored domains of self-perception that best predicted global self-worth and symptom clusters that best predicted second-order factors of self perception. Findings revealed quantitative and qualitative differences in self-complexities, and more positive self-perceptions among the higher ego-level group in scholastic competence, job competence, and behavioral conduct. Results are discussed from a developmental perspective.

Beyond the rhetoric of zero tolerance: long-term solutions for at-risk youth.

Prevention of violence in schools must be accompanied by intervention across multiple contexts and the use of consistent but fair consequences that are implemented with children's positive development in mind.

Clinical and developmental perspectives on adolescent coping.

Although the development of appropriate coping strategies has been understood as an essential element of healthy adjustment, few studies have demonstrated the link between coping and psychological development. Similarly, research on adolescents with behavioral problems has neglected coping as an important variable in understanding and treating these conditions. This study examines the relationships between psychological development, coping strategies and symptoms in a sample of 302 psychiatrically hospitalized adolescents, ages 12-16. Subjects completed the Adolescent Coping Orientation for Problem Strategies Questionnaire, (A-COPE), the Youth Self Report symptom checklist (YSR), and Loevinger's measure of ego development. Results showed that Avoidance and Ventilation were associated with increased behavior problems and lower levels of ego development. Problem solving and interpersonal strategies were associated with fewer symptoms and higher levels of development. Significant gender differences were found with girls using more interpersonal coping and boys using more physically active strategies. Gender differences were also found in the relationship of coping strategies to both symptomatic behavior and development. The results are discussed in the context of a developmental approach to adolescent psychopathology.

Self-perceptions of adolescents with and without mood disorder: content and structure.

This study compared the self-perceptions of three groups of adolescents: one group with conduct disorder, a second group comorbid with both mood and conduct disorder, and a third group of normal controls. Results indicated that the three groups differed on several domains of self-perception, with each group reporting perceived strengths and weaknesses. Second-order principal component analyses revealed differences across groups in the structure of their self-perceptions. Finally, regression analyses indicated that self-perceptions share variance with a mixture of internalizing and externalizing symptoms. Results are discussed from a clinical-developmental perspective.

Development of a short form of the adolescent version of the Defense Mechanisms Inventory.

This article describes the construction of a short form of the adolescent version of the Defense Mechanisms Inventory (DMI; Gleser & Ihilevich, 1969; Ihilevich & Gleser, 1986). The DMI is a paper-and-pencil test for which subjects are asked to describe their reactions to 10 hypothetical dilemmas. The responses involve a forced choice method in which each of the alternative responses represent one of five defense clusters entitled Turning Against the Object, Principalization, Turning Against the Self, Reversal, and Projection. Two hundred ninety-five adolescent psychiatric patients (122 boys and 173 girls) ages 12-16 were administered the adolescent form of the DMI. Based on an analysis of each of the 10 dilemma stories, a 6-story short form was devised. Correlations between this short form and the long form of the DMI ranged from .90 to .95 on the five defense scales, with no significant effect of gender. Internal reliability estimates of the short form scales were also favorable. These results indicate that the short form of the adolescent DMI is an acceptable substitute for the lengthier inventory from which it was derived and is more utilizable in clinical and research settings.

Self-perception and adolescent psychopathology: a clinical-developmental perspective.

The relationship between self-perception and adolescent psychopathology was examined on nine domains of self-perception in a group of adolescent psychiatric inpatients and a comparison group of nonpatients. Inpatients rated themselves significantly lower in four domains, and correlations between symptom reports and domains of self-perception supported a relationship between negative self-perception and psychopathology. Further analysis suggested less differentiated self-perceptions among inpatients than among nonpatients. Implications for developmental assessments and clinical interventions are discussed.

Developmental psychopathology in suicidal and nonsuicidal adolescent girls.

OBJECTIVE: This study presents two distinct profiles of female suicide attempters based on social-cognitive development and investigates the relationship of both developmental and suicide risk variables in these profiles. METHOD: The sample included 139 girls, aged 13-16, admitted to an inpatient psychiatric hospital. Patients were divided into four groups based on their suicidal status (attempter/nonsuicidal) and ego development (preconformist/conformist level). RESULTS: Results support two developmental types of female suicide attempters that differed significantly on symptomatology, diagnoses, and defensive style. Preconformist attempters, the "angry-defiant" suicidal type, present with both depression and aggression as well as externalizing defense mechanisms. Conformist attempters, the "self-blaming" suicidal type, present with depression, and use more internalizing defenses to cope with conflict. Comparing suicide attempters and nonsuicidal girls, depression was found to be a risk factor for suicide at all developmental levels. Defense mechanisms were only associated with suicide at the preconformist developmental level. CONCLUSIONS: Social-cognitive development has an important impact on the expression of suicidal behavior in adolescent girls.

Structured diagnostic interviews and clinicians' discharge diagnoses in hospitalized adolescents.

OBJECTIVE: In this study Diagnostic Interview Schedule for Children (DISC-C) and clinicians' discharge diagnoses, as well as clinicians' admission and discharge diagnoses were compared. METHOD: Patients (N = 163) ages 12 to 16 were interviewed with the DISC-C during the first month of admission. The frequencies for different diagnoses by DISC-C and by clinicians at the time of admission and discharge were tabulated. Kappa coefficients were obtained from cross-tabulated frequencies of DISC and clinicians' discharge diagnoses. RESULTS: At discharge, the clinicians diagnosed more patients with multiple diagnoses and also diagnosed more patients with conduct and substance abuse disorders, dysthymia, and psychosis than they did at admission. The DISC-C diagnosed more patients with these disorders, except with psychosis, than did clinicians at either admission or discharge. The agreement between the clinicians' discharge and DISC-C diagnoses remained low across the diagnostic categories. CONCLUSIONS: These findings support the view that the comprehensiveness and structure of the DISC-C can contribute to the sensitivity of the diagnostic process.

Adolescent suicide and defensive style.

This empirical study investigated the relation between ego defense mechanisms, diagnoses, and suicidality among 200 adolescent psychiatric patients ages 12 to 16 years. Based on a structured diagnostic interview, adolescents were divided into three groups: suicide attempters, suicidal ideators, and nonsuicidal patients. Using the Defense Mechanisms Inventory (DMI), suicidal adolescents scored higher on the defense of turning-against-self and lower on reversal, as compared to nonsuicidal adolescents. Although suicide was significantly more common among adolescents with an affective disorder, turning-against-self remained significantly associated with suicide attempt even when diagnosis was controlled for. Results demonstrate the importance of defense mechanisms in understanding adolescent suicidal behavior.

Adolescent suicidality: a clinical-developmental approach.

This study investigates the relation of ego development, age, gender, and diagnosis to suicidality among 219 adolescent psychiatric inpatients. Using the Diagnostic Interview Schedule for Children, adolescents were classified as suicide attempters or as nonsuicidal and were categorized into three diagnostic groups: affective disorder, conduct disorder, or mixed conduct-affective disorder. Ego development measurement was used to assess developmental maturity. Chi-square analyses demonstrated a relation between suicide attempts and developmental complexity. Attempters were more likely to be diagnosed with affective or mixed conduct-affective disorders and to be girls. Suicidality was not associated with age in this sample. Log-linear analyses demonstrated the interplay of known suicide risk factors with the important new dimension of developmental level.

Adult development and symptomatology.

The purpose of the current study was to explore relationships between symptomatology and ego development in adults. To that end we studied patients presenting for treatment in an outpatient clinic of a major psychiatric hospital. We examined the relationship of ego development to intensity of subjective distress and type of presenting symptoms and hypothesized that with increasing development of ego functioning, subjective distress from all kinds of psychiatric symptoms could be better tolerated and coped with and, therefore, would be experienced as less severe. For the sample as a whole, ego development was significantly related to psychiatric symptoms and symptom severity in patterns predicted from theory. On all but two scales, symptomatology decreased significantly as ego development increased. We argue that the ego development model is useful in further exploring psychopathology during the adult years.

Paths of adolescent ego development: links with family life and individual adjustment.

In broad strokes, we have reviewed family contexts and adjustment of adolescent ego development. We concluded with group portraits, the salient family and individual characteristics of adolescents who followed six paths of ego development. There are strong differences in development--the profound arrests and the dramatic progressions. Although these composite pictures provide us with clearer ideas about each of the paths, we do not yet have a detailed understanding of how adolescents following the varied paths experience the world and relate in their families. Certain questions can only be pursued with this information. For instance, are there ways that parents of the steady conformist adolescents speak and behave that restrain their sons' and daughters' separation from the family? Or do the profoundly arrested teenagers provoke their parents to be less encouraging of their differences from other family members? These questions, touching on complex interactions flowing between parents and adolescents, require a closer look inside the families of teenagers following these paths of arrest and advance. In a work soon to be published, we listen closely to the voices of 13 adolescents and their parents, in solo and while together as a family. These narratives convey the message that paths of individual development are embedded within the intricate matrix of family relationships. The teenagers and their families closely and often poignantly illustrate the ways in which adolescents and parents handle the central dilemma posed during this phase of the life cycle: how to separate from the family and reaffirm one's place within it.

Convergence of DSM-III diagnoses and self-reported symptoms in child and adolescent inpatients.

A systematic study of the relationship between empirically-derived diagnoses and symptom patterns is reported in a sample of 160 preadolescents and adolescents consecutively admitted to a psychiatric inpatient setting. Results show that the DSM-III diagnoses generated using the child version of the Diagnostic Interview Schedule for Children (DISC-C) were significantly associated with several factor analytically-derived symptom scales of the Achenbach and Edelbrock Youth Self-Report. The results included the finding of significant associations for conduct disorders with the delinquency scale, for affective disorders with the depressed scale, and for both affective and anxiety disorders with the broad-band internalizing scales. This study suggests implications about diagnostic categorizations and construct validity as well as implications for clinical evaluation.

Developmental dimensions of DSM-III diagnoses in adolescent psychiatric patients.

In a study of the relationship between ego development and DSM-III diagnoses among 140 psychiatrically hospitalized adolescents, it was found that severity of psychiatric diagnosis decreased with increased ego development. Discussion focuses on the need to introduce innovative and empirically valid developmental perspectives into the process of diagnosing children and adolescents who require mental health services.

Adaptation in adolescence: the influence of time and severe psychiatric disorder.

This study reports the development of adaptive processes in two groups of adolescents assessed initially and 2 years later with clinical research interviews. Students from a public high school (N = 44) and inpatients on an adolescent psychiatric ward (N = 51) formed the two subject groups. The psychiatrically hospitalized group had significantly improved scores after a 2-year interval on four of six adaptive process Summary Scales: Task Orientation, Relatedness, Self Knowledge, and Inner Synthetic Functions. However, these higher scores did not reach the levels of the high school group at either point of assessment. The scores in the high school group remained stable over time except for an increase in the area of Self Knowledge. The value of this interview-derived assessment, in comparison to other forms of measurement, is discussed, and consideration is given to factors which contribute to the differences between groups.

Ego development and treatment requests.

Ego development theory suggests that patients might differ in the forms of psychiatric treatment they find helpful, depending on the maturity of their ego functioning. In our study, 100 adults beginning outpatient psychiatric treatment completed the Sentence Completion Test of ego development and the Patient Request Form, which measures treatment modality preference. Ego development was related to treatment requests in patterns predicted from theory: higher ego stage patients were more likely to request insight therapy, while lower stage patients were more likely to request reality checks, social intervention, and triage. We argue that the ego development construct can help treaters match patients to treatment modalities that are compatible with their frames of reference.

The relationship between defenses and symptoms in adolescent psychopathology.

The relationship between defense mechanisms and symptoms was assessed in a group of 196 psychiatrically hospitalized adolescents. Defense mechanisms were measured through the use of the Defense Mechanisms Inventory (DMI); symptoms and problem behaviors were measured with the Youth Self-Report. Univariate and multivariate analyses indicated that externalizing symptoms are associated with defenses that locate the conflict outside of the self, whereas internalizing symptoms are associated with defenses that locate the conflict within the self. In contrast to previous reports, no gender differences were found in defense preference, though gender differences were found in the relation of defenses to symptoms. The findings are consistent with clinical theory of defense processes and support the distinction between internalizing/externalizing behaviors and personality dimensions for both symptoms and defenses. The study supports the validity of the adolescent form of the DMI.

Suicidality and psychopathology in hospitalized children and adolescents.

The present study presents the incidence of suicidality in a group of hospitalized children and adolescents and the relationship between suicidality, forms of psychopathology, and a variety of demographic and family variables. Specific attention is paid to age and gender differences. More than two-thirds of the sample (70%) showed evidence of suicide attempts, threats or ideation. One third attempted suicide at least once prior to or during their admission, and twice as many girls attempted suicide as boys. The majority of suicide attempters were 12 years or older at the time of their first attempt. Drug overdose was the method most frequently used. The suicide attempters and patients without a history of attempts did not differ on demographic and family psychopathology variables. Interestingly, no diagnostic differences were found between suicide attempters and non-suicidal patients. The majority of suicide attempters were diagnosed conduct disorder. Only a third of the attempters were diagnosed as suffering from an affective disorder. We therefore conclude that factors such as impulsivity and anger may contribute significantly to suicidal behavior in children and adolescents.