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

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

Effectiveness of psychodynamic treatment: Comparing trajectories of internalizing and externalizing psychopathology of adolescents in treatment, healthy and physically ill adolescents.

Effectiveness of psychodynamic therapy for adolescents in reducing internalizing and externalizing psychopathology was determined by comparing treated adolescents (86 sessions) with the normative developmental progression in two groups without treatment: healthy and diabetic adolescents. In a three-wave longitudinal study, n = 531 adolescents (n = 303 patients, n = 119 healthy, n = 109 diabetics) and their mothers filled out psychopathology questionnaires (Youth Self-Report and Child Behavior Checklist). Latent growth curve modeling and multilevel modeling were used to analyze and compare within-person symptoms changes across groups. Analyses showed a significant reduction over the course of treatment for internalizing (Cohen's d = .90-.92) and externalizing (d = .58-.72) symptoms, also when the developmental progression of both control groups was accounted for (d = .48-.76). Mothers reported lower levels than their children in internalizing symptoms (p ≤ .01) while this discrepancy increased over time for treated adolescents (p = .02). Results established the effectiveness of psychodynamic treatment for adolescents both with externalizing and internalizing symptoms in comparison with growth and change in nonclinical samples. Cross-informant differences and age-specific trajectories require attention in psychotherapy treatment and research.

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

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

Does clinically relevant psychopathology in adolescents necessarily require treatment or does it "grow out"?

OBJECTIVE: To determine the treatment effect of psychodynamic therapy for adolescents in comparison to normative developmental progression in two groups without treatment: healthy adolescents and adolescents with juvenile diabetes. RESEARCH DESIGN AND METHODS: In a 3-wave longitudinal study, n = 531 adolescents (n = 303 treated adolescents, n = 119 healthy, n = 109 with diabetes) and their parents filled out psychopathology questionnaires (Youth Self-Report [YSR] and Child Behaviour Checklist [CBCL]). Growth curve modeling (GCM) was used to examine within-person change in psychopathology while controlling for stable between-person differences. RESULTS: GCM analyses revealed significant within-person reductions in patients' YSR and CBCL (d = 1.02-1.99) at the end of treatment. When accounted for the control groups' developmental progression (d = .14-.94), patients' within-person change remained significantly higher (d = .48-.82). In all three groups, parents rated the severity of psychopathology significantly lower, and within-person change significantly higher than the adolescents him/herself. CONCLUSIONS: Psychodynamic therapy led to a significant symptom reduction in treated adolescents and was superior to development-related symptom changes occurring in the two control groups. Hence, clinically relevant symptoms in adolescents do not "grow out", but require psychotherapeutic treatment. Differences between adolescents and their parents in the evaluation of symptom severity and change require attention in psychotherapy treatment and research.

[Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists]. / Entwicklung eines Fragebogens zur Selbst- und Fremdeinschätzung von OPD-KJ-Konflikten durch Patient_innen und ihre Therapeut_innen.

Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists Abstract. The OPD-CA conflict questionnaire represents a means of recording modes of coping with unconscious conflicts according to the Operationalized Psychodynamic Diagnostics (OPD-CA) for patients and their therapists. To select the items for the conflict questionnaire, we combined the expert ratings and psychometric quality criteria using a sample of 427 adolescents (53.6 % patients) and 44 therapists. The short version contains 28 items, which include 7 intrapsychic conflicts and their active and passive coping modes (total ICC = .855; p < .001). We found expected differences between healthy and clinically abnormal adolescents with a higher level of conflicts among outpatients. A comparison of the therapist's version with two different methods (assessment according to the sheet in OPD-CA and the conflict questionnaire) produced consistent assessments of the same patient both in the expert assessment (total ICC = .861; p < .001) and from the point of view of 52 participants in two OPD-KJ training courses (total ICC = .825; p < .001).

[Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients]. / Diagnostische Arbeit mit dem Befundbogen der Konfliktachse der OPD-KJ: Empirische Ergebnisse an stationären und ambulanten Patient_innen.

Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients Abstract. In recent years, the Operationalized Psychodynamic Diagnostics (OPD-CA) is increasingly being used in child and adolescent psychiatry and psychotherapy. This article presents the conflict axis of the OPD-CA, which contains an operationalization of seven psychodynamic conflicts and the processing modes assigned to them. It describes empirical comparisons of the conflict axis ratings and the structure rating in a group of outpatient and inpatient children and adolescents (total N = 186, 12.7 years, 54 % female). The findings in the total sample show that diagnosis-specific gender differences are disappearing, and that male and female patients have largely similar intrapsychic development-impairing conflicts. Patients in inpatient treatment in a child and adolescent psychiatry institution, however, more often show a self-conflict and, as expected, have a lower structural level than patients of the same age in outpatient psychotherapy. The number of highly stressful events before the start of therapy is also significantly higher in this group, which may have contributed to the structural deficits. For outpatients, there is a strikingly higher level of guilt and identity conflicts. In both samples, the mode of processing the conflicts is largely passive. Based on these findings, possible implications for therapeutic practice are discussed.

[Changes in the Level of Conflict through Psychodynamic Psychotherapy: The Perspective of Adolescent Patients and their Therapists]. / Lassen sich intrapsychische Konflikte im Sinne der OPD-KJ-2 durch psychodynamische Psychotherapie verändern? Die Sicht von jugendlichen Patienten und ihren Therapeuten.

Changes in the level of structure and conflict are, in addition to alleviating of symptoms, central goals of psychodynamic therapies. This study examines this question with a focus on intrapsychic development-impairing conflicts in the sense of the OPD-CA on a sample of 121 adolescents and their 46 therapists. At the beginning, in the middle and at the end of the M = 73.27 hours (SD = 17.40) therapy, they assessed the level of conflict and structure from the patients' and the therapists' perspectives. The results show large effect sizes with regard to the reduction of the overall conflict level from the point of view of the therapists (η2 = .33). While the therapists reported higher initial values in almost all intrapsychic conflicts and significant linear decreases over time, the therapy tended to sensitize the patients to the existence of an intrapsychic development-impairing conflict. With regard to the structural level, which was already quite good at the start of treatment, there were no significant changes over time. However, the overall structural level and the conflict scales contributed to the explanation of the variance in the severity of symptoms at the end of therapy.

[Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change]. / Qualitätssicherung in der psychodynamischen Psychotherapie: Diagnosespezifische Verläufe, der Einfluss unterschiedlicher Respondenten und ihre Sicht auf Moderatoren der Veränderung.

Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change Abstract. This study uses a naturalistic design to assess the course and effectiveness of long-term psychodynamic therapies from the perspective of adolescent patients and their mothers. It looks at the context of different moderators of change, including the characteristics of the patient, the therapist, and the therapy. Assessments of the internalizing, externalizing, and overall symptom burden using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL) were collected on 161 patients and their mothers at three timepoints - the beginning, middle, and end of therapy. The assessments of both informants showed a decrease in symptoms over the course of therapy with similar effect sizes (η2 = .25 for the patients, η2 = .31 for their mothers). The adolescents differentiated more between the diagnosis groups, reported higher symptom intensities at the beginning, and saw fewer changes in the second half of the therapy than their mothers. Psychodynamic long-term therapy was particularly effective for internalizing disorders according to both parents and patients. Both informants differed, however, in their evaluation of short-term therapy. An examination of the moderators of change in the mothers' evaluation (difference value of the total symptom burden between the beginning and end) showed that the therapist and therapy characteristics predicted change, whereas for adolescents, the patient characteristics have the greatest influence.

Adolescents' somatic complaints in eight countries: what influence do parental rearing styles have?

Medically unexplained physical symptoms are frequently named by adolescents in both clinical and normative samples. This study analyzed the associations between parental rearing styles and adolescents' body complaints in diverse cultural contexts. In a cross-cultural study of 2415 adolescents from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey), the associations of maternal and paternal support, psychological control, and an anxious parental monitoring style with youth body complaints were tested. Girls reported more somatic complaints than boys, the level of complaints differed between countries, and gender differences varied significantly between countries. Hierarchic multilevel models revealed that the expression of distress via body complaints, after controlling for country, gender, and sociodemographic status, was significantly associated with parental rearing styles. The negative impact of mothers' psychological control on body complaints generalize across countries. In addition, mothers' anxious monitoring had a negative impact on the offspring's health, whereas higher levels of paternal support and lower levels of paternal psychological control contributed to lower levels of somatic complaints. Sociodemographic variables such as family structure, standard of living, and employment status of the parents, did not turn out as significant in the final model. The findings point to the different roles of fathers and mothers play in adolescents' health and their complex interplay.

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

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

[Is sexual activity during adolescence good for future romantic relationships?] / Sind sexuelle Aktivitäten in der Adoleszenz für zukünftige Partnerbeziehungen gut?

Is sexual activity during adolescence good for future romantic relationships? Objectives: The study examines the effects of different forms of sexual activity at the age of 16 on sexuality and the quality of romantic relationships at the age of 23. Methods: In a multimodal longitudinal study (diaries, questionnaires), 144 16-year-old adolescents (59.7 % female) reported on their sexual activities and their relationship status. At the age of 23, they reported on their romantic and sexual experiences in the past two years and the quality of their current romantic relationship. Regressions analyzed the predictive power of adolescent predictors for future sexuality and relationship quality. Results: For men and women, frequent non-committed sexual activities at the age of 16 consistently predicted a higher probability of participating in different patterns of non-committed sexual encounters and short relationship duration at the age of 23 years. Adolescents who were more satisfied in their romantic relationships had more stable, longer-lasting partner relationships at young adulthood. Discussion: The special role that non-committed sexual activities compared to sexual activities within a romantic relationship play in future sexual and romantic activities became clear. Parental influences were negligible.

[What Causes Future-Related Stress in Immigrant and German Adolescents and how do they Cope with these Stressors?] / Was verursacht Zukunftsstress bei immigrierten und deutschen Jugendlichen und wie gehen beide Gruppen damit um?

What Causes Future-Related Stress in Immigrant and German Adolescents and how do they Cope with these Stressors? In the present study, the stress perception and coping of German and immigrant adolescents with regard to future stress were compared. The 1,789 adolescents (164 immigrated, 1,625 German adolescents) at the age of fifteen completed questionnaires on the assessment of stress and coping with regard to future stress. Immigrated youth show a higher stress burden in the domain future than German adolescents. The fear of becoming unemployed was a major stressor in both groups, and both groups were also very active in tackling future-related problems. However, German youths show an even more active approach to coping with future stress and involve parents or friends more often. Migrant youth have higher levels of the coping style withdrawal, especially in emotion regulation and resignative withdrawal. The ability to reflect on the solution of future-related stressors is quite high in both groups. Worries about the increasing destruction of the environment are more important for German youth, while migrant youth care more about how they should reconcile work and family life later.

Patterns of Romantic Pathways among 23 Year Olds and their Adolescent Antecedents.

Observation of the romantic lives of the majority of young people shows that they might move between transitory and inconsistent states, being in and out of a relationship. The present study aims to better understand the meaning of these fluctuations. For this purpose, and employing a multi-method design, 144 Israeli adolescents (59.7% females) were followed from age 16 to 23. At age 23 in-depth interviews were conducted with the participants, focusing on their romantic histories. Analyses of interviews at age 23 yielded four distinctive romantic pathways differing in stability and the ability to progress toward intimacy: Sporadic and Casual Encounters, Sporadic Encounters in Response to a Stressful Romantic Experience, Steady Non-Intimate Involvements, and Progression toward Steady Intimate Involvements. The findings showed that more than half of participants belonged to the Progression toward Steady Intimate Involvements pathway, suggesting that romantic fluctuations served as means to progress toward intimate involvements. Progression toward steady intimate involvement was explained by greater secure attachment, greater capacity to face tension and to express one's views, and greater parental support measured seven years earlier. In contrast, lower earlier intra- and interpersonal assets during adolescence were more likely to associate with a variety of romantic experiences during emerging adulthood that are characterized by romantic instabilities and difficulty to progress toward intimacy. The findings are discussed within the framework of the Developmental Systems Theory.

[Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play?] / Psychopathologie bei Jugendlichen aus sieben Ländern: Welche Bedeutung hat die Kontrolle von Identitätsentwicklung und Familienbeziehungen?

Psychopathology in adolescents from seven countries: What role does controlling identity development and family relationships play? Abstract. This study analyzed the unique effects of gender and culture on psychopathology in adolescents from seven countries, after controlling for factors that might have contributed to variations in psychopathology. In a sample of 2259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, we assessed identity development, maternal parenting (support, psychological control, anxious rearing), and psychopathology (internalizing, externalizing). Using an analysis of covariance (ANCOVA), we analyzed country, sex, age, and the interaction country x sex as independent variables, while controlling for maternal rearing dimensions and identity development as covariates. This resulted in similar findings for internalizing and externalizing symptoms: Identity rumination and maternal rearing (support, psychological control, anxious rearing) proved to be significant covariates. Further, country, sex, age, and the interaction country x sex were significant. These analyses result in a clearer picture of culture- and gender-specific effects on psychopathology, which is helpful in designing interventions.

The Association Between Parental Rearing Dimensions and Adolescent Psychopathology: A Cross-Cultural Study.

Research on parental rearing dimensions faced ethnocentric criticism for mainly focusing on adolescents in Western industrialized countries. Over the past decade, the phenomenon of anxious parenting, so called "helicopter parenting", gained attention in popular media as well as scholarly publications in addition to support and psychological control. Whether these parenting dimensions, which were associated with different health outcomes in adolescents, were only occurring in the Western world or are visible cross-culturally, has not been sufficiently studied. Therefore, it is unclear whether these links exist also for adolescents from other parts of the world. Additionally, the involvement of fathers in child rearing continues to be neglected in adolescent psychopathology research. The current cross-cultural study tested the association of maternal and paternal rearing dimensions with youth internalizing and externalizing psychopathology in a sample of 2415 adolescents (56% female, 15.33 years, SD = 0.61) from eight countries (Argentina, France, Germany, Greece, Pakistan, Peru, Poland, and Turkey). Hierarchical regression models showed that internalizing symptomatology was associated with mothers' support, psychological control, and anxious rearing as well as fathers' psychological control up and above predictors like country and mother's level of education. For predicting externalizing symptomatology, mother's anxious rearing, mother's psychological control, and father's support as well as father's psychological control were significant up and above adolescents' gender, standard of living, and country. To conclude, across countries, anxious rearing and psychological control experienced from both parents were substantially linked with adolescent mental health.

[Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries]. / Identitätsentwicklung, Familienbeziehungen und Symptombelastung bei Jugendlichen aus sieben Ländern.

Identity Development, Family Relations, and Symptomatology in Adolescents from Seven Countries This study analyzed identity development and parental rearing in adolescents from seven countries. In a sample of 2,259 adolescents (M = 15 years; 54 % female) from France, Germany, Turkey, Greece, Peru, Pakistan, and Poland, maternal parenting (support, psychological control, anxious rearing), identity development (exploration, commitment and ruminative exploration) and psychopathology was assessed. Adolescents from central Europe (France and Germany) were characterized by quite low scores in most identity dimensions, compared to adolescents from all other countries. Particular high were scores in exploration and commitment among adolescents from Turkey, Greece, Peru and Pakistan. In some countries, adolescents described the family relations as characterized by high levels of anxious rearing and psychological control, which was, however, not associated with elevated levels of total symptomatology. The findings show that what is adaptive in one cultural context is depending on cultural norms and family traditions. This information is helpful in designing interventions.

[What is "normal"? Maternal parenting behavior as risk and protective factor for psychopathology and identity diffusion]. / Was ist noch "normal"? Mütterliches Erziehungsverhalten als Puffer und Risikofaktor für das Auftreten von psychischen Störungen und Identitätsdiffusion.

What is "normal"? Maternal parenting behavior as risk and protective factor for psychopathology and identity diffusion Objectives: This study analyzes the implications of today's highly altered maternal parenting behaviors on children's development and psychological health. METHODS: The relationship between maternal parenting behaviors (support, psychological control, and anxious monitoring) and delayed identity development or identity diffusion as well as internalizing or externalizing symptomatology was investigated in a sample of 732 youths (301 adolescents, 351 young adults, and 80 patients). Cluster analysis identified two types of maternal parenting behaviors: authoritative maternal behavior and dysfunctionalmaternal behavior. RESULTS: As expected, patients exhibited a high degree of dysfunctional maternal parenting behavior (low support, high psychological control), delayed identity development as well as elevated identity diffusion and symptomatology.Authoritative maternal parenting emerged as a protective factor in the prediction of identity diffusion and symptomatology.All three groups described a high degree of anxious maternal monitoring. CONCLUSIONS: The implications of changed maternal parenting behaviors on identity diffusion and symptomatology are discussed in light of societal changes and changing criteria of personality disorders in the new DSM-5.

Adolescent psychopathology in times of change: Introduction to the special issue.

The aim of this special issue is to understand better the many changes in adolescent psychopathology have taken place over the last decades. The factors associated with adjustment problems and psychopathology in adolescence today are not necessarily the same as the factors that predicted problems and psychopathology in the past. But the basic strategies for connecting negative experiences with adolescent psychopathology remain as important today as they were for understanding adolescent psychopathology decades ago. This is well exemplified in the studies included in this Special Issue. What all this studies have in common is that parenting and the family environment are assumed to play a key role in adolescents' adjustment and psychopathology. Finally, given that all papers in this special issue are based on conference presentations at the 15th Biennial Conference of the European Association for Research on Adolescence (EARA), some more information on that conference in included in this introduction.