Assessing Criterion A of the Alternative Model for Personality Disorders: The Potential of Performance-Based Personality Measures.

The conceptualization of personality disorder has been refined through recent nosological advances introduced in the Alternative Model for Personality Disorders (AMPD). These advances locate self and interpersonal (dys)function at the core of personality pathology. Self-report personality assessment instruments have demonstrated promise in the assessment of Criterion A domains. However, research highlighting the utility of performance-based personality assessment instruments has been largely absent in these advances, despite acknowledgment of their potential. We adhered to PRISMA review guidelines to survey and assess the potential relevance and utility of select performance-based personality instruments in assessing Criterion A domains of the AMPD. We conclude that performance-based personality measures are uniquely positioned to assess maladaptive self- and interpersonal functioning and may address some limitations of self-report measures. Toward this end, we propose a working model that provides ranges of test scores that correspond to the 5-point scale of the Criterion A domains of the AMPD.

Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: toward the Psychodynamic Diagnostic Manual - third edition.

Depressive disorders in adolescence pose unique challenges for assessment and treatment, particularly due to their high comorbidity with various personality disorders. Moreover, young depressed patients may elicit very intense and difficult-to-manage emotional responses in therapists (in this context, countertransference). This study aimed at empirically identifying specific personality disorders (or subtypes) among adolescents with depressive pathology and exploring distinct countertransference patterns emerging in their psychotherapy: 100 adolescents (58 with depressive disorders; 42 with other clinical conditions) were assessed by their respective clinicians (n=100) using the psychodiagnostic chart-adolescent of the Psychodynamic Diagnostic Manual (PDM) - second edition, and the therapist response questionnaire for adolescents. Results showed that depressed adolescent patients exhibited marked traits of four personality subtypes (i.e., depressive, anxious-avoidant, narcissistic, and borderline) characterized by different levels of mental functioning and personality organization. These subtypes were predictably related to specific clinicians' emotional responses, even when controlling for the intensity of depressive symptomatology. Patients with depressive or anxious-avoidant personality subtypes evoked more positive countertransference responses, whereas patients with narcissistic or borderline subtypes elicited strong and hard-to-face emotional responses in therapists. Consistent with the next edition of the PDM, the study emphasizes the importance of comprehensive psychodynamic assessment in the developmental age, which frames depressive disorders in the context of accurate emerging personality and mental functioning profiles. This approach, which also relies heavily on the clinician's subjective experience in therapy, provides crucial information on how to specifically tailor interventions that more effectively meet the needs of adolescents with these heterogeneous and complex clinical conditions.

Familism moderates the association between parent-child conflict, interpersonal needs, and suicidal ideation among adolescents.

Within the framework of the interpersonal theory of suicide, parent-child conflict in adolescence may be associated with suicidal ideation through increases in thwarted interpersonal needs (i.e., perceived burdensomeness and thwarted belongingness). Familism, a cultural value that emphasizes prioritizing familial interconnectedness and honor, may moderate the association between parent-child conflict and thwarted interpersonal needs. This study examined the relationship between parent-child conflict, familism, and suicidal ideation through the interpersonal theory of suicide. Participants were N = 250 psychiatrically hospitalized adolescents aged 12-17 years (Mage = 14.84, 60.8% female; 41.9% Hispanic, 21.5% African American/Black, 26.0% Caucasian). Participants completed survey and interview measures prior to discharge from psychiatric hospitalization. There was a significant conditional indirect effect of parent-child conflict on suicidal ideation through thwarted interpersonal needs [F (3, 246) = 54.41, p < .01], such that the strength of the indirect effects family conflict on suicidal ideation via thwarted interpersonal needs increased as familism increased. Findings indicate that the relationship between parent-child conflict and thwarted interpersonal needs may be exacerbated when levels of familism are also high. For youth who endorse high levels of familism, parent-child conflict may be particularly pernicious. Interventions targeting the family environment are needed to potentially improve adolescents' interpersonal functioning and protect against suicidal ideation.

Child and adolescent suicide is a growing and pressing problem, and it is currently the second leading cause of death among people aged 10­34. One theory of suicide, called the interpersonal theory of suicide, proposes that suicide ideation is related to two main risk factors: feeling that one's life is a burden on others (called perceived burdensomeness) and feeling like one is disconnected from others (called thwarted belongingness). In this theory, risk factors like parent-child conflict may be related to suicide ideation through increases in perceived burdensomeness and thwarted belongingness. It is possible that cultural values that prioritize family connectedness and honor (called familism) may also impact these relationships. The current study looked at how parent-child conflict, familism, and adolescent suicide ideation were related to one another in the context of the interpersonal theory of suicide. Participants in the study were 250 adolescents in a psychiatric hospital who completed survey and interview measures before being discharged. Results found parent-child conflict was related to suicide ideation through increases in one's perceived burdensomeness and thwarted belongingness (higher parent-child conflict was related to higher ratings of perceived burdensomeness and thwarted belongingness, which was related to higher ratings of suicide ideation), and the strength of the relationship between parent-child conflict, perceived burdensomeness, and thwarted belongingness increased as ratings of familism increased. These results indicate that parent-child conflict may have an especially strong relationship with thoughts of suicide in adolescents who also report a high level of familism. Therefore, suicide-related interventions that target the family environment may help prevent and treat adolescent suicide ideation.

Experiential avoidance in participants with borderline personality disorder and other personality disorders.

BACKGROUND: The present study has descriptive and predictive aims. The descriptive aims were to determine if participants with borderline personality disorder (BPD) reported higher levels of experiential avoidance (EA) than participants with other personality disorders (OPD) as well as determine if non-recovered participants with BPD reported higher levels of EA than participants with BPD who have recovered symptomatically and psychosocially. The predictive aim was to determine if the level of EA reported by participants with BPD was predicted by the severity of aspects of childhood or adult adversity and/or aspects of temperament. METHODS: The Overall Anxiety Severity and Impairment Scale (OASIS) was administered to 248 participants at 24-year follow-up in the McLean Study of Adult Development (MSAD). Adversity and temperament were assessed during index admission using interviews (Revised Childhood Experience Questionnaire [CEQ-R], Adult History Interview [AHI], and the NEO-FFI self-report measure). RESULTS: Participants with BPD reported significantly higher levels of EA than those with OPD. Within the BPD group, non-recovered participants reported significantly higher levels of EA than recovered participants. Severity of childhood sexual abuse and lower levels of extraversion were found to be significant multivariate predictors of levels of EA in those with BPD. CONCLUSIONS: Taken together, these results suggest that EA is a serious problem for participants with BPD, particularly those who have not recovered. They also suggest that both the severity of childhood adversity and a temperament marked by lower levels of extroversion are significantly related to levels of EA reported by participants with BPD.

Attachment-Based Mentalization Profiles of Iranian Children: A Mixed-Method Approach.

Mentalization, operationalized as reflective functioning (RF), is the ability to understand one's own and another's mental world implicitly or explicitly. RF is a newly discovered research field in Iran and is largely under-studied in Eastern cultures in general, underscoring the high need for cross-cultural studies in this field of research. A qualitative method was used to examine the ability to understand, process, and respond to high-arousal attachment situations in typical and clinical populations of Iranian children recruited from a Tehran primary school. A well-known semi-structured interview commonly used to assess RF in children was used to collect data. Required information on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of children were collected by parents. The results indicated the identification of four different profiles of RF in children, one of which was adaptive, while the other three were maladaptive. Also, the results showed that typically developing children and those having a high social and economic status (SES) were characterized as having a more adaptive profile of RF, while children from the clinical population and those with a low SES reported a more maladaptive profile (passive mentalizing, helpless mentalizing, narcissistic mentalizing) of RF. The present study is an important step in increasing our understanding of the development of mentalization in children and has significant educational and clinical implications.

Pregnancy and STI/HIV prevention intervention preferences of South African adolescent girls: findings from a cultural consensus modelling qualitative study.

South African adolescent girls experience high rates of unintended pregnancy and sexually transmitted infections including HIV. To inform culturally-tailored dual protection interventions to prevent both unintended pregnancy and STIs/HIV, this study qualitatively examined girls' sexual health intervention preferences. Participants were aged 14-17 years old and Sesotho-speaking (N = 25). To elucidate shared cultural beliefs, individual interviews examined participants' perceptions about other adolescent girls' pregnancy and STI/HIV prevention intervention preferences. Interviews were conducted in Sesotho and translated into English. Two independent coders identified key themes in the data using a conventional content analysis approach with discrepancies resolved by a third coder. Participants indicated that intervention content should include efficacious pregnancy and STI/HIV prevention methods and ways to navigate peer pressure. Interventions should be accessible, avoid criticism and provide high-quality information. Preferred intervention formats included online, SMS/text, or delivery by social workers or older, knowledgeable peers, with mixed acceptability for delivery by parents or same-age peers. Schools, youth centres and sexual health clinics were preferred intervention settings. Results highlight the importance of cultural context in tailoring dual protection interventions to address the reproductive health disparities among adolescent girls in South Africa.

Using the Colaizzi Method to Explore Intimate Partner Violence Caseworkers' Subjective Experience: Pathways to Intimate Partner Violence Work and What Keeps Them Going.

Successful intimate partner violence (IPV) safety, advocacy, and intervention programs require recruitment and retention of persons of experience and commitment. To examine lived experiences of IPV advocates working in transitional shelter programs for women exiting IPV relationships, focus group discussions of 15 transitional housing and IPV shelter caseworkers were analyzed using the Colaizzi seven-step phenomenological method of analysis. Several themes emerged through the analysis, including historical, intergenerational pathways to IPV work and unity in sisterhood with IPV clients. The seven-step Colaizzi method is presented with examples of how each Colaizzi step yields an understanding of what motivates and sustains IPV caseworkers.

Specificity of Insecure Attachment in Adolescents With Borderline Personality Disorder in Psychiatric Inpatient and Community-Dwelling Adolescents.

Borderline personality disorder (BPD) has been conceptualized as a disorder of attachment. However, the specificity of attachment insecurity to BPD in adolescents remains unclear. In this study, an inpatient sample (n = 521), of which 173 (33.2%) met the criteria for BPD, and a control sample of community-dwelling adolescents (n = 294) ages 12-17 were compared on a self-report measure of attachment security. In addition, hierarchical regression analyses were carried out to examine the incremental contribution of BPD symptoms, over and above internalizing and externalizing symptoms, in predicting attachment security. Results showed expected group differences such that adolescents with BPD evidenced higher levels of attachment insecurity to both fathers and mothers than psychiatric and community-dwelling controls. BPD features also incremented internalizing and externalizing problems associated with attachment security. However, because psychiatric controls also evidenced high levels of attachment insecurity, we conclude that while attachment insecurity is particularly salient for BPD, it is not necessarily specific to the disorder.

Impact of the Mediational Intervention for Sensitizing Caregivers on Mentalizing in Orphans and Vulnerable Children in South Africa.

The Mediational Intervention for Sensitizing Caregivers (MISC) is a mentalization-based intervention which aims to enhance caregiver sensitivity and responsiveness. MISC has demonstrated treatment effects on mental health problems of Orphans and Vulnerable Children (OVC) in South Africa working with Community-Based Organization (CBO) careworkers as the point of intervention. Recent elaboration of mentalization-based theory points to alternate figures in a child's early environment as critical resources for enhancing children's mentalizing capacity. In this study we evaluated the treatment effect of MISC on children's mentalizing capacity at baseline and following 12-months of the intervention, controlling for the effects of age, gender, orphan status, socioeconomic status, quality of the home environment, and mental health difficulties at baseline. MISC and Treatment as Usual (TAU) groups were compared using a mixed model linear regression. Results demonstrated significant effects of MISC, time, and mental health difficulties on mentalizing capacity. To our knowledge, this study is the first mentalization-based caregiver intervention to demonstrate treatment effects on child mentalizing capacity, and MISC is the first mentalization-based caregiver intervention to focus on paraprofessionals as the point of intervention.

Social and Monetary Reward Processing in Youth with Early Emerging Personality Pathology: An RDoC-Informed Study.

Very little is known about the mechanisms underlying the development of personality disorders, hindering efforts to address early risk for these costly and stigmatized disorders. In this study, we examined associations between social and monetary reward processing, measured at the neurophysiological level, and personality pathology, operationalized through the Level of Personality Functioning (LPF), in a sample of early adolescent females (Mage = 12.21 years old, SD = 1.21). Female youth with (n = 80) and without (n = 30) a mental health history completed laboratory tasks assessing social and monetary reward responsiveness using electroencephalogram (EEG) and completed ratings of personality pathology. Commonly co-occurring psychopathology, including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) were also assessed. At the bivariate level, significant associations did not emerge between psychopathology and reward processing variables. When covarying symptoms of depression, anxiety, ADHD, ODD, and CD, an enhanced reward positivity (RewP) component to social reward feedback (accounting for response to social rejection) was associated with higher levels of personality impairment. Results were specific to social rather than monetary reward processing. Depression, anxiety, and ODD also explained unique variance in LPF. These findings suggest that alterations in social reward processing may be a key marker for early emerging personality pathology. Future work examining the role of social reward processing on the development of LPF across adolescence may guide efforts to prevent the profound social dysfunction associated with personality pathology.

Interpersonal Trust in Adolescents With Borderline Personality Disorder: Comparisons With Healthy and Psychiatric Controls.

The aim of the current study was to utilize a well-known trust versus lottery paradigm to evaluate interpersonal trust in adolescents with borderline personality disorder (BPD). The study included 126 healthy controls, 59 inpatient adolescents with a diagnosis of BPD, and 137 inpatient adolescents without BPD. Alongside diagnostic measures, a questionnaire-based measure for assessing trust beliefs was administered to probe group differences in trust beliefs and associations between game behavior and trust beliefs. No main effect for group or condition was found. A significant interaction of trial and group was noted, suggesting that across games, psychiatric controls demonstrated the steepest increase in trust over time, followed by the BPD and healthy control groups. Healthy controls evidenced significantly higher levels of trust beliefs compared to BPD and psychiatric controls. Reasons for nonreplication of previously demonstrated anomalous game behavior in adults in this adolescent sample are discussed.

Depressive and anxiety symptom trajectories in Polish adolescents during the COVID-19 pandemic and the outbreak of war in Ukraine: uncovering the role of family relations.

INTRODUCTION: The aim of the study was to investigate longitudinal trajectories of change in anxiety and depression symptoms in Polish adolescents during the second year of the COVID-19 pandemic and after the outbreak of the war in Ukraine. Additionally, we aimed to identify risk/protective factors and outcomes associated with these trajectories. METHOD: We collected data in three waves between November 2021 and May 2022. Adolescents (N = 281 in the first wave) completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Filial Responsibility Scale for Youth, and questions related to the COVID-19 pandemic and war in Ukraine. RESULTS: We identified three trajectories of depressive symptoms: resilient with low, stable symptoms (71% of participants), chronically elevated symptoms (11%), and acute symptoms followed by recovery (18%). We distinguished two trajectories of anxiety symptoms: resilient (75%) and chronic (25%). Non-resilient trajectories were predicted by higher levels of familial unfairness (perceived lack of equality and reciprocity in the family), relationship difficulties at school and at home, older age, and poor socioeconomic status. Chronic depressive and anxiety symptoms were associated with higher war-related concerns. DISCUSSION: These findings can inform preventive and therapeutic interventions for at-risk adolescents to reduce negative long-term outcomes of social crises.

Shame-coping clusters: comparisons regarding attachment insecurities, mentalizing deficits, and personality pathology, controlling for general emotion dysregulation.

BACKGROUND: General Emotion Dysregulation (GED) is increasingly implicated as an underlying factor in personality pathology; however, the regulation of specific emotions, such as shame, has been relatively overlooked in the literature. We aimed to identify distinct clusters of shame-coping/regulation and compare them regarding attachment insecurities, mentalizing deficits, and personality pathology, controlling for GED. METHODS: A convenience sample of 600 participants (351 females and 249 males) from the general population with ages ranging from 18 to 65 (M = 33.78, SD = 12.80) completed a battery of self-report instruments, measuring shame-coping styles, GED, attachment insecurities, mentalizing deficits, criteria A and B of the alternative model for personality disorders, and borderline personality traits. A two-stage clustering method was employed, with shame-coping styles as the clustering variables. The identified clusters were then compared for their effects on dependent variables using multivariate and univariate analyses. These comparisons were also performed after controlling for GED. RESULTS: Multiple determination methods suggested a two-cluster solution: maladaptive and adaptive shame-coping. Attack-self, withdrawal, and attack-other styles were the main discriminators. Compared with the adaptive cluster, the maladaptive cluster was characterized by higher use of maladaptive and lower use of adaptive shame-coping styles. Multivariate analyses demonstrated significant differences for all the between-cluster comparisons, with and without GED as the covariate (p < .001). CONCLUSIONS: The current study provides evidence for the presence of homogenous clusters of shame-coping in community-based adults. Between-cluster contrasts after controlling for GED suggest that addressing shame-coping could have incremental utility over and above GED.

Cultural Consensus Modeling to identify culturally relevant reasons for and against suicide among Black adolescents.

INTRODUCTION: The development of evidence-based treatments relies on accurate theoretical frameworks sensitive to the lived realities of the populations from which they are derived. Yet, the perspectives of Black youth are vastly underrepresented in extant theories of suicidal behavior. Cultural Consensus Modeling provides an evidence-based approach for developing a culturally informed understanding of suicide risk among Black youth. METHOD: Participants were 50 Black adolescents (Mage = 16.20 years; 76.0% male) who completed Phase 1 of a Cultural Consensus Modeling study. Participants freely listed reasons for suicide and reasons for living among similar peer Black youth. Responses were synthesized and coded for major themes. RESULTS: The most common reasons for suicide were racism (40%), depression (32%), poverty (26%), and bullying (22%). The most common reasons for living were family (58%), having a purpose or goals (36%), friends (30%), and hope for a better future (26%). CONCLUSION: Responses highlighted issues of racism and social justice, depression, and poverty, as well as the protective role of relationships, living for the future, and contributing to Black empowerment. Future research should utilize Cultural Consensus Modeling to elevate the voices of Black youth, improving extant theories of suicide, and identifying unique mechanisms or opportunities for prevention.

Awareness of Narrative Identity Questionnaire (ANIQ) in Early Adolescents: Psychometric Evaluation and Association with Features of Personality Disorder.

Identity formation is central to adolescent development. Challenges in establishing a stable sense of self is associated with maladaptive identity function, which has been recognized as a core feature of personality pathology. The narrative identity framework offers a unique lens to garner salient information about one's sense of self. The Awareness of Narrative Identity Questionnaire (ANIQ) is a self-report measure of narrative identity validated in adults but is yet to be validated in adolescents. The current study aimed to conduct the first psychometric evaluation of the ANIQ in a sample of 205 youth aged 10-14 years (M = 12.1 ± 1.06 years; 50.7% female; 73.7% Hispanic) recruited from a public charter school. Results confirmed the four-factor structure of the ANIQ and showed high internal consistency. Convergent validity was supported through negative associations between the ANIQ and borderline personality features and identity diffusion. Incremental validity of the ANIQ over identity diffusion in predicting borderline personality features was also examined, but not supported. Overall, results support the ANIQ as a promising instrument for the assessment of narrative identity in youth. However, some improvements to the ANIQ might be necessary in order to use it as a clinical tool in identifying youth with personality pathology.

Psychometric properties of the Observing Mediational Interactions (OMI) coding system during mother-adolescent conflict discussions.

Background: Observational assessments of parent-adolescent conflict can guide interventions to prevent and reduce conflict and mental health problems. The authors identified the Observing Mediational Interactions (OMI) as a particularly useful coding system for examining parent-adolescent conflict. The OMI is the observational measure used in the Mediational Intervention for Sensitizing Caregivers (MISC) and quantifies emotional (attachment-based) and cognitive (learning-based) behaviors during caregiver-child interactions. Objective: The overall aim of the current study was to tailor and evaluate the OMI specifically for observing conflict interactions. Method: Conflict discussions between 56 clinical youth aged 10-15 years and their mothers were coded using the OMI. Reliability, construct validity, and associations with affect following the conflict discussion were examined. Results: Analyses revealed that the OMI demonstrated adequate internal consistency, interrater reliability, and construct validity in terms of associations with an alternate observational measure and parent-reported family functioning and stress. Additionally, mothers who engaged in fewer negative parenting behaviors reported greater positive affect following the conflict discussion, controlling for baseline affect. Conclusions: Taken together, findings support the use of the OMI in future studies. While further research should attempt to extend findings to other populations and settings and elaborate the coding instructions as needed, researchers can use the OMI to inform ongoing adaptations of MISC and identify targets for prevention and intervention more broadly.

A Consumer Perspective on Personality Diagnostic Systems: One Size Does Not Fit All.

Although providers and patients may largely agree on what is essential to clinically useful assessment and diagnosis, patients have a unique voice and contribute additional information to our conceptualization of clinical utility. The current study evaluated the clinical utility of three diagnostic models (Section II categorial, Section III hybrid, and the original ICD-11 dimensional) from the consumer/user perspective. Participants included 703 undergraduate students and 154 family members or individuals with borderline personality disorder. Participants rated mock diagnostic reports on six indices of clinical utility. Results indicated that undergraduates favored categorical reports over the original ICD-11 dimensional reports on three of six indices but rated categorical and hybrid reports as essentially equivalent. In the patient/family sample, participants favored the hybrid or categorical model on all indices. Our findings speak to the value of a clear diagnostic label and suggest that future iterations of the DSM adopting a hybrid or dimensional model should have a continued focus on simplicity in communication.

The social domains organization of mentalizing processes in adolescents: a contribution to the conceptualization of personality function and dysfunction in young people.

BACKGROUND: We propose and evaluate a contribution to the conceptualization and assessment of personality functioning based on social domains and mentalizing hypotheses. Social domains are distinct social contexts, such as with acquaintances and friends, with differentiated expectations regarding participants' behaviours and social attributions. The capacity to organize social participation according to these expectations requires the ability, we suggest, to modulate mentalizing processes domain by domain. Drawing on evidence that social domain organization is impaired in borderline personality disorder (BPD) and that hypermentalizing, a heightened interpretation of others' motives, thoughts or emotions, is elevated in adolescent BPD, we hypothesized that hypermentalizing levels in adolescents will vary by social domain and that elevated BPD features will be associated with impairment of this domain organization of hypermentalizing. METHODS: Measures including the borderline personality features scale for children (BPFSC) and the movie for the assessment of social cognition (MASC) were administered to 171 adolescents aged 12-17 recruited from public schools and community organizations in a large metropolitan area in southwestern United States. Mean hypermentalizing scores were computed for adolescent interpretations of sequences in the MASC focusing on the social domains of acquaintance, friends and romantic interactions. RESULTS: There was a progressive increase in hypermentalizing scores across the acquaintance, friends and romantic interactions (repeated measures ANOVA, p < .001, all pairwise comparisons, p ≤ .02), which was markedly reduced in the presence of elevated BPD features (interaction term, p = .007). CONCLUSIONS: Hypermentalizing is organized according to social domain and this organization is impaired in the presence of elevated BPD features. The findings are consistent with the proposal that personality functioning entails a social domains organization of hypermentalizing, which is impaired in personality dysfunction. Identifying mentalizing processes domain by domain has the potential to create a personalized focus for the treatment of adolescents with personality difficulties.