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Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.
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The 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) marks a paradigm shift in the diagnosis of personality disorders: In the near future, their classification will no longer be categorical, but dimensional along the severity of personality impairments and optionally regarding the presence of maladaptive personality traits. This study examines the reliability and validity of the German version of the Personality Inventory for ICD-11 (PiCD), a questionnaire designed to assess ICD-11 maladaptive personality domains, in a clinical and nonclinical sample (N=939). The factor structure of the PiCD was examined using Exploratory Factor Analysis (EFA) and showed a tendency for a four-factor model (Negative Affectivity, Dissociality, Detachment, and a bipolar factor Disinhibition-Anankastia). The subscales of the PiCD demonstrated acceptable to excellent reliability coefficients with Cronbach's α (0.79 - 0.89) and McDonald's ω (0.76 - 0.90). Convergent and discriminant validity were examined in conjunction with other questionnaires and were found to be satisfactory. The results suggest that the German version of the PiCD is a reliable and largely valid measurement instrument for assessing ICD-11 maladaptive personality traits. However, further research on factor structure, appropriate cut-off as well as norm values is needed.
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Classificação Internacional de Doenças , Transtornos da Personalidade , Humanos , Reprodutibilidade dos Testes , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos da Personalidade/diagnóstico , Personalidade , Inventário de PersonalidadeRESUMO
Individuals with borderline personality disorder (BPD) show self-regulatory deficits, associated with reduced heart-rate variability (HRV). However, results on reduced HRV in BPD remain heterogeneous, thus encouraging the search for developmental constructs explaining this heterogeneity. The present study first examined predictors of reduced resting-state HRV in BPD, namely the interaction between self-reported adult attachment insecurity and childhood trauma. Second, we investigated if alterations in resting-state HRV are modified by intranasal oxytocin administration, as oxytocin may enhance HRV and is implicated in the interaction between childhood trauma and disturbed attachment for the pathogenesis of BPD. In a randomized, placebo-controlled trial, 53 unmedicated women with BPD and 60 healthy controls (HC) self-administered either 24 I.U. of oxytocin or placebo and underwent a 4-min electrocardiogram. Our results replicate significantly reduced HRV in women with BPD, explained up to 16% by variations in childhood trauma and attachment insecurity. At high levels of acute attachment insecurity, higher levels of childhood trauma significantly predicted reduced HRV in BPD. However, our results do not support a significant effect of oxytocin on mean HRV, and no interaction effect emerged including childhood trauma and attachment insecurity. Our findings highlight a complex interaction between reduced vagal activity and developmental factors in BPD.
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Experiências Adversas da Infância , Transtorno da Personalidade Borderline , Administração Intranasal , Adulto , Transtorno da Personalidade Borderline/tratamento farmacológico , Eletrocardiografia , Feminino , Humanos , OcitocinaRESUMO
PURPOSE OF REVIEW: Childhood trauma is an important risk factor for the development of personality disorders (PDs), yet most research has been devoted to categorical models of personality pathology. Considering the introduction of a dimensional PD model with ICD-11, we review current findings related to various forms of childhood trauma, and PDs, operationalized in the form of personality functioning and maladaptive traits. We focus on the magnitude of associations and examine specific relationships between emotional and physical trauma with areas of personality functioning and single traits. RECENT FINDINGS: Two studies showed a strong association between childhood trauma and personality dysfunction. Seven studies, including clinical and forensic samples, demonstrated heterogeneous associations between various forms of childhood trauma and maladaptive traits. Overall, four studies indicated a slightly stronger association between personality dysfunction, maladaptive trait expression, and higher levels of emotional trauma than for physical or sexual trauma. Regarding specific trait domains and childhood trauma, most studies yielded the strongest associations for either psychoticism or detachment. Research on childhood trauma and dimensional PD models (i.e., personality functioning and traits) has the potential to contribute to a better understanding of their complex relationship. However, high intercorrelations among different types of childhood trauma, areas of personality functioning, and trait domains increase the difficulty of disentangling single effects. More research is needed including clinical and non-Western samples, especially considering the upcoming ICD-11 classification.
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Classificação Internacional de Doenças , Transtornos da Personalidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Personalidade , Transtornos da Personalidade/diagnóstico , Inventário de PersonalidadeRESUMO
BACKGROUND: The alternative model for personality disorders of the DSM-5 introduced an evidence-based, dimensional concept for the diagnosis of personality disorders. Criterion A, operationalized with the Level of Personality Functioning Scale, differentiates different levels of impairments in personality functioning. The Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) is a valid, reliable, and economic interview for the assessment of Criterion A. However, to date, there is no validated form of the interview in the German language. The aim of this study is the psychometric evaluation of the German version of the STiP-5.1. METHODS: The validity and reliability of the STiP-5.1 was investigated in a sample of healthy adults (n=55) and inpatients diagnosed with a mental disorder (n=55). Construct validity was evaluated by correlations with questionnaires for the assessment of structural impairment (IPO-16, OPD-SQS), and maladaptive personality traits (SCID-II-PQ). Interrater reliability was investigated in a sub-sample of healthy individuals and inpatients (n=50). RESULTS: With regard to validity, high correlations (r=0.68-0.78) between STiP-5.1- ratings and convergent self-report questionnaires were found. The sub-sample showed good interrater reliability (ICC=0.93). Interviews took 38 min. on average. CONCLUSIONS: The German version of the STiP-5.1 provides a valid, reliable and economic interview procedure for the dimensional assessment of personality functioning for research and clinical practice.
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Manual Diagnóstico e Estatístico de Transtornos Mentais , Determinação da Personalidade/normas , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia , Testes de Personalidade/normas , Psicometria , Adulto , Idoso , Feminino , Alemanha , Humanos , Pacientes Internados , Entrevista Psicológica , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Autorrelato , Traduções , Adulto JovemRESUMO
Mentalizing as a Mechanism of Change in the Therapy of Conduct Disorder. A Controlled Case Study This controlled case study is dedicated to mentalizing as a mechanism of change in the course of a mentalization-based therapy for the treatment of conduct disorder. Following an introduction to conduct, oppositional defiant disorder and the concept of mentalizing, the case study of a 17-year-old male patient is presented. The patient's mentalizing is measured with the Reflective Functioning Scale and assessed prior to and after treatment as well as in therapy sessions at three time points through the course of therapy. Analyses show that the capacity for mentalizing fluctuates noticeably within but also between the coded therapy sessions. During the course of therapy first an increase and then a slight decrease in mentalizing qualities become apparent. The comparison of the pre- and post-measurement shows a slight increase in the patient's mentalizing abilities. Additionally the patient no longer fulfilled the criteria of a conduct disorder. The results are discussed and implications for clinical practice are formulated.
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Transtorno da Conduta/psicologia , Transtorno da Conduta/terapia , Mentalização , Adolescente , Humanos , MasculinoRESUMO
BACKGROUND: Traumatic childhood experiences are a major risk factor for developing mental disorders later in life. Over the past decade, researchers have begun to investigate the role of early trauma in impairments in personality functioning following the introduction of the Alternative Model of Personality Disorders in Section III of the Diagnostic and Statistical Manual for Mental Disorders 5. Although first studies were able to empirically demonstrate a significant link between early trauma and impairments in personality functioning, only little is known about the underlying mechanisms. One possible mechanism is body connection due to its involvement in self-regulatory processes and its link to both early trauma and personality (dys)functioning. OBJECTIVE: In the current study, we investigated whether body connection, which encompasses the awareness, integration, and utilization of one's own bodily signals, mediates the relationship between childhood trauma and personality functioning. PARTICIPANTS AND SETTING: A total of 1,313 adult participants recruited in Germany and Chile anonymously provided self-report data in an online survey. METHODS: Self-report data included the short form of the Childhood Trauma Questionnaire (CTQ-SF), the Scale of Body Connection (SBC), and the brief form of the Levels of Personality Functioning Scale (LPFS-BF 2.0) as well as demographic data (age, sex, education, clinical diagnoses). RESULTS: Traumatic childhood experiences explained 27.2% of the variance in impairments in personality functioning. Interestingly, 60.5% of this effect was explained by body connection, particularly body dissociation. Additional exploratory analyses revealed that body dissociation and, to a much lesser extent, body awareness, accounted for 64.41% of the variance in self functioning and 55.75% of the variance in interpersonal functioning explained by childhood trauma. CONCLUSION: Body connection appears to be an important mediator in the association between early trauma and impaired personality functioning, underscoring the need for interventions specifically targeting the avoidance and ignorance of signals from one's own body in individuals with traumatic childhood trauma.
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Objective: Previous research suggests that patients with anorexia nervosa (AN) show an impaired capacity to mentalize (reflective functioning, RF). RF is discussed as a possible predictor of outcome in psychotherapeutic processes. The study aimed to explore RF in sessions of patients with AN and its association with outcome and type of treatment. Methods: A post-hoc data analysis of selected cases from a randomized trial on outpatient psychotherapy for AN was conducted. Transcripts from 84 sessions of 28 patients (early phase, middle phase, and end of treatment) were assessed using the In-Session-Reflective-Functioning-Scale [14 cognitive-behavior therapy, enhanced (CBT-E); 14 focal psychodynamic therapy (FPT); 16 with good, 12 with poor outcome after 1 year]. Relations between the level of RF, type of treatment, and outcome were investigated using mixed linear models. Additionally, associations with depressive symptoms, weight gain, and therapeutic alliance were explored. Results: Mean in-session RF was low. It was higher in FPT when compared to CBT-E treatments. The findings point to an association between RF increase and a positive outcome. An increase in BMI in the first half of treatment was associated with higher subsequent in-session RF. There was no association between RF and depressive symptoms or the therapeutic alliance. Discussion: Patients with AN show a low capacity to mentalize in sessions, which seems to be at least partly dependent on the degree of starvation. The results suggest a possible relationship between an increase in in-session RF and outcome, which has to be replicated by further studies.
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Refugees are often exposed to a variety of stressors and traumatic events, posing a significant risk for the development of mental disorders. Young refugees may be particularly at risk because adverse life events affect identity formation, a developmental task that is typically expected in adolescence and emerging adulthood. Trauma and cultural changes may alter identity development, potentially leading to identity diffusion, a core concept of personality disorders. However, previous research on personality pathology among refugees is scarce. In this study, we examine identity development and maladaptive personality traits in young refugees and migrants. Refugees from 22 countries of origin were recruited in a German reception center (n = 120) and a group of adults with a migration background in first- or second generation was obtained via web-based recruitment (n = 281). Identity development was measured using the Assessment of Identity Development in Adolescence - Short Form. Maladaptive personality traits were assessed with the Personality Inventory for DSM-5-Brief Form. Group differences between refugees and migrants regarding identity development and trait expression were investigated using t-tests. The relationship between the two measures and their corresponding subscales was examined by means of correlation analyses. Refugees reported significantly higher levels of identity diffusion, negative affectivity, detachment, antagonism, and disinhibition compared to migrants. No significant differences were found for psychoticism. Correlation analyses revealed low to moderate positive associations between identity diffusion and maladaptive trait expression. Possible implications for early phase of resettlement, preventive psychiatric care and further research questions are discussed.
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Criterion A of the alternative model for the classification of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), introduced the Level of Personality Functioning Scale (LPFS), a dimensional model for the assessment of impairments in self and interpersonal functioning. The LPFS was developed based on a review of different measures of personality functioning, such as the Reflective Functioning Scale, a measure of mentalizing. This study investigated the empirical overlap between the LPFS and mentalization. The study sample included adult inpatients (n = 55) with a mental disorder and a healthy adult control group (n = 55). All participants were examined regarding the LPFS using the Semistructured Interview for Personality Functioning DSM-5; mentalizing was assessed with the Brief Reflective Functioning Interview and coded with the Reflective Functioning Scale. We used structural equation modeling to investigate the relationship between LPFS domains and mentalization. Correlation analysis was used to examine the agreement between interview-rated LPFS and self-report measures of personality dysfunction. All domains of the LPFS were significantly related to mentalizing. Interview-rated LPFS was significantly associated with self-reported personality dysfunction. The findings support the notion that the LPFS and mentalization share a strong conceptual and operational overlap by demonstrating that both constructs are empirically interrelated. The results yield further support for the validity of the LPFS as a dimensional model for the assessment of personality disorder severity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).