Brief psychoanalytic psychotherapy with adolescents.
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Biomedical subjects
Publications and source records attributed to M Korenblum.
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Bowlby's concept of the internal working model is useful in conceptualizing how a child develops a sense of self and security through the availability of significant relationships. The lack of secure attachments may lead to dysphoric moods and poor personality functioning. We have shown that a proportion of teenagers develop dysphoria as well as personality disturbance during adolescence. A study sample of 59 youths was examined at early, middle and late adolescence. Ratings were made of affect, attitudes and personality functions. At the same time, information was obtained about family status and functioning. Results showed that certain family and life events were more strongly correlated with changes in affect in early adolescence. These affects were both internalized and externalized. Middle adolescence appeared to be quiescent, without any correlations with affect or personality problems. In late adolescence, there were correlations between family changes and personality dysfunction as well as dysphoria. This shows that family changes which threaten the availability of significant attachment figures are linked to emotional and behavioural disturbance in early adolescence and personality and emotional disturbance in late adolescence.
OBJECTIVE: This study was undertaken to determine whether the social cognitive skills and social self-appraisal of depressed adolescents differed from those of other adolescents with nonaffective psychiatric disorders or of adolescents free from disorder. METHOD: Within the age range of 15 to 19, 38 depressed adolescent outpatients (14 boys, 24 girls); 31 nondepressed adolescent outpatients (17 boys, 14 girls); and 34 normal high-school students (18 boys, 16 girls) were assessed using the following dependent measures: Interpersonal Negotiation Interview, Adolescent Social Problem Solving Measure, Adolescent Self Perception Profile, and Interpersonal Dependency Inventory. RESULTS: Depressed adolescents were found to have significantly more negative self-concepts and significantly less social self-confidence than either comparison group. They did not differ from the other adolescents in either social problem-solving ability or interpersonal understanding. CONCLUSIONS: These results indicate that depressed adolescents have unique deficits in social self-evaluation which contribute to ineffective social behavior and the maintenance of dysphoric affect. Treatment of social skill deficits should be based on a careful assessment of the patient's functioning in this area.
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Non clinical adolescents in a longitudinal study were examined at ages 16 and 18 to see whether or not there were changes in personality functioning, attitudes and affect over time, and whether or not these were related to each other. Personality functioning remained fairly consistent at both ages, with marked personality problems occurring in about one out of seven. As a group, the older adolescents demonstrated more anxiety and depression, as well as changes in certain attitudes such as more curiosity and interest in people. For individual adolescents it was found that there was considerable predictability of affect and attitudes at age 18 from the presentation at age 16. Furthermore, a relative increase in the amount of anger in middle adolescence was a predictor of personality problems in late adolescence.
The utility of the Beck Depression Inventory (BDI) for differentiating adolescents with depressive disorders from adolescents with non affective psychiatric disorders was examined using a sample of 93 psychiatric outpatients and 26 inpatients. The Diagnostic Interview for Children and Adolescents (DICA) was administered to establish the patients' diagnosis. Psychiatric diagnoses were made by experienced clinicians who used all available information on the patient. The BDI scores discriminated between patients with depressive disorders and patients with non affective psychiatric disorders. This differentiation was true for boys and girls, outpatients and inpatients. The classification accuracy of the instrument was 75% at thresholds of 11 and 16 on the scale. The results indicate that the BDI is a useful instrument for screening for depression in adolescents, and can also be used in conjunction with other tests. However, the BDI by itself is inadequate to establish a diagnosis of depression.
The relationship between adolescent bipolar illness and personality disorder has not been explored. Studies of adult bipolars suggest a bipolar illness/borderline personality disorder (BPD) association. Twenty euthymic bipolar teens were assessed using the Personality Disorders Examination. Thirty-five percent met DSM-III-R criteria for at least one personality disorder. Three of the 20 (15%) had a borderline personality disorder diagnosis. The bipolar illness with personality disorder group differed significantly from the bipolar illness without personality disorder group in terms of increased lithium unresponsiveness (p less than 0.05) and neuroleptic treatment at time of personality assessment (p less than 0.01), but not in terms of age, sex, age of illness onset, serum lithium level, rapid cycling, substance abuse history, alcohol abuse history, or number of suicide attempts. Issues regarding the study of personality disorder in adolescent bipolars are discussed.
1. Forty-two percent of a nonclinical sample of urban 18 year olds displayed some degree of personality dysfunction. This rate of disturbance is similar to a previously reported rate for 13 year olds, but higher than the prevalence rate for 16 year olds. Thus, early and late adolescence seem to represent "at risk periods" for the genesis of character pathology. 2. In late adolescence, the form of this disturbance is as follows: 40% fall into a histrionic, borderline, narcissistic cluster, whereas nearly 30% demonstrate an atypical or mixed picture. This differs markedly from the distribution of dysfunction in earlier subphases. 3. Thirty-eight percent of the disturbed sample showed evidence of dysfunction at all three subphases (early, middle, and late), whereas 62% fluctuated in or out of disturbance at one subphase or another. 4. There was a notable lack of consistency with respect to type of personality dysfunction from both a group and individual perspective, except for paranoid, schizoid, and schizotypal disturbance. This particular cluster retained both group and individual stability from age 13 to 18. 5. Two trends were evident however: teenagers who initially presented as avoidant, dependent, compulsive, or passive-aggressive seemed to grow out of their dysfunction. By age 18, hardly any of the original subjects remained in this cluster, and most had become clear. Secondly, most of the adolescents identified as antisocial in early or middle adolescence migrated into the histrionic, narcissistic, borderline cluster in late adolescence. This latter group showed a steady increase throughout the time span studied, suggesting the importance of developmental factors.
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The Toronto Adolescent Longitudinal Study was launched in 1977 to examine personality development in a non-clinical sample of children from ages ten through 19 over an eight year period. Following a description of their conceptualized model of personality and of the nature of the study, the authors summarize their findings which suggest new perspectives in three areas of adolescent personality development: 1) the subphases of adolescence, 2) the routes of passage through which adolescents proceed, and 3) adolescent turmoil.
Ninety-six psychiatrically ill adolescents admitted to an adolescent inpatient service were systematically assessed to determine the morbidity of conduct disorder (CD), with other Axis I psychiatric disorders. Twenty-six (27%) met DSM-111 criteria for CD in addition to other Axis I disorders. A CD diagnosis was significantly associated with substance abuse, and attention deficit disorder with hyperactivity. Although CD was found in 21% of depressives it was more commonly found in patients with psychotic disorders (25%) and bipolar (42%) disorders. These findings suggest that CD may be commonly found in a variety of adolescent psychiatric disorders. The implications of this finding for pharmacologic treatment of CD, the clinical assessment of the CD patient, and possible relationships between CD and adolescent psychiatric disorders are discussed.
The personality characteristics of 35 consecutively assessed adolescents who met the DSM-III criteria for a current depressive disorder were assessed using independent structured interviews and paper and pencil measures. Sixty-five percent of the sample met the criteria for an Axis II personality disorder. The single most common diagnosis was borderline personality disorder (30%). Depressed adolescents with a concurrent personality disorder were less self-confident, displayed more neuroticism, and were emotionally reliant on others. They also demonstrated greater cognitive distortion. Teenagers who present with a depressive disorder warrant a comprehensive personality assessment. The combination of affective and personality disorder in such patients is associated with attitudes and interpersonal problems which should be therapeutically addressed in addition to symptomatic treatment of the depressed mood. Clinicians should be aware that depressed adolescents with personality disorder may be more likely to make a suicide attempt.
This study describes disturbed personality functioning in early adolescence. A non-clinical sample of 63 thirteen year olds underwent a semi-structured psychiatric interview as part of a longitudinal study investigating the relationship between competence in personality functioning and development. The presence of personality disturbance was determined by two psychiatrists who rated the adolescents on a personality functions scale. The raters then described the type of disturbance using Axis II of DSM-III as a guideline. Forty-six percent of the sample were found to have some degree of disturbed personality functioning. Of these, over one-half fell into a cluster comprised of avoidant, dependent, compulsive, or passive-aggressive types, while another third were characterized by antisocial tendencies. Severity of disturbance was not related to type of disturbance. Ratings of behaviour by teachers and parents supported the division of subjects with personality dysfunction into two broad groups: an anxious, fearful, "quiet" cluster; and a group of more "acting out", disturbing individuals. However, parents and teachers could not distinguish the "quiet" group from teenagers who were free of disturbed personality functioning. These data indicate that it is possible to classify a segment of a non-clinical population of young adolescents who had personality dysfunction using Axis II of DSM-III as a guideline. Furthermore, such a group of teenagers is not homogeneous. They distribute themselves into internalizing and externalizing clusters.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.