Marshall Korenblum

Relationship between psychiatric illness and conduct disorder in adolescents

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 inpatients 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.

Adolescent Bipolar Illness and Personality Disorder

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.

Cognitive Social Skills and Social Self-Appraisal in Depressed Adolescents

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 patients functioning in this area.

Personality dysfunction in depressed adolescents.

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 asessment. 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.

Personality Dysfunction and Behavioral Disturbance in Early Adolescence

This study examines the prevalence of personality disturbance in a nonclinical sample of young adolescents and the relationship between personality functioning and behavior problems. Sixty-three adolescents, initially screened at age 10 using teacher and parent behavior rating scales, were assessed at age 13 by means of a semistructured psychiatric interview. In addition, their parents and teachers again completed behavior rating scales. The findings indicate a prevalence in the population of 54% who are clear of personality disturbance, 19% who display marked disturbance, and 27% who display some disturbance. Disturbance in personality functions was found to be associated with increased anxiety and depression, school difficulties and interpersonal withdrawal. Behavior indicative of conduct problems and hyperactivity did not differentiate the clear, moderately disturbed, and markedly disturbed adolescents.

Adolescent Personality Development: Three Phases, Three Courses and Varying Turmoil. Findings from the Toronto Adolescent Longitudinal Study

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.

A study of disturbed and non disturbed adolescents: the Toronto adolescent longitudinal study. I

The Toronto Adolescent Longitudinal Study was undertaken to examine personality development in a non-clinical sample of children from ages 10 through 19. Fifty-nine boys and girls, selected to represent the full range of behavior presentation in regular classrooms, have participated throughout the complete study. Each year the students and at least one parent participated in a full day evaluation during which a comprehensive battery of measures was administered to assess their psychosocial characteristics. Some exemplary results are presented regarding the personality functioning and associated characteristics of the group at age 13. Our results lead us to conclude that adolescence should not be considered as a homogeneous developmental stage. Young adolescents can be differentiated along a dimension of competence in personality functioning which is associated with differences in their clinical presentation, self concept and behavior patterns.

Personality functioning and clinical presentation in early adolescence. II

This study describes the presentation of early adolescents on clinical examination and its relation to personality function competence. As part of a longitudinal study 63 non-clinical subjects at age 13 underwent a semi-structured psychiatric interview. On the basis of their responses their phenomenology, attitudes, defence mechanisms and degree of relatedness to significant others were assessed independently and blindly by two psychiatrists. Our findings show that a significant minority of early adolescents have a definite personality function disturbance and that these adolescents differ from their more competent peers on a number of characteristics identifiable in a clinical interview. Such a relationship was observed in boys as well as girls, with girls presenting no greater amount of turmoil than boys. These results indicate that adolescents cannot be adequately described as a homogeneous group. Differences in individual personality functioning result in differences in the presentation and internal experience of the early adolescent.

Consistency and change in personality characteristics and affect from middle to late adolescence.

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 relationship between life events during adolescence and affect and personality functioning.

Bowlbys 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.