Stein Ba

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.

Morbidity and mortality of certified adolescent psychiatric patients

Recent legislation has placed greater restrictions on the involuntary hospitalization and treatment of psychiatric patients. A follow-up study was done on adolescent psychiatric patients who were certified during their hospital stay. The rate of certification was 8.5%. Their functioning was compared with that of a control group of voluntarily admitted adolescents. The two main reasons for certification were suicidal behaviour and psychotic symptoms. The majority of patients required further hospital treatment during the five year period after discharge. Few patients were found to be functioning in a successful independent fashion at the time of follow-up and certified patients required much more long-term social assistance. Five patients (22% of those certified) committed suicide and the combination of personality disorder and major depression was of particular importance in predicting suicide.

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.

Adolescents in a general hospital psychiatric unit

The population of 42 adolescents admitted to the Sunnybrook Adolescent Unit in 1977 is described and compared with other populations of general hospital units previously presented in the literature, in order to derive implications for patient selection, treatment techniques and outcome. Analysis of historical, family, and mental status variables provided a cluster of factors leading to successful or unsuccessful treatment in the hospital. Three global types of patients emerged, based on diagnostic groups who have different treatment experiences in hospital, and who require three distinctly different types of treatment programs. Limitations of treatment are also discussed.

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.

The classification of disturbed personality functioning in early adolescence

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.