Page 127 - Personality disorders and insecure attachment among adolescents
P. 127

surprise given the fact that deterioration rates as an outcome of psychotherapy range from 5% to 14% among adult patients and are thought to be even higher among children (Lambert, 2013). Limitations Several limitations exist in this study. This cohort study was not randomised. As a result, it is not possible to draw conclusions about the direct effect of the treatment itself. Furthermore, a large portion of the sample was not assessed at the end of the treatment. Co-morbid disorders next to the personality pathology were not studied. Moreover, the sample was a relatively small inpatient sample from one facility consisting of mainly girls with average cognitive capabilities. In consequence, generalisability to other adolescent personality disorder intensive psychotherapy services is to be determined. Despite these limitations, this study is quite unique because little research has been done into personality disorders and attachment insecurity among adolescents (Courtney-Seidler, Klein, & Miller, 2013; Hutsebaut, Feenstra, & Luyten, 2013; Sharp et al., 2016). Clinical implications What do these findings mean for clinical practice? As stated before, a high rate of co- occurrence between the personality disorders, insecure attachment representations and NSSI was found, let alone other co-morbid disorders that were not examined. The current classifications system for personality disorders seems to be a container of heterogeneity and therefore not appropriate for adolescents with personality pathology. In clinical practice, heterogeneity should be taken into consideration, and not masked by categorising. Consequently, two adjustments are proposed for classifying adolescent personality pathology. It is first suggested that a dimensional approach to personality disorders among adolescents may better account for the developmental variability and heterogeneity. Hopefully, a dimensional approach will reduce risk of stigmatisation or identification with a personality disorder diagnosis in adolescence. In contrast to the categorical diagnostic system, a dimensional system views various personality features along a continuum. The DSM-5 (APA, 2013) proposed dimensional model includes two dimensions: Criterion A: level of personality functioning and Criterion B: pathological personality traits. The second proposal is to use a system of classification that describes the core pathology dimensionally only once the influence of adolescence, attachment insecurity and family interactions has been assessed. In the diagnostic phase, adolescent personality pathology should be described in the context of this developmental phase of life and the patient’s social system. This emphasises the importance of thorough descriptive diagnosis instead of merely a DSM-5 classification. A descriptive diagnosis for an adolescent should incorporate the interactions of the adolescent’s pathology with 1) development and puberty 2) family dynamics and 3) relationships with peers. This descriptive diagnosis could be combined with the emerging concept of health and well-being called positive health (Heerkens et al., 2018). The positive health field works to 123 


































































































   125   126   127   128   129