Page 113 - Personality disorders and insecure attachment among adolescents
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great caution NSSI could be contagious among adolescents in clinical practice, as a small group of patients (N = 10) started this behaviour during treatment. However, it is premature to come to conclusions concerning contagiousness of NSSI in clinical practice based on these findings due to this small sample size. Scratching and cutting were the methods used most frequently among participants committing to NSSI behaviour. Other forms of NSSI were mentioned both with and without body tissue damage, although most to a much lesser extent. Affect regulation was mostly communicated as a function of NSSI behaviour. However, replication is necessary to determine the reliability and generalizability of these results due to the small sample size in one facility and the not validated self- report instrument used. The results show that NSSI was not specific to BPD, as it was common among adolescents with BPD and adolescents with other personality disorders, such as the avoidant personality disorder and the depressive personality disorder. However, patients with BPD used the methods of scratching, drinking, and pills significantly more than patients with other personality disorders. Furthermore, NSSI was related to the number of personality disorders that a patient had. A rapidly growing body of empirical research demonstrates that individuals in the general population who engage in repeated NSSI often do not meet the criteria for BPD (Turner et al., 2015) and that NSSI co-occurs with a variety of psychiatric disorders, including depression, substance abuse disorders, post-traumatic stress disorder, eating disorders, and other personality disorders (Cawood & Huprich, 2011; Gratz et al., 2015; Wilkinson, 2013; Zetterqvist, 2015). Therefore, these results could be perceived as preliminary support for a distinct and independent NSSI Disorder (NSSID) classification as suggested in the DSM-5 (APA, 2013) (Glenn & Klonsky, 2013), although according to the results of this study the NSSID definition excludes a small group of NSSI patients that use NSSI methods without body tissue damage. Many participants (87.7%) that admitted to lifetime NSSI at pre- treatment, met the criteria of NSSID. This new proposed category of NSSI could be helpful to reduce problems from the lack of diagnostic specificity for NSSI; to improve the provision of treatment for adolescents who engage in NSSI; and to enhance research on aetiology, treatment, and outcome. Future studies in patients with NSSI, relating to both Axis I and Axis II diagnoses, may shed more light as to a possible validity of an independent NSSI diagnosis. In this study substantial overlap between the personality disorders was found, which resembles findings in other, mainly adult studies (Chiesa, Cirasola, Williams, Nassisi, & Fonagy, 2017; Tyrer, Crawford, & Mulder, 2011). Due to this substantial personality disorder symptoms overlap in combination with the overlap with adolescence (e.g., confusion, mood swings. or identity conflicts) and with the co-occurrence of Axis I psychiatric disorders, classifying personality pathology in adolescence correctly is problematic, particularly in severely dysfunctional adolescents. For this reason, the current DSM categorisation by type of personality disorder seems arbitrary in adolescents with co-morbidity.
Notable is that the NSSI group relatively often used the coping skills self blame, acceptance, putting in perspective, and less positive re-interpretation and less blaming others. Especially for adolescent girls, it seems important to change the negative coping strategies such as self-blame as
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