Page 126 - Personality disorders and insecure attachment among adolescents

opportunities for change in personality pathology are greater, under the right conditions, than in adulthood. Third, the role of parents and peers could be an important factor of influence on the motivation and outcome of intensive treatment and needs further study. To conduct research on adolescents, the aforementioned circumstances must be considered and likely affect the degree to which this group is examined.
There is dispute concerning classifying personality disorders in adolescence, although momentarily classifications are a starting point in research and in some countries for insured health care. On the one hand, classifying personality disorders in adolescence encourages an early intervention and thus prevention of crystallisation of behaviours that can have severe consequences on functioning. In addition, it may stimulate research and thus the development of effective treatments for specific groups. On the other hand, if a clear distinction cannot be made between normal adolescent problems, adolescent psychiatric problems that know a natural recovery and the adolescent problems that are the start of severe personality pathology, the risk of classifying normal behaviour as pathologic is considerable. Research shows a subgroup of severely affected adolescents for whom BPD remains relatively stable over time, while a less severe subgroup moves in and out of the classification of BPD (Miller, Muehlenkamp, & Jacobson, 2008). Another concern is that adolescents in the phase of identity disturbance and formation may be at risk of identifying with a classification of a personality disorder. Therefore, classifying personality disorders in adolescence may stigmatise adolescents. A dimensional or network approach instead of a categorical approach to personality disorders may better account for the developmental variability and heterogeneity found among adolescents.
Specific concerns exist on how to accurately measure insecure attachment in adolescence. In general, one may wonder how secure attachment appears in the developmental stage of adolescence. First, attempts to gain autonomy in adolescence may temporarily lead to higher rates of dismissing attachment during this developmental period (Warmuth & Cummings, 2015) than at later age. A feature of a separation-individuation process is that adolescents tend to rebel against parents, which in case of negative experiences possibly occurs even more. Second, adolescents generally think short term, which may affect the ability to reflect on parent-child early life experiences. In this adolescent AAI study, the overrepresentation of the cannot classify and forced preoccupied attachment representation is possibly indicative of psychopathology severity in combination with temporary vulnerability associated with adolescence. The change towards increased secure attachment at the end of treatment may be related to the lower scores on psychological distress due to which the adolescents were better able to respond AAI questions. Unfortunately, there are as of yet no validated ‘quick and easy’ measures for identifying attachment insecurity, though accurate detailed analysis of attachment seems important among high-risk adolescents. Measurement of attachment in adolescent psychiatry is in its infancy (van Hoof, 2017), although the probability that this will change is likely hampered
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