Page 120 - Personality disorders and insecure attachment among adolescents

Chapter 7: Summary and general discussion Introduction This final chapter presents a summary of the findings from this thesis. Thereafter, the results are connected and interpreted. Lastly, the broader implications of our study are discussed. What have we learned of personality disorders, insecure attachment and non-suicidal self-injury (NSSI) in adolescents? How can mental health care for adolescents with these problems be improved? What further research is recommended? The aim of this thesis is to investigate personality disorders, insecure attachment and NSSI in adolescence, and to examine therapeutic factors related to dropout and outcome after intensive psychotherapy for these conditions. Summary of findings In Chapter 2, changes in personality disorders and symptomatology were explored after intensive MBT in adolescents, and the relation between personality disorder variables and outcomes. To this end, a sample of 62 (out of 115) adolescents was examined for personality disorders at pre- and post-treatment by using the Structured Clinical Interview for DSM personality disorders (SCID-II) and the Symptom Check List 90 (SCL-90). Dropout was due to respondents failing to complete the set of web-based questionnaires during post-treatment or not showing up for the final SCID-II interview appointment. These respondents did not differ from the final sample in number and type of personality disorders. At pre-treatment, co-occurrence between the personality disorders was high. At post- treatment, about three quarters of the participants showed a lower number of personality disorders, while two thirds no longer met the SCID-II criteria for a personality disorder. However, symptom reduction could not be predicted by pre-treatment personality disorder variables. Thus, personality pathology can diminish after intensive MBT, although it is not clear if this outcome is a result of the treatment given, as no control group was included. In Chapter 3, therapeutic factors known to promote recovery (Yalom & Leszcz, 1985) were examined in farewell letters (N = 70) written without instruction at the end of treatment and whether these factors were related to therapy outcome. Content analysis was performed on these letters by two independent raters using Yalom’s 12 therapeutic factors combined with potential additional therapeutic factors as coding categories. These factors were related to outcome, operationalised as a decrease in psychological symptoms measured with the SCL-90. All therapeutic factors of Yalom and 116