Page 129 - Personality disorders and insecure attachment among adolescents

a questionnaire in high-risk adolescents with varying mental states seems doubtful in this study, qualitative research methods seem to offer more clarity on how to optimise prevention and treatment programs and reduce dropout. Future research could also investigate the dimensional model as proposed by the DSM-5 for clinical adolescents with co-morbidity. The research advice is to adjust criterion A for adolescents. This criterion is divided into four aspects of personality functioning: 1) identity, 2) self-direction, 3) empathy, 4) intimacy. These aspects could be described in the developmental context of adolescence. So far, no studies have followed the course of personality disorder from childhood through puberty to later life, although child and adolescent personality disorder is the strongest predictor of young adult personality disorders (Newton-Howes et al., 2015). Applying staging models (Scott et al., 2013) on personality pathology could be a research direction. However, considering the high co- occurrence found, research should focus on the heterogeneity of problems from a dimensional and developmental point of view of clinical adolescents and not on one classification. With this broader view, staging models among high-risk adolescents can help clinical practice select interventions appropriate to the life phase and to the stage the adolescent is in. Ideally, this information can also help us in the future to differentiate between those adolescents who show temporary symptoms of personality pathology belonging to puberty and those who are at the onset of a chronic problem. Therefore, the focus should be on descriptive diagnosis and treatment, and future research on staging models for adolescent personality disorders from a dimensional and developmental point of view for early detection, prevention and treatment of personality pathology in adolescence Finally, research investigating moderators of outcome among psychotherapy treatments for adolescent personality disorders is needed. Understanding for whom and under what conditions and dosages, clinicians can employ these working elements of treatments to exert their greatest effects and enhance development of personalised psychiatry. The role of parents and other significant others could especially be an important factor of influence on the commitment and outcome of adolescent personality pathology treatment and needs further study. Research should also focus on moderators of dropout of treatment among these adolescents. References APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (5th ed.). Washington, DC: Author. Caspi, A., & Moffitt, T. E. (2018). All for one and one for all: mental disorders in one dimension. The American Journal of Psychiatry, 175(9), 831-844. doi:10.1176/appi.ajp.2018.17121383 Chen, E., Brody, G. H., & Miller, G. E. (2017). Childhood close family relationships and health. American Psychologist, 72(6), 555-566. Chiesa, M., Cirasola, A., Williams, R., Nassisi, V., & Fonagy, P. (2017). Categorical and dimensional approaches in the evaluation of the relationship between attachment and personality disorders: an empirical study. Attachment & Human Development, 19(2), 151-169. doi:10.1080/14616734.2016.1261915 125