Page 17 - Personality disorders and insecure attachment among adolescents

Background Relatively little research has been conducted on personality disorders in adolescents; specifically, research regarding effective treatments is limited (Biskin, 2013; Chanen & McCutcheon, 2013; Courtney-Seidler et al., 2013; Hutsebaut et al., 2013; Weisz et al., 2013). This is an omission, as the psychosocial and the economic burdens of adolescents with (traits of) personality disorders are high (Chanen & McCutcheon, 2013; Feenstra et al., 2012). Interestingly, the direct mental health and medical costs for adolescents in the year prior to treatment for personality disorders were demonstrated to be substantially higher than for adults (Feenstra et al., 2012; Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). Timely detection and treatment of (traits of) personality disorders during adolescence are for that reason important. Therefore, the aim of this cohort pilot study is to examine the changes in a group of adolescents with clinically diagnosed personality disorders who received an intensive mentalization based treatment (MBT) with partial hospitalisation (Bateman & Fonagy, 2006, 2012; Hauber, 2010). Mentalizing refers to the ability to understand and differentiate between the mental states of oneself and others and to acknowledge the relation between underlying mental states and behaviour (Bateman & Fonagy, 2012; Fonagy, Luyten, & Strathearn, 2011). Doubts regarding the permanence of personality disorders in adolescents are considered to be the main problem underlying the lag in research on this topic (Chanen & McCutcheon, 2013; Courtney-Seidler et al., 2013; Feenstra, Busschbach, Verheul, & Hutsebaut, 2011; Tyrer et al., 2015). Despite guidelines (NICE, 2009) advising professionals to diagnose personality disorders (with the exception of antisocial personality disorder during adolescence), most psychologists and psychiatrists are hesitant to diagnose personality disorders in minors. As a result, minors are not offered specific treatments. This is partly understandable as, during adolescence, normal emotional maturation is characterised by an interplay between progression and regression (Kaltiala-Heino & Eronen, 2015), which complicates the diagnostic process of personality disorders. In addition, diagnosing personality disorders might stigmatise adolescents. However, the reluctance of professionals to diagnose (traits of) personality disorders in adolescents is likely to delay research and thus the development of effective treatments for this group of patients. According to current research, the primary information used to treat personality disorders in adolescents is based on randomised controlled trials of treatments developed for adults, mostly treatments for borderline personality disorder (BPD). The few studies that have been conducted on adolescents with (traits of) BPD have yielded mixed results. Two studies showed no advantages over treatment as usual (Mehlum et al., 2014; Rathus & Miller, 2002); one study showed only a short term effect (Chanen et al., 2009); while another found a better outcome compared to treatment as usual (Rossouw & Fonagy, 2012). All treatments were associated with improvements over time, which may 13