Page 7 - Personality disorders and insecure attachment among adolescents

As outpatient treatment resulted in insufficient reduction of these problems, they followed a residential psychotherapeutic treatment for adolescents. To better help adolescents like Marie and Emma, this thesis aims to improve our understanding of personality disorders, insecure attachment and non-suicidal self-injury in adolescence. Personality disorders in adolescence Personality disorders are defined as “ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life” (DSM-5 APA). People with personality disorder have far higher morbidity and mortality than those without (Tyrer, Reed, & Crawford, 2015). Life expectancy at birth is shorter by 19 years for women and 18 years for men than in the general population (Tyrer et al., 2015). Prevalence rates of personality disorder in the general adult population vary from 4% to 15%, and are higher in adolescents than in adults (Chanen et al., 2004; Johnson et al., 2000), which is explicable as normal adolescent characteristics resemble criteria of personality disorders. Personality disorders often start and peak in middle to late adolescence (Hutsebaut, Feenstra, & Luyten, 2013; Shiner & Allen, 2013). When youngsters go to therapy, the risk of dropout is relative high (A. De Haan, A. Boon, J. De Jong, M. Hoeve, & R. Vermeiren, 2013; Hauber, Boon, & Vermeiren, 2017; Owen, Miller, Seidel, & Chow, 2016). In case of dropping out of psychiatric treatment, their personality disorders might persist or even worsen later in life. The psychosocial and economic burden is high (Chanen & McCutcheon, 2013; Feenstra et al., 2012). Against that background it is notable that relatively little research has been done on personality disorders in adolescents and specifically into effective treatments (Biskin, 2013; Chanen & McCutcheon, 2013; Courtney-Seidler, Klein, & Miller, 2013; Hutsebaut et al., 2013; Weisz et al., 2013). This has to do with the fact that the normal emotional maturation in this life phase is characterized by an interplay between progression and regression (Kaltiala-Heino & Eronen, 2015), which resembles criteria of personality disorders. This complicates the diagnostic process of personality disorders and thereby leads to reluctance among professionals to diagnose personality disorders in adolescence (Hutsebaut et al., 2013). This reluctance is intelligible although it is likely to hamper research and thus the development of effective treatments for this group of patients. If personality disorders in adolescence are ignored, inappropriate treatment might be given, resulting in chronic dysfunction. 3