Page 9 - Personality disorders and insecure attachment among adolescents

Non-suicidal self-injury Non-suicidal self-injury (e.g., self-inflicted burning, cutting and hitting) (NSSI) among youth is a major public health concern (Glenn et al., 2016) and occurs pervasively in clinical practice among adolescents with personality disorders. Non-suicidal self injury is associated with significant functional impairment (Madge et al., 2011). Self-reported life-time prevalence of NSSI among adolescents varies from approximately 5% to 40% across community and clinical settings, due to different definitions and numerous methodological variations (Asarnow et al., 2011; Hamza, Stewart, & Willoughby, 2012; Madge et al., 2011; Wilkinson, 2013). Prior to intensive psychotherapy NSSI is often hidden behaviour and therewith a missed signal of an adolescent in need of help. Therefore, enhancing knowledge of NSSI is needed for early detection and for clinical practice. In this thesis the aim is to examine different aspects of NSSI in clinical adolescent practice, in a group of adolescents with personality disorders. Intensive psychotherapy for adolescents As intensive psychotherapy is likely to diminish personality disorders, insecure attachment patterns and non-suicidal self-injury among adolescents (Innerhofer, 2013; Levy et al., 2015; Maxwell, Tasca, Ritchie, Balfour, & Bissada, 2014), the studies in this thesis are based on data collected as part of the treatment protocol of an adolescent residential psychotherapeutic institution. This institution, called the Albatros and located in an urban area (The Hague) in the Netherlands, offers a 5 days a week intensive mentalization based treatment (MBT) with partial hospitalization (Bateman & Fonagy, 2006, 2012; Hauber, 2010) for adolescents in the age of 16 to 23 years with personality disorders and a variety of non-psychotic comorbid disorders. This structured and integrative psychodynamic group psychotherapy program is manualized, adapted to adolescents (Bateman & Fonagy, 2006, 2012; Hauber, 2010) and facilitated by a multidisciplinary team trained in MBT. The program offers weekly verbal and non-verbal group psychotherapies and individual- and family psychotherapy. These different therapies focus on the adolescents’ subjective experience of himself or herself and others, and on the relationships with the group members and the therapists. From January 2008 until July 2018 the clinical adolescents of the Albatros were studied in different overlapping subsamples. Figure 1 shows an overview of the different subsamples regarding number, subject and instruments in this thesis on a timeline according to the chapter order. 5