Page 124 - Personality disorders and insecure attachment among adolescents

insecure attachment distribution of the normative pattern in the whole sample as well as in subgroups of patients with borderline personality disorder (BPD) and other personality disorders. Sixty adolescents were investigated pre-treatment using both categorical and continuous measures of the Adult Attachment Interview (AAI). The second aim of this study was to explore whether attachment representations alter during the course of intensive MBT and whether these alterations are related to changes in psychological distress. Therefore, pre- and post-AAI (N = 33) differences were related to psychological distress measured by the SCL-90. Adolescents without a post-AAI did not differ significantly from the others in age, gender, severity of symptoms or personality disorders. The duration of treatment for these patients, however, deviated significantly. It was found that the most disturbed category of insecure attachment, the ‘cannot classify’ category, was overrepresented at pre- treatment. No differences in attachment insecurity were observed by type of personality disorder, although adolescents who spoke in a devaluing way about their father were more likely (OR 1.6) to be diagnosed with BPD. At post-treatment, half of the participants showed a positive change in the attachment representation, which was related to a significant lowering in level of psychological distress. Furthermore, the whole sample demonstrated change towards increased secure attachment. Taken together, no relation was found between the type of personality disorder and the (forced) attachment classification. Attachment insecurity diminished over the course of intensive MBT. However, as stated before, it cannot be concluded that changes are due to the treatment itself.
Chapter 6 studied different aspects of NSSI in clinical practice in association with personality disorders, symptoms, and coping skills (N = 140), to enhance the understanding of NSSI and improve treatment interventions. Assessment was done pre- and post-treatment using a questionnaire on NSSI developed for clinical practice as well as the SCID-II, the SCL-90 and the Cognitive Emotion Regulation Questionnaire. As expected, NSSI was found to be common, yet more surprising was that NSSI was related to the number of personality disorders and not exclusively to BPD or any other specific personality disorder. Furthermore, the frequency of NSSI was found not to significantly differ between patients with BPD, patients with other personality disorders and patients without personality disorders. Patients with NSSI disclosed significantly more psychological symptoms of distress at the start of treatment. They also reported using the negative coping skill self-blame more often and positive skills refocusing and positive reappraisal less than the no NSSI group and NSSI starters group. Concerning contagiousness of NSSI, this study found that, with great caution, NSSI can be considered contagious in clinical practice, as approximately one fifth of the inpatients without NSSI behaviour started NSSI during treatment. However, other reasons for starting NSSI besides contagiousness could be applicable, such as increasing stress due to the inpatient treatment, therapeutic interventions, or non-reporting of NSSI at the start of the treatment despite psychoeducation and thorough questioning. To summarise, NSSI is common in clinical practice for clinical adolescents and not exclusive to BPD. The presence of NSSI in others may influence those
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