Page 130 - Personality disorders and insecure attachment among adolescents

discover which specific health assets in the three domains of health—namely physical, social and mental health—produce longer, more meaningful and healthier life and which health assets lower disease risk and health care costs (Huber et al., 2011). The above requires development of new methods of researching clinical adolescents using qualitative rather than quantitative research methods, or a combination of both.
The identified co-occurrence has further consequences for treatment of adolescent personality pathology. According to the descriptive diagnosis, the treatment is needed to be part of a bigger personalised plan designed together with the adolescent and his/her social system. During treatment, adolescents could be asked regularly to reflect in writing on the treatment process and progress. With this information, treatment staff could adjust the personalised plan to optimise it for important therapeutic factors per treatment phase.
The co-occurrence that is found in other mental disorders (Caspi & Moffitt, 2018; Kessler, Chiu, Demler, & Walters, 2005) than personality disorders also has consequences for the content and organisation of health care in general, since the current health care system depends on the view that mental problems come as categorical disorders (van Os, Guloksuz, Vijn, Hafkenscheid, & Delespaul, 2019). These disorders should be treated according to evidence-based practice treatment guidelines on the basis of meta-analytic evidence of measurable symptom reduction at the group level. However, evidence-based guidelines at the group level may not be generalisable to the individual level, especially for severely disturbed adolescents with combined conditions. Several novel developments (van Os et al., 2019), however, suggest focussing on enhancing resilience, instead of on symptom reduction, and connectedness with others. Our study on attachment and therapeutic factors seems to show the importance of connection with others to grow emotionally in adolescence. For that reason, clinicians have to emphasise throughout all phases of treatment the importance of attachment relationships and learning from one generation to another and from social systems. In clinical adolescent MBT practice, clinicians enhance resilience to deal with vulnerabilities in contact with significant others. This is a task for modern society in which loneliness is the highest mortality risk for human beings (Holt-Lunstad, Robles, & Sbarra, 2017).
Directions for future research
Adolescence is a period of life in which personality disorders often manifest themselves (Kessler et al., 2005; Newton-Howes, Clark, & Chanen, 2015). Despite this knowledge, clinical attention is focussed mainly on adults and BPD. Research investment is needed on personality disorders with comorbidity in adolescence by means of preventive and treatment evaluation using not only quantitative but also qualitative research methods, or a combination of both. Since the validity of
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