Page 20 - Personality disorders and insecure attachment among adolescents

partially reflect the natural course of BPD in adolescents. Whether existing adult treatment programmes are useful for adolescents with personality disorders other than BPD is mostly unknown, as research is scarce. One study investigated the treatment outcome of a 12 month inpatient psychotherapy intervention for adolescents with personality disorders. Only 51 patients of a total sample of 109 completed the research protocol, of whom 29% recovered fully in terms of the level of symptom severity, 12% improved, while 49% showed no significant change and 10% showed deterioration (Feenstra, Laurenssen, Hutsebaut, Verheul, & Busschbach, 2014). Furthermore, none of the specific personality disorders or clusters of personality disorders (A,B, C and NOS) predicted treatment outcome. In conclusion, the results of the few studied treatments for adolescents with (traits of) personality disorders have shown mixed results; however, the most severe sample studied, the inpatient group, showed moderate results.
Difficulties in establishing randomised clinical trials (RCTs) in clinical practice – especially in a high risk adolescent sample with comorbidity –is another reason that potentially explains the scarcity of research in adolescents with personality disorders. Although RCTs are essential for studying the comparative effectiveness of treatments and have a high internal validity, trials dictate strict protocol adherence and often have a low external validity (Rothwell, 2005). Furthermore, randomising carries ethical and practical ramifications in a high risk adolescent group in need of an inpatient programme due to family dynamics, suicidal actions, self-injury and prolonged school absenteeism. Randomisation on the individual level within an inpatient treatment programme is even more intricate, as it implies training half of the treatment staff to follow a study protocol and compare the effect of their interventions with the effect of the interventions of the non-trained half. Moreover, as populations and circumstances differ significantly, the results of RCTs may have limited relevance to clinical practice. Therefore, nonrandomised evaluations of inpatient programmes focusing on external validity, in order to obtain generalisable knowledge of the patient group and treatment evaluation, are needed. The Transparent Reporting of Evaluations with Nonrandomised Designs (TREND) group (Des Jarlais, Lyles, & Crepaz, 2004) has developed a 22 items checklist to improve the reporting standards of nonrandomised evaluations of behavioural and public health interventions.
In this study, we provide treatment evaluation data following the TREND guidelines (Des Jarlais et al., 2004) from a prospective pilot study of 115 adolescents with clinically diagnosed personality disorders, of whom 62 (54%) completed the treatment protocol and filled out questionnaires during pre- and post-treatment. This group received intensive MBT with partial hospitalisation (Bateman & Fonagy, 2006, 2012; Hauber, 2010). The external validity is tested. Furthermore, the predictive power of personality disorder variables on treatment outcomes concerning symptomology is explored.
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