Page 28 - Personality disorders and insecure attachment among adolescents

Discussion
Our pilot study indicates that, during intensive psychotherapeutic treatment including partial hospitalisation, the number of personality disorders and symptoms may decrease substantially. At the end of the treatment, approximately three quarters of the participants showed a lower number of personality disorders, while two thirds did not meet the SCID-II criteria for a personality disorder after treatment any longer. However, a large part of the sample was not assessed at the end of the treatment. Since this cohort study was not randomised, it is not possible to draw conclusions about the direct effect of the treatment itself. Furthermore, symptom reduction could not be predicted by pre-treatment personality disorder variables. Nevertheless, this pilot study suggests that personality disorders in adolescents can diminish during intensive psychotherapy.
It is of substantial clinical interest to examine whether the positive outcome obtained in the part of the sample that completed measurements at t-1 and t-2 was the result of the provided treatment or other factors. Age-related development or the social support of family and friends (van Harmelen et al., 2016) may partly have been responsible for the decrease in symptoms and personality pathology. Nevertheless, if the treatment affected the outcome, focus should be placed on examining which element of the treatment caused these improvements. A hypothesis is that working in a group with a group psychodynamic approach is especially relevant for adolescents (Yalom & Leszcz, 2005). In combination with MBT (Bateman & Fonagy, 2006, 2012; Hauber, 2010) and the focus on the relationships with group members and therapists, this may have stimulated a positive outcome. Future research directions should focus on the role of treatment groups for adolescents with personality disorders in treatment outcomes.
Moreover, the duration of the partial hospitalisation may be a factor of particular relevance. The treatment lasted relatively long, and effects of time cannot be ruled out without a control group. The effectiveness of approximately five months inpatient psychotherapeutic treatment was described as optimal for adults with cluster B personality disorders (Bartak et al., 2010), cluster C personality disorders (Bartak et al., 2009) and with personality disorders not otherwise specified (Horn et al., 2014), in comparison to longer inpatient psychotherapeutic treatment. Currently, the maximum duration of partial hospitalisation is set at six months. Future research should examine whether there is a general optimal duration of hospitalisation for an intensive group psychotherapy programme for adolescents with personality disorders or the variables a personal optimal length depends on.
Considering our results, the question is whether adolescents with personality disorders are more capable of change than adults with similar problems, as our study found larger changes than those observed in most adult studies. Developmental change may have played a role, as it is known that adolescents become more capable of regulating emotions and behaviour over time. Adolescence
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