Personality disorders in adolescents: prevalence, burden, assessment, and treatment

In adults, personality disorders are among the most common mental disorders in the general population (Torgersen, Kringlen, & Cramer, 2001) and patient samples (Zimmerman, Rothschild, & Chelminski, 2005). Prevalence rates vary from 13.4% in the general population, to 56.5% in treated addicted patients, and 60.4% in psychiatric outpatients (Verheul & van den Brink, 1999). Furthermore, among adults seeking specialized treatment, personality disorders are associated with low quality of life (Soeteman, Verheul, & Busschbach, 2008) and high societal costs (Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). Since the inclusion of personality disorders in the DSM-III in 1980, much research has been conducted investigating the effectiveness of treatments for these patients. Based on this literature, psychotherapy is generally considered the treatment of choice for adult patients with personality disorders (Landelijke Stuurgroep Richtlijnontwikkeling in de GGZ, 2008). Much less is known about personality disorders in adolescents. To the best of our knowledge, the study of Grilo and colleagues (1998) is the only published prevalence study among adolescent patients. Most research on personality disorders in adolescents is derived from the Children in the Community study (CIC; see for example Chen, Cohen, Kasen, & Johnson, 2006; Johnson et al., 2000; Johnson, Chen, & Cohen, 2004; Kasen et al., 2007), which was carried out in the general population. Valuable information to yield arguments in favor of reimbursing treatments for this particular patient group, like the burden of disease or costs, is virtually non-existing. Furthermore, there are almost no outcome studies available in this particular group of patients. This thesis aims to address these above mentioned issues, thereby filling in the existing gap

Diagnosis of personality disorders in adolescents: A study among psychologists

Background: Recent guidelines concerning the treatment of personality disorders (PDs) recommend diagnosing PDs in adolescents. However, it remains unclear whether these guidelines influence the current opinions and practices of mental health care professionals.Methods: Five hundred sixty-six psychologists completed an online survey concerning PDs in adolescents, of whom 367 professionals reported working with adolescents. The survey contained demographical questions (age, gender, profession, work setting) and specific questions related to PD in adolescence.Results: Although a majority of psychologists working with adolescents acknowledged the existence of PDs in adolescents (57.8%), only a small minority diagnoses PDs in adolescence (8.7%) and offers a treatment specifically aimed at targeting PD pathology (6.5%). Reasons for not diagnosing PDs in adolescence mainly concerned the belief that adolescent personality problems are transient (41.2%) and that the DSM-IV-TR does not allow diagnosing PDs in adolescence (25.9%).Conclusions: Although practice guidelines might have influenced clinicians' opinions about PDs in adolescence, they have had little impact so far on routine clinical practice

Day hospital versus intensive outpatient mentalization-based treatment: 3-year follow-up of patients treated for borderline personality disorder in a multicentre randomized clinical trial

BackgroundTwo types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment.MethodsAll 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle.ResultsPatients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up.ConclusionsPatients in both conditions showed sim

Prevalence and comorbidity of axis I and axis II disorders among treatment refractory adolescents admitted for specialized psychotherapy

Research shows that approximately half of the adolescents in a clinical setting suffer from a personality disorder (PD). This finding has not yet been replicated in Europe. To test whether this finding also applies to Europe, structured diagnostic interviews for both Axis I and Axis II disorders were used in 257 adolescents who were admitted to a highly specialized mental health setting in The Netherlands. In this study we found that 40.5% of the adolescents were diagnosed with at least one personality disorder. Most adolescents with a personality disorder (78.9%) also suffered from one or more Axis I disorders. These results are comparable to rates found in previous prevalence studies of personality disorders in both adolescents and adults. Our results provide further evidence to support the cross-national generalizability of the diagnosis of PD in adolescents

The burden of disease among adolescents with personality pathology: Quality of life and costs

In adults, personality disorders are associated with a low quality of life and high societal costs. To explore whether these findings also apply to adolescents, 131 adolescent patients were recruited from a mental health care institute in The Netherlands. Axis I and Axis II disorders were diagnosed using semi-structured interviews. The EuroQol EQ-5D was used to measure quality of life and costs were measured by the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness. The mean EQ-5D index value was 0.55. The mean direct medical cost in the year prior to treatment was €14,032 per patient. The co-occurrence of Axis I and Axis II disorders was a significant predictor of a low quality of life. Direct medical costs were higher for the depressive personality disorder. This study shows that the burden of disease among adolescents with personality pathology is high. This high burden provides evidence to suggest that further research and development of (cost-)effective treatment strategies for this population may be worthwhile