Depression in Children and Adolescents

Dugo su vladala dva krajnja uvjerenja: 1. da djeca i adolescenti ne mogu patiti od depresivnih poremećaja i 2. da postoje tzv. “maskirane depresije” ili “depresivni ekvivalenti” u koje su uključivani različiti tipovi emocionalnih problema i poremećaja ponašanja za koje se smatralo da u osnovi imaju depresiju kao glavni uzrok. Veliki depresivni poremećaj čest je i ozbiljan poremećaj čiji je početak često u djetinjstvu. Distimija je blaži, ali više kroničan depresivni poremećaj koji također može započeti u djetinjstvu ili adolescenciji. Depresija je povezana s povećanim rizikom od drugih psihijatrijskih poremećaja, slabim akademskim, socijalnim i radnim funkcioniranjem, zloupotrebom različitih sredstava ovisnosti i suicidom. Komorbidni psihijatrijski poremećaji povećavaju rizik od povratne depresije, duljeg trajanja depresivne epizode, od povećanja broja pokušaja suicida, pogoršavaju funkcionalni ishod, umanjuju odgovor na tretman, povećavaju rizik od drugih medicinskih problema i umanjuju vjerojatnost korištenja službi mentalnog zdravlja. Važno je prepoznati i što točnije dijagnosticirati depresiju i eventualne komorbidne poremećaje u djece i adolescenata kako bi se što ranije moglo započeti s liječenjem. Najdjelotvorniji je multimodalni tretman koji nije usmjeren samo na depresivne simptome, nego na sve probleme u funkcioniranju. U liječenju djece i adolescenata s depresijom medikacija je rijetko, ako ikada, indicirana kao jedina terapijska strategija, izolirana od psihosocijalnih intervencija. Multimodalni i rani tretman može umanjiti rizik od kroničnoga psihosocijalnog oštećenja.Two extreme beliefs have been dominant for a long time, i.e. 1. that children and adolescents cannot suffer from depressive disorders or 2. that there are the so-called “masked depressions” or “depressive equivalents”, which included different types of emotional and behavioural disorders considered to have depression as their main underlying cause. A major depressive disorder is a frequent and serious disorder, with the onset often in childhood. Dystimia is a mild, but chronic depressive disorder that may also start in childhood or adolescence. Depression is associated with an increased risk of other psychiatric disorders, poor academic, social and work functioning, abuse of various addictive substances and suicide. Psychiatric comorbidities increase the risk of recurrent depression, prolonged depressive episodes, and higher incidence of suicide attempts. They aggravate the functional outcome, reduce treatment response, increase the risk of other medical problems and reduce the possibility of use of mental health services. Depression and possible comorbidities should be recognized and diagnosed as early as possible in children and adolescents in order to enable the timely onset of treatment. The most efficient treatment is a multimodal treatment that is not focused on depressive symptoms only, but also on all problems in functioning. Medication is rarely, if ever, indicated as the only therapeutic strategy, isolated from psychosocial interventions, in the treatment of children and adolescents with depression. Multimodal and early treatment can reduce the risk of chronic psychosocial damages

EMOTIONAL AND BEHAVIORAL PROBLEMS AMONG ADOLESCENTS REFERRED TO CHILD AND ADOLESCENT MENTAL HEALTH SERVICES IN CROATIA

Uvod: Problemi mentalnog zdravlja su rastući problem u društvu. Uzimajući u obzir da se više od 50% psihijatrijskih bolesti u odrasloj životnoj dobi razvilo i progrediralo već u vrijeme adolescencije, poboljšanje zaštite mentalnog zdravlja među mladima je područje kojem je potrebno dati poseban fokus i značaj, posebice po pitanju prevencije i rane dijagnoze. Obiteljski liječnici su prvi koji imaju mogućnost prepoznati potencijalne probleme mentalnog zdravlja među mladima i uputiti ih službama za zaštitu mentalnog zdravlja ako je potrebno. Ova studija je provedena kako bismo dobili uvid u samoprocjenu mentalnog statusa adolescenata upućenih na liječenje te kako bismo u skladu s rezultatima prilagodili i planirali preventivne mjere u primarnoj praksi. Cilj istraživanja je bio odrediti najistaknutije emocionalne i ponašajne probleme među adolescentima i mjere koje mogu biti poduzete po pitanju prevencije i rane dijagnoze tih problema u primarnoj praksi. Metode: Napravili smo presječno istraživanje ne-kliničkog i kliničkog (u trenutku prvog kontakta sa službom za mentalno zdravlje) uzorka od 334 adolescenta, muški spol N=147, ženski spol N=187, u dobi od 14 do 18 godina i usporedili podatke na ljestvicama sindroma između dva uzorka i razlike među spolovima u svakoj grupi. Koristili smo Skalu samoprocjene ponašanja mladih (Achenbach & Rescorla, 2001). Rezultati: Ukupni rezultati su pokazali statistički značajan porast u rezultatima skala kliničke populacije u usporedbi s ne-kliničkom populacijom (F(1,330)=107,976; p<,01), s višim porastom među adolescenticama (F(1,330)=15,892; p<,01). Postoji značajan porast u kliničkoj populaciji u svim skalama: somatske tegobe, anksioznost/depresija, socijalni problemi, problem mišljenja, povlačenje, problemi s koncentracijom, delikventna ponašanja, agresivnost, internalizacija i eksternalizacija, sa značajnim interakcijama spola i skupine u nekim skalama. Zaključak: Emocionalni i bihevioralni problem su učestali u adolescenata upućenih u institucije za zaštitu mentalno zdravlje. Obiteljski liječnici bi trebali aktivno surađivati sa stručnjacima za mentalno zdravlje kako bi razvili aktivnosti koje bi ohrabrile problematične adolescente da pristupe službama za mentalno zdravlje što ranije i na taj način doprinijeti ranoj dijagnozi i prevenciji progresije mentalnih poremećaja.Introduction: Mental health problems are an increasing issue in the society. Considering that over 50% of psychiatric diseases in adults have developed or progressed in time of adolescence, improvement of youth mental health care is a special area of focus, especially in terms of prevention and early diagnosis. GPs often have the opportunity to be the first to recognize a possible mental health problem and refer adolescents to Child and Adolescent Mental Health Services if needed. We conducted this study to gain insight in self-assessed mental status of referred adolescents in order to adjust and plan prevention measures in general practice accordingly. The aim was to determine the most prominent emotional and behavioral problems among adolescents and measures that can be undertaken in terms of prevention and early diagnosis of such problems in general practice. Methods: We performed a cross-sectional study of non-clinical and clinical (at the point of their first contact with mental health service) sample of 334 adolescents, males N=147, females N=187, aged 14-18, and compared the data on the syndrome scales between two samples and male and female adolescents in every group. We used Youth Self Report (Achenbach & Rescorla, 2001). Results: There was a significant increase in findings in clinical population compared to non-clinical one in overall results (F(1,330)=107,976; p<,01), with higher results for females (F(1,330)=15,892; p<,01). There is a significant increase in clinical population in all scales: Somatic Complaints, Anxious/Depressed, Social problems, Thought Problems, Withdrawn, Attention Problems, Delinquent Behavior, Aggressive Behavior, Internalizing and Externalizing, with significant interactions of sex and group in some scales. Conclusion: Emotional and behavioral problems are frequent in referred adolescents. GPs should actively collaborate with mental health professionals to develop activities which would encourage troubled adolescents to approach mental health services earlier and in that way contribute to early diagnosis and prevention of progression of mental disorders

Trichotillomania and comorbidity in adolescents: two case reports

Trihotilomanija je relativno rijedak poremećaj. U Dijagnostičkom i statističkom priručniku mentalnih poremećaja (DSM-V, 2013.) svrstan je u skupinu s opsesivno-kompulzivnim i njemu srodnim poremećajima. Trihilomanija ima i karakteristike poremećaja impulsa i navika. Prvi simptomi trihilomanije najčešće se pojavljuju u adolescenciji. Klinička slika u djece i adolescenata često je komplicirana postojanjem komorbiditeta. Najčešće opisivani komorbiditet su anksioznost i depresija iz područja osjećaja i raspoloženja, a rjeđi su tikovi, hiperkinetski i opsesivno-kompulzivni poremećaj, različiti oblici regresivnog ponašanja i neki drugi. Prikazana su dva bolesnika kod kojih je prepoznavanje poremećaja bilo otežano time što djeca i adolescenti nerado priznaju trihilomaniju, a daljnje liječenje bilo je dijelom multidisciplinarno i u mnogo čemu je ovisilo o komorbiditetu. U prvom prikazu etiopatogeneza je najvećim dijelom emocionalna. U drugom prikazu prateći poremećaj je iz skupine neurorazvojnih poremećaja. Odabir psihoterapijske tehnike i širi pristup liječenju u cijelosti su ovisili o komorbiditetu i zahtjevali su suradnju dječjeg psihijatra sa stručnjacima iz drugih područja pedijatrijske medicine. Mislimo da istraživanja ovog poremećaja treba ustrajno i dalje usmjeravati otkrivanju izravne i druge povezanosti trihilomanije i komorbiditeta, kako bi se omogućilo što primjerenije i učinkovitije prepoznavanje i liječenje ovog poremećaja.Trichotillomania (TTM) is a relatively rare disorder. In recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013), TTM is classifi ed in the group including obsessive-compulsive and related disorders. TTM also has some characteristics of the disorders of impulses and habits. Initially, TTM symptoms usually occur during adolescence. The clinical picture in children and adolescentsis often complicated by the presence of comorbidity. In children and adolescents, the most common comorbidity is in the domain of aff ect, specifi cally depression and anxiety. Rarely described comorbidities are tics, hyperkinetic disorder, obsessive-compulsive disorder, various forms of regressive behavior, and some others. In the two cases reported, recognizing TTM was impeded. Specifi cally, children and adolescentsreluctantly acknowledge TTM, so recognizing and further treatment was in many ways multidisciplinary and depended on the comorbidity. In the fi rst case, the etiopathogenesis is mostly emotional. In the second case, the associated disorder is from the group of neurodevelopmental disorders. The choice of psychotherapeutic techniques and broader approach to the treatment entirely depended on the comorbidity and also required cooperation of experts from other areas of pediatric medicine. We believe that research should persistently be focused on discovering direct and other relationships of TTM and comorbidity in order to allow for the most appropriate and eff ective recognizing and treatment of this disorder

Reliability and validity of the Croatian version of Consultation and Relational Empathy (CARE) Measure in primary care setting

Aim To translate the Consultation and Relational Empathy (CARE) Measure into Croatian and validate the Croatian version of the questionnaire. Methods A cross-sectional study was conducted in July 2011 in 8 general practices (GP) in Croatia. Following two stages of translation, back-translation, and pilot testing, the Croatian version of the CARE was tested on 568 consecutive patients. Results Face validity was high, the number of missing values was low (9%), and the internal consistency (Cronbach’s alpha) was 0.77. A principal component analysis of 10 CARE Measure items extracted two components with eigenvalues >1. These two components explained 43.6% of the total instrument variance. Conclusion The Croatian version of the CARE Measure had acceptable reliability and face validity, but its intended component structure was not reproduced and further research is needed to understand its dimensionality. Receive

Correction to: The child and adolescent psychiatry: study of training in Europe (CAP‑STATE)

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Psychopathological features of adolescents who self-harm

Uvod: Ciljevi istraživanja bili su istražiti pojavnost nekih unutranjih (psihičke karakteristike i poteškoće, mehanizmi obrane, aleksitimija) i vanjskih čimbenika (nepovoljna razvojna, obiteljska iskustva, funkcioniranje u školi i grupi vršnjaka, kršenje pravila) u adolescenata sa samoozljeđujućim ponašanjem koja ih razlikuju u odnosu na adolescente koji ne pokazuju samoozljeđujuće ponašanje. Ispitanici: U istraživanju je sudjelovalo 150 adolescenta u dobi od 14 do 18 godina. Nakon inicijalnog razgovora sa dječjim i adolescentnim psihijatrom i ispunjavanja samoocjenskih upitnika podijeljeni su skupinu sa (24 ispitanika i 55 ispitanica) i bez samoozljeđujućeg ponašanja (45 ispitanika i 26 ispitanica). Korišteni su mjerni instrumenti: Semistrukturirani klinički intervju za djecu i adolescente, Opći upitnik, Torontska skala aleksitimije, Upitnik povezanosti s roditeljima, Upitnik o obrambenim stilovima, Prilagođena skala funkcionalne procjene samomutilacije, Izvješće za mlade od 11 do 18 godina Rezultati: Kod ispitanica samoozljeđujuće ponašanje je povezano sa smanjenom roditeljskog brigom, pogotovo oca, intenzivnom depresivnošću u komorbiditetu s eksternalizirajućim tegobama, značajno lošijim funkcioniranjem u grupi vršnjaka, korištenjem više nezrelih i manje zrelih mehanizama obrane, latentnom aleksitimijom. Kod ispitanika samoozljeđujuće ponašanje povezano je s kroničnom bolešću i prezastičnički roditeljskim stilom majke, s korištenjem nezrelijih mehanizama obrane, aleksitimičnim smetanjama, komorbiditetom visoke razine eksternalizirajućih i subsindromalnih internalizirajućih smetnji, teškoćama u vršnjačkim grupama (interpersonalna i identitetna funkcija samoozljeđivanja). Rezultati sindromskih skala su svih ispitanika imali kliničku razinu. Zaključak: Postoje psihopatološke i okolinske specifičnosti kod adolescenata sa samoozljeđivanjem. Njihovo poznavanje nužno je za planiranje, razvijanje i provođenje prilagođenih preventivnih i kurativnih programa koji za sada ne postoje u Republici Hrvatskoj.Introduction: Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels. Materials and methods: During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females. Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender. Conclusion Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk

Psihopatološke specifičnosti adolescenata sa samoozljeđujućim ponašanjem [Psychopathological features of adolescents who self-harm]

Introduction: Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels. Materials and methods: During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females. Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender. Conclusion Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk

Psychopathological features of adolescents who self-harm

Uvod: Ciljevi istraživanja bili su istražiti pojavnost nekih unutranjih (psihičke karakteristike i poteškoće, mehanizmi obrane, aleksitimija) i vanjskih čimbenika (nepovoljna razvojna, obiteljska iskustva, funkcioniranje u školi i grupi vršnjaka, kršenje pravila) u adolescenata sa samoozljeđujućim ponašanjem koja ih razlikuju u odnosu na adolescente koji ne pokazuju samoozljeđujuće ponašanje. Ispitanici: U istraživanju je sudjelovalo 150 adolescenta u dobi od 14 do 18 godina. Nakon inicijalnog razgovora sa dječjim i adolescentnim psihijatrom i ispunjavanja samoocjenskih upitnika podijeljeni su skupinu sa (24 ispitanika i 55 ispitanica) i bez samoozljeđujućeg ponašanja (45 ispitanika i 26 ispitanica). Korišteni su mjerni instrumenti: Semistrukturirani klinički intervju za djecu i adolescente, Opći upitnik, Torontska skala aleksitimije, Upitnik povezanosti s roditeljima, Upitnik o obrambenim stilovima, Prilagođena skala funkcionalne procjene samomutilacije, Izvješće za mlade od 11 do 18 godina Rezultati: Kod ispitanica samoozljeđujuće ponašanje je povezano sa smanjenom roditeljskog brigom, pogotovo oca, intenzivnom depresivnošću u komorbiditetu s eksternalizirajućim tegobama, značajno lošijim funkcioniranjem u grupi vršnjaka, korištenjem više nezrelih i manje zrelih mehanizama obrane, latentnom aleksitimijom. Kod ispitanika samoozljeđujuće ponašanje povezano je s kroničnom bolešću i prezastičnički roditeljskim stilom majke, s korištenjem nezrelijih mehanizama obrane, aleksitimičnim smetanjama, komorbiditetom visoke razine eksternalizirajućih i subsindromalnih internalizirajućih smetnji, teškoćama u vršnjačkim grupama (interpersonalna i identitetna funkcija samoozljeđivanja). Rezultati sindromskih skala su svih ispitanika imali kliničku razinu. Zaključak: Postoje psihopatološke i okolinske specifičnosti kod adolescenata sa samoozljeđivanjem. Njihovo poznavanje nužno je za planiranje, razvijanje i provođenje prilagođenih preventivnih i kurativnih programa koji za sada ne postoje u Republici Hrvatskoj.Introduction: Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels. Materials and methods: During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females. Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender. Conclusion Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk

Psychopathological features of adolescents who self-harm

Uvod: Ciljevi istraživanja bili su istražiti pojavnost nekih unutranjih (psihičke karakteristike i poteškoće, mehanizmi obrane, aleksitimija) i vanjskih čimbenika (nepovoljna razvojna, obiteljska iskustva, funkcioniranje u školi i grupi vršnjaka, kršenje pravila) u adolescenata sa samoozljeđujućim ponašanjem koja ih razlikuju u odnosu na adolescente koji ne pokazuju samoozljeđujuće ponašanje. Ispitanici: U istraživanju je sudjelovalo 150 adolescenta u dobi od 14 do 18 godina. Nakon inicijalnog razgovora sa dječjim i adolescentnim psihijatrom i ispunjavanja samoocjenskih upitnika podijeljeni su skupinu sa (24 ispitanika i 55 ispitanica) i bez samoozljeđujućeg ponašanja (45 ispitanika i 26 ispitanica). Korišteni su mjerni instrumenti: Semistrukturirani klinički intervju za djecu i adolescente, Opći upitnik, Torontska skala aleksitimije, Upitnik povezanosti s roditeljima, Upitnik o obrambenim stilovima, Prilagođena skala funkcionalne procjene samomutilacije, Izvješće za mlade od 11 do 18 godina Rezultati: Kod ispitanica samoozljeđujuće ponašanje je povezano sa smanjenom roditeljskog brigom, pogotovo oca, intenzivnom depresivnošću u komorbiditetu s eksternalizirajućim tegobama, značajno lošijim funkcioniranjem u grupi vršnjaka, korištenjem više nezrelih i manje zrelih mehanizama obrane, latentnom aleksitimijom. Kod ispitanika samoozljeđujuće ponašanje povezano je s kroničnom bolešću i prezastičnički roditeljskim stilom majke, s korištenjem nezrelijih mehanizama obrane, aleksitimičnim smetanjama, komorbiditetom visoke razine eksternalizirajućih i subsindromalnih internalizirajućih smetnji, teškoćama u vršnjačkim grupama (interpersonalna i identitetna funkcija samoozljeđivanja). Rezultati sindromskih skala su svih ispitanika imali kliničku razinu. Zaključak: Postoje psihopatološke i okolinske specifičnosti kod adolescenata sa samoozljeđivanjem. Njihovo poznavanje nužno je za planiranje, razvijanje i provođenje prilagođenih preventivnih i kurativnih programa koji za sada ne postoje u Republici Hrvatskoj.Introduction: Self-harming behavior is prevalent both in community and in clinical population of adolescents. Potential negative outcomes of such behavior range from low quality of life, academic failure, development of mental health problems in later life to risk of suicide attempts and completition. Broadening and deepening of understanding of psychopathological and enviromental background and function of self-harming behavior is needed. Main goal of this study was identification of psychopathological features in referred adolescents with self-harming behavior which differentiate them from referred adolescents who do not engage self-harming behavior. Data provided with this study could be used in planning, preparing and conducting optimized treatment programs for adolescents and their caregivers, on primary and secondary prevention and treatment levels. Materials and methods: During their initial interview with an child and adolescent psychiatrist adolescents filled out self-rated questionnaires. General questionnaire (with detailed family history), Youth Self Report, (ASEBA, 2001.), Functional Assessment of Self Mutilation (Lloyd E.,1997) - Adapted and modified, Parental bonding instrument (Parker, 1979.), Toronto Alexithymia Scale 20 (Taylor, 1992.) and Defense Style Questionnaire (Bond, 1983.). One hundred and fifty adolescents, 54% female, 46 % male (14–18 years old, median age 17 years) participated in the study. Exclusion criteria were psychotic disorders, cognitive impairment, pervasive spectrum, psychiatric emergency. They were assigned to two groups according to self-harming status. In the self-harming group there were 24 males i 55 females, and in the non self-harming group there were 45 males and 26 females. Results: Self-harming behavior among females, compared to non self-harming group, corelates with low parental, especially paternal, care, commorbidity of depressive and externalising problems (clinical level on all YSR problem scales, except aggression), poor peer relationships, usage of immature defense mechanisms, and latent alexithymia. Self-harming behavior had negative interpersonal function. Self-harming behavior among males was correlated with maternal chronic illnes, maternal overprotection, commorbidity of externalising and latent internalising problems, usage of immature defense mechanisms, significant alexithymic difficulties, poor peer functioning. Self-harming behavior had positive interpersonal and identity and identification seeking function. Predominant parental style in both groups with self-harming behavior was affectionless control. Clinical levels of YSRs’ Total problems scale were found in both gender. Conclusion Self-harming behavior is prevalent among adolescents. Affected adolescents carry heavy psychopathological burden, with a risk for numerous negative events and outcomes including fatality. It has diverse, individually specific manifestations and functions which complicates research, understanding and clinical work. Hence, there are no specific, standardized preventive measures and treatment strategies developed yet. Interventions dealing with self-harming behavior should encompass multidisciplinary and multilevel approach, significant others need to be actively included in the process. Close follow-up and availability of help is needed because of the suicidal risk