![]() ![]() Lack of synchrony with modern medical approaches to diagnostic thresholds. 256 different ways to diagnose a Borderline PD). The rationale for a substantial change referred to six arguments :Įxtensive co-occurrence among PDs (having one PD diagnosis is associated with a high risk to fulfil the criteria of other PD diagnoses).Įxtreme heterogeneity among patients receiving the same diagnosis (e.g. From DSM-IV to DSM-5ĭuring the development of the current revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), that has been published in May 2013, there was discussion to change the classification of personality disorders (PD) from that in the DSM-IV-TR. Currently five manualized approaches for the therapy of adolescents with personality disorders are available: Dialectical Behavior Therapy DBT-A, Cognitive-Analytic Therapy (CAT), Emotion Regulation Training for Adolescents (ERT), Mentalization Based Treatment (MBT-A) and Adolescent Identity Treatment (AIT). Along with the higher acceptance of PD diagnoses in adolescents in the last decade there is substantial progress of specific psychotherapies for adolescents by adapting approaches that had been developed for adult populations. The use of PD diagnoses before adulthood is of high importance for the development of therapeutic approaches that can address this special kind of pathology with developmentally appropriate therapeutic techniques. Reliability, validity, and temporal stability of BPD-diagnoses in adolescents are similar to those in adulthood. If symptoms of Borderline Personality Disorder (BPD) are assessed already in early adolescence, the prevalence rate of BPD in an epidemiological sample of 11 year old children was 3.2%. DSM-5 states cautiously that “Personality disorder categories may be applied with children or adolescents in those relatively unusual instances in which the individual’s particular maladaptive personality traits appear to be pervasive, persistent, and unlikely to be limited to a particular developmental stage or another mental disorder.” (, p. The diagnostic criteria of both, ICD-10 and DSM-IV-TR, define personality disorders to begin in childhood or adolescence. ![]() Personality pathology seems to be highest before the age of 20, with a decline of most of the pathological features (especially in the Cluster B domain) over time. In spite of the reluctance of many clinicians to use the diagnosis before the age of 18, there is a constantly growing body of evidence that PDs can be diagnosed already in adolescence. In their developmental considerations for the new DSM system Tackett and colleagues describe a life span perspective of personality pathology from early childhood to later life. In two case examples we will illustrate impairment of identity integration in adolescent patients with personality disorders (PD). Understanding the development of identity from a psychological perspective and how it is integrated in the new DSM-5 classification system are the focus of this paper. Experience is constituted by the subjective, emotional “I” while perception is the basis of coherence and the definitory “Me”. Identity is related to the individual’s “selfsameness and continuity in time”, and the others’ recognition of these qualities also. The emergence of the self in childhood and adolescence is based on experience and perception, which then becomes organized into identity, which organizes further experience and perception. The relevance of identity problems in assessing and understanding personality pathology is illustrated using the new classification system applied in two case examples of adolescents with a severe personality disorder. With this dimensional approach, the new classification system gives, both clinicians and researchers, the opportunity to describe the patient in much more detail than previously possible. ![]() Pathological personality traits are assessed in five broad domains which are divided into 25 trait facets. The alternative model’s hybrid nature leads to the simultaneous use of diagnoses and the newly developed “Level of Personality Functioning-Scale” (a dimensional tool to define the severity of the disorder). However, an alternative model for diagnosing personality disorders where the construct “identity” has been integrated as a central diagnostic criterion for personality disorders has been placed in section III of the manual. In the revised Diagnostic and Statistical Manual DSM-5 the definition of personality disorder diagnoses has not been changed from that in the DSM-IV-TR. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |