Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care

75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg's theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg's theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.     

The structure of axis II disorders in adolescents: a cluster- and factor-analytic investigation of DSM-IV categories and criteria

The aim of this study was to ascertain whether the structure of personality disorder (PD) symptoms in adolescents assessed using DSM-IV diagnoses and diagnostic criteria resembles the structure intended for the diagnosis of PDs in adults. A national sample of clinicians rated DSM-IV Axis II criteria on 294 adolescent patients in treatment for enduring maladaptive personality patterns. Cluster analysis replicating procedures used in an adult sample by Morey (1988) identified considerable similarity between adult and adolescent PDs, as did exploratory factor analysis of ratings of diagnostic criteria, which yielded ten empirically derived factors that resembled the ten DSM-IV PDs. Cluster analysis and confirmatory factor analysis with indicators of Axis II symptoms produced mixed results in replicating the DSM-IV hierarchical structure of PDs (Clusters A, B, and C), although hierarchical models generally fared better than models specifying only first-order factors or clusters. The structure of personality pathology as assessed by Axis II criteria in adolescents resembles that outlined in DSM-IV Axis II for adults, suggesting that PDs can be assessed in adolescents as in adults. Whether this is an optimal way of diagnosing personality pathology in adolescence, however, requires further investigation.     

Gender differences in a clinical sample of patients with borderline personality disorder

The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to Axis I comorbidity, Axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised [NEO-PI-R] and the Dimensional Assessment of Personality Profile Basic questionnaire [DAPP-BQ]). Fifty-seven men and 114 women with BPD were included in the study. Regarding Axis I and II disorders in an exploratory analysis, men with BPD more often fulfilled the diagnostic criteria for binge eating disorder, antisocial personality disorder, narcissistic personality disorder, and conduct disorder in childhood, whereas women had higher frequencies of bulimia nervosa, posttraumatic stress disorder, and panic disorder with agoraphobia. After correcting for multiple tests, only the gender differences in narcissistic and antisocial personality disorder remained significant. In the SCL-90-R profile, no significant gender differences could be identified. In the exploratory analysis of the dimensional personality traits, women showed higher rates on the NEO-PI-R main factors (Neuroticism and Agreeableness) compared to men. In the DAPP-BQ profile, men reached higher sores on the main factor, Dissocial Behavior. When correcting for multiple tests, gender differences still existed for Neuroticism and Dissocial Behavior. Our results argue for gender differences in Axis I and II comorbidity and dimensional personality traits in BPD. However, in general, more similarities than differences were shown in this study.     

Gender subgroups and intergroup perception: adolescents' views of own-gender and other-gender groups

The authors examined intergroup bias and perceived group variability regarding gender subgroups relevant to the adolescent culture. Participants were 126 high school students, between 16 years and 19 years of age, who listed male and female subgroups, performed a series of group perception tasks, and, for each subgroup, indicated whether they themselves belonged to the group. Results showed that adolescents' perceptions of gender subgroups were subject to in-group favoritism and out-group derogation, as well as to group homogeneity effects. In line with predictions derived from Optimal Distinctiveness Theory, male and female participants favored in-groups over own-gender and other-gender out-groups and favored other-gender out-groups over own-gender outgroups. Ambivalence was particularly high with other-gender out-groups. The authors discussed implications for future research on the development of gender prejudice and for interventions to reduce prejudice.     

Gender and Age Group Differences in Mass Media and Interpersonal Influences on Body Dissatisfaction Among Chinese Adolescents

Despite evidence that middle adolescent girls (ages 14–17) experience more body dissatisfaction than early adolescent girls (ages 10–13) or boys at these ages, researchers have rarely considered whether such differences are observed regarding factors related to body dissatisfaction, particularly within non-Western samples. To address this issue, gender and age group differences in media and interpersonal influences on body dissatisfaction were assessed among early and middle adolescents living in Chongqing, China. In Study 1, 595 boys and 648 girls completed self report measures of demographics, public self-consciousness and appearance-based social pressure, comparisons, and conversations. Compared to boys, girls reported more appearance pressure from mass media and close interpersonal networks (friends, family), appearance comparisons with peers, and appearance conversations with friends; these effects were qualified by interactions with age group, indicating media and interpersonal factors were more prominent in the lives of middle adolescent girls than other groups. Effects were observed independent of body mass index (BMI) and public self-consciousness. In Study 2, 738 girls and 661 boys completed the same measures and a body dissatisfaction scale. By and large, gender and age differences were replicated. Middle adolescent girls also reported more body dissatisfaction than peers did. Perceived appearance pressure from mass media and interpersonal ties were both implicated in mediation analyses to explain this gender × age group effect.     

Using data augmentation to obtain standard errors and conduct hypothesis tests in latent class and latent transition analysis

Latent class analysis (LCA) provides a means of identifying a mixture of subgroups in a population measured by multiple categorical indicators. Latent transition analysis (LTA) is a type of LCA that facilitates addressing research questions concerning stage-sequential change over time in longitudinal data. Both approaches have been used with increasing frequency in the social sciences. The objective of this article is to illustrate data augmentation (DA), a Markov chain Monte Carlo procedure that can be used to obtain parameter estimates and standard errors for LCA and LTA models. By use of DA it is possible to construct hypothesis tests concerning not only standard model parameters but also combinations of parameters, affording tremendous flexibility. DA is demonstrated with an example involving tests of ethnic differences, gender differences, and an Ethnicity x Gender interaction in the development of adolescent problem behavior.     

Peer group membership and a sense of belonging: their relationship to adolescent behavior problems

This study explored three aspects of peer group membership in adolescence: peer group affiliation, the importance of group membership, and a sense of peer group belonging. Each is considered in relationship to adolescents' behavior problems as measured by the Achenbach Youth Self-Report. Participants included an ethnically and socioeconomically diverse sample of 733 adolescents ranging in age from 11 to 18 years. Girls reported more internalizing problems and boys reported more externalizing problems. Girls also reported a higher sense of peer group belonging than boys. When controlling for adolescent age, gender, ethnicity, parent's educational level, and family structure, a sense of peer group belonging was negatively related to internalizing and externalizing behavior problems. Adolescents who viewed peer group membership as very important to them and had a positive sense of peer group belonging had significantly fewer behavior problems than those who viewed peer group membership as very important but did not have a positive sense of peer group belonging.     

Personality disorders in patients with burning mouth syndrome

Burning Mouth Syndrome (BMS) presents high rates of comorbid Axis I disorders while no controlled studies have addressed the question of Axis II comorbidities. The aim of the present study was to examine DSM-IV (APA, 1994) Axis II comorbidity in BMS patients and to control for the specificity of this association. Seventy BMS patients were compared to a nonpsychiatric population sample and to patients with other Somatoform Disorders for the presence of personality disorders (assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders [SCID-II; First, Gibbon, Spitzer, & Williams, 1997). Prevalence rates were compared using the Pearson's chi square test. At least one personality disorder (PD) was found in 85.7%, 24.3%, and 88.6% of subjects in the three groups, respectively. When examining PD subgroups, significant differences emerged even between the BMS and the somatoform disorder group, with BMS patients showing more Cluster A and fewer Cluster B PDs. Our results suggest that BMS is associated with a specific pattern of Axis II comorbidity.     

Two-year stability of personality disorder in older adolescent outpatients

The 2-year stability of categorical and dimensional personality disorder (PD) in an older adolescent psychiatric outpatient sample was examined. One hundred and one 15-18-year-old participants were assessed using the Structured Clinical Interview for DSM Axis II Disorders (SCID-II) at baseline and 97 were re-interviewed, face-to-face, at 2 years. Of those with a categorical PD diagnosis at baseline, 74% still met criteria for a PD at follow-up, with marked gender differences (83% of females and 56% of males). Kappa for specific PDs was low for all except antisocial. Rank order and mean level dimensional stability ranged from high (antisocial, schizoid) to moderate (borderline, histrionic, schizotypal) to low (other PDs), with no decline in PD scores over the 2 years. There was no substantial influence upon stability of dimensional PD from the presence of Axis I disorder at baseline or from outpatient or inpatient treatment. However, categorical PD endured in 100% of those receiving inpatient care. The study supports that, in late teenage outpatients, the 2-year stability of the global category of PD is high and the stability of dimensionally rated PD appears to be similar to that found in young adults in a variety of settings, especially for some cluster A and B PDs. Diagnosis and early intervention appears to be justified in this age group.     

Differences in Adjustment Issues for Male and Female Adolescents

In this article, the matter of gender differences that influence adolescent development is considered by means of an empirical investigation. Implications of the results are discussed for parents, teachers, and special services professionals.     

The Collaborative Longitudinal Personality Disorders Study: development, aims, design, and sample characteristics

This paper describes the aims, background, design, and methods used in a collaborative longitudinal study of Axis II personality disorders (PDs). This study examines the putative stability of selected PD diagnoses and criteria, what factors affect their course, and whether their stability and course distinguishes them from a representative Axis I disorder. This article also describes the acquisition and demographics of the sample on whom the study is being done. A prospective, repeated measures investigation of the stability of PDs is now underway at multiple clinical settings in four collaborating urban sites in Boston. New Haven, New York, and Providence. Diagnostic assignments are based on semistructured interview assessments (by clinically trained raters) and confirmed by at least one additional contrasting diagnostic method. The sample consists of 668 treatment seeking and reliably diagnosed adults recruited from a broad range of clinical sites. By design, patients in the sample met standards for one of five diagnostic subgroups: (a) schizotypal (N = 86); (b) borderline (N = 175); (c) avoidant (N = 157); (d) obsessive-compulsive (N = 153) personality disorders or a control group having (e) major depressive disorder without personality disorder (N = 97).     

The Influence of Multiple Group Identities on Moral Foundations

Moral foundations theory provides a theoretical framework for understanding the universal and societal aspects of morality. The focus thus far has been on understanding the influence of group categories on moral foundations by controlling for relevant factors and then examining the unique contribution of a single factor. Although this type of analysis was critical to demonstrate the efficacy of the Moral Foundations Theory and Moral Foundations Questionnaire (MFQ), the current study examines moral responses from the intersection of culture, ethnic identity and gender group membership in the United States and India. Significant results suggest that moral foundations are better understood through a multiple group identity perspective and that the MFQ is equipped to capture differences in moral foundations within subgroups.     

Multivariate modelling and personality organization: A comparative study of the Defense Mechanism Test and linguistic expressions

The main aim of the study is to establish an empirical connection between perceptual defences as measured by the Defense Mechanism Test (DMT)–a projective percept-genetic method–and manifest linguistic expressions based on word pattern analyses. The subjects were 25 psychiatric patients with the diagnoses neurotic personality organization (NPO), borderline personality organization (BPO) and psychotic personality organization (PPO) in accordance with Kernberg's theory. A set of 130 DMT variables and 40 linguistic variables were analyzed by means of partial least squares (PLS) discriminant analysis separately and then pooled together. The overall hypothesis was that it would be possible to define the personality organization of the patients in terms of an amalgam of perceptual defences and word patterns, and that these two kinds of data would confirm each other. The result of the combined PLS analysis revealed a very good separation between the diagnostic groups as measured by the pooled variable sets. Among other things, it was shown that NPO patients are principally characterized by linguistic variables, whereas BPO and PPO patients are better defined by perceptual defences as measured by the DMT method.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Role of meaningful subgroups in explaining differences in perceived variability for in-groups and out-groups.

Five aspects of the complexity of the knowledge representation of business and engineering majors were examined to see whether these differed by group membership and whether these differences were related to differences in perceived variability. Significantly more subgroups were generated when describing the in-group than the out-group; this difference predicted the relative tendency to see the in-group as more variable, and when controlled for statistically, out-group homogeneity effects were eliminated. Familiarity, redundancy, number of attributes used to describe the group, and the deviance of the subgroups from the larger group generally showed differences for in-group and out-group but did not show consistent evidence of mediation. In a 2nd study, Ss who were asked to sort group members into meaningful subgroups perceived greater variability relative to those who did not perform the sorting task.     

Profiles of Contextual Risk at Birth and Adolescent Substance Use

This study examined whether there are subgroups of families with distinct profiles of prenatal/birth contextual risk, and whether subgroup membership was differentially related to adolescent substance use. Data from the Northern Finland Birth Cohort 1986 were used. A five-class model provided the most meaningful solution. Large Family Size (7.72%) and Low Risk (69.69%) groups had the lowest levels of alcohol, cigarette, and illegal drug use. Similar high levels for each of the three substance-related outcomes were found for Parent Substance Misuse (11.20%), Maternal School Dropout (4.66%), and Socioeconomic Disadvantage (6.72%) groups. Maternal smoking and drinking while pregnant and paternal heavy alcohol use were found to be key prenatal risk factors that tended to cluster together and co-occur with other prenatal risk factors differently for different subgroups of youth.     

Does subgroup membership information lead to better estimation of true subscores?

Haberman (2008) suggested a method to determine if subtest scores have added value over the total score. The method is based on classical test theory and considers the estimation of the true subscores. Performance of subgroups, for example, those based on gender or ethnicity, on subtests is often of interest. Researchers such as Stricker (1993) and Livingston and Rupp (2004) found that the difference in performance between the subgroups often varies over the different subtests. We suggest a method to examine whether the knowledge of the subgroup membership of the examinees leads to a better estimation of the true subscores. We apply our suggested method to data from two operational testing programmes. The knowledge of the subgroup membership of the examinees does not lead to a better estimation of the true subscore for the data sets.     

Identifying Changes in Youth's Subgroup Membership Over Time Based on Their Targeted Communication About Substance Use with Parents and Friends

Using latent class/transition analyses, this study: (a) identified subgroups of youth based on their targeted communication about substance use with parents and friends, (b) examined subgroup differences in substance use, and (c) considered changes in subgroup membership over four years. Among 5,874 youth, five subgroups emerged, with parents‐only communicators having the lowest substance use. Friends‐only and consequence‐focused communicators reported the overall highest use. Subgroup membership was mostly stable across the four years. If, however, youth transitioned, those who began as parents‐only, consequence‐focused, or friends‐only communicators during the first year were most likely to transition to comprehensive communicators by the last year. Youth who started as noncommunicators or comprehensive communicators were most likely to end up as parents‐only communicators.     

Emotional risk factors and postconcussional disorder

Emotional risk factors were examined in 129 litigant and nonlitigant patients diagnosed with Postconcussional Disorder (PCD) following Mild Traumatic Brain Injury (MTBI). According to Millon Clinical Multiaxial Inventory (MCMI) criteria, four subgroups emerged: (a) 14.7% met criteria for an Axis I disorder, (b) 24.8% for an Axis II disorder, (c) 24.0% for bout Axis I and II disorders, and (d) 36.4% fell below threshold for psychopathology. Thus, 63.5% endorsed emotional pathology. Of the four groups, those with both Axis I and II psychopathology presented the greatest number of emotional complaints in a clinical interview and manifested the lowest neurocognitive test scores. Motor skills, verbal abilities, memory functioning, and IQ were primarily affected. With the exception of post-morbid emotional complaints, no significant differences were identified between litigants and nonlitigants. Our analysis suggests that the combination of both Axis I and II psychopathology is associated with greater impairment following MTBI.