Personality Development Disorder

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In child and adolescent psychiatry, a personality development disorder is a pre-form or risk constellation of a personality disorder in adulthood. Personality disorders are also rarely diagnosed in adolescence.

description

Just as with adults, it is about various persistent patterns of experience and behavior that differ from flexible, situation-appropriate (“normal”) experience and behavior in a characteristic way. They are characterized by relatively rigid mental reactions and forms of behavior, especially in situations that are conflicting for the respective person. Personal and social functioning and performance is impaired.

Personality disorders in adulthood refer to solidified personality traits that appear in a certain constellation and that have been embedded over many years. In the case of children and adolescents, however, it cannot be assumed that personality traits must already be fully developed and stable or persistent. While in adulthood it can be assumed that the personality will no longer change to a large extent, serious personality changes still occur up to the end of adolescence. However, this also represents an opportunity for education and therapy to prevent further consolidation of non-conforming personality traits in good time and to build up more adapted behavioral patterns. Because of these possibilities, and in order to take better account of the developmental aspect of personality, we should not speak of personality disorders in children and adolescents. Instead, these young people are referred to as a personality development disorder or a personality development disorder (Adam & Breithaupt-Peters, 2010).

The term personality development disorder was originally coined by Spiel & Spiel (1987). The authors emphasize that psychodynamically it is about "that during the process of development and differentiation of the personality in the process of becoming, long-lasting circumstances act that lead to foreseeable changes in the formation and configuration of certain traits of personality and personality" (Spiel & Spiel, 1987 , P. 236). So you also emphasize the aspect of personality development and its impairment. (Adam & Breithaupt-Peters, 2010). In the meantime, however, there is a new definition by Adam & Breithaupt-Peters (2010), who break away from the underlying theoretical concept and suggest a redefinition of the term personality development disorder:

definition

A personality development disorder was defined by Adam & Breithaupt-Peters (2010) as a complex problem constellation in children and adolescents,

  • that bears a strong resemblance to adult personality disorders
  • which has already manifested itself over a long period of time (at least one year) and shows a tendency towards chronification
  • which has significant negative effects on several areas of life
  • which cannot be influenced at all or only with difficulty with pedagogical-therapeutic approaches
  • which results in a rather low awareness of problems and / or a feeling of suffering in young people, the effects of which are often difficult to bear for the family and social environment
  • which makes positive social interactions between the person concerned and his environment hardly possible and instead makes social collisions the order of the day
  • which permanently threatens the social integration of the child or adolescent and therefore an impending or already existing mental disability (according to §§ 39, 40, § 3 VO to § 47 BSHG, § 35a SGB VIII and SGB IX) can be assumed.

(quoted from Adam & Breithaupt-Peters, 2010, original definition see Chapter 3)

causes

The causes are as diverse as those of a personality disorder. It is important to look at the causes of the fault from a more perspective. In doing so, biological-neurological causes must be taken into account as well as psychosocial factors. A one-dimensional approach does not go far enough here because the existing disturbance patterns are often far too complex. The therapy of personality development disorder often requires a multi-dimensional approach.

Diagnosis

In the ICD-10, the WHO list, in which all recognized diseases are listed and encoded, no personality development disorders are coded , only personality disorders :

In the DSM-IV , a dissocial personality disorder can only be diagnosed from the age of 18. There is no corresponding age specification in the ICD-10. However, it is mentioned that personality disorders do not finally manifest themselves until adulthood, which is why "... the diagnosis of a personality disorder before the age of 16 or 17 is probably inappropriate". (ICD-10, p. 227)

Adam and Breithaupt ignore the age restrictions of the ICD and the DSM and use the ICD to derive their new diagnosis of personality development disorder.

The diagnosis of personality development disorder in children and adolescents must not be given lightly, but only after an intensive diagnostic process. Before the end of puberty , i.e. before the age of 17 or 18, it should only be given if the behavioral pattern of the personality development disorder is permanent, consistent and across wards.

In addition to the patient's medical history, the diagnosis usually requires questioning the parents, as well as the parents and the patient together, in order to determine the persistence and peculiarity of the symptoms . In doing so, intra-family interaction should also be explored. Since it is often difficult to determine a personality development disorder, the use of specific tests can be helpful. This can also help narrow down the diagnosis. Personality disorders are often comorbid with one another or the criteria of one overlap with another personality disorder. Comorbidities with many other mental disorders are also often found in personality development disorders.

therapy

The diagnosis provides information about the severity and long-term duration of a disorder. Thereafter, treatment concepts can be adapted more specifically to the underlying disorder. In particular, reference should be made to the multidimensional help concept developed by Adam & Breithaupt-Peters (2010). Here, flexibly applicable educational-therapeutic action modules are used in a targeted manner on several levels and checked for effectiveness in the help process.

Therapies can be carried out on an outpatient basis or, if the symptoms are severe, inpatient. In the case of some personality development disorders, attention must also be paid to a possible risk to oneself. In addition to psychotherapy , pharmacotherapy has also proven helpful.

For certain disorders, such as borderline personality development disorders, concepts from the treatment of adults have been adapted - here in particular the dialectical-behavioral therapy according to Marsha Linehan .

literature

  • Albert Adam, Monique Breithaupt-Peters: Personality development disorders in children and adolescents. 2nd Edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021242-8 .
  • Ronald Hoffmann: Affected children and adolescents with a borderline disorder. A practice book for therapy, care and advice. Klett-Cotta, Stuttgart 2002, ISBN 3-608-94314-5 .
  • H. Dilling, W. Mombour, MH Schmidt (Ed.): International classification of mental disorders. 3. Edition. Huber, Bern 1999, ISBN 3-456-83208-7 .
  • Paulina Kernberg, Alan Weiner, Karen Bardenstein: Personality disorders in children and adolescents. Klett-Cotta, Stuttgart 2001, ISBN 3-608-94323-4 .
  • F. Leichsenring, E. Leibing: The effectiveness of psychodynamic psychotherapy and cognitive-behavioral therapy in personality disorders: A meta-analysis. In: American Journal of Psychiatry. 160, 2003, pp. 1223-1232.
  • Rudi Merod: Personality Disorders in Children and Adolescents. DGVT-Verlag, Tübingen 2010, ISBN 978-3-87159-097-9 .

See also

Web links