Adolescent Psychiatry - Volume 3, Issue 3, 2013

Background: The evolution of society towards greater individual freedom, autonomy and questioning of authority is altering the ways in which psychopathology is expressed, and demands a new understanding of psychopathology. As a result of the liberalization of society, there has been an evolution of psychopathology from a pathology of conflict fostered by a repressive society towards a pathology of interpersonal relationships, limits, and dependency. Methods: This article explains how problems formerly viewed as related to aggressive or sexual impulses can now only be envisaged dialectically alongside the issues of identity, limits, and fears of engulfment or of abandonment by persons of trust. Narcissistic injury, and the impact of insecure relationships in early life occupy a central position in the understanding of these pathologies. Conclusions: The capacity for self-awareness has led human beings towards an exponentially increased creative potential, but also towards boundless destructiveness. Both appear as a form of reaction in the face of a threatened territory and humiliated narcissism. Rather than the person's impulses, it is the biological emotional particularities of each person, and the quality of his or her internal security and narcissistic foundation that will determine that person's ability for containment, and the balance of his personality, in a process of constant exchange and co-construction with those around him. Adolescence is a particularly crucial period for the expression of these issues. The weight of constraints, whether biological or social, make the self and the familial and environmental setting central in their management. The person's ability to cope, or conversely his or her liability to be engulfed by trauma, are essential determinants of the prognosis.

Background: In recent years, an increasing interest in personality disorders in childhood and adolescence has been observed. This is partly due to recent findings of temperament, personality and neurobiological research. Method: This article reviews the history of the concept of borderline conditions in children and adolescents, and presents recent evidence from developmental psychology and neurobiology to support the diagnosis in adolescents as a disorder of development. An overview of treatment based on the decades-long experience with these patients at the Tiefenbrunn Clinic in Germany is described. Results: While the term personality disorder implies enduring traits, the evidence suggests that it is relatively unstable in adults as well as adolescents. Concerns about labeling adolescents with a presumably lifelong condition have hampered research on pathogenesis and treatment. Nevertheless, some adolescents with severe impairments in functioning do meet adult criteria for BPD, and do respond to the tailored treatment approaches that have been developed for them. Conclusions: The psychopathology of adolescents with BPD is probably a result of the interaction of the adolescent developmental process and defects in attachment and mentalization similar to those in adults with BPD. The term “developmental borderline personality disorder” is suggested to reflect the fluidity of this condition. Appropriate intervention requires a comprehensive multimodal approach in which individual therapy takes place within a protective framework of boundaries and limits.

Background: Social media use among the child and adolescent population is at an all-time high across the globe. This includes use of networking sites like Facebook and Twitter, online magazines, Internet forums, video sharing communities, and weblogs. It is of paramount importance to assess the impact that social media has on adolescent development. A growing body of research addresses social media’s effects upon adolescent friendships, identities, cognitive growth, and health. Social media use has been demonstrated to have links with adolescent depression, anxiety, substance abuse, and personality disorders. However, studies also suggest that social media may be a useful vehicle for public health education and fostering creativity. Method: We present a review of current literature up to 2012 dealing with social media’s impact upon healthy adolescent development. We also describe various websites available for teenagers to help them deal with problems such as online bullying, and resources for parents and professionals to help educate them about how to guide young people’s use of social media. Conclusions: Through a careful examination of the current evidence, parents, physicians, and social policymakers may determine how to best equip adolescents to use social media as a tool rather than a handicap to becoming a fully functioning adult.

Background: Diabetes is a particularly difficult burden for the young adolescent, who is confronted with a chronic and potentially life-threatening illness in addition to the developmental challenges of adolescence. Adolescents with this illness are at risk for impaired psychosocial functioning as well as poor glycemic control and its many consequences. Method: In this article we describe some aspects of the emotional experience of adolescents aged 12 to 14 who are confronted with the sense of limitation caused by diabetes. These descriptions are based on our observations of youngsters who attended a special summer camp aimed at helping them acquire the ability to manage their clinical condition. This camp also offered the teenagers the opportunity to tell something about themselves, their narratives focusing on emotions rather than on the functioning of their body (Barbieri, 2005). Conclusions: The camp experience facilitated a better understanding of diabetes, a realistic self-appraisal, and age appropriate self-management of the diabetes. An essential aspect of the camp was an interdisciplinary approach in which a psychologist played an important role. An intervention in which adolescents told their stories which was modeled on a popular TV reality show that was designed to facilitate the development of mentalization and the creation of narratives that supported healthy development in the face of chronic illness.

Background: Psychoanalytic psychotherapy with adolescents with severe disturbances present many challenges for the therapist. Different difficulties might appear: 1) at the time of the first encounter, when it is difficult to create a therapeutic alliance with the patient; 2) during the therapy, when there are frequent risks of ruptures linked to the adolescent’s acting out as well as the parents’ behavior, attacking the therapeutic setting and links. As a result, aggressive counter-transference feelings develop in the therapist, which lead to therapeutic nihilism and threaten the continuation of the therapy. Method: We present the experience of a supervision group of psychoanalytically oriented therapists working in long term psychotherapy with severely disturbed adolescents. The aim of the group is to support the practitioners in their work with adolescent patients with severe psychopathology. Each participant contributes associations on the case being presented to the group, and these associations are integrated together by a senior analyst. The group process supports the progress of the patient sustains the investment of the therapist in the treatment. Conclusions: The working through in the group supports intersubjectivity, reducing tendencies for disengagement. It highlights particular archaic mechanisms of psychic functioning and prevents pathological repetition in the field of the therapeutic setting.

Background: Myths about vampires have been part of the culture in Western society since ancient times. In recent years, there has been a recrudescence of interest in vampires among teenagers, who have embraced books, movies and television programs on this subject. Method: This article will explore the history and origins of the vampire myth and through a psychoanalytic and psychodynamic perspective, will analyze the life and work of Bram Stocker, the author of the ever-popular novel Dracula. It will also analyze the many modern variations on the vampire metaphor and explain how the developmental struggles of adolescence can be easily displaced on to the figure of the vampire. It will present case material to illustrate the meaning of this myth to adolescents. Conclusions: The myth of the vampire can become a useful therapeutic tool to understand and explore adolescent conflicts so that clinicians can potentially help their adolescent patients overcome resistance and explore issues that are often located outside of their conscious awareness.

Background: In the past several empirical studies have examined the relationship between non-suicidal selfinjury (NSSI) and affect inexpressivity, and have provided mixed results. This led us to the hypothesis that there exist two groups of self-harmers (HS and PS) that differ with respect to affective expression. Methods: To test this we divided a sample of self-harmers into two phenomenologically distinct groups, based on the theory of Huband and Tantam. Subsequently these groups were compared on a number of measures that assess affect expressivity, intensity and management. Results: No difference in affect expression was found between the group of self-harmers as a whole and controls, but a significant difference was obtained for the subtypes. Moreover, one group (PS) was characterized by a significantly higher negative affect intensity and diminished management of emotions, while the other group (HS) scored significantly higher on positive affect intensity. Conclusion: Differences in affect expression were only found in the subgroups of NSSI. In the total group of self-harmers this effect was levelled out. This finding underscores the importance of distinguishing subtypes of NSSI.

Objective: Few studies conceptualize the adolescent’s perceptions of what is helpful in gaining a positive therapeutic relationship. The aim of this study is to present a subjective understanding of what adolescent participants experience as helpful in engaging them in psychotherapy and forming a positive therapeutic relationship. Method: Through the use of a semi-structured interview, 42 adolescents who were in psychotherapy described the factors that they felt promoted a therapeutic relationship. The interviews explored three major themes: motivation to attend psychotherapy, initial fears in attending therapy, and what qualities and experiences in therapy helped enhance the relationship. Results: Adolescents report a unique set of fears about psychotherapy that are tied into their developmental issues. If these fears are addressed, the majority were motivated to seek out psychotherapy. Subjects also reported specific variables of the therapist and the therapy that enhanced the therapeutic relationship: an egalitarian and non-judgmental stance, empathy, being heard and listened to, receiving help with problem solving, feeling safe, expressing affect and the experience of feeling special. Conclusion: The study shows that adolescents’ motivation, fears, and ability to form a positive relationship rest on whether the therapist is attuned to and responsive to their developmental needs. Implications for treatment and strengthening of the therapeutic relationship are discussed.

The author comments on Hollidge, C. ’’Adolescents’ perception of the Factors that Enhance the Therapeutic Relationship.