Symptoms of Borderline Personality Disorder in Adolescents

158 Pages·2012·0.91 MB·English

Symptoms of Borderline Personality
Disorder in Adolescents
Assessment, treatment, and parental factors
Marieke Schuppert
Voor alle jongeren
die dagelijks proberen te overleven
op een stormachtige zee
Schuppert, HM
Symptoms of borderline personality disorder in adolescents
Assessment, treatment, and parental factors
The research described in this thesis was supported by grants from the University
Medical Centre Groningen and ZonMw (The Netherlands Organization for
Health Research and Development).
ISBN: 978-90-367-5705-8
Copyright © Marieke Schuppert, 2012
Layout: Helga de Graaf, Studio Eye Candy, Groningen (www.proefschrift.info)
Image cover: Hiltje Koopmans, ‘être’, 2012
Printed by Ipskamp Drukkers
RIJKSUNIVERSITEIT GRONINGEN
Symptoms of Borderline Personality
Disorder in Adolescents
Assessment, treatment, and parental factors
Proefschrift
ter verkrijging van het doctoraat in de
Medische Wetenschappen
aan de Rijksuniversiteit Groningen
op gezag van de
Rector Magnificus, dr. E. Sterken,
in het openbaar te verdedigen op
woensdag 3 oktober 2012
om 11.00 uur
door
Hermine Maria Schuppert
geboren op 28 januari 1969
te Holten
Promotores: Prof. dr. R.B. Minderaa
Prof. dr. P.M.G. Emmelkamp
Copromotores: Dr. M.H. Nauta
Dr. J. Bloo
Beoordelingscommissie: Prof. dr. K. Silk
Prof. dr. R.A. Schoevers
Prof. dr. F. Boer

Contents
Chapter 1 Introduction 9
Chapter 2 Psychometric evaluation of the Borderline Personality 29
Disorder Severity Index IV – adolescent version and
parent version
Chapter 3 Effectiveness of an Emotion Regulation Group Training 43
for adolescents - a randomized controlled pilot study
Chapter 4 Emotion Regulation Training for adolescents with 61
borderline personality disorder traits: a randomized
controlled trial
Chapter 5 Parental rearing and psychopathology in mothers of 79
adolescents with and without borderline personality
symptoms
Chapter 6 Severity of borderline personality symptoms in 91
adolescence: relationship with parenting stress,
parental psychopathology, and rearing styles
Chapter 7 General discussion 105
Chapter 8 References 123
Summary 138
Samenvatting 144
Dankwoord 152
Curriculum Vitae 156

Chapter 1 Introduction
Chapter 1
Personality is a complex concept that refers to a broad range of individual dif-
ferences in the way people tend to think, feel and act. Personality traits (like for
instance extraversion, neuroticism and conscientiousness) can be recognized at
an early age and are moderately stable (de Fruyt et al., 2006; Shiner, 2005).
In a large meta-analysis, Roberts and DelVecchio (2000; Roberts, Walton, and
Viechtbauer, 2006) found that trait consistency increases steadily over the years:
from .31 in childhood to .54 in young adults, to .64 at age 30 and .74 be-
tween 50 and 70 years. Although there is moderate personality stability already
in childhood, there is also considerable personality change (Specht, Egloff, and
Schmukle, 2011). In general, trait profiles are not pathological. Both adaptive
and maladaptive personality patterns can be described in domains of functioning,
like impulsivity, emotional lability/instability, or interpersonal functioning (Livesley,
2012). Extreme traits can be associated with an increased risk for personality
pathology and related disorders. Though the symptoms in children are not neces-
sarily the same as in adults, childhood antecedents of personality disorders can
be well determined (Mervielde et al., 2005; Paris, 2003).
For many years, both clinicians and researchers have been reluctant in diagnos-
ing personality disorders (PD) before age 18. One of the arguments was that
personality is still developing during adolescence, and that symptoms are not
stable enough to fit a valid and reliable diagnosis. In clinical practice, mental
health professionals are still hesitating in diagnosing PDs in young people. DSM-
IV-TR (APA, 2000) discourages the diagnosis of PDs in youngsters. One of the
consequences of this reluctance is that relatively little research has been done on
(symptoms of) PDs in adolescence, and, more specifically, on borderline person-
ality disorder (BPD) (Crick, Murray-Close, and Woods, 2005; Paris, 2003). Yet,
DSM-IV provides the opportunity to diagnose (B)PD when there is a pervasive,
persistent pattern of maladaptive personality traits, that must have been present
for at least one year, and is not likely to be limited to a particular developmen-
tal stage or Axis I disorder (APA, 2000). Another consequence of the restraints
about diagnosing (B)PD at an early age, is that very little age-specific treatments
have been developed and evaluated (Chanen, Jovev, McCutcheon, Jackson,
and McGorry, 2008b).
In recent decades, the development of BPD has increasingly become a focus
of interest. Several studies have now found ample evidence for a reliable and
valid diagnosis in adolescence (e.g. Crawford et al., 2008; Paris, 2003; Miller,
Muehlenkamp, and Jacoboson, 2008). In an epidemiological study, BPD in
adolescence was found to be a predictor for psychopathology and psychosocial
dysfunctioning later in life. For instance, in a 20 year follow-up study (Children
10