RESUMEN
BACKGROUND: Dialectical behavior therapy (DBT) is an effective approach to decreasing suicidal behaviors; the adapted, family-based model for adolescents (through 18 years old; DBT-A) also demonstrates efficacy. Data on higher dropout rates based on age, initial research on DBT with young adults in the community, and the theory that underlies DBT suggest that adaptations may also be appropriate for young adults. This study examines the effectiveness of DBT-A, presents preliminary data on delivering DBT-A to young adults (ages 18-26), and compares clinical characteristics, service utilization, and outcomes to adolescent clients (ages 13-17) to guide clinical considerations and future research on implementing DBT-A. METHODS: Data were collected from a DBT-A clinic and included results from semi-structured diagnostic interviews, chart review, and scores on self-report measures. The Suicide Ideation Questionnaire and Beck Depression Inventory (BDI), given at program entry, after completion of one rotation through the skills modules, and at graduation, were used to evaluate outcomes. Outcomes were benchmarked against prior DBT-A trials. Adolescents' and young adults' clinical characteristics, service utilization, and outcomes were compared. RESULTS: The effect size observed was smaller than in efficacy trials. Few differences were observed between teens (n = 87) and young adults (n = 45). Young adults were more likely to have participated in intensive services before DBT-A. They participated in fewer family sessions and graduated in fewer months compared to teens. CONCLUSION: This study supports the use of the family-based model of DBT for suicidal teens and young adults although future research is needed to improve the effectiveness of this model when implemented in real-world settings.
Asunto(s)
Trastorno de Personalidad Limítrofe , Terapia Conductual Dialéctica , Conducta Autodestructiva , Centros Médicos Académicos , Adolescente , Adulto , Terapia Conductista/métodos , Trastorno de Personalidad Limítrofe/terapia , Humanos , Escalas de Valoración Psiquiátrica , Conducta Autodestructiva/terapia , Ideación Suicida , Resultado del Tratamiento , Adulto JovenRESUMEN
Rates of deliberate non-suicidal self-injury (NSSI) increase during adolescence and young adulthood, particularly in clinical samples, making these important developmental stages for understanding the functions of NSSI. Borderline Personality Disorder (BPD) symptoms also begin to emerge in adolescence, though little research has examined relationships between BPD symptoms and the functions of NSSI in youth, the primary goal of the present study. Adolescents and young adults recruited from an outpatient psychotherapy clinic (N=36) endorsed a range of NSSI functions on the Inventory of Statements about Self-Injury (Klonsky and Glenn, 2009). Participants engaged in NSSI to serve intrapersonal functions (e.g., regulate affect, punish oneself) more frequently than interpersonal functions (e.g., bond with peers, establish autonomy). As predicted, linear regression analyses indicated that BPD affective dysregulation symptoms were associated with the intrapersonal but not the interpersonal functions of NSSI. In contrast, BPD interpersonal dysfunction symptoms were differentially associated with the interpersonal rather than intrapersonal functions of NSSI. These preliminary data indicate that clusters of BPD symptoms show unique relationships with functions of NSSI in treatment-seeking adolescents and young adults, relationships that can be used to target specific functions of NSSI in treatment planning.
Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Conducta Autodestructiva/psicología , Adolescente , Afecto , Femenino , Humanos , Conducta Impulsiva , Modelos Lineales , Masculino , Pacientes Ambulatorios , Grupo Paritario , Inventario de Personalidad , Psicoterapia , Adulto JovenRESUMEN
We examined posttraumatic stress symptom clusters associations with psychopathology and functional impairment in 899 Norwegian survivors of the 2004 South-East Asia tsunami six months post-disaster. Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R) with intrusion, avoidance, and hyper-arousal subscales. For criterion variables, we used 10 indicators of psychopathology and functional impairment, e.g. having mental health problems, seeing mental health professionals, and use of medication or sick leave. Hyper-arousal had stronger correlations than avoidance with all criterion variables (p values<0.001) and stronger correlations than intrusion with seven of the 10 criterion variables (p values<0.01). Also, intrusion had stronger correlations than avoidance with seven of 10 criterion variables (p values<0.05). Thus, our findings indicate that symptoms of hyper-arousal may be more closely linked to psychopathology and functional impairment than other symptoms of posttraumatic stress following a sudden onset, short duration, natural disaster event.
Asunto(s)
Actividades Cotidianas/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Desastres , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/terapia , Encuestas y Cuestionarios , TsunamisRESUMEN
BACKGROUND: Post-traumatic stress disorder (PTSD) diagnosis often depends on a retrospective, self-report of exposure to a life-threatening event. AIMS: To examine the stability of recalled perceived life threat in a community sample exposed to a distinct stressful event. METHOD: Five hundred and thirty-two Norwegian citizens who experienced the 2004 South-East Asia tsunami completed a self-report questionnaire 6 and 24 months post-disaster. The questionnaire measured perceived life-threat intensity, exposure, immediate stress response, psychopathology, personality dimensions, self-efficacy and social support. RESULTS: Recalled threat intensity increased from 6 to 24 months (P<0.001). Recall amplification was associated with lack of PTSD symptom improvement (P<0.05), but not with degree of exposure, immediate stress response, mood or stress symptoms, personality, self-efficacy or social support. CONCLUSIONS: Recall amplification of perceived life threat from a single stressful event occurs in the general population, it may hinder PTSD symptom improvement and it questions the diagnostic validity of PTSD.
Asunto(s)
Acontecimientos que Cambian la Vida , Trastornos por Estrés Postraumático/diagnóstico , Olas de Marea , Adaptación Psicológica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asia Sudoriental , Desastres , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Recuerdo Mental , Persona de Mediana Edad , Noruega/epidemiología , Percepción , Determinación de la Personalidad , Psicopatología , Apoyo Social , Trastornos por Estrés Postraumático/epidemiología , Adulto JovenRESUMEN
To investigate the role of psychopathic traits in a clinical and comparison sample, we obtained dimensional California Child Q-Set (CCQ) personality profiles for 66 preadolescent boys with attention-deficit/hyperactivity disorder (ADHD) and 56 comparison boys during naturalistic summer programs and correlated each boy's CCQ profile with an expert-derived CCQ psychopathy prototype. These scores, representing each boy's degree of similarity to the prototype, were significantly associated with concurrent externalizing diagnoses and symptoms and, with statistical control of these externalizing features, concurrent measures of objectively observed noncompliance, overt and covert antisocial behavior, and peer sociometric nominations indexing peer rejection. Psychopathic traits were not associated with peer acceptance. CCQ psychopathy dimension scores also predicted severity of delinquency at a 5-7-year prospective follow-up, with statistical control of age, baseline externalizing diagnoses and symptoms, and baseline objective observations of antisocial behavior. Predictions held when overt behavioral items from the CCQ, which may have overlapped with the delinquency outcome criterion, were eliminated. Despite these strong effects, a plethora of false positives were evident in the prospective predictions to delinquency status. We discuss research and clinical implications of measuring psychopathic traits in childhood.