Personality Disorders in Children and Adolescents

Personality Disorders in Children and Adolescents

Personality Disorders in Children and Adolescents

Personality Disorders in Children and Adolescents

Synopsis

Kernberg (psychiatry, Cornell University Medical College and The New York Presbyterian Hospital-Westchester Division), Weiner (psychology, at the same institutions), and Bardenstein (psychology and psychiatry, Case-Western Reserve University) have assembled both the evidence and a theoretical framework to suggest that personality disorders can be diagnosed and treated in children and adolescents. A developmental perspective informs their identification of emerging pathological features at all levels of personality organization -- neurotic, borderline, and psychotic. Special attention is given to the relationship between personality disorders and gender identity, suicidality, substance abuse, and cultural and family background. The authors inflect their review of differential methods with material from the published literature, as well as evidence drawn from their own clinical research and practice.

Excerpt

Personality disorders (PDs) in adulthood have been recognized as having a profound and prolonged impact on the individual, on the family, and on society (Ruegg andFrances 1995). Epidemiological research indicates a high prevalence of PDs between the ages of 9 and 19 as well (Bernstein et al. 1993); however, the development of PDs in young people has not received the attention it merits.

Our purpose is to present the mounting and compelling evidence for the presence of PDs in children and adolescents so that they will be more readily recognized and treated. In this population, they are associated with increased suicidality, delinquency, academic failure, social dysfunction, and substance abuse. They also worsen the prognosis for patients suffering from such other disturbances as anxiety disorders, affective disorders, and eating disorders.

All clinical and research findings about adult PDs emphasize their early developmental precursors. Yet the very existence of PDs in children and adolescents has been questioned. Practically, PDs often require more extended and therefore more costly treatment than that covered by third-party payers. Conceptually, there persists an understandable reluctance to believe that a developing child can have a disorder of such magnitude that it interferes with his relationship to his environment and to himself.

Because of the ongoing debate (P. Kernberg 1990, Shapiro 1990), we think it is timely to focus more systematically on this issue. It is our intention to highlight the usefulness of a developmental perspective for identifying the features of PDs and related pathological personality traits at different developmental phases. We will provide clinical and research evidence to support the reliable identification of PDs in children and adolescents.

The first section begins by introducing the developmental perspective on personality and personality disorders: It reports epidemiological findings and examines the DSM nosology, including its influence on research and . . .

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