The Authors Respond
Kowatch, Robert A., Monroe, Erin, Delgado, Sergio V., Current Psychiatry
We welcome comments about the importance of a thorough diagnostic evaluation to tease out possible etiologies of "mood swings," including psychosocial factors, as in personality disorders. Nevertheless, the debate about diagnosing personality disorders in children and adolescents is not settled. Developmentally, children and adolescents have continuous changes in biology and brain function. There is significantly more empirical evidence of reactive attachment disorders in childhood and adolescence that integrate the affective changes seen in children who live in chaotic environments. DSM defines BPD as a pervasive pattern of instability of interpersonal relationships that begins by early adulthood. (1) Many children with diagnoses of posttraumatic stress disorder, mood disorder, bipolar disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, etc. also can have difficulties in relating to others caused by their neurobiologic deficits, which also may limit response to medication. Furthermore, children with learning disorders also can misperceive motives of others and thus have pervasive patterns of relational instability.
The research Dr. Aguirre suggested is based on treatment histories and not rigorous study methodology. Most empirical evidence of personality disorders is strongly influenced by psychoanalytic literature regarding object relations, which is in flux because of emerging attention to attachment theory and progress in neurologic studies in the evaluation of temperamental variations related to the influence of mirror neurons. …