The Making of Multiple Personality Disorder: A Social Constructionist View

This article explores the social construction of multiple personality disorder by analyzing professional agreements about the nature of the diagnosis, while locating these within their historical and cultural context. First, a historical review of the disorder traces various overlapping streams of discourse that have shaped the construction of the diagnosis. This is followed by a cross-cultural comparison of MPD and dissociative phenomena in several non-Western societies. The article concludes with some reflections on the cultural meanings of MPD in contemporary America.     

Vocal and Facial Emotion Decoding Difficulties Relating to Social and Thought Problems: Highlighting Schizotypal Personality Disorder

Successful social interaction depends on the ability to decode emotion in the nonverbal behaviors of others. Because relationship difficulties are paramount in adolescents with schizotypal personality disorder (SPD), we predicted that adolescents with SPD would (1) make more emotion decoding errors than adolescents with other personality disorders (OPD) or non-psychiatric controls (NPC); and (2) exhibit more social and thought problems than OPD or NPC adolescents. Further, we predicted greater emotion decoding errors for all adolescents would relate to concurrent and future social problems, thought problems, and social reasoning deficits. SPD adolescents made more errors than OPD and NPC adolescents in decoding voices but not faces (except in specific emotion categories). For all adolescents, vocal errors correlated with greater social problems, and facial and vocal errors correlated with greater thought difficulties concurrently and a year later.     

Family-based interventions for child and adolescent disorders

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.     

The nature and effectiveness of program models for adolescents at risk of entering the formal child protection system

This article compares rationales and outcome research for five areas of programming for adolescents: adolescent competence and skill development programs, family- and parent-focused programs, social integration programs, multiple component programs, and neighborhood transformation programs. The article examines program evidence for maltreated teens as well as teens coping with a variety of other challenges. The study uses a framework based on common developmental challenges and risk factors for adolescents to select and review programs.     

On Early Starters and Late Bloomers: The Development of Sexual Behavior in Adolescence Across Personality Types

Little is known about the relationship between personality and sexual development among mid-adolescents. In the current study, we used a person-centered approach to investigate the relation between personality types and the development of sexual behavior. We hypothesized that undercontrolling adolescents would engage in more advanced, casual, and risky sexual behavior compared to their resilient and overcontrolling peers. Data were used from 407 mid-adolescents (M _age = 14.5) followed across four measurement waves spanning 18 months. Results from latent class analyses (LCA) identified the three classical personality types: resilients, undercontrollers, and overcontrollers. Controlling for perceived pubertal timing and biological sex, latent growth curve analyses in Mplus showed that, at baseline, undercontrollers were more sexually experienced and engaged in more casual and risky sexual behavior than resilients and overcontrollers. Although initial levels of sexual behavior differed by personality types, over time increases in sexual behavior occurred at a similar rate across the types. Overall, the current study showed that undercontrolling adolescents are early sexual developers who engage in more advanced, casual, and risky sexual behavior than other adolescents. The implications of these findings for longer-term differences in sexual behavior between personality types in later adolescence are discussed.     

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.     

Adolescent depression: Significant issues in diagnosis and treatment of constricted adolescents

This article examines depression in those adolescents who are constricted emotionally. Specific elements of ego organization are discussed with particular emphasis on loss, grieving, identification, and ego ideal. The authors examine characteristics of such adolescents from a socio-developmental-psychological perspective, utilizing data from the cases of two patients who presented remarkably differing profiles. In terms of treatment, differences in therapeutic style are illustrated to reflect the distinct levels of personality organization achieved by each of the patients. Constricted youth are distinguished from those youngsters who are depressed but are more typically oppositional and negativistic, and reveal a long standing history of chronic acting out.     

The impact of child support on child health

The broad goals of child support policy are to keep children in single-parent families out of poverty and to make sure that their material needs are met. One potentially important, but relatively understudied, set of measures of child well-being are health outcomes. A fixed-effects analysis of data from the Child and Young Adult file of the 1979 National Longitudinal Survey of Youth shows that, conditional upon receipt of some amount of child support, higher payment levels are associated with significantly greater odds of having private health insurance coverage and significantly lower odds of poor or declining health status. These effects persist even after controlling for other factors that are likely to be correlated with child support payments, including total family income and paternal visitation patterns.     

Wellbeing of children and adolescents with special health care needs in the child welfare system

Children and adolescents in child welfare have the highest rates of chronic conditions and disabilities of any studied child population. The purpose of this study is to determine the wellbeing of children and adolescents with special health care needs (SHCN) in child welfare compared to their peers without SHCN. Wellbeing was measured using the Child and Adolescent Needs and Strengths (CANS) assessment; children and adolescents were assessed on the domains of Life Domain Functioning, Traumatic Stress Symptoms, Behavioral/Emotional Needs, Risk Behaviors, and Child Strengths. Scores on the CANS were compared between initial entry into the child welfare system and 18 months later. This is the first study to assess wellbeing over time of children and adolescents with SHCN in the child welfare system. This study found that children and adolescents with SHCN had increased wellbeing over an 18-month period. By the 18-month assessment, children and adolescents with SHCN presented similarly to their healthy peers, indicating that wellbeing improved more for children and adolescents with SHCN than those without SHCN across several domains of wellbeing. Children and adolescents with SHCN still had significant needs compared to children and adolescents without SHCN in the area of Life Domain Functioning. Adolescents (ages 12–18), with and without SHCN, had greater needs and fewer strengths compared to children (ages 6–11) both initially and 18 months later. Children and adolescents without SHCN also improved over the 18-month period. While this study specifically measured needs and strengths, the findings show that the wellbeing of children and adolescents, as measured across a variety of domains, improved while in child welfare.     

Self-reported and case file maltreatment: Relations to psychosocial outcomes for youth in foster care

The aim of the current study was to explore the relation between maltreatment and psychosocial outcomes for youth in foster care, and how this relation differs according to reporter type (self-report or case file). Participants included 285 children and adolescents and their caregivers who completed self-report questionnaires about lifetime maltreatment and psychosocial adjustment. Youths' case files containing lifetime maltreatment reports were obtained from Division of Social Services (DSS), and were coded for physical and sexual abuse, emotional maltreatment, and neglect using the Modified Maltreatment Classification System (MMCS; English & LONGSCAN Investigators, 1997). Crosstabs analysis was used to summarize proportions of youth whose caregivers reported clinically significant internalizing and externalizing and average to high adaptive functioning within groups of youth who had a) neither self-reported nor case file maltreatment, b) only case file maltreatment, c) only self-reported maltreatment, and d) both case file and self-reported maltreatment for each maltreatment type (physical and sexual abuse, emotional maltreatment, and neglect). Results showed that externalizing symptoms differ according to reporter type for physical and sexual abuse, and that internalizing symptoms differ according to reporter type for sexual abuse. Implications for methodology in maltreatment research are discussed.     

Physical abuse after child protective services investigation and adolescent substance use

The longitudinal pathways connecting physical abuse and substance use in child welfare-involved adolescents, a population with multiple risk factors for substance use problems, remain unclear. This study examined the relation between self-reported physical abuse among adolescents investigated by Child Protective Services (CPS) and later substance use, with a particular focus on exposure to physical abuse after CPS investigation as a potential contributing factor to this relation. Using data from the first National Survey of Child and Adolescent Well-being (NSCAW-I), a path analysis was conducted on a sample of 1079 adolescents aged 11–15 years who had recently been investigated by CPS. At baseline and 18-month follow-up, youths self-reported past-year physical abuse using the Parent-Child Conflicts Tactic Scale and past 30-day substance use frequency. At baseline, youths self-reported current internalizing and externalizing problems to the Youth Self Report. Path analysis revealed no significant relation between physical abuse at baseline and substance use at 18 months. Physical abuse at baseline was associated with higher levels of concurrent substance use and externalizing problems, which in turn predicted higher substance use at 18 months. Furthermore, physical abuse and externalizing problems at baseline predicted physical abuse at 18 months, which in turn was related to higher substance use at 18 months. The findings suggest that physical abuse after CPS investigation contributes to the development of adolescent substance use behaviors. Results indicate a need for innovative efforts to prevent physical abuse after CPS investigation, as well as assessment and treatment of substance use and externalizing problems at the point of investigation, to reduce future substance use in child welfare-involved adolescents.     

A longitudinal analysis of some risk and protective factors in marijuana use by adolescents receiving child welfare services

The present study sought to identify risk and protective factors in marijuana use by adolescents involved in child welfare services. Longitudinal records of 1797 adolescents were extracted from the National Survey of Child and Adolescent Well-Being data set. The obtained multivariate results from generalized estimating equations showed that an adolescent's likelihood of being a current marijuana user rose with prior lifetime use of the drug and was also associated with out-of-home child welfare services, perceived parental monitoring, perceived closeness to parent, engagement with school environment, and age. Implications for child welfare services are discussed.     

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.     

Specialist assesstnent services for child abuse and neglect

This paper describes the Child Protection Service, Flinders Medical Centre, South Australia, a specialist assessment service for infants, children and adolescents following allegations of abuse and neglect. The psychosocial and medical services provided for infants, children, adolescents and their families are outlined briefly and the Child Protection Service's view that the assessment process can and needs to be therapeutic is discussed. Data was provided about the age and gender of infants, children and adolescents seen and the number of families referred on for longer-term therapeutic intervention. The unit's philosophical stance, affecting its clinical practice and interagency and consultation service, is described, as is its research focus. The paper also raises a number of issues that warrant further and detailed attention. These include the need for workers to monitor and attend to their emotional responses while working in the area of abuse and the destructive potential of denial that may consequently and subtly impact on professional practice. The tendency for professionals and the wider society to ignore the impact of physical abuse is also raised.     

How School Contexts Shape the Relations Among Adolescents’ Beliefs,Peer Victimization,and Depressive Symptoms

The present research examined how school contexts shape the extent to which beliefs about the potential for change (implicit theories) interact with social adversity to predict depressive symptoms. A preregistered multilevel regression analysis using data from 6,237 ninth‐grade adolescents in 25 U.S. high schools showed a three‐way interaction: Implicit theories moderated the associations between victimization and depressive symptoms only in schools with high levels of school‐level victimization, but not in schools with low victimization levels. In high‐victimization schools, adolescents who believed that people cannot change (an entity theory of personality) were more depressed when they were victimized more frequently. Thus, the mental health correlates of adolescents’ implicit theories depend on both personal experiences and the norms in the context.     

Learning from extremism in the history of mental health. The example of multiple personality disorder

This article reviews some of the history of the cultural forces that shaped the diagnosis of multiple personality disorder/dissociative identity disorder and the subsequent abuses that occurred at the time of its popularization. Some of the implications that can be drawn from these kinds of historical excesses in the field of mental health will be discussed. The article concludes by underscoring the ethical obligation inherent in maintaining healthy professional skepticism toward ideas driven by ideology and fad, rather than scientific empiricism.     

Better together? Cooperation between youth welfare office and child and adolescent psychiatry: A methodological approach

Previous international literature describes a lack of systematic research about cross-institutional cooperation in social and health services although the need is indicated. More and more children and adolescents have complex psychosocial needs. Thus, they require help from different institutions and professions to receive optimal care. However, there is a great need of improvement of the cooperation between institutions in social (e.g. Youth Welfare Office) and health services (e.g. Child and Adolescent Psychiatry (CAP), even in Germany. Therefore, an official Agreement of Cooperation (AoC) between these institutions was implemented as a first attempt to enhance and structure cross-institutional work in Dresden, Germany. This methodological paper describes the corresponding evaluation project that includes cross-sectional and longitudinal assessments. It thereby focuses on the employees' and families' satisfaction as well as the psychosocial development and mental health of children at the intersection of the aforementioned institutions before and after the implementation of the AoC. In addition, it gives a review of literature about cross-institutional work.     

The diagnosis of borderline personality disorder and adopted adolescents: A cautionary note

Patients with Borderline Personality Disorder and adopted emotionally-disturbed adolescents share many personality and psychodynamic characteristics: problems with object loss, separation and abandonment, identity disorders. Emotionally-disturbed adopted adolescents are likely to receive a BPD diagnosis because of 1. unknown genetic or constitutional components, 2. defects in early mothering or chaotic parenting seen in late adoptions, 3. possible misdiagnosis, 4. psychodynamic similarities. Authors caution against the possibility of misdiagnosis because of this environmental reinforcement provided by an adopted status.     

Understanding E-Mental Health Resources: Personality,Awareness, Utilization,and Effectiveness of E-Mental Health Resources Amongst Youth

The focus of this study is to replicate portions of the study by Neal, Campbell, Williams, Liu, and Nussbaumer (2011) to determine if their findings translate to Australian adolescents. Specifically, this study aims to: determine personality types as predictors of knowledge and utilization of e-mental health resources; identify subject usage rates of specific e-mental health resources; and identify subject views on the efficacy of these resources. Participants were an opportunistic sample of 1st-year university students (N = 176) between the ages of 18 and 25. A single session online survey was administered. The hypotheses that extroverted adolescents are less likely to have an awareness of e-mental health resources when compared to neurotic adolescents; and extroverted adolescents are less likely to engage in seeking help from e-mental health resources when compared to neurotic adolescents, were not supported. This study was unable to discern the efficacy of e-mental health resources or the sample's awareness of e-mental health resources. However, it was found that the sample was likely to engage in online help seeking behaviour for mental health concerns. Despite the limited findings, this study suggests several ideas that could be further explored.