Lecture 7: Mood and personality disorder in adolescence Flashcards
(31 cards)
developmental changes in adolescence
- Biological and cognitive changes (e.g., physical maturation, cognitive maturation)
- Psychological changes (e.g., identity development, psychological autonomy)
- Social changes (e.g., increase in societal expectations, romantic relationships)
For some adolescents, these changes may increase the potential for conflict:
- Internal conflict (e.g., mood disruptions or disorder)
- External conflict (e.g., risk behavior, interpersonal conflict or personality disorder)
lastig onderscheiden met normale ontwikkeling
adolescenten hebben sowieso al hogere emoties, ze kunnen dit gevoel minder goed reguleren.
-> kijken naar gemiddelde ontwikkeling en functioneren
MDD DSM5
> 5, during 2 weeks:
* Depressed mood for most of the day, nearly every day
* Diminished interest or pleasure in (almost) all activities
* Significant weight loss/gain or decrease/increase in appetite
* Slowing down of thought and reduction of physical movement
* Fatigue or loss of energy
* Feelings of worthlessness or guilt
* Diminished ability to think, concentrate, or make decisions
* Recurrent thoughts of death or suicidal ideation (with a plan), suicide attempt
If an adolescent seems/is depressed, always check for and talk about:
- Suicidal thoughts or plans, and self-harming behaviors (e.g., cutting), which increase the risk of suicidal thoughts, plans, and attempts
- Look into the functions of self-harm and talk about alternatives
functions of self-harm
- alleviate negative thoughts and feelings
- alleviate feelings of guilt
- regain a sense of control
MDD prevalence in adolescents and trajectories
20%
trajectories:
- Consistently low trajectory (63%)
- Chronically medium trajectory (13%)
- Increasing trajectory (3%)
- Decreasing trajectory (8%)
persistent depressive disorder (PDD, formerly known as dysthymia)
- Depressed mood for most of the day for at least 1 year
- At least two of the following symptoms: poor appetite/overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness
- During this 1-year period, the adolescent has never been without these symptoms for more than 2 months at a time
PDD vs MDD
The symptoms of PDD are less severe than those observed in MDD, but they are
longer lasting and result in long-term impairment in psychosocial functioning
Bipolar Disorder (BD, formerly known as Manic depression):
- Going through cycles of different moods: normal mood, depression, mania, or hypomania (feels like ‘a rollercoaster of emotions’)
- Bipolar 1: the adolescent suffers from manic episodes, which may have been preceded and followed by hypomanic or depressive episodes, or normal mood
- Bipolar 2: the adolescent suffers from milder cycles of normal mood, hypomania, and depression (no mania)
(Hypo)manic episodes in Bipolar Disorder:
- A period of abnormally and persistently elevated, expansive, or irritable mood, and increased goal-directed activity or energy, lasting at least 4 days or 1 week
- During that period, at least three of the following symptoms are present: inflated self-esteem or grandiosity, decreased need for sleep, being more talkative than usual, racing thoughts, distractibility, risky activities, psychomotor agitation
- The mood disturbance is (not) sufficiently severe to cause marked impairment or to necessitate hospitalization to prevent harm to self/others, psychotic features
Borderline Personality Disorder (BPD):
at least 5 for 1 year:
- Frantic efforts to avoid real or imagined abandonment
- Unstable interpersonal relationships (alternating between idealization and devaluation or ‘splitting’)
- Identity disturbance or unstable sense of self
- Impulsivity (e.g., spending, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, or self-harming behavior
- Emotional instability (e.g., intense episodes of sadness, irritability, or anxiety lasting a few hours)
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptom
overeenkomsten MDD, PDD, BPD and BD
PDD - MDD: depressed mood, sleeping problems
PDD: milder, but longeer lasting depressed mood
BPD - MDD: worthlessness, self harm
BPD: anger, unstable interpersonal relationships
BD - MDD: depressed mood, self harm
BD: (hypo)manic episodes, psychotic features
BPD and BD share core features (name them), how do we differentiate?
core features: mood swings, psychotic features, impulsivity, self-harm
differentiatie: in BPD mood swings last hours to days. in BD mood episodes last weeks to months
Alternative Model for Personality Disorders (AMPD): PDs are all characterized by disturbances in two areas:
- Self-functioning: unstable identity, low/high self-worth, inaccurate self-view, problems with self-direction (having no goals, no sense of life direction)
- Interpersonal functioning: inability to develop and maintain mutually satisfying relationships, inability to understand others’ perspectives (mentalizing) and to manage conflict
As self-development and social development are central developmental tasks of adolescence, personality disorder features may become apparent during this life phase.
PDs volgens dit model: borderline, narcissistic, antisocial, obsessive-compulsive, avoidant, and schizotypal personality disorders
BPD prevalence and trajectories
prevalence:
- general population: 3%
- outpatient adolescents: 11%
- inpatient adolescents with suicidal behaviours: 76%
trajectories:
Low trajectory (37.6%)
Moderate trajectory (41.5%)
High trajectory (20.9%
proximal risk factors of MDD: individual
Comorbidity
* Symptom disorders (e.g., anxiety)
* Physical illness
* Substance use
Stressful events
* Financial stress, poverty
* School-related stress
* COVID
Self-functioning
* low self worth
* identity disturbance
proximal risk factors of MDD: social
- Loss and conflict
- Low social support, bullying
proximal en distal =
proximal = close to
distal = far away
MDD distal risk factors: individual
Predisposition
* Genetics (MDD runs in family)
* Alterations in brain stress-systems
* Temperament (negative affect)
Personality
* Traits (neuroticism)
* Maladaptive coping strategies
* Early maladaptive schemas
MDD distal risk factors: social
System
* Insecure attachment, conflict
* Parents with psychopathology
Trauma
* Maltreatment: abuse and neglect
low distress tolerance in BPD
- stressful situation: e.g. cancelling dinner plans
- activation of early maladaptive schemas: “I feel rejected, abandoned, worthless” → negative emotions
- low distress tolerance -> emotion dysregulation (anger)
- interpersonal conflict, self-harm, impulsivity
- identity disturbance, feelings of inner emptiness
zie schrift
MDD as a risk factor of BPD
- emotional problems at age 5 predict BPD at age 12
- depression and suicidality are predictive of BPD features in adolescence
- internalizing disorders in adolescence precede BPD (but not the other way around)
- childhood or adolescent depression seems to be a stepping stone for BPD
- they share underlying vulnerabilities and MDD can disrupt developmental processes
Identity disturbance as a risk factor for MDD and BPD
- consolidation: healthy (know who they are, stable interests, positive identity, have both explored and committed)
- disturbed identity: instability (changing, not stable, base their identity on others)
- lack of identity: feeling fragmented, broken, empty inside, no sense of self
