Personality disorders in adolescents

169 Pages·2012·3.24 MB·Dutch

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r Voor het bijwonen van de
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het proefschrift
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i “Personality disorders in
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r adolescents:
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prevalence, burden,
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i assessment, and treatment”
n
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o van Dineke Feenstra
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v in de Andries Querido Zaal van
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m Paranimfen
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n Marieke Braat
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a [email protected]
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d
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r Ellen Koopmans
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t [email protected]
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Personality disorders in adolescents:
prevalence, burden, assessment,
and treatment
D
in
e
k
e
F
e
e
n Dineke Feenstra
s
t
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Feenstra_Omslag.indd 1 07-08-12 15:24
Personality disorders in adolescents:
prevalence, burden, assessment, and treatment

Dineke Feenstra
Personality disorders in adolescents:

prevalence, burden, assessment, and treatment

Persoonlijkheidsstoornissen bij adolescenten:

prevalentie, ziektelast, diagnostiek en behandeling

Proefschrift
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam
op gezag van de
rector magnificus

Prof. dr. H.G. Schmidt

en volgens besluit van het College voor Promoties.
De openbare verdediging zal plaatsvinden op
woensdag 17 oktober 2012 om 11.30 uur

door

Dine Jerta Feenstra
geboren te Geldrop

© Dineke Feenstra, 2012
ISBN: 978-90-5335-573-2
Printed by Ridderprint, Ridderkerk
Personality disorders in adolescents:

prevalence, burden, assessment, and treatment

Persoonlijkheidsstoornissen bij adolescenten:

prevalentie, ziektelast, diagnostiek en behandeling

Proefschrift
ter verkrijging van de graad van doctor aan de
Erasmus Universiteit Rotterdam
op gezag van de
rector magnificus

Prof. dr. H.G. Schmidt

en volgens besluit van het College voor Promoties.
De openbare verdediging zal plaatsvinden op
woensdag 17 oktober 2012 om 11.30 uur

door

Dine Jerta Feenstra
geboren te Geldrop

© Dineke Feenstra, 2012
ISBN: 978-90-5335-573-2
Printed by Ridderprint, Ridderkerk
Promotores Contents
Prof. dr. J.J. van Busschbach
Prof. dr. R. Verheul Chapter 1 General introduction 7

Copromotor Chapter 2 Personality disorders in adolescents 15
Dr. J. Hutsebaut
Chapter 3 Prevalence and comorbidity of Axis I and Axis II 33
Beoordelingscommissie Disorders among treatment refractory adolescents
Prof. dr. F. Verheij admitted for specialized psychotherapy
Prof. dr. P. Luyten
Prof. dr. J.E. Hovens Chapter 4 The burden of disease among adolescents with 47
personality pathology: quality of life and costs

Chapter 5 Severity Indices of Personality Problems (SIPP-118) 65
in adolescents: reliability and validity

Chapter 6 Predictors of treatment outcome of Inpatient 89
Psychotherapy for Adolescents (IPA) with personality
pathology

Chapter 7 Long-term outcome of Inpatient Psychotherapy for 109
Adolescents (IPA) with personality pathology

Chapter 8 General discussion 131

Summary 139

Samenvatting 145

Dankwoord 153

Curriculum Vitae 159

PhD portfolio 163
Promotores Contents
Prof. dr. J.J. van Busschbach
Prof. dr. R. Verheul Chapter 1 General introduction 7

Copromotor Chapter 2 Personality disorders in adolescents 15
Dr. J. Hutsebaut
Chapter 3 Prevalence and comorbidity of Axis I and Axis II 33
Beoordelingscommissie Disorders among treatment refractory adolescents
Prof. dr. F. Verheij admitted for specialized psychotherapy
Prof. dr. P. Luyten
Prof. dr. J.E. Hovens Chapter 4 The burden of disease among adolescents with 47
personality pathology: quality of life and costs

Chapter 5 Severity Indices of Personality Problems (SIPP-118) 65
in adolescents: reliability and validity

Chapter 6 Predictors of treatment outcome of Inpatient 89
Psychotherapy for Adolescents (IPA) with personality
pathology

Chapter 7 Long-term outcome of Inpatient Psychotherapy for 109
Adolescents (IPA) with personality pathology

Chapter 8 General discussion 131

Summary 139

Samenvatting 145

Dankwoord 153

Curriculum Vitae 159

PhD portfolio 163
Chapter 1
General introduction
Chapter 1
General introduction
In adults, personality disorders are among the most common mental disorders in
the general population (Torgersen, Kringlen, & Cramer, 2001) and patient samples
(Zimmerman, Rothschild, & Chelminski, 2005). Prevalence rates vary from 13.4%
in the general population, to 56.5% in treated addicted patients, and 60.4% in
psychiatric outpatients (Verheul & van den Brink, 1999). Furthermore, among
adults seeking specialized treatment, personality disorders are associated with low
quality of life (Soeteman, Verheul, & Busschbach, 2008) and high societal costs
(Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). Since the
inclusion of personality disorders in the DSM-III in 1980, much research has been
conducted investigating the effectiveness of treatments for these patients. Based
on this literature, psychotherapy is generally considered the treatment of choice for
adult patients with personality disorders (Landelijke Stuurgroep
Richtlijnontwikkeling in de GGZ, 2008). Much less is known about personality
disorders in adolescents. To the best of our knowledge, the study of Grilo and
colleagues (1998) is the only published prevalence study among adolescent
patients. Most research on personality disorders in adolescents is derived from the
Children in the Community study (CIC; see for example Chen, Cohen, Kasen, &
Johnson, 2006; Johnson et al., 2000; Johnson, Chen, & Cohen, 2004; Kasen et
al., 2007), which was carried out in the general population. Valuable information to
yield arguments in favor of reimbursing treatments for this particular patient group,
like the burden of disease or costs, is virtually non-existing. Furthermore, there are
almost no outcome studies available in this particular group of patients. This thesis
aims to address these above mentioned issues, thereby filling in the existing gap.

Personality disorders
Personality disorders are defined as “an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual’s culture, is
pervasive and inflexible, has an onset in adolescence or early adulthood, is stable
over time, and leads to distress or impairment” (DSM-IV-TR; American Psychiatric
Association, 2000). The current general diagnostic criteria for personality disorders
are presented in Table 1.1. Personality disorders can be classified in three
clusters. The odd or eccentric cluster A includes schizoid, schizotypal, and
paranoid personality disorder. The dramatic, emotional, or erratic cluster B
includes narcissistic, histrionic, borderline, and antisocial personality disorder.
General introduction
In adults, personality disorders are among the most common mental disorders in
the general population (Torgersen, Kringlen, & Cramer, 2001) and patient samples
(Zimmerman, Rothschild, & Chelminski, 2005). Prevalence rates vary from 13.4%
in the general population, to 56.5% in treated addicted patients, and 60.4% in
psychiatric outpatients (Verheul & van den Brink, 1999). Furthermore, among
adults seeking specialized treatment, personality disorders are associated with low
quality of life (Soeteman, Verheul, & Busschbach, 2008) and high societal costs
(Soeteman, Hakkaart-van Roijen, Verheul, & Busschbach, 2008). Since the
inclusion of personality disorders in the DSM-III in 1980, much research has been
conducted investigating the effectiveness of treatments for these patients. Based
on this literature, psychotherapy is generally considered the treatment of choice for
adult patients with personality disorders (Landelijke Stuurgroep
Richtlijnontwikkeling in de GGZ, 2008). Much less is known about personality
disorders in adolescents. To the best of our knowledge, the study of Grilo and
colleagues (1998) is the only published prevalence study among adolescent
patients. Most research on personality disorders in adolescents is derived from the
Children in the Community study (CIC; see for example Chen, Cohen, Kasen, &
Johnson, 2006; Johnson et al., 2000; Johnson, Chen, & Cohen, 2004; Kasen et
al., 2007), which was carried out in the general population. Valuable information to
yield arguments in favor of reimbursing treatments for this particular patient group,
like the burden of disease or costs, is virtually non-existing. Furthermore, there are
almost no outcome studies available in this particular group of patients. This thesis
aims to address these above mentioned issues, thereby filling in the existing gap.

Personality disorders
Personality disorders are defined as “an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual’s culture, is
pervasive and inflexible, has an onset in adolescence or early adulthood, is stable
over time, and leads to distress or impairment” (DSM-IV-TR; American Psychiatric
Association, 2000). The current general diagnostic criteria for personality disorders
are presented in Table 1.1. Personality disorders can be classified in three
clusters. The odd or eccentric cluster A includes schizoid, schizotypal, and
paranoid personality disorder. The dramatic, emotional, or erratic cluster B
includes narcissistic, histrionic, borderline, and antisocial personality disorder.

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