What makes Chinese adolescents "trapped" in severe mental illness? An interactionist perspective on self and identity

The aim of this study was to explore the self and identity perspectives among Chinese adolescents with severe mental illness (SMI), with a focus on their illness experience and subjective meaning of a formal diagnosis. Thirty-one Chinese adolescents were interviewed and the interview data were analysed strictly according to principles suggested by the constructivist grounded theory approach. Five theoretical codes emerged in this study, including changes of personal values and beliefs, accumulated persistent developmental challenges and personal stresses, ineffective coping strategies and development, symptoms and development of mental illness, and changed perceptions and understandings of self. A proposed model of "The dynamic interactions of Chinese adolescents' identity and mental illness", was constructed and visualized. The results revealed that adolescents' identity formation is a fluctuating and non-linear process, but tends to be predominantly negative. The negative self, as informed by long-term ineffective coping with accumulated persistent developmental challenges and stressful events, develops towards a more serious status of negative identity and contributes to relapse symptoms, although this impact occurs variably with perceived personal characteristics. Besides, some participants who had achieved a state of "Buddha-like numbness" made a conscious decision to live a seemingly normal life while coexisting with their illness. The study also highlighted the positive aspects of identity formation that can arise from the experience of illness, including an enhanced sense of realism and increased empathy. Our findings will imply much the need for person-centred treatment plan and services that take into account of individual situations.

The Self-Concept and Identity Measure in Patients with Personality Disorders: A Psychometric Evaluation and Associations With Identity Processes, Core Domains of Self-Functioning, and Personality Disorder Symptoms

As developmental and clinical research on identity has largely developed in disconnect, scholars recommend adopting a developmental psychopathology perspective on identity, which considers adaptive and pathological identity functioning. Such a perspective has also been introduced in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Alternative Model for Personality Disorders (AMPD), which suggests that all personality disorders (PDs) are marked by moderate to extreme deficits in self-functioning (i.e., identity and self-direction). The present study aims to validate the Dutch Self-Concept and Identity Measure (SCIM), a 27-item self-report questionnaire that assesses consolidated identity, disturbed identity, and lack of identity, in 153 psychiatric inpatients with PDs (75.2% female; Mage = 31.73). We investigated the factor structure and reliability of the SCIM, and examined associations of SCIM scales with typical identity processes, AMPD domains of self-functioning, and symptoms of all PDs. Results indicated that a 23-item Dutch SCIM produced valid and reliable scores among patients with PDs. Furthermore, SCIM scales were significantly and differentially related to identity commitment processes, ruminative identity exploration, domains of self-functioning, and symptoms of all PDs. Moreover, findings indicated that PDs varied regarding the severity of identity impairment.

Trajectories of adaptive and disturbed identity dimensions in adolescence: developmental associations with self-esteem, resilience, symptoms of depression, and borderline personality disorder features

To advance our understanding of adolescents' identity formation and how it may play into their psychological functioning, this study investigated developmental trajectory classes of adaptive and disturbed dimensions of identity formation, and whether adolescents belonging to different trajectory classes develop differently on self-esteem, resilience, symptoms of depression, and borderline personality disorder (BPD) features. Three-wave longitudinal data from 2,123 Flemish adolescents was used (54.2% girls; M_age = 14.64, range = 12-18 at T1). Results pointed to four trajectory classes of identity formation: adaptive identity, identity progression, identity regression, and diffused identity. The adaptive identity class presented with stable high levels of self-esteem and resilience, and stable low levels of symptoms of depression and BPD, whereas opposite results were obtained for the diffused identity class. The identity progression class reported an increase in self-esteem and resilience as well as a decrease in symptoms of depression and BPD, whereas opposite results were obtained for the identity regression class. These results emphasize that adaptive and disturbed dimensions of identity formation are closely related to markers of well-being and psychopathology among adolescents, and could help identify adolescents with an increased risk for negative psychological functioning or increased opportunity for positive psychological functioning.

A person-centered perspective on the combined DSM-5 AMPD/ICD-11 personality model: Utility, relationship with the categorical personality disorder model, and capacity to differentiate between levels of identity functioning

BACKGROUND

Both the ICD-11 classification of Personality Disorders and the DSM-5 Alternative Model for Personality Disorders (DSM-5 AMPD) conceptualize personality pathology in a dimensional way, but differ in the way they carve up their respective pathological personality domains. Recently, a combination of ICD-11 and DSM-5 AMPD descriptive pathological personality traits, the Modified Personality Inventory for DSM-5-Brief Form Plus (PID5BF + M), was developed.

THE CURRENT STUDY

We investigated the utility of the additional ANANKASTIA domain (not represented in the DSM-5 AMPD) as well as of the additional PSYCHOTICISM domain (not represented in the ICD-11 model) in the identification of meaningful pathological personality domain clusters based on the PID5BF + M. Next to the classical 2- and 3-cluster solutions, we examined whether the presence of the additional ANANKASTIA domain would also gave rise to a meaningful 4-cluster solution. We then validated these clusters by investigating differences between them in mean DSM-5 Section II cluster A, B, and C personality disorder scores. Finally, we investigated whether cluster membership was able to differentiate between levels of identity functioning, a key feature of personality disorder severity in both the ICD-11 model and the DSM-5 AMPD.

MATERIALS AND METHODS

We used a Flemish community sample of 242 participants, and applied k-means cluster analyses in a two-step manner on PID5BF + M domains to investigate 2-, 3-, and 4-cluster solutions. We used MANOVAs to examine differences between clusters in PID5BF + M domains, DSM-IV/DSM-5 Section II Assessment of Personality disorders (ADP-IV) cluster A, B, and C scores, and Self-Concept and Identity Measure (SCIM) scores.

RESULTS

Cluster analyses on PID5BF + M pathological personality domains (1) revealed meaningful 2-, 3-, and 4-cluster solutions, with the 4-cluster solution explaining the most variance in the clustering variables, (2) allowed to identify a classical Overcontrolled cluster which DSM-5 AMPD PID-5 does not, and (3) demonstrated the utility of representing ANANKASTIA and DISINHIBITON as separate pathological personality domains. PID5BF + M clusters (5) were informative of DSM-5 Section II cluster A, B, and C personality disorder scores and (6) showed different levels of clinical-developmental Identity functioning.

CONCLUSION

Current results demonstrate the utility of a combined ICD-11/DSM-5 AMPD view from a person-centered perspective.

An Evaluation of Age-Group Latent Mean Differences in Maladaptive Identity in Adolescence

Little is known about the differences between age groups in maladaptive personality function as denoted in Criterion A of the Alternative Model for Personality Disorder (AMPD) in the DSM-5, which is the entry criterion for diagnosing personality disorder in the upcoming ICD-11. The current study aimed to address this gap by evaluating latent mean age group differences in maladaptive identity, which is one aspect that has been identified as an important feature of maladaptive, general personality function as represented in the DSM-5 and ICD-11. We were also interested whether mean differences would track with mean differences in borderline personality disorder (BPD) features given prior data suggesting that general personality function overlap with the construct of BPD. A community sample of N = 2,381 adolescents, representing a mix of different socio-economic and educational backgrounds, ages 12-18 (M = 14.92, SD = 1.94; 46% male) completed a measure of maladaptive identity. A subset (n = 1,165) completed a measure of borderline personality features. Latent variable modeling was used to evaluate latent mean differences across seven age bands. Results suggested a normative increase in maladaptive identity after age 12, which remained consistent until age 17 when it dropped back to levels observed in 12-year-olds. Maladaptive identity was significantly associated with mean-level increases in borderline personality features, with these constructs becoming more closely associated with increasing age.