Personality Pathology in Youth: Integrating Conceptual Understanding and Clinical Application

Résumé fourni par la source

Personality pathology refers to a stable pattern of thinking, feeling, and behaving toward oneself and others that repeatedly leads to negative consequences. It has been associated with a range of long-term adverse outcomes, including persistent mental health problems, academic failure, unemployment, poor physical health, and even a reduced life expectancy of up to 18 years. In this dissertation, I examined personality pathology in youth (i.e., adolescents and young adults) from multiple conceptual perspectives, aiming to advance our understanding of personality pathology. Across the chapters, the focus is on the integration of conceptual understanding and clinical application through empirical research. The empirical findings presented demonstrate that personality pathology can and must be recognized in youth. In clinical practice, access to specialized care is often delayed due to factors such as waiting lists, limited availability of specialized treatment facilities, and sometimes the assumption that difficulties may be part of normal adolescent turbulence. Our research shows that the outcomes of personality pathology in youth may vary considerably: for some youth, problems seem to decrease in early adulthood, while for others they tend to persist or even worsen. A “wait-and-see” approach therefore carries substantial risk, as adverse consequences may have already unfolded by the time a trajectory becomes clear. Even though personality pathology manifests in youth, and our cross-sectional findings underscored the accompanying problems of comorbid psychopathology and psychosocial dysfunction, establishing an empirically grounded and clinically useful conceptualization of personality pathology remains challenging. While the DSM-5 introduced the Alternative Model for Personality Disorders (AMPD), the model did not demonstrate the expected differentiating properties in outpatient youth. Instead, a general severity dimension of personality pathology emerged, with subgroups representing quantitative rather than qualitative differences. In a subsequent study, we zoomed in on emotion dysregulation in youth with personality pathology. The subgroups that emerged suggest that meaningful differences these youth might be better captured by their difficulties in emotion regulation abilities, especially the relative level of emotional awareness. Finally, smartphone-based research that collects intensive longitudinal data on individual experiences in daily life may offers an innovative avenue for advancing the conceptualization of personality pathology. By taking individual patterns as a starting point, this approach more closely aligns with clinical practice. Moreover, when carefully designed, frequently monitoring and registering experiences might also serve as an intervention that can enhance youths' insight into maladaptive triggers and patterns. Ultimately, meaningful improvement in outcomes for youth with personality pathology will depend on the continued integration of conceptual understanding and clinical application.

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