Assessment of identity development and identity diffusion in adolescence - Theoretical basis and psychometric properties of the self-report questionnaire AIDA

Chinese Medicine

Klaus Schmeck⁴  Oliver Pick⁴  Emanuel Jung⁴  Marc Birkhölzer¹  Susanne Schlüter-Müller²  Pamela Foelsch³  Kirstin Goth⁴ 

[1] Faculty of Medicine, Justus Liebig University, Giessen, Germany;Practice for Child and Adolescent Psychiatry, Frankfurt/Germany, and University of Applied Sciences FHNW, Basel, Switzerland;Weill Medical College of Cornell University, New York, USA;Child and Adolescent Psychiatric Hospital, Psychiatric University Hospitals Basel, Basel, Switzerland

关键词: Adolescence;    Personality disorder;    Psychometrics;    Overview;    Questionnaire;    Identity;   

Others  :  791295
DOI  :  10.1186/1753-2000-6-27

 received in 2012-03-15, accepted in 2012-06-27,  发布年份 2012

【 摘 要 】

Background

In the continuing revision of Diagnostic and Statistical Manual (DSM-V) “identity” is integrated as a central diagnostic criterion for personality disorders (self-related personality functioning). According to Kernberg, identity diffusion is one of the core elements of borderline personality organization. As there is no elaborated self-rating inventory to assess identity development in healthy and disturbed adolescents, we developed the AIDA (Assessment of Identity Development in Adolescence) questionnaire to assess this complex dimension, varying from “Identity Integration” to “Identity Diffusion”, in a broad and substructured way and evaluated its psychometric properties in a mixed school and clinical sample.

Methods

Test construction was deductive, referring to psychodynamic as well as social-cognitive theories, and led to a special item pool, with consideration for clarity and ease of comprehension. Participants were 305 students aged 12–18 attending a public school and 52 adolescent psychiatric inpatients and outpatients with diagnoses of personality disorders (N = 20) or other mental disorders (N = 32). Convergent validity was evaluated by covariations with personality development (JTCI 12–18 R scales), criterion validity by differences in identity development (AIDA scales) between patients and controls.

Results

AIDA showed excellent total score (Diffusion: α = .94), scale (Discontinuity: α = .86; Incoherence: α = .92) and subscale (α = .73-.86) reliabilities. High levels of Discontinuity and Incoherence were associated with low levels in Self Directedness, an indicator of maladaptive personality functioning. Both AIDA scales were significantly different between PD-patients and controls with remarkable effect sizes (d) of 2.17 and 1.94 standard deviations.

Conclusion

AIDA is a reliable and valid instrument to assess normal and disturbed identity in adolescents. Studies for further validation and for obtaining population norms are in progress and may provide insight in the relevant aspects of identity development in differentiating specific psychopathology and therapeutic focus and outcome.

【 授权许可】

   
2012 Goth et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Akhtar S, Samuel S: The concept of identity developmental origins, phenomenology, clinical relevance and measurement. Harv Rev Psychiatry 1996, 3(5):254-267.
• [2]Erickson EH: The theory of infantile sexuality. In Childhood and Society. New York: W. W. Norton; 1959:42-92.
• [3]Taskforce OPD: Operationalized Psychodynamic Diagnosis OPD-2: Manual of Diagnosis and Treatment Planning. Hogrefe & Huber; 2007.
• [4]Foelsch P, Odom A, Schmeck K, Schlüter-Müller S, Kernberg O: Behandlung von Adoleszenten mit Identitätsdiffusion - Eine Modifikation der Übertragungsfokussierten Psychotherapie (TFP). Persönlichkeitsstörungen: Theorie und Therapie 2008, 12(3):153-162.
• [5]Kernberg PF, Weiner AS, Bardenstein KK: Personality Disorders in Children and Adolescents. New York: Basic Books; 2000.
• [6]Resch F: Zur Entwicklung von Identität. In Klinische Psychotherapie des Jugendalters. Edited by D Bois R, Resch F. Stuttgart: Kohlhammer; 2005:55-64.
• [7]Resch F, Freyberger H: Struktur und Identität. In Adoleszenzpsychiatrie – Psychiatrie und Psychotherapie der Adoleszenz und des jungen Erwachsenenalters. Edited by Fegert J, Streeck-Fischer , Freyberger H. Stuttgart: Schattauer; 2009:105-111.
• [8]Brackens AB: MSCS: Multidimensional Self Concept Scale. Pro-Ed. 1992.
• [9]Deusinger IM: Frankfurter Selbstkonzeptskalen (FSKS). Handanweisung. Göttingen: Hogrefe; 1986.
• [10]Erikson EH: Identity, youth and crisis. New York: W.W. Norton, Inc.; 1968.
• [11]Marcia JE: Development and validation of ego identity status. J Pers Soc Psychol 1966, 3:551-558.
• [12]Kroger J, Martinussen M, Marcia JE: Identity status change during adolescence and young adulthood: A meta-analysis. J Adolesc 2010, 2010(33):683-698.
• [13]Meeus W, Branje S, Schwartz SJ: On the Progression and Stability of Adolescent Identity Formation: A Five-Wave Longitudinal Study in Early-to-Middle and Middle-to-Late Adolescence. Child Dev 2010, 81(5):1565-1581.
• [14]Marcia JE: Ego Identity and Personality Disorders. J Pers Disord 2006, 20(6):577-596.
• [15]Fonagy P, Gergely G: Jurist EL, Target M: Affect regulation, mentalization, and the development of the self. New York: Other Press; 2002.
• [16]Seiffge-Krenke I, Weyers B: Coping Trajectories from Adolescence to young Adulthood: Links to Attachment State of Mind. JOURNAL OF RESEARCH ON ADOLESCENCE 2005, 15(4):561-582.
• [17]Kernberg O: The diagnosis of borderline conditions in adolescence. In Adolescent Psychiatry, 6, 298-319. Edited by Feinstein S, Giovacchini P. Chicago: University of Chicago Press; 1978.
• [18]Foelsch PA, Odom A, Kernberg OF: Treatment of Adolescents with Identity Diffusion: A Modification of Transference Focused Psychotherapy. Sante Ment Que 2008, 33(1):37-60.
• [19]Clarkin JF, Yeomans FE, Kernberg OF: Psychotherapy for borderline personality. New York: Wiley; 1999.
• [20]Clarkin JF, Yeomans FE, Kernberg OF: Psychotherapy of borderline personality: Focusing on object relations. Washington, D.C.: American Psychiatric Publishing, Inc.; 2006.
• [21]Kernberg O: Schwere Persönlichkeitsstörungen. Stuttgart: Klett-Cotta; 1985.
• [22]Westen D, Betan E, Defife JA: Identity disturbance in adolescence: Associations with borderline personality disorder. Dev Psychopathol 2011, 23:305-313.
• [23]Crick NR, Murray-Close D, Woods K: Borderline personality features in childhood: A short-term longitudinal study. Dev Psychopathol 2005, 2005(17):1051-1070.
• [24]Poreh AM, Rawlings D, Claridge G, Freeman JL, Faulkner C, Shelton C: The BPQ: A scale for the assessment of borderline personality based on DSM-IV criteria. J Pers Disord 2006, 20:247-260.
• [25]Chanen AM, Jovev M, Djaja D, McDougall E, Yuen HP, Rawlings D: Screening for borderline personality disorder in outpatient youth. J Pers Disord 2008, 22:353-364.
• [26]Diagnostic and Statistical Manual, Fourth Edition. APA; 1994.
• [27]Becker D, Grilo C, Edell W, McGlashan T: Diagnostic efficiency of borderline personality disorder criteria in hospitalized adolescents: Comparison with hospitalized adults. Am J Psychiatry 2002, 159:2042-2046.
• [28]Widiger TA, Simonsen E, Krueger R, Livesley WJ, Verheul R: Personality Disorder Research Agenda for the DSM-V. J Pers Disord 2005, 19(3):315-338.
• [29]Livesley WJ: A framework for integrating dimensional and categorical classifications of personality disorder. J Pers Disord 2007, 21(2):199-224.
• [30]Skodol AE, Gunderson JG, Pfohl B, Widiger TA, Livesley WJ, Siever LJ: The borderline diagnosis I: Psychopathology, comorbidity, and personality structure. Biol Psychiatry 2002, 51:936-950.
• [31]Chanen AM, Jovev M, Jackson HJ: Adaptive functioning and psychiatric symptoms in adolescents with borderline personality disorder. J Clin Psychiatry 2007, 68:297-306.
• [32]Coid J, Yang M, Tyrer P, Roberts M, Ullrich S: Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 2006, 188:422-431.
• [33]Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR: Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry 2006, 163:827-32.
• [34]Sharp C, Romero C: Borderline personality disorder: A comparison between children and adults. Bull Menninger Clin 2007, 71:85-114.
• [35]Miller AL, Muehlenkamp JJ, Jacobson CM: Fact or fiction: Diagnosing borderline personality disorder in adolescents. Clinical PsychologyReview 2008, 28:969-981.
• [36]Schmid M, Schmeck K, Petermann F: Persönlichkeitsstörungen im Kindes- und Jugendalter? Kindheit und Entwicklung 2008, 17(3):190-202.
• [37]Schmeck K, Schlüter-Müller S: Persönlichkeitsstörungen im Jugendalter. Heidelberg: Springer; 2009.
• [38]Kernberg O: The structural diagnosis of borderline personality organization. In Borderline Personality Disorders: The concept, the syndrome, the patient. Edited by Hartocollis MP. New York: I.U.P; 1977.
• [39]Kernberg P, Koenisgberg H: The Extensive Identity Diffusion: On a Particular Form of Identity Diffusion in borderline patients extending the limits of treatability. New York: Basic Books; 1999.
• [40]Clarkin JF, Foelsch PA, Levy KN, Hull JW, Delaney JC, Kernberg OF: The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change. J Pers Disord 2001, 2001(15):487-495.
• [41]Foelsch P, Odom A, Arena H, Krischer M, Schmeck K, Schlüter-Müller S: Differenzierung zwischen Identitätskrise und Identitätsdiffusion und ihre Bedeutung für die Behandlung am Beispiel einer Kasuistik. Prax Kinderpsychol Kinderpsychiatr 2010, 59(6):418-34.
• [42]Kernberg OF, Foelsch PA: Übertragungsfokussierte Psychotherapie für Jugendliche: Ein vorläufiger Gedankenaustausch. Kinderpsychiat. 2008, 59:418-434.
• [43]Kernberg PF: The Inventory of Personality Organization for Children/Adolescents (IPO-CH). New York: White Plains, Personality Disorders Institute, Weill Medical College of Cornell University; 2001.
• [44]Clarkin JZ, Foelsch PA, Kernberg OF: The Inventory of Personality Organization. New York: White Plains, Personality Disorders Institute, Weill Medical College of Cornell University; 2001.
• [45]Igarashi H, Kikuchi H, Kano R, Mitoma H, Shono M, Hasui C, Kitamura T: The Inventory of Personality Organisation: its psychometric properties among student and clinical populations in Japan. Annals of General Psychiatry 2009, 8(9):1-21.
• [46]Clarkin JF, Caligor E, Stern BL, Kernberg OF: Structured Interview of Personality Organization (STIPO). New York: Unpublished Manuscript, Personality Disorders Institute, Weill Medical College of Cornell University; 2004.
• [47]Verheul R, Andrea H, Berghout C, Dolan C, Vanderkroft P, Busschbach J, Bateman A, Fonagy P: Severity Indices of Personality Problems (SIPP-118): Development, Factor Structure, Reliability, and Validity. Psychol Assess 2008, 20(1):23-34.
• [48]Tan AL, Kendis RJ, Fine JT, Porac J: A short measure of Eriksonian ego identity. J Pers Assess 1977, 41(3):279-84.
• [49]Gable RK, La Salle AJ, Cook KE: Dimensionality of Self Perception: Tennessee Self Concept Scale. Percept Mot Skills 1973, 36:551-560.
• [50]Akhtar S, Samuel S: The identity consolidation inventory (ICI): Development and application of a questionnaire for assessing the structuralization of individual identity. Am J Psychoanal 2009, 69:53-61.
• [51]Raatz U: Better Theory for Better Tests? Lang Test 1985, 2(1):60-75.
• [52]Mayer JD: A tale of two visions - Can a new view of personality help integrate psychology? Am Psychol 2005, 60:294-307.
• [53]Livesley WJ, Jang KL: Differentiating normal, abnormal, and disordered personality. Eur J Personal 2005, 19:257-268.
• [54]Frick PJ: Integrating Research on Temperament and Childhood Psychopathology: Its Pitfalls and Promise. J Clin Child Adolesc Psychol 2004, 33:2-7.
• [55]Cloninger CR, Przybeck TR, Svrakic DM: A psychobiological model of temperament and character. Arch Gen Psychiatry 1993, 50:975-990.
• [56]Cloninger CR, Svrakic DM: Integrative Psychobiological Approach to Psychiatric Assesment and Treatment. Psychiatry 1997, 60:120-141.
• [57]Cloninger CR, Svrakic DM: Differentiating normal and deviant personality by the seven-factor personality model. In Differentiating normal and abnormal personality. Edited by Strack S, Lorr M. New York: Springer; 1994:40-64.
• [58]Cloninger CR, Svrakic NM, Svrakic DM: Role of personality self-organization in development of mental order and disorder. Dev Psychopathol 1997, 9:881-906.
• [59]Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR: Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002, 106:189-195.
• [60]Barnow S, Herpertz S, Spitzer C, Stopsack M, Preuss U, Grabe HJ, Kessler C, Freyberger HJ: Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account. Psychopathology 2007, 40:369-378.
• [61]Arens A, Grabe HJ, Spitzer C, Barnow S: Testing the biosocial model of borderline personality disorder: Results of a prospective 5-year longitudinal study. Personal Ment Heal 2011, 5:29-42.
• [62]Ubbiali A, Chiorri C, Donati D: The Italian version of the Inventory of Interpersonal Problems Personality Disorders Scales (IIP-47): psychometric properties and clinical usefulness as a screening measure. J Pers Disord 2011, 25(4):528-541.
• [63]Goth K, Cloninger CR, Schmeck K: The Junior Temperament und Character Inventory for adolescents - JTCI 12-18 R. Department of Child and Adolescent Psychiatry, J. W. Goethe University Frankfurt; 2004.
• [64]Goth K: Temperament und Charakter - Die inhaltsäquivalente Abbildbarkeit der Grundpersönlichkeit vom Kindergarten- bis zum Erwachsenenalter mithilfe des sieben-dimensionalen Modell Cloningers. Hut: Verlag Dr; 2008.
• [65]Jackson D: A sequential system for personality scale development. In Current topics in clinical and community psychology. Edited by Spielberger CD. New York, NY: Academic Press; 1970:61-96.
• [66]Cloninger CR: The Temperament and Character Inventory—Revised. MO: Washington University, Center for Psychobiology of Personality, St. Louis; 1999. Available from C. R. Cloninger, Washington University School of Medicine, Department of Psychiatry, P.O. Box 8134, St. Louis, MO 63110
• [67]Goth K, Schmeck K: Das Junior Temperament und Charakter Inventar. Göttingen: Hogrefe, Eine Inventarfamilie zur Erfassung der Persönlichkeit vom Kindergarten- bis zum Jugendalter nach Cloningers biopsychosozialem Persönlichkeitsmodell; 2009.
• [68]Oh H, Min B: The Temperament and Character Inventory for children and adolescents JTCI – Korean version. Seoul: Maumsarang; 2004.
• [69]Wittchen HU, Zaudig M, Fydrich T: SCID II - Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe; 1997.
• [70]Suppiger A, In‒Albon T, Hendriksen S, Hermann E, Margraf J, Schneider S: Acceptance of structured diagnostic interviews for mental disorders in clinical practice and research settings. Behav Ther 2009, 40:272-279.
• [71]Amelang M, Zielinski W: Psychologische Diagnostik und Intervention. 2nd edition. Berlin: Springer; 1997.
• [72]Lienert GA, Raatz U: Testaufbau und Testanalyse. 5. neu bearb. und erw. Auflage. Weinheim: Psychologie Verlags Union; 1994.
• [73]Bortz J, Döring N: Forschungsmethoden und Evaluation. 2nd edition. Berlin: Springer; 1995.
• [74]Kroger J: Gender and identity: the intersection of structure, content, and context. Sex Roles 1997, 36:747-770.