Diagnosis of personality disorders in adolescents and young adults

The importance of clinical diagnosis

Making an accurate diagnosis of personality disorders, or clearly ruling them out, is fundamental to the therapeutic process. It often precedes or accompanies the diagnosis of comorbid Axis I disorders (e.g., depression, anxiety disorders, eating disorders, addictions). Most importantly, it provides a solid foundation for planning personalized and effective treatment strategies and therapeutic interventions.

A precise diagnosis allows clinicians to better understand the complexity of a patient’s symptoms, which translates into more effective management and significant improvements in quality of life. Furthermore, the diagnostic process itself can have therapeutic value, providing patients and their loved ones with a framework for interpreting observed behaviors and experienced difficulties. Understanding that certain behavioral patterns stem from structured disorders, rather than “bad faith” or intentional actions, can bring relief, reduce feelings of guilt and frustration, and increase a sense of control over the clinical situation. This, in turn, fosters a therapeutic alliance and increases motivation to initiate and continue treatment.

Diagnostic criteria and adolescence

According to current diagnostic classifications (DSM-5, ICD-10), a formal diagnosis of personality disorder is made to adults (usually after the age of 18). This is based on the assumption that personality is still malleable and subject to dynamic change during the developmental period. However, numerous clinical studies and observations indicate that precursors and full-blown symptoms of personality disorders often manifest in adolescence.

If a teenager observes persistent, maladaptive patterns of self-perception and the world that significantly impact their social, emotional, and academic functioning, even if they do not yet meet all the criteria for a full-blown personality disorder, immediate psychological consultation is recommended. In adolescents, the terms “abnormally developing personality” or “at risk of developing a personality disorder” are more commonly used. Early intervention to support a young person’s development, such as individual therapy, family therapy, or psychoeducation, can significantly prevent the entrenchment of pathological patterns and the development of more serious problems in adulthood.

Diagnostic Process: Methodology and Tools

The diagnostic process for personality disorders is multi-stage, comprehensive, and requires clinical experience. It aims to provide a comprehensive picture of the patient’s functioning in various areas of life.

Stage One: Detailed Clinical Interview

The first phase includes an in-depth diagnostic interview that collects information from several key areas:

• Developmental interview: Concerning the course of early development, temperament in childhood, key developmental milestones, adaptation problems in kindergarten and school.
• Family interview: Analysis of family dynamics, parenting style, presence of mental illness in the family, relationships with siblings and parents, significant life events in the family.
• Current Problem Interview: Detailed discussion of current difficulties, their severity, frequency, impact on functioning, and history of previous therapeutic interventions.
• Interviewing Significant Persons: For adolescents and young adults, an extremely valuable source of information is interviewing parents, other caregivers, or significant adults (e.g., teachers, coaches) who can provide perspective on long-standing behavioral patterns, interpersonal difficulties, and the patient’s emotional reactions in various contexts.

Stage Two: Application of specialized psychological tests

The second stage involves the use of standardized and validated psychometric tools that provide objective data and complement the information gathered during the interview. The most commonly used include the Minnesota Multiphasic Personality Inventory (MMPI-2). This is one of the most renowned and widely used tools in the diagnosis of personality disorders and other psychological difficulties. The MMPI-2 allows for a comprehensive assessment of various personality dimensions, pathological thinking patterns, emotion regulation, stress coping styles, and tendencies to engage in specific types of interpersonal relationships. The patient responds to a series of statements, indicating whether they are true, false, or “don’t know.” The profile of obtained results is then interpreted by an experienced diagnostician.

In the case of children and adolescents, it is particularly important to use other screening tools, such as:

• KBPK-R (Questionnaire for Examining the Sense of Control – revised version) – assesses the child’s beliefs about the ability to influence events in his or her life
• CISS (Coping Inventory for Stressful Situations) – examines the adaptive strategies of young people in the face of difficulties
• IVE (Impulsivity Questionnaire) – measures the level of impulsivity, sensation-seeking and empathy in children and adolescents

These tools take into account the developmental specificity of young patients and often require cooperation with parents or guardians in the process of interpreting the results.

Stage Three: Synthesis and Discussion of Results

The final phase of the diagnostic process involves synthesizing all the collected information—interview data, clinical observations, and psychological test results. Based on this comprehensive analysis, an experienced diagnostician diagnoses or rules out personality disorders. The results are then discussed in detail with the patient and their loved ones, and most importantly, the most appropriate therapeutic strategies are planned, such as individual psychotherapy (e.g., dialectical behavioral therapy, schema therapy), pharmacotherapy (in the case of comorbid disorders), or family therapy.

The benefits of precise diagnosis

Taking the diagnostic path, although it may require commitment and time on the part of the patient and their family, is associated with a number of invaluable benefits of both clinical and personal dimensions:

• Understanding and Psychoeducation: Diagnosis provides a starting point for a deeper understanding of the underlying causes of the difficulties observed. This can be a source of immense relief for the patient and their loved ones, helping them realize that behaviors and reactions that previously seemed incomprehensible or intentionally hurtful are, in fact, manifestations of the disorder. Parents, with this knowledge, can develop more effective communication and support strategies for their child, understanding their specific needs and challenges.
• Individualizing the treatment plan: Accurate diagnosis is absolutely crucial for planning appropriate, targeted interventions and treatments that are tailored to the individual needs and specific nature of the disorder. Without an accurate diagnosis, treatment may be ineffective or even harmful because it fails to address specific, deeply ingrained behavioral patterns and personality pathologies.
• Improving quality of life and functioning: Effective treatment, based on an accurate diagnosis, can significantly manage symptoms, reduce suffering, and improve the overall quality of life of the affected person. It enables them to function better in everyday life, including social, educational, and professional relationships.
• Support for the patient’s environment: Diagnosis equips the patient’s loved ones with the tools and knowledge to better support the person with the disorder and cope with the challenges posed by this specific clinical situation. Understanding the pathogenesis of difficulties significantly reduces feelings of guilt, frustration, and helplessness within the family, fostering a supportive environment.

Support for specialists and patient families

Diagnosing a personality disorder in a young patient is a challenge not only for the patient and their family but also for the therapeutic team. It is crucial that professionals remember the importance of support for caregivers. It is recommended to actively promote support groups for families of individuals with mental disorders and offer individual psychological consultations to help them cope with the accompanying emotions, stress, and challenges. Available scientific and popular science literature can also be a valuable source of information, helping families understand the mechanisms of disorders and more effectively support their loved ones. It is crucial to build awareness that the path to recovery is a process that requires patience, consistency, and cooperation from all parties involved.

In summary, the process of diagnosing personality disorders is a fundamental step toward better understanding oneself and the world in the context of personality pathology. Although it requires commitment and time, the benefits of a precise diagnosis and the implementation of appropriate, personalized treatment are invaluable. If any concerns arise regarding the mental health of young people, it is crucial to immediately refer them to a specialist. It is important to remember that early intervention is often key to halting the progression of pathology, improving quality of life, and building healthier and more fulfilling interpersonal relationships.