Adolescent Psychiatry (v.1, #1)

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I am delighted to introduce the inaugural issue of Adolescent Psychiatry in its new quarterly format. The new version of Adolescent Psychiatry continues the tradition of this distinguished series, published from 1971 – 2008 as a hardcover annual volume. Inaugurated two years after the inception of the American Society for Adolescent Psychiatry in 1969, Adolescent Psychiatry was published for many years with Sherman Feinstein as its very able Editor-in-Chief and Peter Giovacchini as coeditors. Max Sugar, Richard Marohn, and I, also served as Editors-in-Chief. The late 1960s were a time of student protests and riots, communes and hippies. These developments challenged society to understand disaffected youth and spurred the study of the phenomenon of adolescence and the formation of ASAP. From its inception, Adolescent Psychiatry explored the roots of adolescence as a biological, psychological and social phenomenon. Early volumes included many classic papers by such authors as Peter Blos, Erik Erikson, Otto and Paulina Kernberg, and Hans Kohut. In its early years and into the 1990s the series had a decidedly psychoanalytic perspective, which was brought to bear not only in the study of individual patients, but in attempts to understand social movements as well. But, from the beginning, Adolescent Psychiatry began to introduce a broad range of topics such as normal development, inpatient treatment, family therapy, and social and community psychiatry, as they pertained to the adolescent. As neurobiology and psychopharmacology advanced these topics were included as well. Volume 30, the last hardcover volume, was published 2008 in the midst of a sea change in publishing. Questions were being raised about whether that the old model of print publication of journals could continue. Publication costs had risen and it looked as though print publication itself might be doomed. Scholars, researchers, and students no longer went to libraries to research topics of interest, but surfed on line to find content. In addition, many authorities were questioning why readers should have to pay to read about work that was funded by public funds, such as government grants (which they had already funded by taxes). The notion of and#x201C;open accessand#x201D; developed, promoted by such organizations as the Soros Foundation. The National Institutes of Health in the US and many other foundations and agencies around the world established a rule that publications based on work that they fund must be made freely available. Under the open access rubric, the costs for publication are shifted to authors. A new generation of open access on-line journals began to appear. Today nearly all journals are published on-line, with some having only on-line publication. There is a range in terms of access, with some having only pay per view or subscriptions, others having only some articles freely available, and still others being totally open access. Our new publisher, Bentham Science Publishers has journals that fit all of these models. Adolescent Psychiatry follows a hybrid model with articles being made open-access at the discretion of their authors. Thus there is no obligation for authors to pay to have their work published, but they may pay for the work to be freely available if they wish. We have a very wide range of options, including posting supplementary material such as assessment instruments or slide presentations online, with links to it from the journal. ADOLESCENT PSYCHIATRY TODAY With all these changes, some things have not changed. The primary readership of Adolescent Psychiatry has always been clinicians who work with adolescents. The new journal will retain its emphasis on articles that offer syntheses of topics relevant to adolescent development, psychopathology, and treatment of the adolescent patient. It will include reviews, research articles, and case reports. As time goes on, it will also have sections for letters to the editor and book reviews. In addition, there will be issues that focus on a single emerging topic of adolescent psychiatry, composed of invited articles, and coordinated by a guest editor. Adolescent Psychiatry will continue to reflect the view that adolescence is quintessentially a biological, psychological and social phenomenon, and work with adolescents can never be reduced to a simplistic approach. IN THIS ISSUE This issue includes articles on borderline personality disorder and bipolar disorder in adolescents, cybercruelty, immigrant adolescents, research on identity and self-esteem, and psychotherapy. Several articles deal with the challenges presented by difficult to reach and difficult to treat adolescents, reminding us that, although informed by such research as that on attachment, psychotherapy with adolescents is still an art....

This paper presents a follow-up of the psychoanalytic psychotherapy of three female adolescents who met DSM III criteria for borderline personality disorder (BPD). A questionnaire was offered to them 15-30 years after their initial psychotherapeutic contact in an effort to assess the effects of the psychotherapy and their current status. Although all patients came from a White, privileged background, they had very chaotic, disturbed families with absent parent(s), sexual and physical abuse, and few supportive adults during their teenage years. The findings were that all of them had 1) completed the developmental tasks of adolescence; 2) met requirements for being in remission; and 3) had fulfilling, successful adult lives, despite not being entirely free of psychopathology. While not discounting the fact that other influences in their ecosystems were also helpful, we conclude that psychoanalytic psychotherapy with adolescents with borderline personality disorder may be very beneficial.

Borderline Personality Disorder in Adolescents by Lois T. Flaherty (20-22).
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The shame-ethic, which emphasizes courage, disregard of personal safety and maintenance of one's social image, probably goes back to early human history. It tends to arise in social systems that view themselves as under attack and that lean toward combative, aggressive or even militaristic solutions. Cultures operating with this ethic place great importance on appearing strong and invincible; losing face and being shamed are to be avoided at all costs. In our era, the and#x201C;Code of the Streetsand#x201D; is a modern version of this ethic, to which many inner city teenagers subscribe. This code values self-protection, self-aggrandizement, and the capacity to dominate others. It is fragile and must be continually maintained by actions that demean and victimize others. The behavior that characterizes many adolescents who come into treatment settings can be understood in terms of the shame ethnic. Treatment approaches for these young people need to take this dynamic into account and frame interventions in ways that support self esteem while suggesting pro-social behavioral alternatives. This article discusses ways that therapists can be effective with adolescents who subscribe to the shame ethic.

Teenage boys who are mandated into mental health treatment through either probation or juvenile diversion are often reluctant to engage in treatment. These young men typically adhere to both rigid masculine gender norms and the code of the street, both of which discourage men to talk about their feelings or display any sign of vulnerability. However, if these young men fail to connect to supports they are at-risk for school dropout, incarceration and possibly significant injury or death. This article identifies barriers to engaging in treatment for systems-involved adolescent males as well as practical techniques for clinicians to help facilitate buy-in to treatment by reframing the treatment process for this population.

Adolescent immigrants need to navigate typical adolescent challenges while also struggling with the impact of immigration. Mastering the developmental tasks of adolescence is even more daunting for those teenagers who have underlying psychopathology. Intensive psychotherapy with these troubled teens provides a rich opportunity to better understand their struggles and to examine how best to provide necessary support for them. In this paper we explore how the task of engaging adolescents and their families warrants an approach that provides a space that is both flexible and responsive, addressing the underlying loss and behavior secondary to insecure or disorganized attachments. A case study of an immigrant teen in long-term treatment at a school-based health center (SBHC) highlights the importance of utilizing an attachment based model when intervening with this rewarding and highly vulnerable population. The case example illustrates the long term, therapeutic work which is reflective of the complicated patients in our caseloads, and also illuminates how the attachment framework shapes the therapeutic work. The advantages of the SBHC for utilizing this model are discussed.

Self-reflection is a developmental competence that fully emerges in adolescence. In this paper, self-reflection development is explored from the perspectives of developmental psychology, resilience studies, and developmental psychopathology as a way to deepen clinicians' understanding of the clinical relevance of self-reflection development. Literature on narrative identity formation in normative adolescence is reviewed, and research on self-reflection in narratives of high-risk adolescents participating in a 30+ year ongoing longitudinal study of adolescent developmental psychology and psychopathology is presented. A theoretical synthesis is proposed to account for the relations between self-reflection, competence and resilient outcome.

The diagnosis of juvenile bipolar disorder (JBD) has been the subject of much controversy and confusion. There have been well documented increases in the application of this diagnosis, at least in the United States. This has led to concerns about overdiagnosis. At the same time, juvenile bipolar disorder presenting in adolescents can be difficult to detect, with symptoms being perceived as normal, if exaggerated, adolescent behavior. Two cases, one mistakenly diagnosed as JBD and the other in which the diagnosis was missed, illustrate the difficulty in making an accurate diagnosis. Recent refinements in diagnosis have the potential to clarify and improve clinical diagnosis and treatment. The three main diagnostic approaches to JBD (the so-called and#x201C;narrow phenotypeand#x201D; approach, the and#x201C;cardinal symptomsand#x201D; and brief frequent cycles approach, and finally the persistent, impairing irritability approach) are reviewed. The author then reviews the longitudinal data examining continuity between juvenile and adult bipolar disorder. Returning to the cases, the author reviews her treatment decisions, and how they could have been improved with better diagnostic precision. Finally, some thoughts are shared about why the diagnosis of JBD has become both so much more frequent and controversial, and what practicing clinicians should focus on.

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Cyber Cruelty: Understanding and Preventing the New Bullying by Ruth Gerson, Nancy Rappaport (67-71).
As adolescents increasingly adopt cell phones, smart phones, and the Internet as tools for communication and social networking, they can become victims of the growing trend of cyberbullying – targeted harm inflicted through such technology. These forms of technology are often strange and unfamiliar to parents, teachers, and medical and mental health providers. This review article provides an introduction to cyberbullying, tools for screening, and opportunities for prevention.

Identity and Acculturation in Immigrant and Second Generation Adolescents by Eugenio M. Rothe, Andres J. Pumariega, Diana Sabagh (72-81).
The experience of immigration presents developmental challenges to adolescents that can lead to negative mental health outcomes, or can result in resiliency, psychological growth and enrichment of the personality structure. This article reviews the most recent demographics and research findings of the first and second generation immigrant adolescents in the United States. It explains the psychodynamic processes of migration and acculturation, and the risk factors and protective factors that affect these adolescents. Finally, it offers some suggestions regarding treatment approaches with this population.

Rational emotive behavioral therapy (REBT) is a form of cognitive behavioral therapy developed by Albert Ellis. Developed in the 1950s, REBT was one of the earliest forms of what became known as cognitive behavioral therapy. It was successfully adapted for children and adolescents in the 1980s (Barnard and Joyce, 1984) and has been studied extensively and shown to be effective in this population (Gonzales, Nelson, and Gutkin, 2004). This article provides a selective review of the literature, and brief overview of REBT, and discusses its advantages and disadvantages.

Effects of Self-Image on Identity Status Among Turkish Adolescents by Fusun Cuhadaroglu Cetin, Halime Tuna Ulay (88-93).
The concepts of identity and self-image are realms of two different theories, but both are frequently used and are very helpful in understanding adolescents. The present study explores the relation of the self-image with identity status among 364 Turkish adolescents of varied socioeconomic status. The results show that adolescents from low socioeconomic status have more negative self-images on all measures and those from upper socioeconomic status are differentiated from those of middle and lower SES by having a more positive sense of identity. The main effects of sense of identity are seen in the emotional tone, body-image, social relations, family relations, and vocational-educational goals aspects of self-image.