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The British Journal of Psychiatry (2005) 186: 227-238
© 2005 The Royal College of Psychiatrists

Assessing adolescent personality pathology

Drew Westen, PhD

Emory University, Atlanta, Georgia

Lissa Dutra, EdM

Center for Anxiety and Related Disorders and Department of Psychology, Boston University, Boston, Massachusetts

Jonathan Shedler, PhD

University of Denver, Denver, Colorado, USA

Correspondence: Dr Drew Westen, Department of Psychology and Department of Psychiatry and Behavioral Sciences, Emory University, 532 N. Kilgo Cir., Atlanta, Georgia 30322, USA. E-mail: dwesten{at}emory.edu

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Personality pathology constitutes a major form of psychopathology in adolescents.

Aims To examine the reliability and validity of a Q-sort instrument for assessing adolescent personality pathology designed for clinically experienced informants.

Method A sample of 294 randomly selected psychiatrists and psychologists each provided data on a current patient, aged 14-18 years. Clinicians completed several measures, including the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A).

Results Factor analysis identified II dimensions of adolescent personality: psychopathology/malignant narcissism, dysphoria/inhibition, psychological health, histrionic sexualisation, schizotypy, sexual conflict, emotional dysregulation, anxious obsessionality, peer rejection, delinquent behaviour and attentional dysregulation. These correlated in predicted ways with a range of criterion variables, including measures of adaptive functioning, Axis II pathology, the Five Factor Model and the Child Behavior Checklist.

Conclusions The SWAP-200-A shows promise as an instrument for assessing personality pathology in adolescents. Trait dimensions such as delinquent behaviour and emotional dysregulation may prove useful additions to a classification of personality.




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