Psychogenetische und psychodynamische Aspekte von Störungen in der Adoleszenz

Abstract

This article points to specific psychodynamic aspects in the development and phenomenology of mental disorders in adolescence. Adolescence is defined psychologically, neurobiologically and culturally as an extended developmental phase, which is typical for highly industrialised and covers teenagers and young adults up to the age of 25 years. Due to its prolongation and the tendency of adolescent disorders to develop into disabling chronic mental illnesses, adolescence is becoming more and more of a challenge for general psychiatry. In post-war decades epidemiological data show a strong tendency towards higher prevalence rates of psychosocial disorders at this age, explained by an increase in family conflicts, psychosocial and cultural risk constellations and individualisation. The model of hot societies provides further understanding. Between childhood and adult status, today's adolescents go through a complex identity and personality transformation in familial and social areas of conflict, facing personal and sociocultural tasks of development under uncertain and contradictory conditions. Continuity of self-experience and identity formation is more difficult, and the biography becomes vulnerable to unforeseeable breaks and polysymptomatic crises of adolescence. Adolescent symptomatology typically forms out of dynamic polarities of inhibition and turbulence, adjustment and dissociality, retreat and expansion, internalising and externalising, often remaining disorganised, plastic, masked and not definable as states or traits. Factor analysis extracts dimensions from the phenomenological disturbance diversity of experiencing and behaviour, to be understood as vectors of expansiveness, inhibition, conformation and transcending in adolescent development. Dimensional scale profiles for individual and typable conditions can be used for both treatment planning and process control. Depending on dimensional expression, coping with psychogenetic and psychodynamic central issues of modern adolescence varies from adolescent patient to patient. Phenomenologically and psychogeneticly, international diagnostic systems do not classify adolescent disorders as specific and do not consider developmental issues. Although some common diagnoses like borderline personality disorder or social phobia are more strongly connected to adolescence than others, there is no consensus regarding the classification of highly specific entities such as crises and adjustment reactions to adolescence, anthropophobia, school phobia and underachievement. Derived from problems in coping with developmental tasks such as identity, autonomy, intimacy and socialisation, their developmental psychopathology consists of identity diffusion, depersonalisation, flagging propulsion, dissocialisation, hypersensitivity, self-destruction and a rivalry and authority complex. Focussing on finality, the developmental psychiatric approach to treatment regards these symptoms within a dynamic, interpersonal and sociocultural adjustment process and examines defences and coping. With respect to the relative disorganisation and plasticity of adolescent personality, common adult therapeutic techniques are used with restraint. In contrast, adolescent individual processes of experimenting, analysing, adaptation, synthesis and consolidation have to be stimulated and supported in an appropriate, ecologically valid therapeutic setting.