TENDENCIAS DE INVERSIÓN EN INSTITUCIONES PRIVADAS

Assessment of Axis I and Axis II diagnoses. To examine the participants’ current or past DSM-IV- TR diagnoses for Axis I disorders, we conducted a structured interview. The Diagnostic Interview for Mental Disorders in Children and Adolescents (Kinder-DIPS; Schneider, Suppiger, Adornetto,

& Unnewehr, 2009) assesses the most frequent mental disorders in childhood and adolescence (all anxiety disorders, depression, ADHD, conduct disorder, sleep disorders, eating disorders). We included substance use disorders and borderline personality disorder from the adult DIPS (Schneider & Margraf, 2006). The Kinder-DIPS has good validity and reliability for axis I disorders (child version, kappa = 0.48-0.88; Adornetto, In-Albon, & Schneider, 2008; Neuschwander, In-Albon, Adornetto, Roth, & Schneider, 2013). NSSI was assessed using the proposed DSM-5 criteria from 2012. The proposed criteria as of 2012 and the final published version are comparable (see Table 6). The criteria were reformulated as questions. Interrater reliability estimates for the diagnosis of NSSI were very good (kappa = 0.90). Suicide attempts were also assessed at the end of the interview. Master’s students in clinical child psychology were first systematically trained in conducting the interviews.

Table 6

Proposed and Actual Diagnostic Criteria for Nonsuicidal Self-Injury (NSSI) for the 5th _{edition of the Diagnostic and}

Statistical Manual of Mental Disorders (DSM-5)a

Proposed diagnostic criteria for nonsuicidal self-injury (NSSI) for the fifth edition of the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5):

A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body, of a sort likely to induce bleeding or bruising or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), for purposes not socially sanctioned (e.g., body piercing, tattooing, etc.), but performed with the expectation that the injury will lead to only minor or moderate physical harm.

The behaviour is not a common one, such as picking at a scab or nail biting. B. The intentional injury is associated with at least 2 of the following:

1. Psychological Precipitant: Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act.

2. Urge: Prior to engaging in the act, a period of preoccupation with the intended behaviour that is difficult to resist.

3. Preoccupation: Thinking about self-injury occurs frequently, even when it is not acted upon.

4. Contingent Response: The activity is engaged in with the expectation that it will relieve an interpersonal difficulty, or negative feeling or cognitive state, or that it will induce a positive feeling state, during the act or shortly afterwards.

C. The behaviour or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. (This criterion is subject to final approval on the use of criteria that relate symptoms to impairment).

D. The behaviour does not occur exclusively during states of psychosis, delirium, or intoxication. In individuals with a developmental disorder, the behaviour is not part of a pattern of repetitive stereotypies. The behaviour cannot be accounted for by another mental or medical disorder (i.e., psychotic disorder, pervasive developmental disorder, mental retardation, Lesch–Nyhan Syndrome, stereotyped movement disorder with self-injury, or trichotillomania).

E. The absence of suicidal intent has either been stated by the patient or can be inferred by repeated engagement in a behaviour that the individual knows, or has learnt, is not likely to result in death.

Proposed diagnostic criteria for NSSI according to DSM-5 (APA, 2013):

A. In the last year, the individual has, on 5 or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent).

Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the

individual’s repeated engagement in a behaviour that the individual knows, or has learned, is not likely to result in death.

B. The individual engages in the self-injurious behaviour with one or more of the following expectations: 1. To obtain relief from a negative feeling or cognitive state.

2. To resolve an interpersonal difficulty. 3. To induce a positive feeling state.

Note: The desired relief or response is experienced during or shortly after the self-injury, and the

individual may display patterns of behaviour suggesting a dependence on repeatedly engaging in it. C. The intentional self-injury is associated with at least one of the following:

1. Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self- injurious act.

2. Prior to engaging in the act, a period of preoccupation with the intended behaviour that is difficult to control.

3. Thinking about self-injury that occurs frequently, even when it’s not acted upon.

D. The behaviour is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting.

E. The behaviour or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.

F. The behaviour does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behaviour is not part of a pattern of repetitive stereotypies. The behaviour is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual disability, Lesch- Nyhan syndrome, stereotyped movement disorder with self-injury, trichotillomania [hair pulling disorder], excoriation [skin picking disorder].

a_{As of November 2012, www.dsm5.org}

Participants were administered the Structured Clinical Interview for DSM-IV Axis II personality

disorders (SCID-II; Fydrich, Renneberg, Schmitz, & Wittchen, 1997) to assess personality

disorders. The SCID-II was found to be suitable for use among adolescents (Salbach-Andrae et al., 2008). Interrater reliability for BPD in our sample was very good (kappa = 1.00). Before conducting the interviews all interviewers received an intensive standardized training.

The Global Assessment of Functioning (GAF; APA, 2000), assesses overall patient functioning and symptom severity; these characteristics have been reliably associated with clinical diagnosis, psychopathologic symptoms, and other clinical outcome ratings (Friis, Melle, Opjordsmoen, & Retterstol, 1993; Renneberg, Schmidt-Rathjens, Hippin, Backenstrass, & Fydrich, 2005).

The Beck Depression Inventory-II (BDI-II; Hautzinger, Keller, & Kühner, 2006), The BDI- II consists of 21 items and assesses depressive symptoms in adolescents. The internal consistency within the present sample was α = 0.96.

The Barratt Impulsiveness Scale (BIS; Barrat, 1959; German version Hartmann, Rief, & Hilbert, 2011), is a widely used self-report questionnaire to assess impulsive personality traits with

three subscales: Attentional, motor, and nonplanning impulsivity. The BIS demonstrated good psychometric properties (Barrat, 1959; Hartmann et al., 2011). The internal consistency within the present sample was α = 0.81.

The Borderline Symptom List (BSL-95; Bohus et al., 2007), is a self-rating instrument for specific assessment of borderline-typical symptomatology. The symptomatology is collected for the last week. The BSL-95 includes 95 items that are based on DSM-IV criteria, the revised version of the Diagnostic Interview for Borderline Personality Disorder, and the opinions of both clinical experts and borderline patients. It consists of seven subscales assessing self-perception, affect regulation, self-destruction, dysphoria, loneliness, intrusions, and hostility. Within our sample the internal consistency for the subscales ranged from α = 0.84 to 0.96. The internal consistency within the present sample for the total score was α = 0.98.

The Depression Anxiety Stress Scale (DASS-21; Köppe, 2001; Lovibond & Lovibond, 1995), is a reliable and valid self-report questionnaire comprising three scales measuring depression, anxiety, and stress. The internal consistency within the present sample was α = 0.93 for the depression scale, 0.85 for the anxiety scale, 0.84 for the stress scale, and 0.94 for the total scale.

The Functional Assessment of Self-Mutilation (FASM; Lloyd, Kelley, & Hope, 1997), is a self-report measure of the methods, frequency, and functions of NSSI. The internal consistency within our sample was α = 0.85 for the overall scale.

The Junior Temperament and Character Inventory (JTCI; Goth & Schmeck, 2009), is a self-report measure assessing the seven personality traits based on Cloningers (1987) bio-psycho- social model of personality. The questionnaire measures the scales novelty seeking, harm avoidance, reward dependence, persistence, self-directedness, cooperativeness and self- transcendence. The scales have good levels of internal consistency, with Cronbach´s α ranging from 0.79 to 0.85 (Goth & Schmeck, 2009). The internal consistency within the present sample was α = 0.84.

The Questionnaire of Thoughts and Feelings (QTF; Renneberg et al., 2005), is a self- report scale (37 items) designed to measure borderline-specific basic assumptions and negative feelings. It is based on cognitive models and Linehan’s biosocial model of BPD. The internal consistency within our sample was α = 0.97.

The Youth Self Report (YSR; Döpfner et al., 1994; Achenbach, 1991) measures a broad range of psychopathology. Internal consistency within the present sample was α = 0.96 for the total score, α = 0.94 for the internalizing score, and α = 0.90 for the externalizing score.