title: An empirically derived classification of adolescent personality disorders.
abstract: OBJECTIVE
  This study describes an empirically derived approach to diagnosing adolescent personality pathology that is clinically relevant and empirically grounded.
  
  
  METHODS
  A random national sample of psychiatrists and clinical psychologists (N = 950) described a randomly selected adolescent patient (aged 13-18 years, stratified by age and gender) in their care using the Shedler-Westen Assessment Procedure-II-A for Adolescents (SWAP-II-A) and several additional questionnaires.
  
  
  RESULTS
  We applied a form of factor analysis to identify naturally occurring personality groupings within the patient sample. The analysis yielded 10 clinically coherent adolescent personality descriptions organized into 3 higher-order clusters (internalizing, externalizing, and borderline-dysregulated). We also obtained a higher-order personality strengths factor. These factors and clusters strongly resembled but were not identical to factors similarly identified in adult patients. In a second, independent sample from an intensive day treatment facility, 2 clinicians (the patients' treating clinician and the medical director) independently completed the SWAP-II-A, the Child Behavior Checklist (CBCL), and a measure of adaptive functioning. Two additional clinicians, blinded to the data from the first 2 clinicians, independently rated patients' ward behavior using a validated measure of interpersonal behavior. Clinicians diagnosed the personality syndromes with high agreement and minimal comorbidity among diagnoses, and SWAP-II-A descriptions strongly correlated in expected ways with the CBCL, adaptive functioning, and ward ratings.
  
  
  CONCLUSIONS
  The results support the importance of personality diagnosis in adolescents and provide an approach to diagnosing adolescent personality that is empirically based and clinically useful.
authors.affiliation: Emory University. Electronic address: dwesten@emory.edu.
authors.forename: Drew
authors.initials: D
authors.lastname: Westen
authors.affiliation: Emory University.
authors.forename: Jared A
authors.initials: JA
authors.lastname: DeFife
authors.affiliation: Massachusetts General Hospital and Harvard Medical School.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Malone
authors.affiliation: New York University School of Medicine and New York City Administration for Children's Services.
authors.forename: John
authors.initials: J
authors.lastname: DiLallo
mesh_terms: D000293:Adolescent; D036262:Empirical Research; D005260:Female; D006801:Humans; D008297:Male; D010552:Personality Assessment / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis* / Q000523:psychology; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014481:United States
keywords: adolescent personality disorders; adolescent personality pathology; emotional dysregulation; externalizing; internalizing