Personality functioning in adolescents with depression: links with childhood maltreatment, psychopathology, self-harm...

Adolescence represents a critical developmental period marked by significant vulnerability to depression, a condition with heterogeneous presentations that complicate clinical management. The co-occurrence of personality dysfunction with depression is known to indicate greater severity and poorer prognosis, yet specific features of this comorbidity in adolescent clinical samples require further delineation. This study aimed to compare clinical and psychosocial correlates in depressed adolescents with and without impaired personality functioning.

The clinical sample comprised 73 adolescents (aged 12-17; 83.6% female) diagnosed with depression or reporting clinically significant depressive symptoms. Participants completed self-report measures assessing personality functioning (LoPF-Q 12-18), childhood maltreatment (CEQ), psychopathology (YSR 11-18), mentalizing capacity (RFQY-8), borderline traits (BPFS-C), and self-harm behavior. Based on LoPF-Q 12-18 T-scores, participants were categorized into two subgroups: depression without personality dysfunction (T ≤ 64; n=20) and depression with personality dysfunction (T ≥ 65; n=53).

Results indicated that adolescents with co-occurring depression and personality dysfunction exhibited significantly lower functioning across all personality domains compared to those with depression alone. This subgroup also reported an earlier onset and higher frequency of self-harm, more severe suicidal ideation, elevated borderline traits, and greater impairments in mentalizing. Furthermore, they demonstrated higher levels of internalizing, affective, conduct, and PTSD symptoms, alongside greater exposure to emotional neglect.

Impaired personality functioning in depressed adolescents is associated with elevated and multifaceted patterns of symptoms, including subjective distress and risky behaviors. These findings underscore the necessity of routinely assessing personality functioning in adolescents with clinically significant depressive symptoms to enable early identification and the development of tailored, integrated interventions for this high-risk subgroup.