Mentalizing, personality organization, and symptomatology in children and adolescents using the psychodynamic diagnostic manual

This study aims to investigate mentalizing, personality organization, symptomatology, and their relationships in the developmental age within nonclinical and clinical samples. We compared three groups of participants, including children (8–11 years old) and adolescents (12–15 years old): a nonclinical sample (n = 79), a group diagnosed with externalizing disorders (disruptive behavior disorders, DBD; n = 31), and a group diagnosed with internalizing disorders (somatic symptom disorders, SSD; n = 50). Mentalizing was assessed using the Child and Adolescent Reflective Functioning Scale. We applied the Psychodynamic Diagnostic Manual, second edition to the transcripts of the Child Attachment Interview to evaluate personality organization. Symptomatology was assessed by parents using the Child Behavior Checklist. Results indicate that participants with DBD exhibit greater difficulties in mentalizing and a lower level of personality organization compared to SSD and nonclinical participants. On the other hand, SSD participants demonstrate a healthier level of personality organization and a stronger association with the ability to mentalize than their DBD peers. Regression analysis shows that, in both clinical and nonclinical samples, mentalizing play a stronger predictive role on the symptomatology than personality organization. Mentalizing confirms its key role in healthy and psychopathological development. The clinical implications of these findings are discussed.