La valutazione della patologia di personalità con la SWAP-200 A: un'applicazione a un campione clinico di adolescenti italiani

SUMMARY Objectives: this paper presents the results of a preliminary study aiming at verifying the cuncurrent validity the taxonomy of personality pathology in adolescence of the Shedler and Westen Assessment Procedure (SWAP-200-A; Westen et al., 2003). Methods: a sample of 60 subjects, aged between 14 and 18, referred to the Institute of Developmental Rehabilitation, Neurological and Psychiatric Sciences of the University of Rome have been evaluated through the following instruments of evaluation: SWAP-200-A, DSM-IV Axis II PD Dimensional scores, CBCL, GAF, 10 measures of adjustment in adolescence. Correlations between the SWAP-200-A q factors and the other criteria have been evaluated. Results: The application of the SWAP-200-A to the sample of Italian adolescents has evidenced that three major areas of personality pathology can be distinguished: an area corresponding to a psychotic organization of personality correlating with Cluster A personality traits and aspects of functioning (the avoidant-constricted q-factor); an area overlapping with Cluster B personality disorders (covered by antisocial-psychopathic, emotionally disregulated and hystrionic q-factors); a non-inherently pathologic mode of adjustment characterized by dysphoric feelings and overt selfinhibition (the self-inhibited personalità style). The application of SWAP-200-A to the sample of 60 adolescents also provide useful suggestions as to the roots of borderline and narcissistic pathology in adolescence. In particular, our pilot study shows that Cluster B personality pathology (which is, Antisocial, Borderline, Narcissistic and Hystrionic personality disorders) tend to overlap with three q-factors of the SWAP-200-A: psychopath-antisocial, emotionally disregulated and hystrionic. These q-factors describes different and independent prototypes of personality pathology associated with peculiar relational modes, aspects of muladjastment and psychopathological symptoms. The empirical evidence of our preliminary study seems to be at tally with clinical descriptions of severe personality pathology in adolescence coming from the psychodynamic tradition (Bleiberg, 2003). As far as the narcissistic dimension is concerned, the correlations emerged in this study show that the SWAP-200-A narcissistic prototype is able to capture not only the aspects of functioning traditionally identified by the DSM Narcissistic Personality Disorder, but also more integrated aspects of functioning. This preliminary evidence seems to warrant the SWAP-200-A dimensional approach to the evaluation of narcissistic pathology in adolescence. Conclusions: The results from this pilot application of the SWAP-200-A to an Italian clinical sample of adolescents, seem to show that the theoretical and clinical constructs corresponding to the seven q-factors of the SWAP-200-A can be consistenlty identified adolescence and provide useful indications for the understanding of personality pathology in this developmenal phase. These results are a preliminary non american study in support of the idea that the SWAP-200-A provides the resercahers and clinicians with a developmentaly and clinically relevant synthesis of personality pathology taxonomy.