Adolescent violence: the parallel psychiatric histories of two teenagers

IntroductionViolent behaviour in children and adolescents can include a wide range of behaviour: explosive temper tantrums, physical aggression, fighting, threats or attempts to hurt others, use of weapons, cruelty toward animals, fire setting, intentional destruction of property and vandalism. Most studies have pointed out that the exposure to violence in the home and/or community, the presence of stressful socio-economic factors in family environment, the being the victim of physical abuse and/or sexual abuse contribute to an increased risk of violent behaviour in children and adolescents (Wolfe et al., 2001). These conditions can affect dimensions of development such as peer and intimate relationships, self-regulation of emotions, and behavioural adjustment (Kaplan et al., 1999; Thompsona &Tabone, 2010). Violence often represents one of symptoms of psychiatric diseases and constitutes ones of major challenges of our time because it is difficult to treat. In fact, it evokes feelings of fear, provokes hostility and calls for punitive responses which can produce an escalation of violence (Greenwood, 2005).MethodWe analyzed the parallel history of two adolescent girls, who presented stressful family socioeconomic factors (poverty, severe deprivation, single parenting, etc.) in childhood, Attention-Deficit/Hyperactivity Disorder (ADHD) in scholar age, wide range of aggressive and self-dangerous behaviour with an extreme mood instability and impulsivity in adolescence, which required long and frequent psychiatric hospitalizations with the diagnosis of Borderline Personality Disorder (BPD).ResultsThe two young girls, despite of their disruptive and dangerous life-style, are alive but at the price of strong dependence from institutions. After long psychiatric inpatient care, they live in two different therapeutic communities, require pharmacologic therapy and frequent but brief hospitalizations, follow rehabilitative programs with many professionals aimed to acquire capacity of autonomy.Discussion and conclusionsThe clinical history of these two emblematic cases confirms the literature observations that child deprivation, emotional neglect or abuse may lead to perpetration of perverse life style characterized by violence and self-destructiveness and may affect mental health development. Many psychiatric disorders are associated to child maltreatment and abuse such as ADHD and BPD (Matthies et al., 2011; Miller et al., 2008), which can reflect an early developmental failures of containment. The complexity of these cases, characterized by the persistence of a childhood disease, developed into a stables unstable mood chronic pathology till the late adolescence, suggests us pathogenic relationship among BPD, Bipolar Disorder and ADHD, as observed by other authors (Benazzi, 2008; Rydén et al., 2009; Zapolski et al., 2010; Zepf , 2009). Finally, these clinical cases suggest that an emphatic therapeutic approach and a long-term rehabilitative program based on creative and constructive responses may be more effective in reducing violence than a coercive or punitive approach (Greenwood, 2005).