Document Type : Research Paper
Authors
1 Professor, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
2 PhD Student in Psychology & Education of Individuals with Special Needs, University of Isfahan, Isfahan, Iran.
Abstract
Abstract
The present study aimed to determine the prevalence of social-emotional problems in adolescents in Mashhad and to determine their relationship with childhood trauma and borderline personality syndrome. This study was methodologically conducted in two formats: exploratory and descriptive-correlation regression. The target population was all adolescent girls and boys aged 14 to 18 years in Mashhad in 2023-2024, from which 630 people were selected as a sample and available. The data collection tools were the Woodworth Psychoneurotic Inventory (WPI); Childhood Trauma Questionnaire (CTQ) and Schizotypal Trait Questionnaire-B form (STB). Pearson correlation tests and multiple regression were used to analyze the data. The results of this study showed that among social-emotional problems, avoidance-withdrawal (6.4%) and hyperactivity-impulsivity (4.8%) have a significant prevalence. In addition, there was a significant direct relationship between childhood trauma (P < 0.01, r = 0.32) and borderline personality disorder (P < 0.01, r = 0.67) with social-emotional problems, and these two variables, when combined, predicted 45% (p < 0.01) of the changes in emotional problems. These results can be used to design interventions aimed at preventing social-emotional problems in adolescents.
Keywords: Prevalence, Internalizing and Externalizing Problems, Childhood Trauma, Borderline Personality, Adolescents.
Extended Abstract
Introduction
The present study investigates the prevalence of socio-emotional difficulties among adolescents in Mashhad and explores the associations between these problems, childhood trauma, and borderline personality traits. Adolescence, typically spanning ages 12 to 19, is characterized by profound physical, cognitive, and socio-emotional transformations. These developmental shifts often heighten emotional reactivity and increase the propensity for unstable decision-making, rendering this period critical for the emergence of socio-emotional disturbances (Alikhani et al., 2022; Squires et al., 2020). Socio-emotional problems are conceptualized as relatively enduring, intense, and maladaptive emotional and behavioral responses that deviate from an individual’s cultural, developmental, or ethnic norms (Flores et al., 2020). These difficulties are broadly categorized into internalizing and externalizing dimensions (Lorence et al., 2019). Internalizing problems encompass intrapersonal and covert disturbances, such as anxiety, depression, social withdrawal, and fear—conditions that primarily manifest as subjective psychological distress. Conversely, externalizing problems involve observable, overt behaviors in social interactions, including bullying, aggression, and oppositional behavior (Chen et al., 2022; Kochanova et al., 2021; Danielson et al., 2021).
Empirical evidence indicates that both internalizing and externalizing difficulties frequently emerge during adolescence. For instance, Montoya-Castilla et al. (2018) reported cross-cultural prevalence rates of emotional problems ranging between 10% and 20%, while Cui et al. (2021) estimated that approximately 18% of adolescents exhibit emotional-behavioral disorders. In the Iranian context, however, recent and updated epidemiological data remain scarce. The most recent meta-analysis by Mohammadi et al. (2019) estimated a prevalence of approximately 23% for socio-emotional problems among Iranian adolescents. Given the paucity of contemporary domestic studies and the severe long-term consequences of these disturbances, a more rigorous and up-to-date investigation is warranted.
A primary theoretical framework for explaining the etiology of socio-emotional problems emphasizes the pivotal role of childhood trauma as a critical developmental antecedent (Zhang et al., 2021; Anderson et al., 2022; Valladares-Garrido et al., 2023). The concept of childhood trauma was formally introduced in 1988 by the U.S. Centers for Disease Control and Prevention (CDC) to describe adverse and distressing early experiences, including physical, emotional, and sexual abuse, as well as neglect (Schäfer & Fisher, 2022; Brown et al., 2021). Such adverse childhood experiences (ACEs) are a global phenomenon; for example, a World Health Organization report indicated that approximately 25% of children worldwide have been victims of various forms of maltreatment, with emotional abuse being particularly prevalent (Ekmekci Ertek et al., 2021; Fang et al., 2023).
In Iran, Mir Drikvand (2023) reported that nearly 28% of children are exposed to various forms of maltreatment. The consequences of childhood trauma are far-reaching; extensive research has linked these early adversities to depression, suicidal ideation, personality disorders, psychological distress, borderline personality traits, attention-deficit/hyperactivity disorder (ADHD), and substance use disorders (Ebrahimi et al., 2023; Humphreys et al., 2020; Beck et al., 2021; Shamsabadi et al., 2022; Nakhaei et al., 2022; Lotzin et al., 2019). Beyond childhood trauma, maladaptive personality patterns—particularly borderline personality traits—have been implicated in the development of socio-emotional difficulties (Norup & Bo, 2019; Babinski et al., 2021; Benzi et al., 2023). Borderline personality is conceptualized as a persistent and severe psychological disturbance characterized by interpersonal instability, emotional dysregulation, intense anger, chronic feelings of emptiness, distorted cognitions, and recurrent self-harm or suicidal behaviors (Bozzatello et al., 2019).
Evidence suggests that 1–3% of the adolescent population may manifest borderline features (Cavelti et al., 2022). Furthermore, longitudinal studies, such as Benzi et al. (2023), have demonstrated that these features significantly predict the emergence of both internalizing and externalizing problems. Given the critical importance of adolescence for long-term mental health and the detrimental impact of undetected socio-emotional difficulties, the present study aims to estimate the prevalence of such problems among adolescents in Mashhad and to evaluate their associations with childhood trauma and borderline personality traits. It is anticipated that these findings will not only address a significant gap in the domestic literature but also provide an empirical foundation for early prevention, targeted interventions, and the enhancement of adolescent mental health at the community level.
Research Question
The primary objective of the present study is to estimate the prevalence of socio-emotional difficulties among adolescents in Mashhad and to investigate the associations between these difficulties, childhood trauma, and borderline personality traits. Specifically, this research addresses the following central question: To what extent do childhood trauma and borderline personality traits predict internalizing and externalizing problems in adolescents aged 14 to 18? By addressing this question, the study aims to elucidate the relative contributions of early adverse experiences and maladaptive personality patterns to the emergence of socio-emotional challenges in youth. Ultimately, these findings are intended to provide an empirical basis for developing evidence-based prevention and intervention strategies.
Literature Review
Adolescence represents a critical developmental window for the emergence of socio-emotional difficulties, which are broadly categorized into internalizing (e.g., anxiety, depression) and externalizing (e.g., aggression) dimensions (Lorence et al., 2019). While global prevalence estimates range from 10% to 20% (Montoya Castilla et al., 2018; Chiu et al., 2021), a meta-analysis in Iran suggests a higher rate of approximately 23% (Mohammadi et al., 2019). A predominant etiological framework identifies childhood trauma—comprising adverse experiences such as abuse and neglect—as a significant developmental antecedent (Zhang et al., 2021; Anderson et al., 2022). In the Iranian context, nearly 28% of children are reported to be exposed to such maltreatment (Mirdrikvand, 2023). Furthermore, maladaptive personality patterns, particularly borderline personality traits characterized by emotional instability and interpersonal dysfunction, are strongly implicated in these disturbances (Norup & Bo, 2019; Benzi et al., 2023). Cumulative longitudinal evidence confirms that both childhood trauma and borderline traits significantly predict the trajectory of internalizing and externalizing difficulties, underscoring their pivotal role in understanding adolescent psychopathology.
Methodology
The present study employed a cross-sectional design, utilizing both exploratory and descriptive-correlational approaches. The target population comprised all male and female adolescents (aged 14 to 18 years) in Mashhad during the 2023–2024 academic year. A sample of 630 participants was selected using a convenience sampling method. Data collection was performed using three standardized psychometric instruments: the Woodworth Psychoneurotic Inventory (WPI) to assess socio-emotional difficulties, the Childhood Trauma Questionnaire (CTQ) to evaluate adverse early experiences, and the Schizotypal Trait Questionnaire-B Form (STB) to measure borderline personality traits. These instruments provided a comprehensive framework for analyzing the predictive relationships among the primary study variables.
Results
A total of 630 adolescents participated in this study, comprising 386 (61.3%) females and 244 (38.7%) males. The age distribution of the sample was as follows: 207 participants (32.9%) were 14 years old, 134 (21.3%) were 15 years old, 97 (15.4%) were 16 years old, 109 (17.3%) were 17 years old, and 83 (13.2%) were 18 years old. All participants were within the target age range of 14 to 18 years, providing a representative cross-section of the adolescent population in Mashhad during the 2023–2024 academic year.
Table 1. Prevalence of Socio-Emotional Problems Among Adolescents
Type of Problem
Total prevalence percentage
Girls
Boys
p-value
Weakness and Obsession
2.3
3.8
0.2
0.001
Impulsivity and Emotional Lability
1.2
1.1
0.9
0.23
Avoidance and Social Withdrawal
6.4
8.3
3.7
0.02
Depression
3.7
3.2
1.4
0.12
Paranoid Thoughts and Beliefs
1.4
1.6
0.6
0.18
Hyperactivity and Restlessness
4.8
3.5
1.8
0.13
Antisocial Behaviors
1.1
1.3
0.9
0.24
Aggression
1.7
2.6
0.7
0.08
The descriptive data presented in Table 2 indicate that avoidance/withdrawal ($6.4\%$) and hyperactivity/impulsivity ($4.8\%$) exhibited the highest prevalence rates among the sampled adolescents. Furthermore, significant gender differences were observed specifically in the prevalence of obsessive-compulsive symptoms and avoidance/withdrawal behaviors ($p < 0.05$).
Beyond the prevalence rates, the inferential analysis revealed significant positive correlations between the occurrence of socio-emotional difficulties and both childhood trauma ($r = 0.32, p < 0.01$) and borderline personality traits ($r = 0.67, p < 0.01$). Additionally, a multiple regression analysis demonstrated that these two variables—childhood trauma and borderline personality features—collectively account for $45\%$ of the total variance in socio-emotional problems among adolescents.
Discussion
The present study aimed to estimate the prevalence of socio-emotional difficulties among adolescents in Mashhad and to examine their associations with childhood trauma and borderline personality traits. The findings revealed a significant prevalence of socio-emotional problems within this population, with both childhood trauma and borderline personality features demonstrating robust predictive capacity for these challenges. In line with the multidimensional framework of adolescent psychopathology, this study categorized socio-emotional difficulties into internalizing and externalizing dimensions. Notably, avoidance and social withdrawal were identified as the most prevalent internalizing problems, while hyperactivity and restlessness emerged as the most common externalizing manifestations.
The elevated prevalence of avoidance and social withdrawal observed in this study can be elucidated through the pervasive influence of technology and digital media. Many adolescents increasingly favor virtual interactions over face-to-face relationships, a shift that often results in a diminished inclination for physical social participation and a heightened sense of chronic isolation. Furthermore, the constant exposure to idealized self-representations in digital spaces may exacerbate feelings of inadequacy and inferiority, thereby intensifying the tendency toward social withdrawal as a maladaptive coping mechanism.
In addition to digital factors, systemic elements—including peer dynamics, the family environment, and broader cultural norms—play a pivotal role in adolescent isolation. Adolescents subjected to peer victimization or rejection may adopt social avoidance as a protective strategy to mitigate further psychological harm. Similarly, within the family system, unrealistic parental expectations and rigid cultural standards regarding the "ideal child" can impose significant psychological pressure, further driving adolescents toward social withdrawal to escape perceived failure.
Regarding the elevated prevalence of hyperactivity and restlessness, neurobiological frameworks implicate significant alterations in both brain architecture and functional connectivity. These perturbations primarily involve two critical domains: dysregulation within neurotransmitter systems—specifically the dopaminergic and noradrenergic pathways which are fundamental to attentional processes and behavioral inhibition—and structural deficits in the prefrontal cortex (PFC). Given the PFC's pivotal role in executive functions, such as cognitive flexibility, self-regulation, and impulse control, its impairment often results in the clinical manifestations of hyperactivity and persistent physical restlessness. Furthermore, although hyperactivity is not intrinsically synonymous with externalizing disorders, the underlying impulsivity frequently serves as a precursor to overt externalizing behaviors, including aggression and non-compliance with social norms.
The present study further established significant positive correlations between childhood trauma, borderline personality traits, and the emergence of socio-emotional difficulties. Developmental perspectives suggest that early childhood experiences serve as the architectural foundation for emotional, social, and cognitive schemata, which subsequently dictate the quality of behavioral patterns and interpersonal dynamics during adolescence. Whether manifesting as abuse, neglect, or exposure to violence, childhood adversity profoundly disrupts psychological equilibrium.
These findings can be further elucidated through the lens of Attachment Theory, which posits that the quality of early caregiver-child bonds serves as a primary template for subsequent emotional regulation and social competence. For adolescents with a history of trauma, the development of insecure or disorganized attachment patterns often results in the formation of "internal working models" characterized by mistrust and perceived threat. These maladaptive cognitive frameworks can lead to internalizing states, such as anxiety and depression, as well as externalizing manifestations, including social avoidance and reactive aggression. In essence, the trauma-exposed adolescent may utilize these behaviors as dysfunctional attempts to navigate a social environment they perceive as inherently unstable or hostile.
Beyond attachment frameworks, neurobiological mechanisms offer critical insights into the long-term sequelae of childhood trauma. Chronic stress resulting from adverse childhood experiences (ACEs) can significantly derail normative brain maturation, leading to structural and functional aberrations in the amygdala, hippocampus, and prefrontal cortex (PFC). These regions constitute the neural circuitry essential for affective processing, mnemonic consolidation, and executive decision-making. Disruptions in this circuitry impair the adolescent's capacity for top-down emotional regulation, empathetic resonance, and adaptive social navigation, ultimately precipitating pervasive socio-emotional difficulties.
Concurrently, the constellation of borderline personality features—characterized by interpersonal instability, profound emotional dysregulation, and chronic feelings of emptiness—exacerbates these challenges. The intense fear of abandonment and affective lability inherent in borderline pathology often drive adolescents toward maladaptive coping strategies. For instance, individuals may engage in non-suicidal self-injury (NSSI) as a dysfunctional attempt to modulate overwhelming emotional pain. Such behaviors, while providing temporary relief, frequently intensify underlying feelings of guilt, shame, and worthlessness, thereby perpetuating a self-sustaining cycle of socio-emotional impairment and psychological distress.
Furthermore, the maladaptive cognitive architecture characteristic of these adolescents serves as a psychological catalyst for persistent distress. A pervasive framework of negative self-schema and distorted perceptions of others, coupled with chronic feelings of emptiness and existential meaninglessness, creates a fertile ground for internalizing pathologies. These cognitive distortions not only foster social withdrawal and profound isolation but also exacerbate depressive symptoms, as the adolescent perceives the social world as either threatening or fundamentally devoid of purpose.
In light of these findings and the significant prevalence of socio-emotional difficulties—particularly social withdrawal, depression, and restlessness—it is imperative for educational and mental health authorities to implement targeted interventions. Prevention-oriented workshops and psychoeducational seminars should be prioritized to enhance awareness among both adolescents and parents, providing them with evidence-based strategies to mitigate the escalation of these issues. Furthermore, for adolescents with a documented history of childhood trauma or emerging borderline personality traits, specialized individual and family-based counseling is essential to intercept potentially debilitating long-term outcomes.
Despite its contributions, the present study is not without limitations. Certain confounding variables, such as cognitive functioning and socioeconomic status, were not controlled, which may influence the generalizability of the results. Additionally, the reliance on convenience sampling limits the representativeness of the findings beyond the specific demographic studied. Nevertheless, this research offers valuable insights into the developmental psychopathology of adolescents, underscoring the critical interplay between early adverse experiences, personality organization, and subsequent behavioral manifestations.
Conclusion
In conclusion, the findings of this study reveal a significant prevalence of socio-emotional difficulties among adolescents in Mashhad, with social withdrawal and hyperactivity/restlessness identified as the most prominent internalizing and externalizing manifestations, respectively. The analysis confirms that childhood trauma and borderline personality features serve as robust predictors of these challenges, likely mediated by complex neurobiological dysregulations and maladaptive psychosocial pathways. These results underscore the urgent necessity for early intervention initiatives grounded in trauma-informed care and focused on enhancing affective regulation skills. Furthermore, establishing targeted public awareness campaigns and providing accessible, specialized counseling for adolescents and their families are imperative to address this public health concern and mitigate its potential long-term adverse sequelae.
Acknowledgments
The authors extend their sincere appreciation to all the adolescents who participated in this study. Their cooperation, patience, and commitment were invaluable in ensuring the accuracy and reliability of the research findings.
Keywords
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