Age dependent effects of early intervention in borderline personality disorder in adolescents

Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study

Introduction

This study investigates age-related differences in Borderline Personality Disorder (BPD) traits and childhood maltreatment (CM) experiences among adolescents, young adults, and older adults within a clinical sample.

Methods

A cross-sectional design was employed, involving 2029 outpatients aged 15-50 years from the Shanghai Mental Health Center. BPD traits were assessed using the Personality Diagnostic Questionnaire 4th Edition Plus (PDQ-4+), and CM experiences were evaluated using the Child Trauma Questionnaire Short Form (CTQ-SF). Participants were categorized into three age groups: adolescents (15-21 years), young adults (22-30 years), and older adults (31-50 years).

Results

Adolescents reported significantly higher frequencies of BPD traits and diagnoses compared to young adults and older adults (p=0.036). Specifically, identity disturbance and impulsivity were more pronounced in adolescents (p<0.001). Additionally, adolescents reported higher levels of emotional (F=15.987, p<0.001) and physical abuse (F=12.942, p=0.002), while older adults reported higher levels of emotional and physical neglect. Logistic regression analysis identified key BPD criteria and CM subtypes that differentiated adolescents from adults.

Discussion

The findings underscore the importance of age-specific interventions in treating BPD and addressing childhood maltreatment. Adolescents exhibit distinct patterns of BPD traits and CM experiences, necessitating tailored therapeutic approaches.

Psychotherapies for the treatment of personality disorders: the state of the art

PURPOSE OF REVIEW

To provide an update of systematic reviews, meta-analyses and recent clinical outcome studies for personality disorder (PD) in order to investigate the state of the art of the evidence of psychotherapy for personality disorders.

RECENT FINDINGS

Few outcome studies in patients with Cluster A and Cluster C PD have been conducted, which limits the conclusions which can be drawn. Most recently published research has been conducted with borderline PD. There is limited evidence that dialectical behavior therapy (DBT), mentalization based therapy and schema therapy are more effective than treatment as usual. There is no convincing evidence that long and intensive therapy is more effective than short and less intensive therapy. Drop-out is rather high for patients with borderline PD. Group therapy results in more drop-outs than individual therapy.

SUMMARY

There is a clear need of studies evaluating whether psychotherapies developed for PDs are more effective than CBT for patients with Cluster C PD. Given that studies with patients with Cluster B PD suggest that longer treatment of DBT and mentalization-based treatment is not more effective than shorter treatment this needs to be studied with other evidence-based therapies as well. Serious efforts are needed to evaluate therapies for patients with Cluster A PDs.

The evaluation of a stepped care approach for early intervention of borderline personality disorder

BACKGROUND

The current study evaluated the stepped care approach applied in AtR!Sk; a specialized outpatient clinic for adolescents with BPD features that offers a brief psychotherapeutic intervention (Cutting Down Program; CDP) to all patients, followed by a more intensive Dialectical Behavioral Therapy for Adolescents (DBT-A) for those whose symptoms persist.

METHODS

The sample consisted of 127 patients recruited from two AtR!Sk clinics. The number of BPD criteria, psychosocial functioning, severity of overall psychopathology, number of days with non-suicidal self-injury (NSSI; past month), and the number of suicide attempts (last 3 months) were assessed at clinic entry (T0), after CDP (T1), and at 1- and 2-year follow-up (T2, T3). Based on the T1 assessment (decision criteria for DBT-A: ≥ 3 BPD criteria & ZAN-BPD ≥ 6), participants were allocated into three groups; CDP only (n = 74), CDP + DBT-A (eligible and accepted; n = 36), CDP no DBT-A (eligible, but declined; n = 17).

RESULTS

CDP only showed significantly fewer BPD criteria (T2: β = 3.42, p < 0.001; T3: β = 1.97, p = 0.008), higher levels of psychosocial functioning (T2: β = -1.23, p < 0.001; T3: β = -1.66, p < 0.001), and lower severity of overall psychopathology (T2: β = 1.47, p < 0.001; T3: β = 1.43, p = 0.002) over two years compared with CDP no DBT-A, while no group differences were found with regard to NSSI and suicide attempts. There were no group differences between CDP + DBT-A and CDP no DBT-A, neither at T2 nor at T3.

DISCUSSION

The findings support the decision criterion for the offer of a more intense therapy after CDP. However, there was no evidence for the efficacy of additional DBT-A, which might be explained by insufficient statistical power in the current analysis.