Bullied by peers in childhood and borderline personality symptoms at 11 years of age: a prospective study

Childhood maltreatment, peer victimization, borderline personality feature, suicidal risk in adolescents: Direct and indirect associations among developmental trajectories

INTRODUCTION

Childhood maltreatment, peer victimization, and borderline personality traits have all been shown to be linked to suicidal risk. However, there remains a need to illuminate the possible direct and indirect pathways among them from a developmental perspective that could serve as intervention targets. This study thus aimed to investigate the direct and indirect relationships among developmental trajectories of childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk in adolescents.

METHODS

A total of 1648 Chinese adolescents (48.12% boys; Mage = 13.69; SD = 0.82) in junior middle schools completed self-report measures on three-time points across 1 year. Latent growth curve modeling was used to evaluate the direct and indirect relationships among the developmental trajectories of the aforementioned study variables.

RESULTS

The developmental trajectories of childhood maltreatment, peer victimization, and borderline personality feature were positively and directly related to the developmental trajectory of suicidal risk; and the developmental trajectories of childhood maltreatment, peer victimization were indirectly related to the developmental trajectory of suicidal risk through the mediating effect of the developmental trajectory of borderline personality feature.

CONCLUSIONS

The findings elucidated the direct and indirect longitudinal relationships among childhood maltreatment, peer victimization, borderline personality feature, and suicidal risk, highlighting that interventions should target childhood maltreatment, peer victimization, and borderline personality feature to decrease suicidal risk in adolescents with a developmental perspective.

Neurophysiological insights into impaired mentalization in borderline personality disorder an electroencephalography study

Introduction

Borderline personality disorder (BPD) is characterized by interpersonal and emotional instabilities, recurring suicidal tendencies, and feelings of emptiness. Childhood adverse event is reported in 70%-80% of cases involving BPD. Furthermore, the deficiency in mentalization capacity plays a significant role in emotion dysregulation and social interaction problems within individuals with BPD. This study explored the relationship among childhood adverse experiences, mentalization capacity, and neurophysiological activity in patients with BPD.

Methods

Resting-state electroencephalography was used to identify the neural correlates associated with childhood adversity and mentalization deficits. The participants included 45 patients with BPD and 15 healthy controls.

Results

The BPD group exhibited reduced alpha activity during eyes-closed rest, indicating heightened arousal even during relaxation. Correlations were found between the power spectral density (PSD) and mentalization capacity in the delta and theta ranges, suggesting an association between PSD and emotional awareness and expression. Gamma activity negatively correlated with psychic equivalence, implying a blurring of the boundaries between internal mental experiences and the external world.

Conclusion

These findings offer insights into the pathophysiology of BPD, provide potential diagnostic markers, and suggest personalized treatment approaches based on mentalization traits.

Prevalence of violence against children in the United Kingdom: A systematic review and meta-analysis

BACKGROUND

Violence against children can have extensive, long-term, and far-reaching adverse impacts on survivors and society. There is currently little consensus in the United Kingdom around the prevalence of violence against children: maltreatment, intimate partner violence, sexual violence, bullying, and community violence, and most existing studies focus on only a single or a few forms of violence. This study aims to produce data to highlight the current magnitude of the problem in the UK, to inform policy, drive action and allow for monitoring of progress over time.

OBJECTIVE

To produce weighted prevalence estimates by violence type, as well as gender and age sub-categories, to give as full a picture as possible of the current prevalence of violence against children in the UK.

PARTICIPANTS AND SETTING

The prevalence of violence against children from 23 self-report studies conducted in the United Kingdom was gathered through a systematic review.

METHODS

Databases were searched from inception to 24th June 2022. Studies were reviewed systematically for appropriate data and meta-analyses were conducted to give pooled prevalence data based on a quality effects model.

RESULTS

The most prevalent self-reported experience of childhood violence was community violence at 27.33 % (95 % CI [9.84, 48.97]). Prevalence of bullying was also high at 22.75 % (95 % CI [13.25, 33.86]). The most prevalent forms of child maltreatment were domestic violence exposure at 11.9 % (95 % CI [6.34, 18.84]) and emotional maltreatment at 11.84 % (95 % CI [5.58, 19.89]).

CONCLUSION

National child maltreatment surveys are needed in the UK, using a comprehensive and conceptually robust approach, and valid and reliable instruments, to provide data for researchers and policymakers on the prevalence of all types of violence against children including exposure to multiple types. This allows monitoring of trends over time, can inform strategies for prevention, and can enable monitoring of future progress in reducing violence against children and its associated health and economic burden.

Mentalizing in Adolescents with Borderline Personality Disorder

Mentalizing, recognized as the capacity to understand behaviors in the context of our own mental states and those of other people, is being researched more and more commonly in regard to various mental disorders. The research on mentalization focuses on, among other things, borderline personality disorder, which is at present perceived as an emerging problem in the population of adolescents. In order to summarize the currently accessible knowledge of mentalizing in adolescents with borderline personality disorder, we thoroughly analyzed relevant publications. Based on the available literature, it can be concluded that the mentalizing ability of adolescents with borderline personality disorder can be impaired. The evidence demonstrates that they are prone to hypermentalizing, defined as an overattribution of mental states to other people. However, this tendency has not been proven to be specific to teenagers with this disorder. Moreover, the existing data suggest that young people with borderline personality exhibit a reduced capacity to mentalize their own inner states.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Integrating Psychosocial Risks With Emerging Evidence for Borderline Personality Disorders in Adolescence: An Update for Clinicians

Borderline personality disorder (BPD) has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence. Various genetic, neurobiological, psychological, and social factors are implicated in the etiology of BPD. With emerging evidence on BPD development in adolescence, the review focused on recent literature to understand the role of psychosocial risk factors. The effects of adverse familial environment, physical, emotional, verbal, and sexual abuse, intergenerational transmission of psychopathological traits, maternal neglect and rejection, low socioeconomic status, bullying victimization, and dating violence were reviewed to understand their role in the development of BPD. BPD is a highly complex, serious, and enduring mental illness that has now been widely accepted to have symptoms that onset in early adolescence and could be diagnosed as early as age 12. BPD symptoms are stable, phenomenologically distinct from externalizing and internalizing disorders, and often present with co-occurring disorders, which during assessment could not explain impairments associated with BPD. New measures like the Difficulties in Emotion Regulation Scale (DERS), detailed developmental histories, understanding of psychosocial risks, shared decision-making, and psychoeducation could assist in early diagnosis and improvement of long-term outcomes. The implementation of evidence-based treatments is a challenge given higher costs and access to services; therefore, modifications in the treatment based on the core principles of these strategies should be considered. It is imperative to screen for psychosocial factors early in higher-risk groups. The assessment of familial factors, parental histories of psychopathologies, and histories of childhood abuse is important in context with impairing symptoms of clinical presentation and dimensional aspects of self-functioning. The role of family therapies, parental psychoeducation, and the integration of trauma-informed care approaches are important for clinical outcomes. Also, coordinated efforts with multiple stakeholders like school awareness programs, anti-bullying policies, legislation, and enforcement of existing laws might be instrumental in addressing issues related to victimization by peers.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

The longitudinal course of childhood bullying victimization and associations with self-injurious thoughts and behaviors in children and young people: A systematic review of the literature

INTRODUCTION

Bullying victimization has consistently been highlighted as a risk factor for self-injurious thoughts and behaviors (SITBs) in young people. This systematic review of prospective, community-based studies explored associations between bullying victimization (traditional/face-to-face and cyber) across the full spectrum of self-harm and suicidality, in children and young people aged up to (and including) 25 years. Importantly, associations by sex/gender were explored.

METHODS

MEDLINE, Embase, PsycINFO, CINAHL and Scopus were searched for articles meeting the inclusion criteria. Articles were screened by title, abstract and full text. Quality appraisal was performed using the Newcastle-Ottawa Scale for cohort studies. Data were synthesized narratively. The protocol is registered on PROSPERO (CRD42021261916) and followed PRISMA 2020 guidelines.

RESULTS

A total of 35 papers were included, across 17 countries. Results were presented by bullying type: traditional/face-to-face (n = 25), cyber (n = 7) and/or an aggregate of both types (n = 7). Outcomes included suicidal ideation (n = 17), self-harm (n = 10), suicide attempt (n = 4), NSSI (n = 4), other (n = 7). Studies measured outcomes in under 18s (n = 24), 18-25-year-olds (n = 8) and both under 18s and 18-25-year-olds (n = 3). Studies exploring the role of sex/gender (20%) found some interesting nuances.

CONCLUSIONS

Some weak to strong associations between bullying and SITBs were found yet conclusions are tentative due to study heterogeneity (e.g., methods used, conceptualizations and operationalisations of exposures/outcomes). Future research should address methodological issues raised in this review, and further explore gender differences in bullying, including by bullying sub-types (e.g., overt or relational) and victim status (e.g., victim or bully-victim).

Persönlichkeitsstörung im Jugendalter

Zusammenfassung: Die kategoriale Klassifikation der Persönlichkeitsstörungen (PS) wurde im letzten Jahrzehnt durch eine „Perspektive der Lebensspanne“ mit zunehmend dimensionaler Sichtweise abgelöst. Für den Kinder- und Jugendbereich ist maßgeblich, dass die PS als Ergebnis dieses Prozesses als Erkrankungen angesehen werden, welche die gesamte Lebensspanne betreffen können. Diese Neuerung bereitet den Weg zu einer möglichen Frühbehandlung und ggf. sogar Prävention der PS bei Kindern und Jugendlichen. Im klinischen Alltag jedoch wird die Vergabe von PS in dieser Altersgruppe bis heute oft als kritisch angesehen. Das Themenheft möchte einen Beitrag zur Aufklärung über PS im Jugendalter leisten. Ziel ist es, dass die Vergabe von PS nicht als eine Stigmatisierung junger Menschen angesehen wird, sondern vielmehr als Chance schwerwiegende Entwicklungsverläufe früh zu erkennen und zielgerichtet zu verhindern oder zu behandeln. Der Fokus der Beiträge des Themenheftes liegt dabei auf der Borderline-Persönlichkeitsstörung (BPS) im Jugendalter.

Zusammenhang zwischen unterschiedlichen Mobbingerfahrungen und der Ausprägung von Borderline-Persönlichkeitsstörungsmerkmalen bei Jugendlichen in der Kinder- und Jugendpsychiatrie

Zusammenfassung: Theroretischer Hintergrund: Die vorliegende Studie untersucht den Zusammenhang zwischen Mobbing‍(–Arten) und der Ausprägung der Borderline-Persönlichkeitsstörung (BPS) bei Jugendlichen. Methode: 513 konsekutiv rekrutierte, jugendliche Patient_innen nahmen an einer umfassenden Diagnostik teil. Der Zusammenhang zwischen der Häufigkeit von Mobbingerfahrungen und der Anzahl der BPS-Kriterien wurde mit Hilfe von ordinalen logistischen Regressionen untersucht. Ergebnisse: Jugendliche Patient_innen, die in den vergangenen drei Monaten mehrmals pro Woche gemobbt wurden, wiesen eine stärkere BPS-Symptomatik auf als Jugendliche ohne Mobbingerfahrung (OR = 3.47, CI = 2.32 – 5.18, p < 0.001). Soziales Mobbing und Bedrohen erwiesen sich als wichtigste Prädiktoren für den Schweregrad der BPS-Symptomatik. Diskussion und Schlussfolgerung: Häufigere Mobbingerfahrungen, insbesondere sozialer und bedrohender Art, waren mit mehr Symptomen der BPS assoziiert. Programme zur Prävention von Mobbing an Schulen sollten gefördert sowie in der Behandlung von Patienten thematisiert werden.

Bullying Perpetration and Victimization as Social Mechanisms in the Development of Borderline Personality Traits during Adolescence: A Longitudinal Study

INTRODUCTION

Borderline personality features are often associated with toxic social relationships and problematic peer functioning. Less is known, however, about the extent to which bullying experiences may shape the development and maintenance of borderline-related traits during crucial periods of rapid normative developments in impulse and emotion regulation skills. Given the core interpersonal character of borderline personality pathology (BPP), such research focus may be relevant to better understand possible causal social mechanisms in the development of personality difficulties within the borderline trait spectrum.

METHOD

The current longitudinal study examined whether experiences of both bullying perpetration and victimization in pre-adolescence mediated the developmental course of BPP traits between childhood and adolescence. To examine these associations, a sample of children (N = 242; 57% girls; Mage = 10.87 years) was recruited and followed up 1 and 4 years later.

RESULTS

Mediation analysis indicated that the prospective link between child and adolescent BPP trait vulnerability was shaped by pre-adolescent experiences of bullying victimization, but not by bullying perpetration.

DISCUSSION

These results indicate that the continuity between child and adolescent borderline trait features are partly explained by exposure to bullying victimization, indicating that the impact of environmental invalidation on BPP development also extends to the peer context.

Die Borderline-Persönlichkeitsstörung im Jugendalter

Zusammenfassung: Die Borderline-Persönlichkeitsstörung (BPS) ist eine schwere psychische Erkrankung, die durch hohe Morbidität und Mortalität gekennzeichnet ist sowie mit einem niedrigen psychosozialen Funktionsniveau einhergeht. Die BPS zeigt sich oft mit Beginn der frühen Adoleszenz (ab dem 12. Lebensjahr). Neben repetitiver Selbstverletzung und Suizidalität bestehen häufig sowohl Symptome internalisierender (Depression und Angst) als auch externalisierender Störungen (Hyperaktivität und Substanzkonsum). Daher kommt einer differentialdiagnostischen Abklärung und der Diagnosestellung mit dem Ziel der Frühintervention im klinischen Alltag eine besondere Rolle zu. Die Psychotherapie stellt bei der BPS eine äußerst wirksame Behandlungsmethode dar, Belege für die Wirksamkeit von pharmakologischen Intervention fehlen. Der Schlüssel zu einer Verbesserung der Versorgung für Jugendliche mit BPS liegt in einer Generierung von Wissen zu Vorläufersymptomen sowie einer evidenzbasierten, stadienspezifischen Behandlung (frühe Behandlung bereits subklinischer BPS mit Behandlungsintensität abgestuft nach dem Schweregrad). Dieser Übersichtsartikel beleuchtet den aktuellen Stand der Forschung und gibt Empfehlungen für die therapeutische Arbeit in der klinischen Praxis.

Perceived social support as related to social wellbeing in patients with Emotionally Unstable Personality Disorder (EUPD)

Background

People diagnosed with EUPD also known as borderline personality disorder (BPD) experience different challenges in their lives. These challenges include compulsive behavior, irritability, depression, sadness, guilt, shame, loneliness, grandiosity, and feeling of worthlessness. It is noteworthy that such challenges trigger among them a self-destructive behaviour, in addition to social isolation, and impaired social relationships. It is also found to significantly impact their physical, mental, and social wellbeing. This study is a humble attempt to examine the role of perceived social support in improving the social wellbeing of BPD outpatients. Through the purposive sampling technique, 100 BPD outpatients were selected for the study. The mean age of the participant was 25 years.

Results

It was found that perceived social support (family, friends, and significant others) plays a vital role in the wellbeing of these participants. The correlation between the two is positive as well as statistically significant. This means higher the support these patients experience from their relatives, the better is their social wellbeing.

Conclusions

This study has practical implications for counselors, clinical psychologists, and psychiatrists working in the field.

Comparing Differences between Two Groups of Adolescents Hospitalized for Self-Harming Behaviors with and without Personality Disorders

Self-harm (non-suicidal self-injury (NSSI) and suicidal behavior (SB)) is frequent display during adolescence. Patients with personality disorders (PDs) frequently self-harm. However, few studies have focused on the role of PDs in self-harming adolescents. In this study, we collected 79 adolescents hospitalized due to self-harm (88.6% female; 78.5% Caucasian) and divided them into two groups, with or without a diagnosis of PD. The socio-demographic and psychological-clinical data were collected through a structured interview by clinicians. Univariate, subgroup, and multiple logistic regression analyses were performed. Univariate analysis showed that adolescents with a PD and self-harm had (1) an older age at hospitalization (p < 0.01); (2) experienced physical and sexual abuse (p = 0.05, and p < 0.01, respectively); (3) ADHD (p = 0.05); (4) a greater number of SA (p < 0.01); and (5) probability of being a major NSSI patient (>20 lifetime NSSI episodes) (p < 0.01). After multivariate stratified analysis, the results indicated that an older age, and particularly major NSSI status were predictors of PD diagnosis. Early identification and a better understanding of the characteristics of adolescent PDs can assist clinicians in intervening earlier and developing more rational treatment strategies to reduce the long-term effects of PDs.

ADHD Symptoms, Peer Problems, and Emotion Dysregulation as Longitudinal and Concurrent Predictors of Adolescent Borderline Personality Features

OBJECTIVE

ADHD and borderline personality (BP) disorder are highly comorbid and characterized by emotion dysregulation and peer problems. However, limited research has examined social and emotional predictors of BP features in samples that include youth with ADHD.

METHOD

Using a sample of 124 youth with and without ADHD (52% female), ADHD symptoms, peer problems, and emotion dysregulation were assessed in childhood (8-13 years) and in adolescence, along with BP features (13-18 years).

RESULTS

In addition to the significant effect of ADHD symptoms, teacher-rated child peer victimization and adolescent-reported peer victimization, poorer close friendships, and emotion dysregulation domains significantly predicted adolescent BP features. Greater parent-rated child and adolescent emotion dysregulation domains also significantly predicted adolescent BP features, with ADHD symptoms no longer significant.

CONCLUSION

Even for youth with ADHD, peer and emotional vulnerabilities in childhood and adolescence may serve as important markers of risk for adolescent BP features.

Parental Reports of Physically Self-Destructive Behavior in the Offspring of Patients With Borderline Personality Disorder and Other Personality Disorders

The main aim of this article is to compare the prevalence of four forms of physically self-destructive behavior in the offspring of parents with borderline personality disorder (BPD) and compare them to the offspring of parents with other personality disorders (OPD). At the 4- and 6-year waves in a prospective study of the long-term course of BPD, participants were asked to report on the self-destructive behaviors of their children using the Childhood Self-Destructiveness Scale. A total of 68 parents were interviewed regarding 131 children, 104 of whom were offspring of parents with BPD (n = 55) and 27 were offspring of parents with OPD (n = 13). BPD parents reported significantly more self-injury and substance abuse in their children than OPD parents. The results from this study suggest that both direct and indirect forms of self-destructive behavior are both more common and quite specific for the children of parents with BPD.

Understanding personality pathology in a clinical sample of youth: study protocol for the longitudinal research project 'APOLO'

INTRODUCTION

We propose that a dimensional, multilayered perspective is well suited to study maladaptive personality development in youth. Such a perspective can help understand pathways to personality pathology and contribute to its early detection. The research project 'APOLO' (a Dutch language acronym for Adolescents and their Personality Development: a Longitudinal Study) is designed based on McAdams' integrative three-layered model of personality development and assesses the interaction between dispositional traits, characteristic adaptations, the narrative identity and functioning.

METHODS AND ANALYSIS

APOLO is a longitudinal research project that takes place in two outpatient mental healthcare centres. Participants are youth between 12 years and 23 years and their parents. Data collection is set up to build a data set for scientific research, as well as to use the data for diagnostic assessment and systematic treatment evaluation of individual patients. Measurements are conducted half-yearly for a period of 3 years and consist of self-report and informant-report questionnaires and a semistructured interview. The included constructs fit the dimensional model of personality development: maladaptive personality traits (dispositional traits), social relations, stressful life events (characteristic adaptations), a turning point (narrative identity) and functioning (eg, achievement of youth specific milestones). Primary research questions will be analysed using structural equation modelling.

ETHICS AND DISSEMINATION

The results will contribute to our understanding of (the development of) personality pathology as a complex phenomenon in which both structural personality characteristics as well as unique individual adaptations and experiences play a role. Furthermore, results will give directions for early detection and timely interventions. This study has been approved by the ethical review committee of the Utrecht University Faculty for Social and Behavioural Sciences (FETC17-092). Data distribution will be anonymous and results will be disseminated via communication canals appropriate for diverse audiences. This includes both clinical and scientific conferences, papers published in national and international peer-reviewed journals and (social) media platforms.

Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents

Although associations among borderline personality disorder (BPD), social rejection, and frontal EEG alpha asymmetry scores (FAA, a neural correlate of emotion regulation and approach-withdrawal motivations) have been explored in different studies, relatively little work has examined these relations during adolescence in the same study. We examined whether FAA moderated the relation between BPD features and rejection sensitivity following a validated social exclusion paradigm, Cyberball. A mixed, clinical-community sample of 64 adolescents (females = 62.5%; Mage = 14.45 years; SD = 1.6; range = 11-17 years) completed psychodiagnostic interviews and a self-report measure of BPD (Time 1). Approximately two weeks later (Time 2), participants completed a resting EEG recording followed by Cyberball. FAA moderated the relation between BPD features and overall feelings of rejection following Cyberball: individuals with greater relative left FAA had the highest and lowest feelings of social rejection depending on whether they had high and low BPD feature scores, respectively. Results remained after controlling for age, sex, gender, depression, and BPD diagnosis. These results suggest that FAA may moderate the relation between BPD features and social rejection, and that left frontal brain activity at rest may be differentially associated with those feelings in BPD. Findings are discussed in terms of the link between left frontal brain activity in the regulation and dysregulation of social approach behaviors, characteristic of BPD.

Relationships of Homophobic Bullying Victimization during Childhood with Borderline Personality Disorder Symptoms in Early Adulthood among Gay and Bisexual Men: Mediating Effect of Depressive Symptoms and Moderating Effect of Family Support

This study investigated (1) the associations of homophobic bullying victimization in childhood with borderline personality disorder (BPD) symptoms in early adulthood among gay and bisexual men; (2) the mediating effect of depressive symptoms on the association between homophobic bullying victimization and BPD symptoms, and (3) the moderating effects of perceived family support on the association between homophobic bullying victimization and BPD symptoms. A total of 500 gay or bisexual men aged between 20 and 25 years were recruited into this study. The experiences of physical, verbal and social relationship bullying victimization during childhood were evaluated using the Mandarin Chinese version of the School Bullying Experience Questionnaire. The experiences of cyberbullying victimization during childhood were evaluated using the Cyberbullying Experiences Questionnaire. BPD symptoms were assessed using the Borderline Symptom List. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale. Perceived family support was evaluated using the Family Adaptation, Partnership, Growth, Affection, and Resolve index. The results of mediation analyses demonstrated that all the types of homophobic bullying victimization in childhood were directly associated with BDP symptoms in young adulthood as well as indirectly associated with BPD symptoms through the mediation of depressive symptoms. The results of moderation analyses demonstrated that the association between homophobic bullying victimization and BPD symptoms decreased when the individuals had more family support. Intervention programs to reduce homophobic bullying victimization and enhance family support for gay and bisexual men and their families are necessary. Interventions to improve depressive and BPD symptoms among gay and bisexual men are also necessary, especially for those who experienced homophobic bullying victimization during childhood.

Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents

BACKGROUND

Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap.

METHODS

Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI.

RESULTS

NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender.

LIMITATIONS

Cross-sectional design through self-report assessment.

CONCLUSIONS

Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.

A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial

OBJECTIVE

The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group.

METHODS

One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n = 64) and older (aged 18 to 25 years; n = 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression.

RESULTS

Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age.

CONCLUSIONS

Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.

Borderline Personality Disorder: Risk Factors and Early Detection

Personality disorders (PDs) exert a great toll on health resources, and this is especially true for borderline personality disorder (BPD). As all PDs, BPD arises during adolescence or young adulthood. It is therefore important to detect the presence of this PD in its earlier stages in order to initiate appropriate treatment, thus ameliorating the prognosis of this condition. This review aims to highlight the issues associated with BPD diagnosis in order to promote its early detection and treatment. To do so, we conducted a search on PubMed database of current evidence regarding BPD early diagnosis, focusing on risk factors, which represent important conditions to assess during young patient evaluation, and on diagnostic tools that can help the clinician in the assessment process. Our findings show how several risk factors, both environmental and genetic/neurobiological, can contribute to the onset of BPD and help identify at-risk patients who need careful monitoring. They also highlight the importance of a careful clinical evaluation aided by psychometric tests. Overall, the evidence gathered confirms the complexity of BDP early detection and its crucial importance for the outcome of this condition.

Precursors and correlates of transient and persistent longitudinal profiles of psychotic experiences from late childhood through early adulthood

BACKGROUND

Psychotic experiences are reported by 5-10% of young people, although only a minority persist and develop into psychotic disorders. It is unclear what characteristics differentiate those with transient psychotic experiences from those with persistent psychotic experiences that are more likely to be of clinical relevance.

AIMS

To investigate how longitudinal profiles of psychotic experiences, created from assessments at three different time points, are influenced by early life and co-occurring factors.

METHOD

Using data from 8045 individuals from a birth cohort study, longitudinal profiles of psychotic experiences based on semi-structured interviews conducted at 12, 18 and 24 years were defined. Environmental, cognitive, psychopathological and genetic determinants of these profiles were investigated, along with concurrent changes in psychopathology and cognition.

RESULTS

Following multiple imputations, the distribution of longitudinal profiles of psychotic experiences was none (65.7%), transient (24.1%), low-frequency persistent (8.4%) and high-frequency persistent (1.7%). Individuals with high-frequency persistent psychotic experiences were more likely to report traumatic experiences, other psychopathology, a more externalised locus of control, reduced emotional stability and conscientious personality traits in childhood, compared with those with transient psychotic experiences. These characteristics also differed between those who had any psychotic experiences and those who did not.

CONCLUSIONS

These findings indicate that the same risk factors are associated with incidence as with persistence of psychotic experiences. Thus, it might be that the severity of exposure, rather than the presence of specific disease-modifying factors, is most likely to determine whether psychotic experiences are transient or persist, and potentially develop into a clinical disorder over time.

Preschool Age Predictors of Adolescent Borderline Personality Symptoms

OBJECTIVE

Developmental models of borderline personality disorder (BPD) have highlighted the interplay of psychological variables (ie, impulsivity and emotional reactivity) with social risk factors, including invalidating parenting and childhood trauma. Prospective longitudinal studies have demonstrated the association of BPD with social, familial, and psychological antecedents. However, to date, few of these studies have studied the interaction of multiple risk domains and their potential manifestations in the preschool period.

METHOD

Participants were 170 children enrolled in a prospective longitudinal study of early childhood depression. Participants completed a baseline assessment between ages 3 and 6 years. Psychopathology, suicidality, and self-harm were assessed using a semistructured age-appropriate psychiatric interview before age 8 and self-report after age 8. BPD symptoms were assessed between ages 14 and 19 by self-report. Adverse childhood experiences (ACEs) and peer relationships were reported by parents. Maternal support was assessed using an observational measure between ages 3 and 6.

RESULTS

Preschool ACEs accounted for 14.9% of adolescent BPD symptom variance in a regression analysis. Controlling for gender and preschool ACEs, preschool and school-age externalizing symptoms, preschool internalizing symptoms, and low maternal support were significant predictors of BPD symptoms in multivariate analyses. Preschool and school-age suicidality composite scores significantly predicted BPD symptoms.

CONCLUSION

These findings suggest that preschool factors may be early predictors of BPD symptoms. Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms. However, further research is needed to guide key factors for targeted early intervention.

Longitudinal Associations Between Cognitive Deficits in Childhood and Psychopathological Symptoms in Adolescence and Young Adulthood

IMPORTANCE

Cognitive deficits are core features of mental disorders and are important in predicting long-term prognosis. However, it is still unknown whether individual patterns of cognitive deficits predate specific mental disorders.

OBJECTIVE

To investigate the specificity of the associations of attention, working memory, and inhibition in childhood with borderline personality disorder (BPD), psychosis, depression, and hypomania in adolescence and young adulthood.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study obtained data from the Avon Longitudinal Study of Parents and Children in the United Kingdom. All pregnant women resident in Avon, United Kingdom, with an expected date of delivery from April 1, 1991, and December 31, 1992, were eligible. Data analysis was conducted from April 1 to September 30, 2020. The sample initially comprised 13 988 participants who were alive at 1 year of age. For this study, data were available for 6333 individuals reporting on any psychopathological measure at ages 11 to 12 years, 4903 individuals at ages 17 to 18 years, and 2963 individuals at 22 to 23 years.

EXPOSURES

Sustained attention, selective attention, and attentional control were assessed with the Test of Everyday Attention for Children at age 8 years, and working memory and inhibition were assessed at age 10 years with the Counting Span Task and the stop-signal paradigm, respectively.

MAIN OUTCOMES AND MEASURES

Symptoms of BPD were assessed at ages 11 to 12 years, psychotic experiences and depression were examined at ages 17 to 18 years, and hypomania was examined at ages 22 to 23 years.

RESULTS

Among 5315 individuals included in the statistical analysis, 2551 (48.0%) were male and 2764 (52.0) were female. Higher sustained attention at 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (adjusted odds ratio [aOR], 0.964; 95% CI, 0.933-0.996; P = .03), better performance on inhibition at age 10 years with decreased risk of psychotic experiences at ages 17 to 18 years (aOR, 0.938; 95% CI, 0.890-0.989; P = .02), higher sustained attention at age 8 years with decreased risk of depressive symptoms at ages 17 to 18 years (aOR, 0.969; 95% CI 0.938-0.9997; P = .048), and better performance in working memory at age 10 years with decreased risk of hypomania symptoms at ages 22 to 23 years (aOR, 0.694; 95% CI, 0.529-0.911; P = .008). After controlling for potential psychopathological overlay, all the associations remained, except for working memory and hypomania. Higher sustained attention at age 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (β = -0.05; P < .001) and of depression at ages 17 to 18 years (β = -0.03; P = .04), and better performance in inhibition at age 10 years was associated with decreased risk of psychotic experiences at ages 17 to 18 years (β = -0.03; P = .04).

CONCLUSIONS AND RELEVANCE

These findings suggest that specific cognitive deficits in childhood are distinctively associated with different psychopathological symptoms in young people. Furthermore, these results suggest the potential of early cognitive interventions in childhood as a way of modifying or attenuating risk for subsequent psychopathological symptoms.

Emerging child competencies and personality pathology: toward a Developmental Cascade model of BPD

The guiding principle of this synthesis is to organize research on predictors of BPD features within a developmentally specific framework (e.g. infancy, preschool, middle childhood, adolescence). In addition, studies are prioritized that have longitudinal and observational components. On the basis of current literature, a Developmental Cascade Model of BPD is offered in which specific difficulties during one developmental period contribute to specific difficulties in a succeeding period, resulting in increasingly broad areas of dysregulation over time. Furthermore, to address specificity, we contrast trajectories toward BPD with trajectories toward antisocial behavior, noting shared and divergent predictors. The review highlights the importance of locating research findings in relation to the competencies and challenges of particular developmental periods when modelling developmental trajectories toward BPD.

Exposure to Bullying and General Psychopathology: A Prospective, Longitudinal Study

Although there is mounting evidence that the experience of being bullied associates with both internalizing and externalizing symptoms, it is not known yet whether the identified associations are specific to these symptoms, or shared between them. The primary focus of this study is to assess the prospective associations of bullying exposure with both general and specific (i.e., internalizing, externalizing) factors of psychopathology. This study included data from 6,210 children participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). Child bullying was measured by self-report at ages 8 and 10 years. Child psychopathology symptoms were assessed by parent-interview, using the Development and Well-being Assessment (DAWBA) at ages 7 and 13 years. Bullying exposure significantly associated with the general psychopathology factor in early adolescence. In particular, chronically victimized youth exposed to multiple forms of bullying (i.e., both overt and relational) showed higher levels of general psychopathology. Bullying exposure also associated with both internalizing and externalizing factors from the correlated-factors model. However, the effect estimates for these factors decreased considerably in size and dropped to insignificant for the internalizing factor after extracting the shared variance that belongs to the general factor of psychopathology. Using an integrative longitudinal model, we found that higher levels of general psychopathology at age 7 also associated with bullying exposure at age 8 which, in turn, associated with general psychopathology at age 13 through its two-year continuity. Findings suggest that exposure to bullying is a risk factor for a more general vulnerability to psychopathology.

The Role of Trauma in Early Onset Borderline Personality Disorder: A Biopsychosocial Perspective

The role of childhood trauma in the development of borderline personality disorder (BPD) in young age has long been studied. The most accurate theoretical models are multifactorial, taking into account a range of factors, including early trauma, to explain evolutionary pathways of BPD. We reviewed studies published on PubMed in the last 20 years to evaluate whether different types of childhood trauma, like sexual and physical abuse and neglect, increase the risk and shape the clinical picture of BPD. BPD as a sequela of childhood traumas often occurs with multiple comorbidities (e.g. mood, anxiety, obsessive-compulsive, eating, dissociative, addictive, psychotic, and somatoform disorders). In such cases it tends to have a prolonged course, to be severe, and treatment-refractory. In comparison with subjects who suffer from other personality disorders, patients with BPD experience childhood abuse more frequently. Adverse childhood experiences affect different biological systems (HPA axis, neurotransmission mechanisms, endogenous opioid systems, gray matter volume, white matter connectivity), with changes persisting into adulthood. A growing body of evidence is emerging about interaction between genes (e.g. FKBP5 polymorphisms and CRHR2 variants) and environment (physical and sexual abuse, emotional neglect).

Trauma and psychopathology associated with early onset BPD: an empirical contribution

Prodromal symptoms of borderline personality disorder (BPD) often arise in young age, especially in early adolescence. Several factors for early BPD onset have been identified to consent a precocious detection of high-risk population. The present study is aimed: (1) to identify what psychopathological, traumatic, and functional factors are significantly associated to early onset in a sample of BPD patients and (2) to evaluate what factors are associated to the time interval between symptoms onset and first psychiatric visit (Δ age). Participants were enrolled from BPD outpatients attending the Center for Personality Disorder of the University of Turin, Italy. Patients were tested with assessment instruments for specific BPD symptoms, exposure to traumatic experiences, global functioning, and perception of quality of life. All variables that were found significant at a bivariate analysis were included in two multiple regressions (stepwise backward), with the age of onset and the Δ age as dependent variables. Significance level was P ≤ 0.05. Seventy patients were included in the study (68 completers). Factors that were found related to age of onset were: CTQ-SF emotional abuse (P = 0.001); ACE-IQ bully victimization (P = 0.005), alcohol/drug abuser in the household (P = 0.001), and physical neglect (P = 0.006); BIS non-planning impulsivity (P = 0.005); and SOFAS score (P = 0.033). Factors that were found related to Δ age were: ACE-IQ total score (P = 0.001) and BIS total score (P = 0.001). Earlier onset of BPD is mainly associated to traumatic events, including abuse, neglect, dysfunction in household environment, and bullying. Earlier onset is also related to a worse social functioning. Among BPD symptoms only non-planning impulsivity was found associated to early onset. A higher number of traumatic events and worse impulsive dyscontrol induce a significant reduction of the time interval between onset and first psychiatric observation.

Association of Parent-Reported Sleep Problems in Early Childhood With Psychotic and Borderline Personality Disorder Symptoms in Adolescence

IMPORTANCE

Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. However, the extent to which this association is also true for behavioral sleep problems is still unknown, and the potential mechanisms are unexplored.

OBJECTIVE

To examine the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study assessed 13 488 participants in the Avon Longitudinal Study of Parents and Children birth cohort who were followed up for more than 13 years. Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. Data analysis was conducted from May 1 to December 31, 2019.

MAIN OUTCOMES AND MEASURES

Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age.

RESULTS

Data were available on 7155 participants (3718 girls [52%]) who reported on BPD symptoms and 6333 (3280 boys [52%]) who reported on BPD symptoms. Higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53) of age were significantly associated with psychotic experiences in adolescence, whereas shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated with BPD symptoms. Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association. Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age (bias-corrected estimate, -0.005; 95% CI, -0.008 to -0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate, -0.006; 95% CI, -0.010 to -0.003; P = .003) with psychosis.

CONCLUSIONS AND RELEVANCE

The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized interventions in psychosis and BPD.

Developmental Pathways to BPD-Related Features in Adolescence: Infancy to Age 15

The self-damaging behaviors central to borderline personality disorder (BPD) become prominent in adolescence. Current developmental theories cite both early family processes and childhood dysregulation as contributors to BPD, but longitudinal data from infancy are rare. Using the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development database (SECCYD; N = 1,364), we examined path models to evaluate parent and child contributors from infancy/preschool, middle childhood, and adolescence to adolescent BPD-related features. In addition, person-centered latent class analyses (LCA) investigated whether adolescent BPD-related features were more strongly predicted by particular patterns of maladaptive parenting. Path modeling identified unique influences of maternal insensitivity and maternal depression on BPD-related features, first, through social-emotional dysregulation in middle childhood, and second, through continuity from infancy in maternal insensitivity and depression. LCA results indicated that early withdrawn parenting was particularly predictive of BPD-related features in adolescence. Results suggest multiple points of intervention to alter pathways toward adolescent borderline psychopathology.

Relationship between gingival bleeding and associated factors with reports of verbal bullying in adolescents

BACKGROUND

Dentofacial features are related to increased bullying episodes in young people. The aim of this study was to assess the association between gingival bleeding and reports of verbal bullying among adolescents.

METHODS

This is a cross-sectional study conducted with a representative sample of 608 12-year-old adolescents from southern Brazil. The occurrence of verbal bullying was verified through adolescents' self-report. Oral health measurements included the presence of gingival bleeding, dental fracture, dental fluorosis, and dental caries experience. Gingival bleeding was assessed through adolescent self-perception by the following question: "Did you notice any bleeding in your gums?" Demographic, socioeconomic, and psychosocial variables were also evaluated. Poisson regression models with robust variance were used to evaluate the influence of gingival bleeding on the occurrence of verbal bullying. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI).

RESULTS

Out of 608 adolescents evaluated, 577 answered bullying questions. The prevalence of self-reported verbal bullying was 12.8%. Adolescents who presented gingival bleeding had an 80% higher prevalence of verbal bullying than their counterparts (PR 1.80; 95% CI 1.01 -3.19). Dental shame, speech difficulties and influence of dental condition on studies also impacted the higher prevalence of bullying.

CONCLUSION

Our results suggest that the presence of gingival bleeding negatively impacts the social life of adolescents, causing more episodes of verbal bullying. These findings encourage public health policies aimed at reducing oral health inequities, thus reflecting on the well-being and quality of life of this target population.

Emerging child competencies and personality pathology: toward a Developmental Cascade model of BPD

The guiding principle of this synthesis is to organize research on predictors of BPD features within a developmentally specific framework (e.g. infancy, preschool, middle childhood, adolescence). In addition, studies are prioritized that have longitudinal and observational components. On the basis of current literature, a Developmental Cascade Model of BPD is offered in which specific difficulties during one developmental period contribute to specific difficulties in a succeeding period, resulting in increasingly broad areas of dysregulation over time. Furthermore, to address specificity, we contrast trajectories toward BPD with trajectories toward antisocial behavior, noting shared and divergent predictors. The review highlights the importance of locating research findings in relation to the competencies and challenges of particular developmental periods when modelling developmental trajectories toward BPD.

Psychopathological outcomes of adolescent borderline personality disorder symptoms

OBJECTIVE

Despite considerable morbidity and functional losses associated with adolescent borderline personality disorder, little is known about psychopathological outcomes. This study examined associations between adolescent borderline personality disorder symptoms and subsequent depressive, psychotic and hypomanic symptoms.

METHODS

We used data from the Avon Longitudinal Study of Parents and Children. Participants were adolescents living in the community who had data for all longitudinal outcomes (N = 1758). We used logistic regression and path analysis to investigate associations between borderline personality disorder (five or more probable/definite symptoms) reported at age 11-12 years and depressive and psychotic symptoms reported at age 12 and 18, and lifetime hypomanic symptoms reported at age 22-23 years.

RESULTS

Adolescent borderline personality disorder symptoms were associated with psychotic symptoms (odds ratio: 2.36, confidence interval: [1.82, 3.06]), diagnosis of depression at age 18 years (odds ratio: 1.30, confidence interval: [1.03, 1.64]) and hypomanic symptoms (odds ratio: 2.89, confidence interval: [2.40, 3.48]) at 22-23 years. Path analysis controlling for associations between all outcomes indicated that borderline personality disorder symptoms were independently associated with depressive symptoms (β = 0.97, p < 0.001) at 12 years and hypomanic (β = 0.58, p < 0.01) symptoms at 22-23 years. Borderline personality disorder symptoms were also associated with psychotic symptoms at age 12 years (β = 0.58, p < 0.01), which were linked (β = 0.34, p < 0.01) to psychotic symptoms at age 18 years.

CONCLUSION

Adolescents with borderline personality disorder symptoms are at future risk of psychotic and hypomanic symptoms, and a diagnosis of depression. Future risk is independent of associations between psychopathological outcomes, indicating that adolescent borderline personality disorder symptoms have multifinal outcomes. Increasing awareness of borderline personality disorder in early adolescence could facilitate timely secondary prevention of these symptoms subsequently, helping to prevent future psychopathology.

Bullying Victimization and Trauma

Bullying victimization and trauma research traditions operate quite separately. Hence, it is unclear from the literature whether bullying victimization should be considered as a form of interpersonal trauma. We review studies that connect bullying victimization with symptoms of PTSD, and in doing so, demonstrate that a conceptual understanding of the consequences of childhood bullying needs to be framed within a developmental perspective. We discuss two potential diagnoses that ought to be considered in the context of bullying victimization: (1) developmental trauma disorder, which was suggested but not accepted as a new diagnosis in the DSM-5 and (2) complex post-traumatic stress disorder, which has been included in the ICD-11. Our conclusion is that these frameworks capture the complexity of the symptoms associated with bullying victimization better than PTSD. We encourage practitioners to understand how exposure to bullying interacts with development at different ages when addressing the consequences for targets and when designing interventions that account for the duration, intensity, and sequelae of this type of interpersonal trauma.

A Four-Year Prospective Study of Bullying, Anxiety, and Disordered Eating Behavior Across Early Adolescence

We investigated the developmental pathways by which bullying perpetration and victimization, anxiety, and disordered eating behavior were related. Participants were drawn from the Canadian McMaster Teen Study. From Grade 5-8 (age 10-14), students (n = 657) were assessed on bullying involvement and symptoms of anxiety, and in Grade 7 and 8, students additionally completed a measure of clinically significant disordered eating behavior. Bullying victimization initiated a cascading effect on bullying perpetration, which subsequently led to disordered eating behavior. Anxiety had direct effects on disordered eating behavior at multiple time points and initiated a cascading effect on bullying victimization, and subsequently, perpetration. There was no evidence of moderation by sex. Bullying perpetration and anxiety may serve as early signals of eating pathology. Bullying prevention programs may attenuate the risk of disordered eating in both sexes, and the high continuity of disordered eating behavior suggests that early intervention is critical.

Do Cross-National and Ethnic Group Bullying Comparisons Represent Reality? Testing Instruments for Structural Equivalence and Structural Isomorphism

Bullying in schools is a widespread phenomenon, witnessed worldwide, with negative consequences for victims and perpetrators. Although it is an international issue, there are several issues with cross-national and cross-cultural/ethnic research that can make comparisons between countries and cultures/ethnic groups difficult including language, cultural perception, and/or methodological issues. As statistical techniques rapidly develop, there may be more scope to be statistically creative in how we assess the utility of one tool across different groups such as cultures, nations, etc. At the very least, an attempt to do this should be paramount in studies investigating different groups (e.g., from different countries) at one time. This study investigated bullying and victimization rates in a large cross-ethnic and -country comparison between adolescents from four countries and five different ethnic groups including: Israel (Jewish Israelis and Arab Palestinian Israelis), Palestine (the Gaza Strip), Germany, and Greece. A total of 3,186 school children aged 12-15 years completed self-report questionnaires of peer bullying/victimization. A stepwise data analytic approach was used to test comparability of the psychometric properties: (1) Structural equivalence contributes to the valid use of the instrument in cultural contexts other than the one for which the instrument has been developed. Structural equivalence is a necessary condition for the justification of indirect or direct comparisons between cultural groups. (2) Additionally, structural isomorphism is necessary to demonstrate that the same internal structure of the instrument applies to the cultural and individual levels. Findings support the internal structural equivalence of the questionnaire with the exception of the Palestinian sample from the Gaza Strip. Subsequently, exploratory factor analysis on the cultural level structure revealed a one-factor structure with congruence measure below 0.85. Thus, no evidence was found for internal structural isomorphism suggesting that no direct comparisons of cultural samples was justified. These results are discussed in detail and the implications for the international research community and cross-national/-ethnic comparison studies in bullying are addressed.

Genetic risk for bipolar disorder and psychopathology from childhood to early adulthood

BACKGROUND

Studying the phenotypic manifestations of increased genetic liability for Bipolar Disorder (BD) can increase understanding of this disorder.

AIMS

We assessed whether genetic risk for BD was associated with childhood psychopathology and features of hypomania in young adulthood within a large population-based birth cohort.

METHODS

We used data from the second Psychiatric Genetics Consortium Genome Wide Association Study (GWAS) for Bipolar Disorder to construct a polygenic risk score (PRS) for each individual in the Avon Longitudinal Study of Parents and Children (ALSPAC). Linear and logistic regression models were used to assess associations between the BD-PRS and emotional/behavioural difficulties, attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) traits in childhood, as well as hypomania in early adulthood (sample sizes from 2654 to 6111).

RESULTS

The BD-PRS was not associated with total hypomania score, but was weakly associated with a binary measure of hypomania (OR = 1.13, 95%CI 0.98,1.32; p = 0.097), and particularly at higher hypomania symptom thresholds (strongest evidence OR = 1.33, 95%CI 1.07, 1.65; p = 0.01). The BD-PRS was also associated with ADHD (OR = 1.31, 95%CI 1.10, 1.57; p = 0.018), but not with other childhood psychopathology.

LIMITATIONS

The PRS only captures common genetic variation and currently explains a relatively small proportion of the variance for BD.

CONCLUSIONS

The BD-PRS was associated with ADHD in childhood, and weakly with adult hypomania, but not with other psychopathology examined. Our findings suggest that genetic risk for BD does not appear to manifest in childhood to the same extent as schizophrenia genetic risk has been reported to do.

Aggression Predicts Changes in Peer Victimization that Vary by Form and Function

Peer victimization is predictive of serious problems in adjustment, especially among children who are both victimized and aggressive. This study investigated how different types of aggression contribute to later victimization. Specifically, we examined prospective relationships between the types of aggression that children perpetrated and the types that they experienced at the hands of others. Trained observers coded schoolyard behavior of 553 children in grades 3-6 during the initial year of a bullying intervention program. Both observed aggression and victimization were specified by form (direct, indirect) and function (proactive, reactive). Total hourly rates of victimization were highest in the upper grades. Direct-reactive aggression uniquely predicted increases in victimization, while direct-proactive aggression predicted decreases, particularly in direct-proactive victimization. Indirect-proactive aggression (e.g., derogatory gossip) predicted increases in indirect-proactive victimization only in the control group. Indirect-reactive aggression and victimization occurred too rarely to detect change. Aggression-victimization relationships did not differ for boys and girls. Discussion considers why children might risk direct reactive aggression in the face of increased victimization. Different sequelae for different forms and functions of aggression highlight the need to resolve theoretical ambiguities in defining proactive and reactive aggression.

Early Detection and Outcome in Borderline Personality Disorder

Borderline personality disorder (BPD) is a severe and heterogeneous mental disorder that is known to have the onset in young age, often in adolescence. For this reason, it is of fundamental importance to identify clinical conditions of childhood and adolescence that present a high risk to evolve in BPD. Investigations indicate that early borderline pathology (before 19 years) predict long-term deficits in functioning, and a higher percentage of these patients continue to present some BPD symptoms up to 20 years. There is a general accordance among investigators that good competence in both childhood and early adulthood is the main predictive factor of excellent recovery in BPD patients. Some authors suggest that specific childhood personality traits can to be considered precursors of adult BPD, as well as some clinical conditions: disruptive behaviours, disturbance in attention and emotional regulation, conduct disorders, substance use disorders, and attention-deficit-hyperactivity disorder. Unfortunately, diagnosis and treatment of BPD is usually delayed, also because some clinicians are reluctant to diagnose BPD in younger individuals. Instead, the early identification of BPD symptoms have important clinical implications in terms of precocious intervention programs, and guarantees that young people with personality disorders obtain appropriate treatments. This review is aimed to collect the current evidences on early risk and protective factors in young people that may predict BPD onset, course, and outcome.

The Assertive Resolution of Conflicts in School With a Gamified Emotion Education Program

Coexistence in schools inevitably carries a higher risk of conflicts among peers. This fact can be detrimental to the well-being and academic achievement of the students. In many developed countries, about 90% of the pupils in compulsory secondary education report witnessing assaults among peers. In this regard, recognizing, controlling and managing emotions is key to ensure a healthy and effective interaction with others. Negative emotions, such as anger, can trigger conflicts or even episodes of violence if not regulated properly. Interactive tools, such as specialized software's, have shown high rates of efficacy for the training of different kinds of competences like the regulation of emotions. The aim of the present work is to describe the Happy Emotional Education Program and its effects over a sample of secondary school students. This software focuses in the training of emotional competences of the students with the objective of solving conflicts in a more assertive way. The design employed in the present work was a quasiexperimental design with pretest and posttest with a control group. Results show that Happy Emotional Education Program contributes to the management of emotions and the absence of negative affect or anxiety in a significant way. Additionally, the constant use of this interactive tool enhances motivation and the learning process of students. Results also indicate the importance of assessing the effects of the program in the long term. This would enable researchers to further assess the effects of the program over those emotional competences that are more resistant to change given its stable nature.

Borderline personality disorder: does its clinical features show specificity to differing developmental risk factors?

OBJECTIVES

To determine if differing developmental factors show specificity to differing manifestations of borderline personality disorder (BPD).

METHODS

A clinical sample of 73 females diagnosed with BPD undertook a psychiatrist interview and completed self-report questionnaires, including the semi-structured Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV) assessing for BPD status. A set of negative and potentially traumatic developmental factors were included in the assessment.

RESULTS

Childhood sexual abuse, affirmed by 49% of the sample, showed specificity in being linked with DIPD-defined affective instability. DIPD-defined identity disturbance also showed specificity in being associated only with reporting significant non-sexual developmental trauma. DIPD-defined anger and paranoia/dissociation showed minimal specificity and were associated with most antecedent developmental factors in adulthood.

CONCLUSIONS

Differing manifestations of BPD are likely to be shaped by specific and non-specific developmental events. Clarification of such links has the potential to shape more specific therapeutic interventions.

Borderline personality and attention-deficit hyperactivity traits in childhood are associated with hypomanic features in early adulthood

BACKGROUND

There is limited understanding of the symptomatic development of bipolar disorder from childhood to early adulthood.

AIMS

We assessed whether borderline personality disorder traits, ADHD, and emotional, behavioural and social difficulties during childhood were associated with hypomania assessed in young adulthood.

METHOD

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), to examine associations between measures of childhood psychopathology and lifetime hypomanic features assessed at age 22-23 years using the Hypomania Checklist-32 (HCL-32; n = 3372). We also conducted a factor analysis of the HCL to identify latent constructs underlying hypomania, and the extent to which childhood psychopathology was associated with these.

RESULTS

We identified two factors of the HCL corresponding to energy/mood and risk-taking/irritability. There was evidence of association between childhood borderline personality disorder traits and both hypomania factors, with evidence that the association was stronger with the risk-taking/irritability factor. All individual borderline traits, with the exception of fear of abandonment, were associated with hypomania. There was also evidence of association between most other measures of childhood psychopathology (ADHD, hyperactivity, conduct problems, peer relationship problems and reduced prosocial behaviour) and the risk-taking/irritability factor, but much less consistent evidence of association with the energy/mood factor.

LIMITATIONS

The HCL cannot diagnose bipolar disorder and may be subject to reporting bias.

CONCLUSIONS

A broad range of childhood psychopathologies may represent early markers of risk for hypomania. Further studies are required to understand the mechanisms underlying these associations, and to inform earlier detection of bipolar disorder.

Bullying: Effects on School-Aged Children, Screening Tools, and Referral Sources

Bullying is not a new concept or behavior, and is now gaining national attention as a growing public health concern. Bullying leads to short- and long-term physical and psychological damage to both the victims and the bullies. The serious implications of bullying drive a clinical mandate for teachers and school nurses to be educated and adequately trained to identify and address bullying within schools. This review of the literature describes screening tools that can be utilized to identify both victims and bullies. In addition, referral services utilizing collaborative intervention measures are discussed. This literature review will help school nurses and teachers to identify and expand their role in school-wide bullying prevention and intervention measures.

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.

Bullying Mediates Between Attention-Deficit/Hyperactivity Disorder in Childhood and Psychotic Experiences in Early Adolescence

Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.