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Papadopoullos R, Fisher P, Leddy A, Maxwell S, Hodgekins J. Diagnosis and dilemma: Clinician experiences of the use of 'borderline personality disorder' diagnosis in children and adolescents. Personal Ment Health 2022; 16:300-308. [PMID: 35394667 PMCID: PMC9787350 DOI: 10.1002/pmh.1541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 12/30/2022]
Abstract
Borderline personality disorder (BPD) diagnosis in adolescents is a relatively recent concept and a fast-emerging research area. Regarded by some as controversial, it is important for research to provide greater understanding of differing perspectives and their impact on the use of this diagnosis. Perspectives of 13 clinicians (therapists, psychiatrists and mental health nurses) were explored, to provide a contemporary understanding of perceptions and use of BPD diagnosis within child and adolescent mental health services in England. A particular focus was to explore dilemmas faced by clinicians and how these dilemmas were negotiated. This research took a qualitative, social constructionist approach to explore the in-depth views and experiences of each participant. Interviews were analysed using thematic analysis, to seek out patterns and commonalities across these clinical perspectives. Three overarching themes were generated: 'Who holds the power?', 'Dilemmas within the multidisciplinary team (MDT)' and 'The weightiness of making this decision'. Professional opinions of an adolescent BPD diagnosis are influenced by dominant and less dominant mental health discourses, including the impact of power, and availability of resources within the service context. The role of meaningful collaboration with young people, clinical implications and directions for future research are discussed.
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Affiliation(s)
- Rose Papadopoullos
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.,The Family Psychologist, Kidderminster, UK
| | - Paul Fisher
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Adrian Leddy
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Maxwell
- Cranbrook Centre, Northgate Hospital, Great Yarmouth, UK
| | - Jo Hodgekins
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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2
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Frontal EEG asymmetry moderates the relation between borderline personality disorder features and feelings of social rejection in adolescents. Dev Psychopathol 2022; 35:876-890. [PMID: 35440357 DOI: 10.1017/s0954579422000128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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3
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Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel) 2021; 11:diagnostics11112142. [PMID: 34829488 PMCID: PMC8620075 DOI: 10.3390/diagnostics11112142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Nannini S, Tung I, Northrup JB, Stepp SD, Keenan K, Hipwell AE. Changes in severity of depression and borderline personality disorder symptoms from pregnancy to three years postpartum in adolescent mothers. J Affect Disord 2021; 294:459-463. [PMID: 34325165 PMCID: PMC8410668 DOI: 10.1016/j.jad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among women, little is known about changes in emotional distress across the early postpartum years among adolescent mothers. We tested the hypothesis that symptoms of depression and borderline personality disorder (BPD) would differ between pregnant and non-pregnant adolescents, and that these differences would be maintained in the three years following delivery. METHODS Data were drawn from the longitudinal Pittsburgh Girls Study: 307 adolescent mothers (14-18 years) and 307 never-pregnant adolescents, matched on age, race and household receipt of public assistance, self-reported severity of depression and BPD across four years. RESULTS There were no group differences on depression severity during or after pregnancy. However, compared with their non-pregnant peers, pregnant adolescents reported more severe BPD symptoms even after comorbid depression symptoms were accounted for, and this group difference was sustained during the following three years. LIMITATIONS Findings are based on a community sample rather than a clinical sample, which may have limited the severity of symptoms captured. CONCLUSIONS Findings suggest that adolescent mothers are a high-risk group for BPD symptoms during and after pregnancy, highlighting pregnancy as a critical window of opportunity to reduce morbidity among young mothers and potential negative effects on the next generation.
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Affiliation(s)
- Sierra Nannini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, Corresponding author: Alison E. Hipwell PhD, ClinPsyD. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213.
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5
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Vanwoerden S, Hofmans J, De Clercq B. Reciprocal effects between daily situational perceptions and borderline personality symptoms in young adulthood: the role of childhood parenting experiences. Psychol Med 2021; 51:2388-2398. [PMID: 32321603 DOI: 10.1017/s0033291720000987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation. METHODS N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected. RESULTS Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts. CONCLUSIONS The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.
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Herpers PCM, Neumann JEC, Staal WG. Treatment Refractory Internalizing Behaviour Across Disorders: An Aetiological Model for Severe Emotion Dysregulation in Adolescence. Child Psychiatry Hum Dev 2021; 52:515-532. [PMID: 32748274 PMCID: PMC8113221 DOI: 10.1007/s10578-020-01036-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
Auto-aggressive behaviour, especially treatment refractory suicidality in adolescents with psychiatric disorders, may be challenging to clinicians. In search of therapeutic possibilities, we have integrated current opinions regarding causality and interdependency of suicidality and auto-aggressive behaviour across disorders within the HiTOP framework. We propose a developmental model regarding these unsettling behaviours in youths that may help to guide future directions for research and interventions. We argue that the interdependent development of biologic factors, attachment, moral reasoning and emotion regulation in an overprotective environment may lead to social anxiety and later during development to emotion dysregulation and severe internalizing behaviour disorders. To optimize treatment efficacy for both internalizing and externalizing behaviour, we emphasize the importance transdiagnostic interventions, such as addressing non-compliance, restoration of trust between parents and their child, and limitation of avoidance behaviour. These may be seen as higher order interventions within the HiTOP framework.
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Affiliation(s)
- Pierre C M Herpers
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands.
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands.
| | - Josephine E C Neumann
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Geert Grooteplein 10, Nijmegen, 6525 GA, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
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Scarpato BS, Swardfager W, Eid M, Ploubidis GB, Cogo-Moreira H. Disentangling trait, occasion-specific, and accumulated situational effects of psychological distress in adulthood: evidence from the 1958 and 1970 British birth cohorts. Psychol Med 2021; 51:804-814. [PMID: 31910922 DOI: 10.1017/s0033291719003805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The trajectories of psychological distress differ between individuals, but these differences can be difficult to understand because the measures contain both consistent and situational features; however, in longitudinal studies these sources of information can be disentangled. In addition to occasion-specific features, interindividual differences can be decomposed into two sources of information: trait and carry-over effects between neighboring occasions that are not related to the trait (i.e. accumulated situational effects). METHODS To disentangle these three sources of variance throughout adulthood, the consistency (trait and accumulated situational effects) and occasion specificity of nine indicators of psychological distress from the Malaise Inventory were examined in two birth cohorts, the 1958 National Child Development Study (NCDS58), and the 1970 British Cohort Study (BCS70). RESULTS The scale was administered at ages 23, 33, 42, and 50 in NCDS58 (n = 7147), and at ages 26, 30, 34, and 42 in BCS70 (n = 6859). For each psychological symptom, more variance was consistent than occasion-specific. The majority of the consistency was due to trait variance as opposed to accumulated situational effects, indicating that an individual predisposed to be distressed at the beginning of the study remained more likely to be distressed over the whole period. Symptoms of rage were notably more consistent among males than females in both cohorts (78.1% and 81.3% variance explained by trait in NCDS58 and BCS70, respectively), and among females in the NCDS58 (69%). CONCLUSIONS Symptoms of psychological distress exhibited high stability throughout adulthood, especially among men, due mostly to interindividual trait differences.
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Affiliation(s)
- B S Scarpato
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
| | - W Swardfager
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - M Eid
- Department of Educational Science and Psychology, Freie Universität Berlin, Berlin, Germany
| | - G B Ploubidis
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
| | - H Cogo-Moreira
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil
- Centre for Longitudinal Studies, UCL Institute of Education, University College London, London, UK
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Beeney JE, Forbes EE, Hipwell AE, Nance M, Mattia A, Lawless JM, Banihashemi L, Stepp SD. Determining the key childhood and adolescent risk factors for future BPD symptoms using regularized regression: comparison to depression and conduct disorder. J Child Psychol Psychiatry 2021; 62:223-231. [PMID: 32449286 DOI: 10.1111/jcpp.13269] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Research has yielded factors considered critical to risk for borderline personality disorder (BPD). Yet, these factors overlap and are relevant to other disorders, like depression and conduct disorder (CD). Regularized regression, a machine learning approach, was developed to allow identification of the most important variables in large datasets with correlated predictors. We aimed to identify critical predictors of BPD symptoms in late adolescence (ages 16-18) and determine the specificity of factors to BPD versus disorders with putatively similar etiology. METHOD We used a prospective longitudinal dataset (n = 2,450) of adolescent girls assessed on a range of clinical, psychosocial, and demographic factors, highlighted by previous research on BPD. Predictors were grouped by developmental periods: late childhood (8-10) and early (11-13) and mid-adolescence (14-15), yielding 128 variables from 41 constructs. The same variables were used in models predicting depression and CD symptoms. RESULTS The best-fitting model for BPD symptoms included 19 predictors and explained 33.2% of the variance. Five constructs - depressive and anxiety symptoms, self-control, harsh punishment, and poor social and school functioning - accounted for most of the variance explained. BPD was differentiated from CD by greater problems with mood and anxiety in BPD and differences in parenting risk factors. Whereas the biggest parenting risk for BPD was a punitive style of parenting, CD was predicted by both punitive and disengaged styles. BPD was differentiated from MDD by greater social problems and poor behavioral control in BPD. CONCLUSIONS The best predictors of BPD symptoms in adolescence are features suggesting complex comorbidity, affective activation, and problems with self-control. Though some risk factors were non-specific (e.g., inattention), the disorders were distinguished in clinically significant ways.
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Affiliation(s)
- Joseph E Beeney
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa Nance
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexis Mattia
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Joely M Lawless
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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9
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Abstract
PURPOSE OF REVIEW We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment. RECENT FINDINGS Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.
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Bock A, Huber E, Müller S, Henkel M, Sevecke K, Schopper A, Steinmayr-Gensluckner M, Wieser E, Benecke C. [Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:400-410. [PMID: 30939974 DOI: 10.1024/1422-4917/a000656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.
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Affiliation(s)
- Astrid Bock
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Hall in Tirol, Österreich
| | - Eva Huber
- Institut für Psychologie, Universität Innsbruck, Österreich
| | - Steffen Müller
- Institut für Psychologie, Universität Kassel, Deutschland
| | - Miriam Henkel
- Institut für Psychologie, Universität Kassel, Deutschland
| | - Kathrin Sevecke
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Hall in Tirol, Österreich.,Universitätsklinik für Psychiatrie, Psychotherapie und Psychosomatik im Kindes- und Jugendalter, Medizinische Universität Innsbruck, Österreich
| | - Alexander Schopper
- Institut für Psychologie, Universität Innsbruck, Österreich.,Klinik für Kinder- und Jugendpsychiatrie und Psychosomatik, DRK-Kinderklinik Siegen , Deutschland
| | - Maria Steinmayr-Gensluckner
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Hall in Tirol, Österreich
| | - Elke Wieser
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Hall in Tirol, Österreich
| | - Cord Benecke
- Institut für Psychologie, Universität Kassel, Deutschland
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Stead VE, Boylan K, Schmidt LA. Longitudinal associations between non-suicidal self-injury and borderline personality disorder in adolescents: a literature review. Borderline Personal Disord Emot Dysregul 2019; 6:3. [PMID: 30783532 PMCID: PMC6375156 DOI: 10.1186/s40479-019-0100-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/01/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) in adolescent samples is similar to BPD in adults concerning clinical characteristics. A notable difference is that adolescents with BPD - and adolescents in general - are more likely than adults to present with acute symptoms such as non-suicidal self-injury (NSSI) and suicidal behaviours. BPD is the only disorder in the Diagnostic and Statistical Manual- 5th Edition that includes a criterion of NSSI. Additionally, NSSI is purported to be a developmental precursor of BPD under the biosocial developmental model. Though much cross-sectional data have illustrated the robust association of adolescent NSSI and BPD, no review to date has summarized the longitudinal associations between these phenomena. The aim of this literature review was to summarize what is known about the longitudinal associations between adolescent NSSI and BPD symptoms. Information on the developmental course of NSSI in relation to BPD would be helpful to clinicians, as the rate of NSSI is high in adolescent populations, and research indicates early, possibly BPD-specific interventions are imperative. METHODS A literature search was conducted using Embase, MEDLINE, and PsycINFO databases and cited reference searches. Criteria included studies of adolescents (age ≤ 18 at baseline) from either epidemiological or clinical samples, incorporating a longitudinal design, with predictors and outcomes of interest, including both NSSI and BPD diagnosis/symptoms/traits. RESULTS Six independent samples were identified that matched our search criteria.The articles were grouped and reported on separately by population type (epidemiological vs. clinical), and directionality of relations. We identified two epidemiological and four clinical samples. Five samples examined the longitudinal associations of NSSI preceding BPD, three samples measured BPD in adolescence (baseline age ≤ 18), and two of those samples measured BPD at baseline. Both epidemiological studies revealed significant longitudinal associations between NSSI and later BPD/BPD symptoms; however, they differed notably in their methodologies hindering data synthesis across studies. In the clinical studies, findings of the association or predictive relations were not consistent. This is potentially due to differing methodologies, or differences in treatment effectiveness and responsiveness across the samples. CONCLUSIONS This review highlights the paucity of data that are available examining the longitudinal association between NSSI and BPD within adolescent samples. Thus, it is not possible to reliably comment on how NSSI and BPD are related over time. Future studies will benefit from the measurement of BPD symptoms in very early adolescence, and concurrent measurement of NSSI as well as other forms of suicidal behaviours across adolescence.
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Affiliation(s)
- Victoria E Stead
- 1Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 King St West, Hamilton, ON L8S 4K1 Canada
| | - Khrista Boylan
- 2Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th, Administration - B3, Hamilton, L8N 3K7 ON Canada.,3McMaster Children's Hospital, 1200 Main St. West Hamilton, Hamilton, ON L9N 3Z5 Canada
| | - Louis A Schmidt
- 1Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 King St West, Hamilton, ON L8S 4K1 Canada
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Bozzatello P, Bellino S, Bosia M, Rocca P. Early Detection and Outcome in Borderline Personality Disorder. Front Psychiatry 2019; 10:710. [PMID: 31649564 PMCID: PMC6794381 DOI: 10.3389/fpsyt.2019.00710] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023] Open
Abstract
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.
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Affiliation(s)
| | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Bosia
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
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13
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Sharp C, Wall K. Personality pathology grows up: adolescence as a sensitive period. Curr Opin Psychol 2018; 21:111-116. [DOI: 10.1016/j.copsyc.2017.11.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 01/22/2023]
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