Ob jec tive: To es ti mate the fre quency of bor der line per son al ity dis or der (BPD) in French high school stu dents. Method: A ran dom sam ple of high school stu dents (n=1363) rang ing in age from Con clu sion: This study found a high fre quency of BPD in French ado les cents, which adds to ques tions re gard ing the va lid ity of di ag nos ing this dis or der in ado les cents.(Can J Psy chia try 2001;46:847-849) Key Words: adolescence, borderline personality disorder, frequency S ome stud ies have sug gested that bor der line per son al ity dis or der (BPD) can be di ag nosed re lia bly and have concur rent va lid ity in ado les cents (1,2). How ever, the low rate of per sis tence and the high rates of BPD comor bid ity with other per son al ity dis or ders in ado les cents may sug gest that this diag no sis lacks pre dic tive and con struct va lid ity in this age group (3-5). Ado les cents with per son al ity dis or ders are none the less at ele vated risk for ma jor men tal dis or ders dur ing early adult hood (6).The one study ex am in ing BPD preva lence in ado les cents found an over all preva lence of about 11% (7). Our study assesses its preva lence in a sam ple of high school stu dents. To our knowl edge, it is the first epi de mi ol ogi cal study of BPD in Euro pean ado les cents. Method Sam ple and Meas uresA ran dom sam ple of 1363 high school stu dents from Toulouse, France, were asked to com plete a per son al ity ques tionnaire, the Screen ing Test for Comor bid Per son al ity Dis or ders (STCPD) (8). STCPD is a 51-item self-report ques tion naire de vised to screen for bor der line, his tri onic, avoidant, and depend ent per son al ity dis or ders. The items were modi fied to reflect age-appropriate lan guage. Of the 1363 sub jects, 1202 (479 boys, 723 girls; mean age 16.6 years, SD 1.6; range 13 to 20) sat is fac to rily com pleted the ques tion naire. The sex dis tribu tion sug gested that the sam ple was not rep re sen ta tive; this al lowed us to cal cu late fre quency rates only. Stu dents were asked to con tinue in the study by par tici pat ing in in ter views with mas ter's level psy chol ogy stu dents, and 107 stu dents (34 boys, 73 girls; mean age 16.7 years, SD 1.8; range 14 to 20) vol un teered for the in ter view. We ob tained writ ten informed con sent. This subsam ple was com pa ra ble to the to tal sam ple in terms of age (t = 0.61, df 1307, ns) and sex (P² = 2.31, df 1, ns). These sub jects were as sessed us ing the Revised Di ag nos tic In ter view for Bor der lines (DIB-R) (9), the re li abil ity and va lid ity of which have been shown in ado lescents (10,11). In ter view ers were trained to ad min is ter and score the DIB-R, and the in ter views were audio taped.
Summary: Borderline personality disorder (BPD) is a frequent disorder in in- and outpatient settings. However, empirical studies suggest that BPD lacks construct validity in adolescents. Problems with validity may be linked to the fact that borderline symptoms can occur in the course of normal adolescence. This study examined the factor structure of borderline symptomatology in a community-based sample of 616 adolescents (mean age = 16.9±1.5). Borderline symptomatology was assessed by the Borderline Personality Inventory (BPI), a self-report instrument for which reliability and validity have been demonstrated. An exploratory factorial analysis, which was performed on the first half of the sample, extracted six factors. They were the dissociative/psychotic symptoms factor, the substance use factor, the interpersonal instability factor, the affectivity/identity disturbances factor, the narcissistic features factor, and the impulsivity factor. This six- factor model was tested using a confirmatory factorial analysis on the second half of the sample and on the whole sample. It provided an adequate fit with the data. This factor structure captured central components of borderline symptomatology. As it differs from the one obtained in the study of the BPI in adults, these components may be specific to adolescents and reflect developmental issues rather than psychopathology.
The goal of this study was to examine the factor structure of the Revised Diagnostic Interview for Borderlines (DIB-R; Zanarini, Gunderson, Franckenburg, & Chauncey, 1989) in a nonpatient sample of 118 adolescents. A principal components factor analysis with a Varimax rotation extracted three factors. A confirmatory factor analysis showed that this three-factor model provided an adequate fit. The first factor, which included depression, anxiety, helplessness/hopelessness, loneliness/emptiness, and also encompassed odd thinking/unusual perceptive experiences and quasi-psychotic experiences, appeared to be centered on painful feelings and dissociative defense. The second factor, labeled "impulsivity," consisted of impulse action patterns, counterdependency, and stormy relationships. This factor seemed to be centered on defensive acting-out. The third factor, called "aggressiveness," consisted of anger, hypomania, devaluation/manipulation/sadism, and demand/entitlement, and might express manic/narcissistic defenses. These analyses suggest that there may be homogeneous components of borderline symptomatology in adolescents that may reflect affective disturbances and defensive mechanisms.
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