Borderline Personality Disorder in Young People: Are We There Yet?

Abstract

Although borderline personality disorder (BPD) usually has its onset in young people, its diagnosis and treatment is often delayed. The past 2 decades have seen a rapid increase in evidence establishing that BPD can be diagnosed before 18 years of age and that BPD in young people is both continuous with BPD in adults and more notable for its similarities than for any differences. This knowledge has led to the first wave of controlled treatment trials, which have established that early intervention through appropriate BPD diagnosis and treatment leads to clinically meaningful improvements for patients. However, there is still much work to do in terms of treatment development and innovation and overcoming challenges to successful translation of evidence into practice. To advance early intervention for BPD, access to evidence-based treatments needs to improve, the variety of available treatments (including novel pharmacotherapies) needs to increase, treatments need to be matched to individual development and to the phase and stage of disorder, and workforce development strategies need to update knowledge, culture, and practice in relation to BPD in young people.

Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research

“…Consistent with knowledge on the course and development of PD, indicated prevention and early intervention programs should not just target the diagnostic features of PDs, which might naturally attenuate over time; rather, they should aim to improve adaptive functioning and alter the developmental trajectory of PD. Furthermore, it should be noted, that not all treatment that occurs for individuals who are less than 18 years old by definition is prevention or early intervention (161,169,178). For example, it is possible to see a 15-year-old child with many years of enduring personality pathology who is in need of standard treatment, and it is also possible to see a nevertreated 24-year-old adult with subsyndromal personality pathology who is in need of indicated prevention.…”

Prevention and early intervention for borderline personality disorder: a novel public health priority

“…, incomplete education with fewer qualifications and disproportionately high unemployment 4 , physical ill health 5 , greater burden of mental disorders, recurrent self-harm, and a suicide rate of around 8% 1 . The high economic costs of BPD (estimated to be e16,852 per patient per annum in the Netherlands) are attributable to high direct treatment costs and high indirect costs, chiefly workrelated disability 1 .…”

“…Although BPD usually has its onset in the period between puberty and emerging adulthood (young people) 7 , delay in the diagnosis and treatment is the norm, and discrimination against people with BPD is widespread. Specific treatment is usually only offered late in the course of the disorder, to relatively few individuals, and often in the form of inaccessible, highly specialized and expensive services 4 . Accumulating evidence indicates that such "late intervention" often reinforces functional impairment, disability and therapeutic nihilism.…”

Prescribing and borderline personality disorder

“…mood, anxiety, eating and substance use disorders) can overwhelm the clinical picture, but this does not indicate that the underlying personality pathology is unimportant or should be a secondary concern. 21 Rather, there is evidence to suggest that personality disorder might be a key vulnerability factor for recurrent mental state disorders. 22,23 Patients with borderline personality disorder who have these co-occurring conditions should be treated for these conditions in accordance with best practice.…”

“…This places them at risk of being given treatments that are ineffective or even harmful. 21 The central task for diagnosing personality disorder is to separate 'state' (transient aberrations in mental state) from 'trait' (long-standing patterns of thinking, feeling, behaving, perceiving and relating). Many mental state disorders can present with features that are similar to borderline personality disorder.…”