Diagnosing Borderline Personality Disorder During Adolescence: A Review of the Published Literature

Abstract

Borderline personality disorder (BPD) is a debilitating disorder that occurs in approximately 1% to 3% of the general population. BPD is not only relatively prevalent; it is also associated with significant public health and security concerns. The clinical and social burden of adult BPD diagnosis has resulted in the desire for early diagnosis and the implementation of early intervention programs. A qualitative review of the scientific literature suggested that adolescence is a critical point for the early identification and therapeutic treatment of BPD. Although findings are far from conclusive, the inter-rater reliability and internal consistency of the Diagnostic and Statistical Manual of Mental Disorders symptom criteria for BPD during adolescence seem adequate. Recent studies based on a rigorous methodology of BPD assessment and large community samples reported prevalence rates for BPD diagnosis during adolescence that were less suspect than previous findings. A number of research studies addressed the construct validity of BPD in adolescents (i.e., whether a BPD diagnosis during adolescence actually measures what is intending to measure) and reported consistent relationships between BPD and associated areas of dysfunction and distress as evidence of the validity of the BPD diagnosis. Research evidence indicates that there is no single symptom that is predictive of later BPD diagnosis during adolescence; rather, a pattern of two to three selected BPD symptoms that are evident during adolescence seemed to be highly predictive of later BPD diagnosis, particularly when measures that were specifically designed to assess for BPD during adolescence were used as part of the assessment process.

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

“…As we demonstrate later in this review, such ideas enshrined in the current diagnostic manuals can no longer be supported. Section III of the DSM-5 and the forthcoming ICD-11 both reflect the progress made in understanding the reliability and validity of PD diagnoses (22) in childhood and adolescence, supporting the feasibility of their use and recognizing that they are as reliable and valid in young people as they are for adults (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…Few studies have investigated PD in childhood and adolescence as a predictor of adult PD using prospective longitudinal designs. However, the available studies indicate that PD symptoms in childhood and adolescence are the strongest longterm predictors of PD diagnoses in adulthood, over and above other predictors such as disruptive behavior disorders and depression (23,25,53,55,74,78,155).…”

Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features—A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis

“…Borderline personality disorder (BPD) is a severe mental disorder characterized by a pervasive pattern of instability in affect, impulse control, interpersonal relationships and behavior [ 1 , 2 ]. BPD manifests during childhood or adolescence, and we now know that BPD can be validly diagnosed in adolescence [ 3 – 5 ]. In spite of this, many clinicians have been reluctant in diagnosing personality disorders in youth.…”

Identity Diffusion as the Organizing Principle of Borderline Personality Traits in Adolescents—A Non-clinical Study

“…Growing evidence shows that BPD is a valid, reliable, and clinically meaningful construct in adolescence ( 19 , 20 ). The importance of emphasizing and promoting the BDP diagnosis for adolescents is twofold.…”