ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

Abstract

Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.

Borderline personality disorder in children and adolescents: discriminant validity in relation to major depressive disorder

“…Recent studies have documented similar estimates of reliability and validity of BPD in both adolescent-and adult-aged samples [8,19].…”

“…Pharmacotherapy is not currently recommended by several expert reviews as a primary treatment for BPD in youth [8,129,130]. This is because there are no controlled studies on the use of medication in youth with BPD or BPD symptoms.…”

“…In contrast, there is strong reluctance to diagnose BPD in youth, much of which is due to stigma associated with the diagnosis [8], and the relatively recent changes to The Diagnostic and Statistical Manual of Mental Disorders (DSM) permitting the diagnosis of personality disorders prior to age 18 [9]. Adding to their reluctance is the common problem facing clinicians concerning the high rate of comorbidity between depressed mood or a major depressive episode and BPD.…”

Epidemiologie psychischer Störungen bei Kindern und Jugendlichen

“…Die falsche Annahme eines lebenslangen "Schicksals" mit nur sehr eingeschränkten Therapieoptionen hat lange zu einer Angst vor Stigmatisierung und damit leider auch zu therapeutischem Nihilismus geführt. Zahlreiche Übersichtsarbeiten und Stellungnahmen von Fachgesellschaften geben mittlerweile Richtlinien zu Diagnostik und Therapie jugendlicher BPS und betonen die Sinnhaftigkeit von möglichst frü-her Intervention [19][20][21][22], im 2013 erschienenen DSM-5 wurde die Altersbeschränkung für Persönlichkeits-störungen aufgehoben [23]. BPS sind mit einer Präva-lenz von etwa 1 % in der jugendlichen Allgemeinbevölkerung zwar eine verhältnismäßig seltene Störung, allerdings erhalten bis zu 10 % aller ambulanten und bis zu 50 % aller stationären Patienten in kinder-und jugendpsychiatrischen Settings diese Diagnose [19].…”

Need for a more developmental perspective: QTc prolongation under psychotropic medication

“…In this context, the definition and weighting of the (above mentioned) cardiovascular risk factors and the resulting effective individual risk for a cardiovascular adverse event are discussed controversially. Some admonitory authors call for a more detailed consideration of the risk of the There are several areas of child and adolescent psychiatry for which the quality and quantity of evidence are substantially lower than for psychiatric care of adults [1][2][3][4]. In this context, one of the most frequently asked questions is about the existence of appropriate and well-regulated pediatric psychopharmacological research to generate evidence as a basis for clinical recommendations [5].…”