The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence

Abstract

Although national guidelines explicitly state that personality disorder can be diagnosed and treated in young people aged 12 to 18 years (adolescents), most clinicians remain hesitant. This creates a gap between science and practice, which we argue is largely motivated by moral reasons and, therefore, is best challenged by ethical arguments. We provide seven arguments in support of the notion that it is ethically right to diagnose and treat personality disorder when it occurs in adolescents. Central to these arguments is the scientific evidence that features of personality disorder are among the best predictors of a complex cluster of psychopathology leading to impairments in many areas of current and future mental, social and vocational functioning. We argue that intervention during adolescence and young adulthood is not only humane, but also critical for efforts to avert the longstanding psychosocial and health problems that seem refractory to treatment in adults with personality disorder. Moreover, we argue that regular services are often inadequately equipped to meet the needs of young people with personality disorder and that the common ‘stepped-care’ approach should be replaced by a ‘staged-care’ approach. Finally, we argue that early detection and intervention might have anti-stigmatizing effects, similar to other areas of healthcare in which stigmatizing labels have changed meaning when the conditions to which they refer have become more amenable to treatment.

Children and adolescents at risk for seclusion and restraint in inpatient psychiatric treatment: a case control study

“…One explanation for this novelty might be recent changes in diagnostic recommendations in DSM-5 and ICD-11 [30,31] and the latest German clinical guideline following suit and recommending diagnosis from the age of 12 [32]. Until a decade ago, clinicians were reluctant to diagnose PD in adolescents [33,34]. Recently, there has been a shift towards screening for personality organization de cits in adolescents in order to avoid delayed treatment adaptations [35].…”

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial

“…Accumulating data show that early intervention for BPD is time-sensitive, indicating adolescence as a critical juncture in the development of BPD, determining its course and long-term outcomes (13).…”

The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial

“…Symptoms of BPD typically emerge in adolescence [ 10 ], and evidence consistently suggests that negative outcomes, such as educational challenges, unemployment, and increased health care utilization and costs, are already prevalent during the transition from adolescence to young adulthood in persons with BPD [ 11 , 12 ]. Accumulating data show that early intervention for BPD is time-sensitive, indicating adolescence as a critical juncture in the development of BPD, determining its course and long-term outcomes [ 13 ].…”