Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists

Abstract

Aims and methodTo establish the views of child and adolescent psychiatrists (n = 52) regarding the conceptual and empirical validity, clinical utility and acceptability of the diagnosis of borderline personality disorder in child and adolescent populations. A questionnaire survey was carried out.ResultsThe child and adolescent psychiatrists' perception of the validity of borderline personality disorder for adult populations was relatively high (82% felt it to be valid). Significantly fewer of those considered borderline personality disorder to be valid for adolescent populations (37%). Strikingly different results were obtained when the questions related to child (<12 years) populations (2%).Clinical implicationsGiven the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations.

A systematic review of the neurobiological underpinnings of borderline personality disorder (BPD) in childhood and adolescence

“…Reflecting these findings, national treatment guidelines and classification systems have recently confirmed the legitimacy of the BPD diagnosis in adolescence (American Psychiatric Association, 2013;NICE, 2009;Tyrer, Crawford, & Mulder, 2011). Nevertheless, many clinicians remain reluctant to diagnose the disorder prior to age 18 (Griffiths, 2011;Laurenssen, Hutsebaut, Feenstra, Van Busschbach, & Luyten, 2013), meaning that adolescents manifesting BPD symptoms may be misdiagnosed (Paris, 2013) and opportunities for early intervention missed (Newton-Howes, Clark, & Chanen, 2015). Increasing awareness and understanding of the biological correlates of youth BPD may help to reduce clinical reluctance, and further our understanding of the aetiological mechanisms and pathological processes germane to the development of BPD (Goodman, Mascitelli, & Triebwasser, 2013).…”

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

“…As the moral philosopher David Hume (243) pointed out long ago, one cannot automatically make a normative claim solely based on facts: in moral matters, claims of what is must be severed from claims about what ought to be. Indeed, mental health professionals who work with children and adolescents often report concerns about stigma as a reason for not using PD diagnoses (20). Researchers and clinicians should always be wary of the potential harmful effects of diagnostic labeling.…”

“…Despite the remarkable scientific progress of the past two decades, skepticism, unease, and misunderstanding with regard to PD diagnoses in adolescence seem to continue among some clinicians (18)(19)(20)(21). Hence, a major goal of this special issue of the Scandinavian Journal of Child and Adolescent Psychiatry and Psychology is to increase researchers' and clinicians' awareness of the validity and importance of PD during adolescence so that it might be more readily identified and treated.…”

L’enfant borderline en devenir : pourquoi s’y intéresser?

“…Griffiths (2011) rapporte d'ailleurs que la grande majorité des psychiatres estime que ce diagnostic est inapproprié et invalide, à la fois chez les enfants et les adolescents, et qu'il pose des problèmes conceptuels et empiriques. Son utilité clinique n'est d'ailleurs pas perçue, ce qui peut expliquer le scepticisme des cliniciens envers le diagnostic de TPL (Griffiths, 2011). La réticence à poser un diagnostic de TPL aux enfants, observée dans le DSM-IV-TR (APA, 2003) et chez plusieurs cliniciens, s'explique également en partie par le fait que ce diagnostic suppose la durabilité de traits inadaptés et risque donc de provoquer des effets iatrogènes et la stigmatisation à long terme (Hinshaw & Cicchetti, 2000).…”

“…À ces résultats s'ajoutent des modèles théoriques qui tiennent compte des aspects développementaux (Freud, 1988;Kernberg, 1990;Pine, 1986) et supposent que certaines formes de cette psychopathologie peuvent apparaître dès l'enfance. Griffiths (2011) rapporte toutefois que malgré ces recherches, seuls 2 % des pédopsychiatres anglais estiment que le diagnostic de TPL est valide chez les enfants, considérant que les instruments de mesure permettant d'identifier des traits de personnalité pathologiques dès l'enfance sont peu nombreux. Le présent article a www.laurentienne.ca Enfance en difficulté Vol.…”