What works for adolescents with borderline personality disorder: towards a developmentally informed understanding and structured treatment model

Abstract

The efficacy of treatment of borderline personality disorder in adolescents is an underresearched area.Although increasing research in borderline personality disorder in adolescents has emerged over the last decade there is a paucity of knowledge about how treatment is adequately designed for this group of patients. As a consequence, it is currently difficult to provide evidence-based guidelines and firm recommendations for how to design and implement borderline treatment in adolescence. In this selective review we summarize the most important research findings concerning treatment for adolescents with borderline personality disorder, including a recent mentalisation-based group treatment program. We highlight pivotal developmental obstacles for psychotherapy in adolescence and integrate these into a framework for the understanding and designing of effective treatment of borderline in adolescence.

Borderline personality disorder in adolescence: The role of narrative identity in the intrapsychic reasoning system.

“…BPD has shown to be a reliable and valid diagnosis in adolescence (Chanen, 2015) and a precursor to later social functional disability (Winograd et al, 2008). A growing number of researchers have come to focus on adolescence, with the end goal of developing earlier and more empirically supported interventions to reduce the overall severity and costs of the disorder (Bo et al, 2021; Hutsebaut et al, 2020).…”

Improving treatment outcomes for adolescents with borderline personality disorder through a socioecological approach

“…The socioecological approach seems specifically suited for adolescents due to the normative developmental challenges they encounter [ 98 ], and the fact that they are more dependent on adults and family in a range of areas compared to adults. However, the approach might also be feasible with adults, and is consistent with the Good Psychiatric Management [ 141 ] suggesting that a major focus of therapy should be “getting a life”.…”

“…Again, the MBT family therapy sessions had an explicit focus on understanding the dynamics between the two of them, and not interpreting the chaotic interpersonal situations as a result of Jennifer´s PDs alone, but rather how misunderstandings, emotional arousal and basic mistrust from both parts often caused the exhausting conflicts. The individual MBT therapy was delivered ad modum the MBT manual [ 89 ], with adaptations made specifically for the developmental challenges encountered in adolescence [ 98 ].…”

“…In fact, a recent Cochrane review on the effectiveness of psychotherapeutic treatments for BPD found that the effect of treatment was lower for people aged younger than 18 years of age compared to those above [ 7 ]. Accordingly, despite trends pointing to a small but growing variety of promising psychotherapeutic treatment programs for adolescents with BPD, the available research identifies many important gaps in our knowledge and reveals that the treatments are not as effective as we would like them to be [ 11 , 12 ]. Thus, with limited results regarding treatment of adolescents with BPD, we lack knowledge to decide how to best design a treatment approach for those young people.…”

“…Indeed, mentalizing has been suggested as a common factor for treatment in general, and of BPD treatment in particular [ 88 , 95 – 97 ], because it activates the social context in which the patient functions, not only in the therapy room but also outside of it. This feature of MBT is particularly important in adolescence, which is a developmental stage characterized by increased mistrust as young people move the source of knowledge from parents to peers [ 98 ]. Thinking about how an adolescent is making use of learning that takes place inside the therapy room when outside in the world therefore forms a key feature of the socioecological approach we propose here.…”