Abstract
ObjectiveBorderline personality disorder in adolescence remains a controversial construct. We addressed concerns about the prognostic significance of adolescent borderline pathology by testing whether borderline symptoms at age 12 years predict functioning during the transition to adulthood, at age 18 years, in areas critical to life-course development.MethodWe studied members of the Environmental Risk (E-Risk) Longitudinal Twin Study, which tracks the development of a birth cohort of 2,232 British twin children. At age 12, study members' borderline symptoms were measured using mothers’ reports. At age 18, study members’ personality, psychopathology, functional outcomes, and experiences of victimization were measured using self-reports, coinformant reports, and official records.ResultsAt age 18, study members who had more borderline symptoms at age 12 were more likely to have difficult personalities, to struggle with poor mental health, to experience poor functional outcomes, and to have become victims of violence. Reports of poor outcomes were corroborated by coinformants and official records. Borderline symptoms in study members at 12 years old predicted poor outcomes over and above other behavioral and emotional problems during adolescence. Twin analyses showed that borderline symptoms in 12-year-olds were influenced by familial risk, particularly genetic risk, which accounted for associations with most poor outcomes at age 18.ConclusionBorderline symptoms in 12-year-olds signal risk for pervasive poor functioning during the transition to adulthood. This association is driven by genetic influences, suggesting that borderline symptoms and poor outcomes are manifestations of shared genetic risk.
Highlights
We described predictors and correlates of borderline symptoms measured in 12-year-old study members of the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative birth cohort of twins born in the United Kingdom.[12]
Difficulties were evident in numerous areas; observed by multiple informants; and assessed through multiple www.jaacap.org methods, including official records
These findings show that adolescent borderline symptoms observed as early as at age 12 forecast meaningful individual differences in young people’s lives
Summary
Borderline personality disorder in adolescence remains a controversial construct. We addressed concerns about the prognostic significance of adolescent borderline pathology by testing whether borderline symptoms at age 12 years predict functioning during the transition to adulthood, at age 18 years, in areas critical to life-course development. At age 18, we assessed study members’ performance on a wide range of outcomes in areas critical to positive life-course development: personality functioning, mental health, functional outcomes, and experiences of victimization Using these data, we tested the hypothesis that adolescent borderline symptoms predict poor outcomes during the transition to adulthood. We tested the role of familial risk because adolescent borderline behaviors are strongly influenced by risk factors originating in families, both environmental and genetic.[12,13] Familial risk factors implicated in adolescent borderline symptoms, such as harsh parenting, maltreatment, and genetic susceptibility, predict psychosocial adjustment in young adulthood.[13,14] These findings raise the possibility that poor outcomes are not due to adolescent borderline symptoms themselves, but that symptoms index familial risk for poor outcomes We tested this hypothesis by comparing www.jaacap.org outcomes at age 18 within genetically identical twin pairs growing up in the same family who differed in adolescent borderline symptoms when assessed at age 12. Because these twins share all of their family-wide environment and genes, these analyses effectively control for familial risk factors shared between members of a family
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