Abstract
BackgroundAs borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention. Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. Relational factors such as adverse childhood experiences and current relational problems can be considered important in adolescents who are at-risk for BPD. Nonsuicidal self-injury (NSSI) is a key precursor for adolescent BPD and one of the most promising targets for early detection and intervention of BPD.MethodsIn a clinical sample of 152 adolescents engaging in nonsuicidal self-injury (NSSI) disorder referred to mental healthcare in Germany, this study investigated whether we can differentiate who has BPD from 1) adverse childhood experiences; and 2) the quality of current relationships, both with parents and peers. BPD was assessed both categorically as a dichotomized score and dimensionally as a continuous score.ResultsMore adverse childhood experiences, but not low quality of current social relationships, were related to more BPD symptoms and an increased risk for meeting full criteria for BPD. In the dimensional model, current social relationship quality with parents and peers did not show a moderating (protecting or aggravating) effect on the association between adverse childhood experiences and BPD. Using a categorical approach, however, the association between childhood adversity and meeting full criteria for BPD was higher in individuals reporting higher quality of current parent-child relationship.ConclusionsThese results highlight adverse childhood experiences as risk factors of BPD, while the role of current social relationships seems more complex.
Highlights
As borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention
We still have limited data available on the developmental mechanisms associated with BPD [4], current literature focuses on the identification of risk factors and precursors that play a role in the developmental pathways or mechanisms leading to BPD, in younger populations, such as dysregulated behavior in childhood, family adversity, maladaptive mother-child interactions [6], bullying behaviour [5, 7] and childhood nightmares [8]
Most important for our research questions, adverse childhood experiences were related to more BPD symptoms (both continuous (r = .30, p < .05) and categorical (r = .27, p < .05)), whereas quality of current parent and peer relationships were not related to either operationalization of BPD
Summary
As borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. The developmental pathways can be understood by examining the dynamic interaction of normal and abnormal biological, psychological, and sociocultural factors and systems over critical developmental periods across the life course [5] This dynamic interaction can be understood as for example children demonstrating higher levels of childhood dysregulation are prone to the development of BPD symptoms when exposed to environmental risk factors, and dysregulated children seem to be more likely to be exposed to these environmental risks [9]. An indirect association between childhood dysregulation and BPD via an increased risk of bullying was found [7]
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