Abstract
Chart review is a low-cost, but highly informative, method to describe symptoms, treatment, and risk factors associated with borderline personality disorder (BPD) and to adapt screening and intervention to clinical reality. Previous chart review studies report more aggressiveness/anger and psychotic features in youths with BPD. They show that adverse family environment and parental psychopathology constitute important factors for BPD pathology. To examine clinical characteristics of depressed BPD adolescents (12-17 years old) outpatients according to gender and to explore variables which are associated with BPD traits. A retrospective chart review using the child and adolescent version of the retrospective diagnostic instrument for borderlines was conducted on 30 depressed adolescents with BPD traits and 28 depressed patients without BPD traits. Participants who reached the retrospective diagnostic instrument for borderlines threshold for BPD were included in the BPD traits group. Comparison analyses were performed using Pearson's Chi-square test. Associated factors were determined using regression analyses. BPD traits participants were characterized by higher family problems (parental psychopathology, parent disagreement/argument, and parent-child relational problem), more aggressive symptoms, and higher rates of family intervention and hospitalization. A number of familial factors (parental history of delinquency, substance use, personality disorders, having siblings, or parental disagreement/argument in boys) were associated with BPD traits. Attention seeking and problematic functioning (does not adapt well to group activities) were also associated with BPD traits. Our study stresses the need to assess BPD traits in adolescent psychiatric evaluation, especially in the presence of aggressive behaviors, family problems and attention seeking. Our results also highlight the importance of exploring family characteristics intervention in adolescents with BPD traits.
Highlights
Considering its high association with suicidal behaviors and its alarming prevalence in the general adolescent population (15–20%), it is surprising to find few descriptive studies on depressive disorders (DD) in clinical youth population [1]
Data were obtained through a retrospective chart review, which is a validated cost-effective means to obtain relevant sociodemographic and clinical information on children and adolescents treated in psychiatry [21]
Using the C-diagnostic interview for borderlines (DIB), we determined that half of the depressed adolescents had many borderline personality disorder (BPD) traits, which strongly suggest the presence of this diagnosis
Summary
Considering its high association with suicidal behaviors and its alarming prevalence in the general adolescent population (15–20%), it is surprising to find few descriptive studies on depressive disorders (DD) in clinical youth population [1]. Major DD is the main contributor for suicide whereas borderline personality disorder (BPD) is the greatest source of suicidal behaviors in adolescents. Studies on children and adolescents with BPD are still rare since many psychiatrists are reluctant to diagnose this disorder in youths, despite growing consensus on the construct [6, 7]. Clinical and structured interviews and self-reported questionnaires can reliably identify adolescents with BPD symptomatology deviating strongly from typical adolescence [11,12,13,14]. Diagnosis nowadays is encouraged [19] and some countries, like Australia, have issued practice guidelines to promote diagnostic and therapeutic services dedicated to youths with BPD symptomatology [20]
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