Abstract
BackgroundThe heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. There is an ongoing scientific debate whether the heterogeneity can best be understood in terms of qualitative (categorical) or quantitative (dimensional) differences between individuals. The present study examined the latent structure of BPD in adolescents.MethodsFive-hundred and six outpatients aged 12 to 17 years with risk-taking and/or self-harming behavior were assessed at baseline and one-year follow-up. Latent class analysis (corresponding with the categorical approach), factor analysis (corresponding with the dimensional approach), and factor mixture models (allowing for both categorical and dimensional aspects) were applied to the DSM-IV BPD criteria.ResultsThe best fitting model distinguished between a majority class with high probabilities for all BPD criteria (“borderline group”) and a minority class with high probabilities for the impulsivity and anger criteria only (“impulsive group”). Sex significantly affected latent class membership, and both a latent factor and age explained within-class variability. The borderline group primarily consisted of females, frequently reported adverse childhood experiences, scored high on the emotion dysregulation and inhibitedness personality traits, and was associated with internalizing psychopathology. In contrast, the impulsive group primarily consisted of males, scored high on the dissocial behavior personality trait, and was associated with externalizing psychopathology. After one year, the two groups showed similar clinical improvement.ConclusionsThe study provides evidence for two distinct subgroups of adolescents with BPD features that resemble the subtypes of the ICD-10 emotionally unstable personality disorder. More research is needed to further investigate the diagnostic stability of the two groups over time and potential differential treatment indications.
Highlights
Borderline personality disorder (BPD) is a severe mental disorder that is characterized by interpersonal instability, cognitive and self-disturbance, and affective and behavioral dysregulation [1]
In order to address this research gap, we investigated the latent structure of DSM borderline personality disorder (BPD) criteria by systematically comparing Latent Class Analysis (LCA), Factor Analysis (FA), and different variants of Factor Mixture Models (FMM), in a large sample of help-seeking adolescents presenting with BPD features
Five (0.9%) who did not meet the age criteria, and 20 (3.8%) with missing information on the DSM-IV BPD criteria were excluded from the current study, resulting in a total sample of N = 506
Summary
Borderline personality disorder (BPD) is a severe mental disorder that is characterized by interpersonal instability, cognitive and self-disturbance, and affective and behavioral dysregulation [1]. It usually emerges during adolescence and early adulthood, and can interfere with key developmental tasks in this period of life [2]. In the long-term, individuals with BPD show psychosocial impairments that are more severe and enduring than many other major psychiatric disorders [3,4,5]. The heterogeneous presentation of borderline personality disorder (BPD) represents a clinical challenge. The present study examined the latent structure of BPD in adolescents
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