Self-reported patterns of impairments in mentalization, attachment, and psychopathology among clinically referred adolescents with and without borderline personality pathology

Sune Bo,Mickey Kongerslev

doi:10.1186/s40479-017-0055-7

Abstract

BackgroundPrevious research, which primarily focused on adult samples, suggests that individuals with borderline personality disorder (BPD) display high levels of psychopathology, dysfunctional mentalization and problematic attachment to others. The current study investigated whether impairments in mentalization, attachment, and psychopathology are more severe in outpatient adolescents with BPD than in a clinical comparison group.MethodsConsecutive referrals to a child and adolescent psychiatric clinic were clinically assessed with a battery of self-report instruments to assess mentalization, attachment, and psychopathology. Specifically, in regard to BPD a self-report questionnaire was employed to decide if patients were classified into the BPD or the clinical comparison group. The main outcome variables of adolescents with a primary diagnosis of BPD were then compared with those of a clinical comparison group comprising patients receiving psychiatric diagnoses other than BPD.ResultsRelative to the clinical group without BPD, and after controlling for sociodemographic variables, the BPD group displayed poorer mentalizing abilities, more problematic attachments to parents and peers, and higher self-reported levels of psychopathology.ConclusionsThe results of this study suggest that BPD is a severe mental condition in adolescents and is characterized by poor mentalizing abilities, attachment problems and high levels of psychopathology compared to adolescents with psychiatric disorders other than BPD. Hence, clinicians should consider BPD when conducting diagnostic assessments, and evidence-based treatments for this vulnerable group should be developed.

Highlights

Previous research, which primarily focused on adult samples, suggests that individuals with borderline personality disorder (BPD) display high levels of psychopathology, dysfunctional mentalization and problematic attachment to others
The bivariate correlations indicate that more borderline pathology is correlated with increased dysfunctional mentalization, problematic attachment relations to both parents and peers, and psychopathology, including depression and self-harm
Clinical differences between the BPD and clinical comparison groups multivariate analysis of covariance (MANCOVA) was used to test for differences between the BPD and clinical comparison groups in attachment, mentalization, borderline features, externalizing and internalizing pathologies, depression, impulsivity and selfharm while controlling for age, gender, educational level, and living status

Summary

Introduction

Previous research, which primarily focused on adult samples, suggests that individuals with borderline personality disorder (BPD) display high levels of psychopathology, dysfunctional mentalization and problematic attachment to others. Personality disorders (PDs) in general and borderline personality disorder (BPD) in particular are related to significant impairments in general functioning when compared to subjects without PD diagnoses and those with other mental disorders [1]. Many clinicians and researchers did not acknowledge the existence of personality pathologies in adolescents [16,17,18] They did so despite the fact that, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and its predecessors, PD diagnoses may be applied to adolescents when the individual’s particular maladaptive personality traits appear to be pervasive and persistent, are unlikely to be limited to a particular developmental state or to another mental disorder, and are present for 1 year or more [19]

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