Trouble de personnalité limite à l’adolescence : quelle réalité clinique ?

Abstract

AimsTo better describe the population of adolescents diagnosed with “borderline personality disorder”, by identifying some distinct clinical profiles based on their psychopathology. Material and methodsThis retrospective study included both adolescents hospitalized between January 2013 and December 2014 in the adolescent inpatient psychiatry service of the University Hospital of Tours, and adolescents followed up between January 2014 and December 2014 in the adolescent outpatient psychiatry service of Chinon. After identification of the patients diagnosed with “borderline personality disorder” (screening using ICD-10 diagnoses codes and confirmation or invalidation of the diagnosis by the clinician in charge of the patient), we assessed for each of these patients their sociodemographic characteristics, their psychopathological characteristics, and the other psychiatric comorbidities (comorbid ICD-10 diagnoses). We identified different clusters of patients using ascending hierarchical classification, and compared them using univariate statistics. ResultsAmong the 823 eligible adolescents, 14.2% (n=117) had a borderline personality disorder, including two third of female (n=79) and one third of male (n=38), with a mean age of 15.5 years. Prevalence for borderline personality disorder was 9.0% for outpatients and 19.4% for inpatients. Cluster analysis identified three distinct groups of patients. The first group (called confirmed borderline personality disorder; 17.1%) included patients with higher symptom severity, intrapsychic symptoms and social isolation. The second group (called borderline crisis at adolescence; 35%) included patients that had lower symptom severity, and lower impulsivity. The third group (called expressive borderline disorder; 47.9%) included patients that were more oftenly female, and that had higher prevalence for behavioural manifestations but lower alexithymia and better social adjustment. ConclusionWe identified three distinct clinical profiles in patients diagnosed with a borderline personality disorder: confirmed borderline personality disorder, borderline crisis at adolescence and expressive borderline disorder.