Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists

Mark Griffiths

doi:10.1192/pb.bp.109.028779

Abstract

Aims and methodTo establish the views of child and adolescent psychiatrists (n= 52) regarding the conceptual and empirical validity, clinical utility and acceptability of the diagnosis of borderline personality disorder in child and adolescent populations. A questionnaire survey was carried out.ResultsThe child and adolescent psychiatrists' perception of the validity of borderline personality disorder for adult populations was relatively high (82% felt it to be valid). Significantly fewer of those considered borderline personality disorder to be valid for adolescent populations (37%). Strikingly different results were obtained when the questions related to child (<12 years) populations (2%).Clinical implicationsGiven the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations.

Highlights

Clinical implications Given the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations
Fewer respondents considered borderline personality disorder to be valid for adolescent populations (37%)
The profiles of responses to the questions and the additional comments suggest that consultant child and adolescent psychiatrists in the UK view the category of borderline personality disorder as conceptually problematic, empirically insufficiently supported, lacking in clinical utility, and tending towards being perceived as unacceptable for individuals and their families

Summary

Results

The referral population ethnic profile does not match the wider population of the borough; a third of the borough is Bangladeshi, but only 9% of those referred to the service are. Of those diagnosed with borderline personality disorder and on psychotropic medications, only one person had a clear current indication based on NICE guidelines. Clinical implications The under-representation of Black and minority ethnic individuals in referrals in the peresonality disorder service needs to be actively addressed. The National Institute for Health and Clinical Excellence (NICE) guidance on borderline personality disorder has wide implications for psychiatric services.[1] Key priorities outlined in this document include access to service, autonomy and choice, developing an optimistic and trusting relationship, and managing endings and transitions.

Method

Discussion