Adolescent Borderline Personality Disorder Research Articles

Divergent mentalization types in adolescent borderline personality disorder and attention deficit/hyperactivity disorder

Background Attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents. We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD + BPD in an inpatient sample to determine the effect of co-morbidity on mentalization abilities. Methods We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD + BPD groups in terms of their mentalization abilities. Results Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups. Limitations We included only inpatient sample without considering their medication condition, we did not compare the mentalization scores of the patient groups with healthy controls and we used self-report measures for several assessments. Conclusion Mentalization patterns in ADHD and BPD are distinct. ADHD may be related to hypomentalization, instead, BPD may be related to hypermentalization.

A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial.

The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group. One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n = 64) and older (aged 18 to 25 years; n = 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression. Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age. Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.

Childhood maltreatment, personality vulnerability profiles, and borderline personality disorder symptoms in adolescents.

Adverse childhood experiences are significant risk factors in the development of adolescent borderline personality disorder symptoms (BPDs). Theorists have posited that two personality vulnerabilities factors, self-criticism and dependency, may inform our understanding of this relationship. However, no research has examined the associations between early negative experiences, personality vulnerabilities, and adolescent BPDs. The current study aimed to identify profiles of dependency and self-criticism to examine the associations of these profiles with cumulative forms of childhood maltreatment (CM) and BPDs as well as to explore the mediating and moderating role of vulnerable personality profiles in the relationship between cumulative CM and BPDs. Two hundred and forty-one nonclinical and clinical adolescents participated in the study (Mage = 16.37, SD = 1.84). The findings indicated three different profiles: average dependent profile, dependent and self-critical profile, and self-critical profile. Individuals in the average dependent profile presented lower levels of CM and BPDs. Mediation analyses showed that relative to the average dependent profile, a higher cumulative CM history predicted a higher probability of belonging in the dependent and self-critical profile or the self-critical profile and, in turn, this was associated with higher levels of BPDs. No moderating effects of profiles of dependency and self-criticism were found.

Testing the Link Between Mothers' General Reflective Function Capacity and Adolescent Borderline Personality Features: Perceived Parenting Behaviors as a Potential Mechanism.

Impairments in mothers' reflective function (RF), the ability to imagine the mental states of the self and others, underlies maladaptive parenting strategies, which have been associated with borderline personality disorder (BPD). The current study evaluated the association between mother's RF and adolescents' BPD and the mediating role of a range of parenting behaviors. Five hundred and thirty-one inpatient adolescents and their mothers participated in the current study. A multimethod assessment of BPD was used alongside mothers' self-reported quality of RF. Children completed three questionnaires about maternal parenting behaviors. There was no direct relation between mother's RF capacity and adolescents' BPD. However, mothers' adaptive certainty about mental states related to less severe BPD in adolescents, specifically through decreases in inconsistent punishment. Mothers' RF capacity predicted various parenting behaviors, which was associated with adolescents' BPD severity. Implications of findings for early intervention and prevention are discussed.

Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features-A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis.

To review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features. We included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summarized as mean difference (MD) with 95% confidence intervals (CI) for continuous data and as Odds ratios (OR) with 95% CI for dichotomous data. Risk of bias was assessed using Cochrane's risk of bias tool for each domain. When possible, we pooled trials into meta-analyses, and used Trial Sequential Analysis (TSA) to control for random errors. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). 10 trials on adolescents with BPD or BPD features were included. All trials were considered at high risk of bias, and the quality of the evidence was rated as "very low". We did TSA on the primary outcome and found that the required information size was reached. The risk of random error was thus discarded. Only 10 trials have been conducted on adolescents with BPD or BPD features. Of these only few showed superior outcomes of the experimental intervention compared to the control intervention. No adverse effects of the interventions were mentioned. Attrition rates varied from 15-75% in experimental interventions. The overall quality was very low due to high risk of bias, imprecision and inconsistency, which limits the confidence in effect estimates. Due to the high risk of bias, high attrition rates and underpowered studies in this area, it is difficult to derive any conclusions on the efficacy of psychological therapies for BPD in adolescence. There is a need for more high quality trials with larger samples to identify effective psychological therapies for this specific age group with BPD or BPD features.

The Course of Borderline Psychopathology in Adolescents with Complex Mental Health Problems: An 18 Month Longitudinal Follow-up Study.

A persistent and significant barrier to the diagnosis and treatment of borderline personality disorder (BPD) in adolescents is clinician reluctance to label an adolescent with a stigmatized, intractable, treatment-resistant diagnosis. The goal of the current study was to evaluate this claim by examining the 18-month longitudinal course of borderline pathology in adolescents after discharge from inpatient treatment. 556 adolescent consecutive admissions (64.6% female; ages 12-17, M = 15.29, SD = 1.46) were assessed during admission to an inpatient treatment facility. They were followed up at discharge, 6months, 12months and 18months after discharge with validated self-and parent report measures of adolescent BPD features. Latent growth modeling was used to evaluate outcomes. BPD features showed a significant decline over the follow-up period with very large effect sizes (> .80) for both parent and adolescent self-report. Rates of change were steeper for adolescent report although adolescent report fell below clinical cut-off 6months later than parent-report. However, when internalizing and externalizing psychopathology were included in latent growth models, youth-reported BPD features did not show the same level of decline, while parent-reported BPD features maintained the same level of decline. The rate of decline between parents and adolescents was correlated, and baseline levels of BPD features were predictive of rate of change. This is the first study to show that adolescent borderline pathology follows a similar course after discharge from inpatient treatment previously demonstrated for adults. Like adult BPD, adolescent BPD appears to be not as intractable and treatment resistant as previously thought, mitigating against therapeutic nihilism.

Interactive Effects of Parent Emotion Socialization and Child Physiological Reactivity in Predicting Adolescent Borderline Personality Disorder Features.

Theories suggest that a transaction between child biological vulnerability and parent emotion socialization underlies the development of borderline personality disorder (BPD) features. Yet, few studies have examined the interaction between these factors prospectively in at-risk samples. Consequently, this study tested whether parental reactions to children's negative emotions moderated the effect of the child's physiological reactivity to stress in predicting adolescent BPD features in a sample of youth with and without clinical elevations in attention deficit/hyperactivity disorder (ADHD). Participants were 61 children (52% female) and parents (90% mothers). When children were 9-13years old, their physiological reactivity to a social stressor was assessed based on respiratory sinus arrhythmia (RSA) and skin conductance level (SCL) reactivity; parents also reported on their supportive and non-supportive reactions to their child's negative emotions. Children were followed-up four to five years later at ages 14-18years old and their BPD features were assessed based on parent and adolescent report. Significant interactions between children's SCL reactivity and parental reactions to children's negative emotions were found in predicting adolescent BPD features. Children with low SCL reactivity to social stress and parents high in supportive/low in non-supportive reactions were lowest in adolescent BPD features. However, greater SCL reactivity predicted greater adolescent BPD features specifically when the parent was high in support or low in non-support. Childhood ADHD symptoms also significantly predicted greater adolescent BPD features. Findings suggest that children with different patterns of SCL reactivity may respond differently to parental reactions to their emotions.

Exploring mentalizing in adolescents with anorexia nervosa and borderline personality disorder: A comparative study of psychiatric inpatients and healthy controls.

Background:Impaired mentalizing, i.e., difficulties in understanding oneself and others in terms of mental states, has been associated with the development of Anorexia Nervosa (AN), mainly among adults. However, few studies have addressed this question in clinical samples of adolescents with AN. Moreover, no study has explored mentalizing abilities among inpatient adolescents presenting with AN and Borderline Personality Disorder (BPD), despite their high comorbidity in a highly relevant age group.Objective:This study attempted, for the first time, to further examine differences in mentalizing abilities and to identify specific mentalizing impairments in different psychiatric inpatient groups and healthy adolescents.Methods:Using samples of female adolescents aged 12–17, comparison analyses were performed between psychiatric inpatient adolescents with AN (n = 44), BPD (n = 101), AN+BPD (n = 48), other psychopathology (n = 163) and healthy adolescents (n = 129). Structured and semi-structured clinical interviews, and two experimental tasks were administered to assess AN, BPD and mentalizing, respectively.Results:Comparison analyses showed that patients with BPD and other psychiatric disorders evidenced higher levels of hypermentalizing compared to healthy adolescents. Hypermentalizing was also reported among inpatients with AN+BPD, although to a lesser extent. BPD and AN scores were positively correlated with hypermentalizing responses.Conclusions:Our results suggest that hypermentalizing is a specific mentalization impairment in inpatient adolescents, particularly with BPD and both AN+BPD. Further investigation into the efficacy of mentalization based treatments for adolescents with BPD and AN+BPD is recommended. Prospective studies are needed to assess mentalizing using experimental tasks among adolescents with AN, taking into account the potential influence of temporality and severity of the disorders’ symptoms.

The relation between measures of explicit shame and borderline personality features in adolescent inpatients

BackgroundShame is a highly negative emotion frequently experienced by individuals with borderline personality disorder (BPD) as well as those with internalizing or externalizing psychopathology. However, few studies have examined whether shame is related to BPD above and beyond other psychopathology. Further, although feelings of shame peak during adolescence, coinciding with the onset of BPD, very few studies have examined the relationship between shame and BPD in adolescence. Therefore, the current study examined (1) whether levels of shame differ between adolescent psychiatric inpatients with and without BPD and (2) whether borderline personality pathology accounts for additional variance in the experience of shame above and beyond internalizing and externalizing psychopathology. MethodsAdolescent psychiatric inpatients (n = 184, 67% female, M age = 15.26) completed clinical interviews and self-report measures as well as self-report measures of three types of explicit shame: state-shame, shame-proneness, and trait-shame. ResultsT-tests revealed that adolescents with BPD reported significantly higher levels of each type of explicit shame. In hierarchical regression models, borderline personality features explained significant additional variance in shame-proneness and trait-shame while controlling for age, gender, and internalizing and externalizing psychopathology. LimitationsOur sample was limited by a lack of demographic diversity and healthy control group, and the study did not examine relations with unique internalizing/externalizing disorders or features of BPD. ConclusionsOur findings contribute to growing evidence that shame is an important component of BPD, particularly during adolescence, and suggest that shame should be addressed in treatment.

Affective and Behavioral Characteristics of Adolescent and Adult Borderline Personality Disorder.

Adults with borderline personality disorder (BPD) report greater affective lability, impulsivity, and aggression compared to same-age peers, but no studies have examined whether these findings are replicable among adolescents with BPD and their peers, or whether adolescents and adults with BPD report symptoms of comparable severity. One hundred and one adolescent (age 13-17) BPD inpatients and 60 age-matched, psychiatrically healthy adolescents completed self-report measures for affective lability, impulsivity, and aggression. Comparison samples included 29 and 41 adult outpatients with BPD and 127 community adults with BPD. Adolescents with BPD reported greater severity of all symptoms except nonplanning impulsiveness compared to peers. They reported similar symptom severity to adults but reported less severe verbal aggression and anger. Adolescents with BPD are distinguishable from typically developing adolescents on self-reported, dimensional affective and behavioral symptom measures, and may experience these symptoms at comparable severity to adult counterparts.

Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach.

In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, Mage = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.

Preschool Age Predictors of Adolescent Borderline Personality Symptoms

Developmental models of borderline personality disorder (BPD) have highlighted the interplay of psychological variables (ie, impulsivity and emotional reactivity) with social risk factors, including invalidating parenting and childhood trauma. Prospective longitudinal studies have demonstrated the association of BPD with social, familial, and psychological antecedents. However, to date, few of these studies have studied the interaction of multiple risk domains and their potential manifestations in the preschool period. Participants were 170 children enrolled in a prospective longitudinal study of early childhood depression. Participants completed a baseline assessment between ages 3 and 6 years. Psychopathology, suicidality, and self-harm were assessed using a semistructured age-appropriate psychiatric interview before age 8 and self-report after age 8. BPD symptoms were assessed between ages 14 and 19 by self-report. Adverse childhood experiences (ACEs) and peer relationships were reported by parents. Maternal support was assessed using an observational measure between ages 3 and6. Preschool ACEs accounted for 14.9% of adolescent BPD symptom variance in a regression analysis. Controlling for gender and preschool ACEs, preschool and school-age externalizing symptoms, preschool internalizing symptoms, and low maternal support were significant predictors of BPD symptoms in multivariate analyses. Preschool and school-age suicidality composite scores significantly predicted BPD symptoms. These findings suggest that preschool factors may be early predictors of BPD symptoms. Findings demonstrate that preschoolers with internalizing and externalizing psychopathology, high ACEs, and early suicidality are at greater risk of developing BPD symptoms. However, further research is needed to guide key factors for targeted early intervention.

Developmental Trajectories of Adolescent Girls' Borderline Personality Symptoms and Sexual Risk Behaviors.

Adolescence is a developmental period during which youth tend to initiate sexual behavior, which may include sexual risk behavior. Symptoms of borderline personality disorder (BPD) are associated with increased rates of risky behaviors. However, little is known about longitudinal associations between BPD symptoms and sexual risk behaviors during adolescence. This study examines developmental trajectories of adolescent girls' BPD symptoms and sexual risk behaviors in a community sample of Black and White girls from the Pittsburgh Girls Study (n = 1620). Dual trajectory modeling provided insights into the temporal precedence and co-development of BPD symptoms and sexual risk behaviors from ages 14 to 18. In order to examine the unique association between BPD symptoms and sexual risk behaviors, analyses controlled for symptoms of depression and conduct disorder, as well as race, sexual orientation, and pubertal development. Girls with more BPD symptoms at age 14 showed steeper growth over time in sexual risk behaviors from ages 14 to 18. Additionally, adolescents who showed steeper increases in BPD symptoms over time also showed steeper increases in sexual risk behaviors across adolescence. Notably, however, sexual risk behavior at age 14 was not significantly associated with longitudinal trajectories of BPD symptoms. Results suggest that adolescent girls with early symptoms of BPD are at heightened risk for the development of sexual risk behaviors during adolescence, while the reverse association does not hold. Implications for adolescent development and sexual risk behavior are discussed.

Dropout from mentalization-based group treatment for adolescents with borderline personality features: A qualitative study

Objective: Premature termination, or dropout, is a major concern in psychotherapy in general and an issue of particular importance in treatments for borderline personality disorder (BPD). Yet few studies investigating dropout from therapy in adolescent BPD populations exist. This study investigates reasons for dropping out from group-based mentalization-based treatment (MBT-G) for BPD or borderline features in an adolescent population. Method: Ten semi-structured interviews were performed with female adolescents who had dropped out from group-based MBT for BPD. The data were analyzed qualitatively using Systematic Text Condensation. Results: The results point to the existence of a subgroup of adolescent BPD patients who do not perceive the treatment sufficiently helpful or worthwhile, who experienced treatment as emotionally demanding, time-consuming and connected with unpleasant experiences. Positive reasons for early termination were reported in the form of experienced improvement in condition. Dropping out became understood as a process of weighing perceived benefits against perceived costs of staying in treatment. This understanding of dropout as a process implies the existence of a window of time where intervention to prevent dropout is possible, presupposing the detection of at-risk patients.

Links between sleep problems in early childhood and borderline personality disorder/psychosis in adolescence

Some behavioral sleep problems in childhood are associated with onset of psychosis and borderline personality disorder (BPD) in early adolescence, researchers have found. In addition, the association with psychosis may be mediated by depression at 10 years of age. The study, published in JAMA Psychiatry, used the Avon Longitudinal Study of Parents and Children birth cohort and included 13,488 participants who were born in 1991–92 and focused on parent‐reported nighttime sleep duration, night awakening frequency, bedtime, and regulatory of sleep routines in children assessed at 6 months, 18 months, and 30 months of age, and at 3.5, 4.8, and 5.8 years of age. While it is known that persistent childhood nightmares are associated with psychosis and BPD in adolescence, little was known about the association with general behavioral sleep problems, as well as the potential mechanisms.

Früherkennung und -behandlung der Borderline-Persönlichkeitsstörung

Early detection of and intervention for borderline personal-ity disorderBorderline personality disorder is a severe mental disorderthat typically appears in adolescence and early adulthood,and interferes with important developmental tasks in thisphase of life. If left untreated, it can lead to much sufferingand persistent psychosocial impairment for those affected,distress for family members and significant economiccosts. Contrary to continuing scepticism, the researchfindings of the last 20 years show that borderline per-sonality disorder is a valid and reliable diagnosis in ado-lescence. In addition, the findings of the first randomisedcontrolled trials on the psychotherapeutic treatment ofadolescents with subsyndromal or syndromal borderlinepersonality disorder indicate that clinically relevant im-provements can be achieved. In the present study, the ra-tionale and evidence for early detection of and interventionfor borderline personality disorder in adolescence is pre-sented and compared with the current reality of care.

Association of Parent-Reported Sleep Problems in Early Childhood With Psychotic and Borderline Personality Disorder Symptoms in Adolescence

Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. However, the extent to which this association is also true for behavioral sleep problems is still unknown, and the potential mechanisms are unexplored. To examine the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age. This cohort study assessed 13 488 participants in the Avon Longitudinal Study of Parents and Children birth cohort who were followed up for more than 13 years. Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. Data analysis was conducted from May 1 to December 31, 2019. Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age. Data were available on 7155 participants (3718 girls [52%]) who reported on BPD symptoms and 6333 (3280 boys [52%]) who reported on BPD symptoms. Higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53) of age were significantly associated with psychotic experiences in adolescence, whereas shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated with BPD symptoms. Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association. Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age (bias-corrected estimate, -0.005; 95% CI, -0.008 to -0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate, -0.006; 95% CI, -0.010 to -0.003; P = .003) with psychosis. The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized interventions in psychosis and BPD.

Reciprocal Influences of Parent and Adolescent Borderline Personality Symptoms Over 3 Years.

Leading etiological theories implicate the family environment in shaping borderline personality disorder (BPD). Although a substantive literature explores familial aggregation of this condition, most studies focus on parent influence(s) on offspring symptoms without examining youth symptom influence on the parent. The current study investigated reciprocal relations between parent and adolescent BPD symptoms over time. Participants were 498 dyads composed of urban-living girls and their parents enrolled in a longitudinal cohort study (Pittsburgh Girls Study). The authors examined BPD severity scores assessed yearly when youth were ages 15-17 years in a series of cross-lagged panel models. After controlling for autoregressive effects, a measure of parent-child conflict, and an indicator of socioeconomic status, evidence of parental influence on adolescent symptoms did not emerge. However, adolescent BPD symptoms at age 16 predicted greater parent BPD symptoms at age 17 above the influence of depression. Results highlight the importance of considering the influence of youth BPD on parental symptoms.

Examining the predictive association of irritability with borderline personality disorder in a clinical sample of female adolescents.

Borderline personality disorder (BPD) is a disorder associated with emotion dysregulation and is common in clinical samples of adolescents. The identification and delineation of BPD from other disorders is important, yet methods for effectively screening for BPD are lacking. Here, we examine whether irritability can be used as a screening item for BPD in adolescents at risk for the disorder. We assessed Diagnostic Interview for Borderline-Revised and Development of Well-Being Assessment scores in a clinical sample of female adolescents ages 12-17 (n=78) to identify BPD and group cases into 'irritable' and 'non-irritable' mood types, respectively. We then examined the prevalence of irritability and its predictive association with BPD. The prevalence of BPD was 26% (n=20). There was a significant association between irritable mood and BPD, specifically (χ2 (1)=17.740, p<0.001). Irritability was endorsed in all (n=20) BPD cases (sensitivity: 100%), while in non-BPD cases (n=58), irritability was endorsed in 27 (specificity: 53%; positive predictive value: 0.33; and negative predictive value: 1.0). Irritability is a highly sensitive screening item for BPD in adolescents. The absence of irritability in an adolescent may be an important clinical tool to rule out BPD. © 2020 John Wiley & Sons, Ltd.

Emotion dysregulation and resting-state autonomic function in adolescent borderline personality disorder-A multimodal assessment approach.

Borderline personality disorder (BPD) is characterized by persistent emotion dysregulation (ED), and ED is one of the core features of BPD. In recent years, research aimed to identify distinct patterns of ED characteristic of patients with BPD. These efforts comprised translational approaches, including psychophysiological measures. Autonomic nervous system (ANS) dysfunction, indexed by reduced resting-state heart rate variability (HRV), is suggested to be a psychophysiological marker of ED. Reduced HRV is seen in patients with a variety of psychiatric disorders, including adolescents with depression and BPD. No previous study, to the best of our knowledge, addressed the association between ANS function and different measures of ED in adolescents with BPD. Here, we used a multimodal assessment of ED (self-reports, interviews, ambulatory assessment) in a sample of 43 adolescent patients (95.4% female, Mage = 15.5 years), fulfilling at least 3 BPD criteria. Replicating earlier findings, greater BPD symptom severity was significantly related to reduced resting-state HRV and increased heart rate. However, other measures of ED and mean affect were unrelated to ANS function. Findings suggest that ANS dysfunction maps to symptom severity in general rather than specific symptomatology (such as ED) in adolescents with BPD. Implications for the use of ANS measures in clinical practice and directions for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).