Adult Borderline Personality Disorder Research Articles

Associations of Child Amygdala Development with Borderline Personality Symptoms in Adolescence.

The understanding of the neural correlates of borderline personality disorder (BPD) is limited, but suggests alterations in limbic structures play a role in adult BPD. The developmental course of structural neural differences in BPD is unknown. Whether there is specificity for structural alterations in BPD compared with other psychiatric presentations, such as major depressive disorder (MDD), remains unexplored. The current study examined childhood trajectories of two limbic regions implicated in BPD, hippocampal and amygdala volume, as they relate to adolescent BPD symptoms as compared with MDD symptoms. Participants (N =175; 85 [48.6%] female) were from a 17-year longitudinal study of preschool depression. Participants completed up to 5 MRI scans from late childhood through adolescence. General linear models assessed the relationship between gray matter volume intercepts/slopes and BPD symptoms to understand the influence of the developmental trajectory of brain regions on BPD. Separate models assessed the relationship between MDD symptoms and volume intercepts to assess diagnostic specificity. Lower childhood amygdala volume (intercept; age 13 centered) across scans was associated with higher adolescent BPD symptoms (β=-0.25, adj. p=.015). There was no relationship between the slope of amygdala volume and BPD symptoms. There was no relationship between hippocampal volume and BPD, nor any relationship between amygdala or hippocampal volume and MDD symptoms in adolescence. Our findings add evidence for the role of alterations in amygdala structure in BPD development. Decreased amygdala volume as early as age 13 may be an early indicator for the development of BPD in adolescence.

Traits de personnalité limite en émergence, empathie et comportements intériorisés et extériorisés chez les enfants maltraités

IntroductionSome studies suggest that emerging borderline personality traits (EBPD) are linked to childhood maltreatment and that the presence of empathy difficulties and internalized and externalized behaviors are associated with them. Since most children housed in Youth Protection Centers (YPC) have been victims of maltreatment, they appear to be at greater risk of developing these difficulties compared to children from the general population and those consulting a psychologist. ObjectivesThis study compares these three groups regarding EBPD, empathy (cognitive, affective, global), and internalized and externalized behaviors. It also aims to verify the moderating role of empathy in the relationship between EBPD and externalized behaviors. Method. One hundred and sixteen children aged 6 to 12 were divided into three groups: 35 housed in Youth Protection Centers, 42 consulting in psychology, and 39 from the general population. Children and caregivers responded to separate questionnaires measuring the various variables under study. ResultsAnalysis of variance revealed a significant difference between children housed in YPC and those in the general population regarding EBPD, self-reported global empathy, and internalized and externalized behaviors. Global empathy also seems to moderate the relationship between EBPD and externalized behaviors when assessed by children. ConclusionThese results would make it possible to target variables to consider during interventions with children with EBPD to avoid the consolidation of their EBPD traits into adult borderline personality disorder.

Subtypes of borderline personality features in adolescence: Insights from cross-lagged panel network analysis.

Borderline personality disorder (BPD) is a complex and severe psychiatric condition characterized by emotional, self-image, behavior, and relational instability. While adult BPD heterogeneity has been extensively studied, the phenomenological borderline personality features (BPFs) in adolescence remain uninvestigated. This study aimed to explore the potentially dynamic causal relationships between BPFs in adolescence and identify the subtypes through cross-lagged panel network (CLPN) analysis. Two independent Chinese adolescent samples were followed over 18 months (N₁ = 1,056, M1age = 15.37, SD1 = 1.86) and 6 months (N₂ = 723, M2age = 16.84, SD₂ = 0.48) to track BPFs. CLPN modeling was employed to investigate the stability, potential causal relations, and subtypes of adolescent BPFs. The results revealed a relatively stable overall adolescent BPF network structure with some subtle changes over time. Impulsivity emerged as the BPF with the highest out-expected influence, indicating its predictive role for other BPFs. A strong reciprocal causal relationship was observed between impulsivity and affective instability. Based on the CLPN estimation, two distinct BPFs subgroups were spontaneously clustered: externalized-dysregulation subtype (impulsivity, affective instability, and self-harm/suicide) and introjective-disturbance subtype (identity disturbance, chronic emptiness, and stress-related dissociation). The present study tentatively explores a potential typology for adolescent BPF based on these two clusters, which possibly have different pathological mechanisms, and moreover offer insights into the essential construct and clinical intervention of adolescent BPD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impulsivity profile analysis and it’s potential role in the differential diagnostics of adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder

IntroductionImpulsivity is a complex construct, having at least three factors: 1) impulsivity as a personality trait, 2) ismpulsive action – waiting and stopping impulsivity and 3) choice impulsivity. Impulsive symptoms are present in Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) as well, eventhough impulsvity profile significantly differs.ObjectivesOur aim is to describe the impulsivity profile in adult ADHD (aADHD) and BPD in comparison with the control group, and describe a characteristic pattern, which associates with these disorders.Methods aADHD (n=100) and BPD Patients (n=63) were included, based on DSM-5 diagnostic criteria. Healthy control subjects (n=100) were screened using the Derogatis Symptom Checklist (SCL-90). Comorbid psychiatric disorders were assessed by structured clinical interviews and those who have both aADHD and BPD were excluded from the study. Participants were further investigated with online questionnaires: e.g. Barratt Impulsiveness Scale (BIS-11) Difficulties in Emotion Regulation Scale (DERS) and neuropsychological tests, like CANTAB Rapid Visual Processing, Stop Signal Task, and the Rogers’ decision-making test.Results Based ont the BIS-11 results, significantly higher attentional impulsivity was present in adult ADHD compared to BPD (p<.001) and healthy controls (p<.001). Emotional regulation difficulties, measured by DERS were significantly higher in BPD (p<.001) than aADHD, but the impulse control problems were more pronounced in the aADHD group, compared to BPD (p<.001). Using CANTAB neuropsychological test battery, strategy formulation difficulties (p=0.16) and stopping impulsivity (p<.001) were only present in aADHD compared to HC. BPD patients did not differ significantly from the control group in strategy formulation and in Stop Signal Reaction Time, a measure of stopping impulsivity. The significantly higher level of total false alarms, reflecting on waiting impulsivity were present both in aADHD and BPD.ConclusionsAccording to our results these two disorders have different impulsivity profile characteristics, which can be useful in differentiating these two disorders, and in buiding treatment plans. Stopping impulsivity, measured by SST was found in aADHD, but not in BPD. In BPD impulsive behavior is more likely attached to emotional dysregulation, a trait rooted in childhood traumatization.This study was supported by the National Research, Development and Innovation Office grant K 129195 and K 135437.Disclosure of InterestNone Declared

Dialectical Behavior Therapy for Adolescents with Borderline Personality Disorder: Emotion Dysregulation, Abuse, and Treatment Outcomes

ABSTRACT Objective Borderline Personality Disorder (BPD) is characterized by extreme emotional dysregulation. Dialectical Behavioral Therapy (DBT) is an empirically supported and effective treatment for BPD in adolescents and adults. However, the extent to which exposure to childhood abuse (i.e. physical and sexual abuse) impacts treatment outcomes is not well understood. This open trial investigated the effectiveness of an intensive residential DBT program in reducing emotion dysregulation in adolescents with BPD symptoms, as well as the impact that severity and type of childhood abuse had on treatment outcomes. Method Participants (N = 46) were female-identifying adolescents 13–20 years of age enrolled in an intensive residential DBT treatment program. Severity of abuse exposure and abuse subtype (Childhood Trauma Questionnaire, Short Form, CTQ-SF) and difficulties with emotional dysregulation (DERS) were assessed at admission and DERS again after 1 month of treatment. Results Bivariate correlation between DERS Total Score and Abuse Exposure Total Score indicated that severity of abuse exposure had a medium positive association with emotion dysregulation at admission. Mixed model ANOVA results showed significant reductions in emotional dysregulation following 1 month of treatment, with a large effect size. Exploratory analysis testing exposure to different subtypes of childhood abuse as a moderator of treatment effects was non-significant. Conclusions Emotion dysregulation showed significant reductions following intensive residential DBT interventions. Reductions were consistent across subtypes of abuse exposure. Implications for the treatment of adolescents with abuse histories and current BPD-related problems, and the relationship between child abuse exposure and emotional dysregulation overall, are discussed.

Attention Deficit Hyperactivity Disorder in Childhood, Resilience, Compassion, Mentalization, and the Prevention of Borderline Personality Disorder in Adulthood: A Review

ABSTRACT This paper explores the co-occurring features of Attention Deficit Hyperactivity Disorder (ADHD) and Borderline Personality Disorder (BPD) and ADHD as a risk factor for the emergence of BPD. It emphasizes the importance of clinical treatment to improve resiliency and addresses co-occurring areas of vulnerability in individuals with ADHD and those with BPD, as well as in individuals with both disorders. Although the specific developmental pathways and mediating factors remain uncertain, many investigations have identified ADHD and emotion dysregulation in childhood as risk factors for developing personality disorders, particularly BPD, in late adolescence and early adulthood. The frequent co-occurrence of ADHD with BPD in adulthood contributes to worse outcomes and continuing problems with impulsivity and regulating emotional arousal among individuals with both disorders. While the comorbidity of ADHD and BPD poses a risk, it is essential to also consider what factors may help moderate the risks and contribute to resiliency. This review highlights the gaps in the literature about resilience by reviewing existing literature that points to treatment approaches, such as compassion-focused and mentalization-focused psychotherapy, that may mediate ADHD-related risks. Long-term treatment outcome studies of emotion regulation therapies with children are needed to ascertain their effectiveness in reducing the psychological adversity associated with experiencing ADHD in childhood and reducing the emergence of BPD in adolescents and adults.

The effectiveness of individual schema therapy in older adults with borderline personality disorder: A multiple-baseline case series design.

The aim of this study was to explore the effectiveness of schema therapy (ST) in older adults with borderline personality disorder (BPD). Multiple baseline case series design with five BPD patients, with a mean age of 66. After a baseline phase with random length, patients received weekly ST sessions for a year, followed by follow-up sessions during 6months. Participants rated the credibility of negative core beliefs weekly; various secondary outcome measures were assessed every 6months (severity of BPD, early maladaptive schemas, schema modes, personality functioning, maladaptive personality traits, psychological distress and quality of life), and BPD diagnosis was assessed before baseline and after follow-up. Data were analysed with mixed regression analyses and paired t-tests. Results revealed that ST led to a significant decrease in credibility of negative core beliefs, with high effect sizes. All participants remitted from their BPD diagnosis. This is the first study exploring the effectiveness of ST for BPD in older adults, and it suggests that ST can be a powerful intervention for this group of patients.

Clinical improvement of teens participating in a dbt skills training

IntroductionDialectical behavioural therapy (DBT) developed by Linehan has been shown to be widely effective in improving emotional regulation capacity in patients diagnosed with borderline personality disorder in adults and adolescents, but also for other profiles of emotional dysregulation, even in the general non-clinical population through emotional regulation skills training programs in schools.ObjectivesThe objective was to describe psychopathological characteristics and to evaluate clinical outcome variables (self-harm, suicide attempts, admissions and emotional regulation difficulties) in young patients who participated in the DBT skills training group carried out by the child and adolescent psychiatry team of Hospital del Mar (Barcelona) between February 2020 and April 2022.MethodsProspective longitudinal study with two evaluations (before starting the group and after finishing it). The clinical variables were evaluated by reviewing the medical records, and the improvement in emotional regulation difficulties was evaluated through the Difficulties in Emotion Regulation Scale (DERS) adaptation to adolescents before and after the intervention.ResultsA total of 36 participants have been referred and assessed to participate in the previously mentioned emotional regulation program. The mean age was 15.6 years (14-17 years old). 100% of the participants were female. All of them met criteria for BPD according to the SCID-II questionnaire; but only 23 patients (63.9%) had BPD as their main diagnosis. 63.9% (n=23) presented psychiatric comorbidities, being 27.8% (n= 10) ADHD, 30.6% (n= 11) substance use disorder and 47.2% (n= 17) eating disorders,77.8% (n=28) had presented self-injurious behaviour, 52% (n=18) had committed a suicide attempt, requiring hospital admission in 36.2% (n=13) at some point in their lives before the therapy group. In the three months after the end of the group, admissions were reduced to 17% (n=6), suicide attempts to 14.8% (n=5) and non-suicidal self-injurious behaviours to 27.8% (n=10).The mean score of all participants on the DERS scale was 129.91 points before participating in the DBT skills group and 105 points right after the group finished. Higher scores translate into greater emotional regulation difficulties.ConclusionsThe reduction in DERS scores, self-injurious behaviours, suicide attempts, and admissions was notable for all participants. It remains to add the results of the groups currently in operation and perform the statistical analysis of all the results. It is necessary to continue studying and testing the benefits of DBT both in the clinical adolescent population and in the general child and adolescent population in order to generalize the promising results observed in our sample. At Hospital del Mar, we will continue to expand the DBT program so that more children and adolescents with emotional dysregulation can benefit.Disclosure of InterestNone Declared

Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD

BackgroundResearch on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains.MethodsWe examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD).ResultsAfter adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status.ConclusionsGiven our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Development and Preliminary Evaluation of a Rapid Screening Tool for Detecting Borderline Personality Disorder in People Aged over 60 Years

ABSTRACT Objectives Screening and diagnostic instruments for Borderline Personality Disorder (BPD) are not validated in people aged over 60. We report a pilot study examining the sensitivity and specificity of a de-novo screening instrument in older adults. Methods The BPD-OA screening tool incorporates DSM 5 and literature describing the expression of BPD in older adults. This study was conducted using a case control design. The Diagnostic Interview for Borderlines–Revised (DIB-R) and the McLean Screening Instrument for BPD (MSI-BPD) were used as comparators. Comprehensive assessment by psychiatric teams determined participants to be (i) BPD-positive (n = 22) or (ii) BPD-negative (gender matched; n = 21). Results The BPD-OA was the most sensitive instrument for discriminating older adult BPD from non-BPD participants (sensitivity = 0.82). No significant relationship was found between the BPD-OA score and age in BPD-diagnosed participants (r = −0.181, n = 21, p = .432). Participant age explained 3.2% of the variance in BPD-OA scores. Of the 21 BPD-negative participants, eight false positives experienced prominent mood disorders (specificity = 0.62). Conclusions The BPD-OA screening tool is clearly superior to instruments validated for use in younger people. Further refinement and evaluation will enhance its sensitivity and specificity. Clinical Implications Detection of BPD in older adult care settings will improve outcomes for patients, families, and staff through better understanding and appropriate management and treatment strategies.

Childhood symptoms of attention-deficit/hyperactivity disorder and borderline personality disorder.

Childhood attention-deficit /hyperactivity disorder (ADHD) is known to be associated with adult Borderline Personality Disorder (BPD). We investigated if any of the subdimensions of childhood ADHD, that is, impulsivity, inattention, or hyperactivity was more prominent in this association. In a nation-wide cohort (N= 13,330), we utilized parent reported symptoms of childhood ADHD and clinically ascertained adult BPD diagnoses. The summed total scores of ADHD symptoms and its three subdimensions were used and standardized for effect size comparison. Associations were analyzed using Cox regression with sex and birth-year adjustments. Secondary outcomes were BPD-associated traits (i.e., self-harm and substance use) analyzed using logistic- and linear regression respectively. ADHD symptom severity was positively associated with BPD with a hazard ratio (HR) of 1.47 (95% confidence interval [CI]: 1.22-1.79) per standard deviation increase in total ADHD symptoms. Impulsivity was the most prominent subdimension with the only statistically significant association when analyzed in a model mutually adjusted for all ADHD subdimensions-HR for inattention: 1.15 (95% CI: 0.85-1.55), hyperactivity: 0.94 (95% CI: 0.69-1.26), impulsivity: 1.46 (95% CI: 1.12-1.91). In secondary analyses, weak positive associations were seen between total ADHD symptom score and self-harm and substance use. In analyses by subdimensions of ADHD, associations were weak and most prominent for inattention in the model with self-harm. Childhood ADHD symptoms were associated with subsequent development of BPD diagnosis and appeared to be driven primarily by impulsivity. Our findings are important for understanding the association between childhood symptoms of ADHD and subsequent BPD.

Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review.

Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.

Comparative analysis of impulsivity profiles in adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder

IntroductionHigh levels of impulsive behavior represent a core symptom of different psychiatric conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), impulse control and conduct disorders, bulimia nervosa, substance use disorders, and other maladaptive behaviors. Impulsivity is a multidimensional construct, having at least three factors.ObjectivesOur aim was to describe the impulsivity profile in adult ADHD and BPD patients in comparison with a healthy control group, taking into consideration the different impulsivity factors.MethodsaADHD (n=80) and BPD Patients (n=60) were recruited, based on the DSM-5 criteria. Control subjects (n=80) were screened using Derogatis Symptom Checklist (SCL-90). Comorbidities were assessed by structured clinical interviews. Participants were further investigated with online questionnaires including the Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), and neuropsychological tests, like Rogers’ decision-making test.ResultsBased ont the BIS-11 and DERS results, significantly higher levels of impulsivity (motor, attentional, non-planning) and difficulties in emotion regulation were present both in the aADHD and BPD groups, compared to the control group. Impulsivity factors were more characteristic to aADHD, emotion dysregulation was more specific to BPD. In the Rogers test, aADHD group was significantly slower in decision-making, while in BPD decision quality and risk-taking were affected.ConclusionsImpulsivity profiles of the two disorders are different, which leads to the assumption of potentially altered pathway of developing impulsive behavior. As a neuropsychiatric condition, impulsivity in aADHD is related to neurobiological dysinhibition, in BPD impulsive behavior is attached to emotionally involving situations, and emotional dysregulation rooted in childhood adverse events.DisclosureNo significant relationships.

Non-suicidal Self-Injury Among Adolescents From Diverse Ethnocultural Groups in Israel: The Association With Sleep Problems and Internet Addiction

ObjectivesAlthough Non-suicidal Self-Injury (NSSI) has received more attention in recent years, most of these studies focused on samples from North American and European countries; consequently, little is known about its patterns and frequency in other cultures as well as its relation to sleep problems and internet addiction. As one of the few studies that aim to fill this gap, the current study examined the prevalence, characteristics, and types of NSSI behaviors among adolescents from diverse ethnocultural groups.MethodsA sample of 642 adolescents, aged 12–18 years, were randomly recruited from different middle and high schools in Israel, employing a snowball sampling technique. The sample included the following: 50% Jews and 34.7% Muslims born in Israel, 9.7% immigrants from the former Soviet Union (FSU), and 4.4% immigrants from Ethiopia. The participants completed self-report questionnaires that assessed their NSSI, sleep problems, internet addictions, and depressive symptoms.ResultsAlmost one-third of the sample had engaged in NSSI, while 6% frequently injured themselves. More than half of the FSU immigrants and one-third of the Muslim participants indicated that they engaged in NSSI. These two population groups also exhibited severe depressive symptoms, sleep problems, and internet addictions. The most parsimonious correlations with NSSI included being male, an immigrant/Muslim minority who exhibited severe depressive symptoms and internet addictions.ConclusionsThese results emphasize the need for routine NSSI assessments to prevent long-term sequelae, including any forms of suicidal thoughts and behaviors and adult borderline personality disorder (BPD). Primary preventive programs that include adaptive coping skills may eliminate the social contagion effect of NSSI.

Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder.

Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.

Effectiveness of Psychological Treatments for Borderline Personality Disorder and Predictors of Treatment Outcomes: A Multivariate Multilevel Meta-Analysis of Data from All Design Types.

We examined the effectiveness of psychotherapies for adult Borderline Personality Disorder (BPD) in a multilevel meta-analysis, including all trial types (PROSPERO ID: CRD42020111351). We tested several predictors, including trial- and outcome type (continuous or dichotomous), setting, BPD symptom domain and mean age. We included 87 studies (N = 5881) from searches between 2013 and 2019 in four databases. We controlled for differing treatment lengths and a logarithmic relationship between treatment duration and effectiveness. Sensitivity analyses were conducted by excluding outliers and by prioritizing total scale scores when both subscale and total scores were reported. Schema Therapy, Mentalization-Based Treatment and reduced Dialectical Behavior Therapy were associated with higher effect sizes than average, and treatment-as-usual with lower effect sizes. General severity and affective instability showed the strongest improvement, dissociation, anger, impulsivity and suicidality/self-injury the least. Treatment effectiveness decreased as the age of participants increased. Dichotomous outcomes were associated to larger effects, and analyses based on last observation carried forward to smaller effects. Compared to the average, the highest reductions were found for certain specialized psychotherapies. All BPD domains improved, though not equally. These findings have a high generalizability. However, causal conclusions cannot be drawn, although the design type did not influence the results.

Characterization of Structural and Functional Brain Abnormalities in Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder in Adulthood: An Overlapping Multimodal Meta-Analysis

Characterization of Structural and Functional Brain Abnormalities in Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder in Adulthood: An Overlapping Multimodal Meta-Analysis

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.

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.