Adolescent Personality Disorder Research Articles

Clinical and Psychopathological Features of Borderline Personality Disorder in Adolescence

Background: Borderline personality disorder (BPD) in adolescence has a high prevalence and a signicant polymorphism of the psychopathological structure which creates considerable difculties to conduct differential diagnostics and assessing comorbidity with other disorders. To date, special research has not been carried out to explore BPD in adolescents that highlights the relevance of the present study. Objectives: identication of the borderline personality disorder (BPD) clinical features, leading psychopathological syndromes and differential diagnostics criteria in adolescence. Patients and methods: 71 young patients (16–25 years old) with borderline personality disorder were examined by clinical psychopathological and psychometrical methods (PBQ-BPD, TAS, BIS-11). This study includes 28 women (39%) and 43 men (61%) who were examined as inpatient or outpatient in the Mental Health Research Centre in 2019–2021. Results: key symptoms complexes were identied and presented by affective instability, dissociative state with identity disturbance and addictive behavior. Based on the analysis of the clinical picture and the discovered patterns, three types of BPD in adolescents were identied: with an “affective storm” (type I); with a dominance of impulsive and addictive features such as “adrenaline addiction” (type II); with a dominance of “cognitive dissociation” and self-identity disorder (type III). Distinctive features of the clinical pictures of affective and behavioral disorders for each type of BPD in adolescence were found and psychopathological signs and their impact on further dynamics were determined, taking into account an auto-aggressive behavior and a high level of suicidality. Conclusions: the found psychopathological patterns of BPD formation in adolescence help to assess the disorders of personality and social functioning and to predict the risk of auto- aggression and suicidal activity for the diagnostic and prognostic assessment of borderline personality disorder in adolescence.

Analysis of Early Family-related Factors of Predisposition to Borderline Personality Disorder in Adolescents

Analysis of Early Family-related Factors of Predisposition to Borderline Personality Disorder in Adolescents

Clinical evaluation of Major Depressive Disorder (MDD) and Borderline Personality Disorder(BPD) in youth adolescents

IntroductionAccording to international studies, at least 70% of BPD in adolescence are comorbid with MDD.ObjectivesTo determine the clinical and psychopathological markers of MDD in BPD in adolescence.MethodsClinical psychopathological interview, SCID-II, Hamilton Depression Rating Scale (HDRS). Sample: N=73 male and female, age: 18-25 with MDD and BPD.ResultsMDD comorbid with BPD in adolescence is characterized by polymorphism of its’ psychopathological manifestations due to the structure of BPD and the input of the age factor. In the studied sample 31 (42,5%) with both MDD and BPD also revealed addictions; 24 patients (32,9%) - anxiety and obsessive-compulsive (OCD) disorders, 18 patients (24,7%) had overvalued ideas. The high contingency of MDD with autoaggressive actions confirmed their high suicidal risk (53 patients). Among them - 31 patients (58,5%) - had non-suicidal self-harm (NSSI), 7 patients – (13,2%) had suicidal attempt (SA), and 15 patients (28,3%) had NSSI and suicidal attempts (NSSI+SA). The highest incidence of NSSI and NSSI+SA was noted in MDD with addictive disorders: NSSI – N=20 (80,00%), NSSI+SA - N=5 (20,00%), SA – N=0. MDD with BPD and anxiety disorders: NSSI – N=9 (56,25%), NSSI+SA – N= 6 (37,50%), SA–N=1 (6,25%). MDD with BPD and overvalued ideas: NSSI – N=2 (16,67%), NSSI +SA – N= 4 (33,33%), SA N=6 (50,0%), (results p<0.01).ConclusionsPsychopathological relations between BPD and MDD in youth are different due to additional comorbid conditions, like addictions, anxiety and OCD, overvalued ideas and have clinical implications in terms of suicidal and NSSI risks, individualized interventions and prognosis.DisclosureNo significant relationships.

Adolescent borderline personality disorder: Does early intervention 'bend the curve'?

The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits. People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.

Associations between symptoms of borderline personality disorder and suicidality in inpatient adolescents: The significance of identity disturbance

Several studies report that borderline personality disorder (BPD) is a risk factor for suicidality in adults. However, this issue requires further research in adolescents, as it is not clear which individual BPD symptoms are significant correlates of suicidality in this age group. The main aim of the current study was to test which symptoms of BPD are associated with suicidality in adolescent inpatients, even when controlling for age, gender, and depressive symptoms. Inpatient adolescents (N = 339) aged 12–17 years completed the Childhood Interview for DSM-IV Borderline Personality Disorder, the Beck Depression Inventory-II, the Modified Scale for Suicidal Ideation, and reported their number of lifetime suicide attempts. Multivariable regression analyses showed that, after controlling for confounding variables, overall BPD symptom severity was positively related to suicidal ideation and suicide attempts. Of the individual BPD symptoms, identity disturbance, chronic emptiness, avoid abandonment, and transient paranoia were the most robust correlates of suicidal ideation intensity, and only identity disturbance was associated with the number of lifetime suicide attempts. To assess the risk of suicidality in youth, it is essential to assess for BPD symptoms; it is important to focus on adolescents’ subjective feelings to assess the severity of identity disturbance and chronic emptiness.

Debate: Should CAMHs professionals be diagnosing personality disorder in adolescents - 'No rationale to deprive adolescents of effective treatment'.

Personality disorders (PD) are among the most severe mental disorders, leading to high clinical, familial and societal burden. In contrast to former perceptions, PDs are not a life-long destiny, but treatable with specialized treatment approaches. The current reluctance of clinicians to use this diagnosis in younger age groups obstructs the correct choice of treatment options for young people. Not diagnosing PD at an early stage means to deprive adolescents of effective treatments, thus increasing their risk of fatal outcome. In the upcoming ICD-11, a life-span perspective on mental disorders has been adopted that facilitates the use of the diagnosis PD in young people. Future research will show if the use of the new ICD-11 diagnosis of complex posttraumatic stress disorder will be helpful in a proportion of patients with a history of severe childhood traumatization.

Debate: Stigma implications for diagnosing personality disorders in adolescents.

Diagnosing personality disorders (PDs) in adolescence is a complex and often controversial decision. While early diagnosis provides a pathway to treatment, stigmatizing labels might unintentionally increase prejudice and discrimination for youth and their families, resulting in harm and treatment avoidance. In this paper, we outline stigma-related considerations for diagnosing PDs in adolescence, including types of stigma (public stigma, self-stigma, associative stigma) and moderators of stigma (continuum beliefs, biogenetic attributions, PD sub-diagnosis). Research indicates that PDs are among the most stigmatizing diagnoses in adults, particularly among healthcare providers. Experiences with stigma may differentially impact adolescents, who are undergoing rapid changes in identity development and profound influences from educational systems, peers, and social media. Youth who receive mental health services (especially those embedded in schools) worry about whether and how to talk about a diagnosis. However, adolescents with significant behavioral symptoms are often seen as different from their peers even prior to a formal diagnosis. Systematic efforts are needed to anticipate and mitigate stigma-related impacts on adolescents who might be diagnosed with PDs.

The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults

The Validation of a Five-Item Screening Scale for Personality Disorders in Dutch-Speaking Community Adolescents and Adults

Perceived Parenting and Borderline Personality Features during Adolescence.

This study investigates the associations between perceived parenting and borderline personality disorder (BPD) in adolescents. The relations between components of parenting and BPD features were explored. Participants (N = 270; mean age = 15.3) assessed their own BPD features (Personality Assessment Inventory) and both of their parents' parenting practices (Parents as Social Context Questionnaire; Perceived Parental Autonomy Support Scale). SEM results suggest that controlling, rejecting and chaotic parenting all predicted global BPD, and all these parenting components were significantly associated with at least one BPD feature. Chaotic parenting, a relatively neglected construct in the BPD literature, seems to play an important role in early BPD.

Clinical and psychological assessment of the variability of schizotypal personality disorder in children and adolescents

To analyze the variability of violations of cognitive and emotional-personal parameters in schizotypal disorder (STD) in children and adolescents according to the pathopsychological profile. 47 patients with STD were examined, 21 of them with psychopathic variant (F21.4), 16 with neurotic (F21.3) and 10 with personality schizotypal disorder (F21.8) aged 9 to 16 years (37 boys and 10 girls). All patients were examined in detail by a psychiatrist and clinical psychologists. The method of integrative assessment of the pathopsychological profile was used, including the assessment of the presence and severity of impairments in cognitive functioning, emotional-personal and motivational-volitional spheres (the assessment was carried out according to detailed psychological reports). Mathematical processing of the obtained data was carried out. Cluster analysis of clinical and psychological indicators showed that patients differ in the level of intellectual impairment, as well as in the characteristics of motivational-volitional and personal spheres. Three clusters are described, two of which included patients (10 and 31 patients) with individual variants of STD with a greater severity of various cognitive deficits, and parameters of the emotional and personal sphere, the last cluster included 6 patients with personality variants of STD. A separate largest cluster included all three analyzed variants of STD in approximately equal proportions, with a mildly pronounced intellectual decline and more noticeable changes (deficiency) in the emotional and personal sphere. Thus, patients with STD differ in the severity and structure of deficient changes. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is of great importance. Patients with STD differ in the severity and structure of deficient changes. The identified clusters differed in age, in the presence of patients of both sexes, and in various indicators of the pathopsychological profile. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is important for diagnosis.

Non-Suicidal Self-Injury in the Decompensation of Personality Disorder in Adolescents During the COVID-19 Pandemic in 2020–2021

The aim of the study was to determine the clinical and psychopathological characteristics of non-suicidal self-injury (NSSI) in personality disorder (PD) in the comparative age-related aspect during the coronavirus infection (COVID-19) pandemic. Patients and methods: a total of 230 patients (177 males and 53 females) aged 16–25, diagnosed with PD and NSSI behavior manifestations, were studied retrospectively in mental hospital and outpatintly by using clinical-psychopathological method. All patients were divided into two equal groups of 115 people each. Group I was examined in 2017–2019, Group II — in 2020–2021 during the coronavirus infection (COVID-19) pandemic. Results: common features established in both groups were as follows: affective instability, alexithymia, conflict relations with significant others, and current traumatic experience. For a comparative assessment of NSSI in patients of both groups, we used the NSSI typology in adolescent PD, previously developed by the authors. Impulsive, demonstrative, addictive, depersonalizing and self-destructive types of NSSI were recognized as significant for the diagnostic assessment. In the second group of patients, that is, during the period of the COVID-19 pandemic, a change in the selected variants of NSSI was found, that is, in borderline and narcissistic PD the impulsive type was replaced by a demonstrative type, and in schizoid and anxious PD it turned into an addictive one. For a comparative assessment of NSSI in patients of both groups, we used the NSSI typology in PD in adolescence, previously developed by the authors. When assessing suicidality in group II, it was revealed that in most types of PD, with a decrease in the number of suicidal attempts, there was a noticeable increase in the incidence of NSSI with demonstrative suicidality, which correlated with the trajectories of the identified variants of NSSI. Conclusions: the study underlined the role of personality pathology in in adolescence in the development of psychopathological disorders with NSSI and their high association with suicidal activity. The modification of various NSSI variants in the context of a coronavirus infection (COVID-19) pandemic may be due to the unique characteristics of the psychotraumatic factor. With the same strength of impact, the multidirectional influence on various personality types and comorbid psychopathological disorders in adolescence should be taken into account, when creating new models of therapeutic and socio-rehabilitation interventions for the adolescent contingent of patients.

Suicidal Risk and Adverse Social Outcomes in Adulthood Associated with Child and Adolescent Mental Disorders

ObjectiveThe life course of children and adolescents with mental disorders is an important area of investigation, yet it remains understudied. This study provides a first-ever comprehensive examination of the relationship between child and adolescent mental disorders and subsequent suicidal and adverse social outcomes in early adulthood using population-based data. MethodsDe-identified administrative databases were used to create a birth cohort of 60,838 residents of Manitoba born between April 1980 to March 1985 who were followed until March 2015. Unadjusted and adjusted hazard ratios (aHRs) and odds ratios (aORs) were calculated to determine associations between physician-diagnosed mental disorders in childhood or adolescence and a range of adverse early adulthood (ages 18 to 35) outcomes. ResultsDiagnoses of mood/anxiety disorders, attention-deficit hyperactivity disorder, substance use disorder, conduct disorder, psychotic disorder, personality disorders in childhood or adolescence were associated with having the same diagnoses in adulthood. These mental disorder diagnoses in childhood/adolescence were strongly associated with an increased risk of suicidal behaviors and adverse adult social outcomes in adulthood. Similarly, suicide attempts in adolescence conferred an increased risk in adulthood of suicide death (aHR: 3.6; 95% confidence interval [CI]: 1.9-6.9), suicide attempts (aHR: 6.2; CI: 5.0–7.6), social housing use (aHR: 1.7; CI 1.4–2.1), income assistance (aHR: 1.8; CI 1.6–2.1), criminal accusation (aHR: 2.2; CI 2.0–2.5), criminal victimization (aHR:2.5; CI 2.2–2.7), and not completing high school (aOR: 3.1; CI: 2.5–3.9). ConclusionMental disorders diagnosed in childhood and adolescence are important risk factors not only for mental disorders in adulthood but also for a range of early adult adversity. These findings provide an evidence-based prognosis of children's long-term well-being and a rationale for ensuring timely access to mental health services. Better population-level mental health promotion and early intervention for children and adolescents with mental disorders are promising for improving future adult outcomes.

Interpersonal Relatedness and Non-suicidal Self-Injurious Behaviors in Female Adolescents With Borderline Personality Disorder.

Background: Psychopathological models of adolescent borderline personality disorder (BPD) suggest that non-suicidal self-injuring (NSSI)—a particularly frequent symptom in girls—may constitute a way of coping with distress resulting from interpersonal concerns they typically experience as a developmental psychopathological feature.Objectives: Our objective was to investigate the relationship in BPD female adolescents between NSSI and the Sidney Blatt two-polarities model of personality development, which focuses on the psychological processes of interpersonal relatedness and self-definition.Methods: The study was conducted within the European Research Network on Borderline Personality Disorder in Adolescence, using the Depressive Experience Questionnaire (DEQ).Results: BPD patients (n = 59; mean age = 16.6 ± 1.3) scored significantly higher than healthy controls on the two DEQ sub-factors assessing the more immature forms of Interpersonal Relatedness (Neediness) and Self-definition (Self-criticism) and significantly lower on the more mature form of Self-definition (Efficacy). BPD adolescents with NSSI showed significantly higher scores on both mature and immature forms of Interpersonal Relatedness (Neediness and Connectedness) compared to BPD adolescents without NSSI. A logistic regression analysis showed that the subfactor Neediness of the DEQ was the only significant predictor of the presence of NSSI among BPD adolescents.Conclusions: The preliminary results of this study suggests that NSSI in adolescents with BPD is developmentally linked to high developmental concerns in the domain of interpersonal relatedness, which may be taken into consideration in clinical practice. More studies are necessary to better understand the relationships between NSSI and developmental psychopathology in borderline adolescents.

Paradoxes in Borderline Emotional Dysregulation in Adolescence: Influence of Parenting, Stressful Life Events, and Attachment.

Introduction: Borderline personality disorder (BPD) in adolescents is characterized by emotional dysregulation, insecure attachment, a history of stressful life events (SLEs) as well as dysfunctional parent–child interactions. The respective contribution of each of these factors on BPD affective symptoms is not yet clear. The purpose of this study is to assess the distinct impact of parental adversity and SLEs on BPD affective symptoms and the role of attachment and alexithymia in such emotional processes.Method: This study explored parental dysfunction and SLEs as predictors of affective symptoms of BPD and of attachment insecurity in BPD adolescents (n = 85) and healthy controls (n = 84) aged 13–19 years from the European Research Network on BPD. The links between adversity and BPD symptoms were also investigated by emotional dysregulation assessment, as measured by alexithymia and hopelessness.Results: Dysfunctional parental interactions were linked to affective symptoms, hopelessness, and anxious attachment in healthy controls but not in BPD. Cumulative SLEs were positively correlated with affective symptoms and avoidant attachment in the control group but negatively correlated with both these variables in BPD. Multivariate regression analysis revealed that, in BPD, affective symptoms were independent of dysfunctional parenting but depended on attachment, whereas in controls, a maternal affectionless control style directly predicted affective symptoms. Moreover, increasing numbers of SLEs reduced affective symptoms in BPD, independently of parental interactions or attachment, and were associated with growing use of operative thinking.Discussion: BPD patients showed paradoxical emotional reactions: there was no increase of hopelessness and affective symptoms with an increased parental dysfunction, but a decrease in affective symptoms and hopelessness with cumulative SLE. Two pathways arose, one involving attachment as an emotional dysregulation process for parent–child interactions and a second one for SLE, with a more direct pathway to affective symptoms, independent of attachment but dependent on early interactions, and involving alexithymia. In summary, adversity factors have distinct effects in BPD, and attachment is partly accountable for affective symptoms independently of adversity. Our results suggest that in highly insecure conditions, cumulative adversity may produce paradoxical effects, including a lesser expression of affective symptoms and hopelessness.

30.2 Comparing the Associations Between Borderline Personality Symptoms and PTSD Symptom Severity Between Adolescent and Adult Patients

The first goal of this study was to examine the relationship between PTSD symptom severity and borderline personality traits and secondly to compare these relationships between adolescent and adult patients. There is increasing supporting evidence for diagnosing borderline personality disorder (BPD) in adolescence given that it is a well-known risk factor for completed suicides in adults. It has also been documented that many of those with BPD have experienced childhood trauma.

Assessing Criterion A in adolescents using the Semistructured Interview for Personality Functioning DSM–5.

Accumulating evidence supports the reliability and validity of the diagnosis of personality disorders (PDs) in adolescents, but whether the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), criteria are optimal to capture and help detect emerging PDs in this age-group remains controversial. The Level of Personality Functioning Scale (LPFS), included in the alternative model for personality disorders, may provide a more developmentally sensitive way to identify impaired personality features in young people. This study investigates the feasibility of the LPFS in adolescents by examining the psychometric properties of the Semistructured Interview for Personality Functioning DSM-5 in a clinical sample of referred adolescents (N = 84) and in a community sample (N = 12). Additionally, referred adolescents completed self-report questionnaires pertaining to symptom severity, personality functioning, and personality traits. In general, good interrater reliability and internal consistency were observed, and the associations with external variables largely followed theoretical prediction. Interestingly, and in contrast to data on adults, we found no significant associations between the LPFS scores on the one hand and traditional DSM-5 PD diagnoses in the clinical sample on the other (except for borderline PD criteria). In discussing these findings, we argue that the assessment of personality functioning may be better suited for detecting personality pathology in adolescence than the traditional Section II criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Childhood Personality Assessment Q-Sort (CPAP-Q): A Clinically and Empirically Procedure for Assessing Traits and Emerging Patterns of Personality in Childhood.

Background: Despite increasing research confirming the existence of childhood personalities, which are recognizable from a developmental perspective, controversies over the possibility to assess personality in childhood have continued. The purpose of this study was to provide initial data on the validation of the Childhood Personality Assessment Q-Sort (CPAP-Q), a clinician report instrument that can be employed to evaluate children’s personalities and address the gap in the field of emerging personality in children classification. Method: A sample of 135 clinicians completed the CPAP-Q to assess the personality features of 135 children (ages 4–11) who had been in their care between two and 12 months. The clinicians completed a clinical questionnaire to collect information on them, the children, and their families, as well as the Child Behavior Checklist (CBCL), to evaluate the children’s behavioral problems and social competencies. Results: Q-factor analysis identified seven specific emerging personality patterns: psychological health, borderline/impulsive, borderline/dysregulated, schizoid, inhibited/self-critical, obsessive, and dysphoric/dependent. These patterns revealed good levels of validity and reliability. Conclusions: These findings are preliminary, but seem to support the possibility of evaluating emerging personality patterns in childhood and their developmental pathways that may lead to personality disorders in adolescence and adulthood. The CPAP-Q promises to significantly contribute to less explored research areas and encourage systematic studies of children assessment, promoting best practices for individualized diagnoses.

Transference-Focused Psychotherapy for Adolescents With Personality Disorders.

This article presents a conceptualization of personality disorders in adolescence and the adaptation of transference-focused psychotherapy (TFP) for personality disordered adolescents (TFP-A). The model of assessment and treatment presented is based on contemporary psychoanalytic object relations theory developed by Otto F. Kernberg and supported by findings from current evidence-based outcome research. We present a method of assessing personality disorders in adolescents that addresses the variability of personality disorder symptoms and traits among adolescents and their instability over time. We then present the goal of TFP-A and its major phases of implementation. A major focus is therapist interventions.

Longitudinal Associations Between Cognitive Deficits in Childhood and Psychopathological Symptoms in Adolescence and Young Adulthood

Cognitive deficits are core features of mental disorders and are important in predicting long-term prognosis. However, it is still unknown whether individual patterns of cognitive deficits predate specific mental disorders. To investigate the specificity of the associations of attention, working memory, and inhibition in childhood with borderline personality disorder (BPD), psychosis, depression, and hypomania in adolescence and young adulthood. This cohort study obtained data from the Avon Longitudinal Study of Parents and Children in the United Kingdom. All pregnant women resident in Avon, United Kingdom, with an expected date of delivery from April 1, 1991, and December 31, 1992, were eligible. Data analysis was conducted from April 1 to September 30, 2020. The sample initially comprised 13 988 participants who were alive at 1 year of age. For this study, data were available for 6333 individuals reporting on any psychopathological measure at ages 11 to 12 years, 4903 individuals at ages 17 to 18 years, and 2963 individuals at 22 to 23 years. Sustained attention, selective attention, and attentional control were assessed with the Test of Everyday Attention for Children at age 8 years, and working memory and inhibition were assessed at age 10 years with the Counting Span Task and the stop-signal paradigm, respectively. Symptoms of BPD were assessed at ages 11 to 12 years, psychotic experiences and depression were examined at ages 17 to 18 years, and hypomania was examined at ages 22 to 23 years. Among 5315 individuals included in the statistical analysis, 2551 (48.0%) were male and 2764 (52.0) were female. Higher sustained attention at 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (adjusted odds ratio [aOR], 0.964; 95% CI, 0.933-0.996; P = .03), better performance on inhibition at age 10 years with decreased risk of psychotic experiences at ages 17 to 18 years (aOR, 0.938; 95% CI, 0.890-0.989; P = .02), higher sustained attention at age 8 years with decreased risk of depressive symptoms at ages 17 to 18 years (aOR, 0.969; 95% CI 0.938-0.9997; P = .048), and better performance in working memory at age 10 years with decreased risk of hypomania symptoms at ages 22 to 23 years (aOR, 0.694; 95% CI, 0.529-0.911; P = .008). After controlling for potential psychopathological overlay, all the associations remained, except for working memory and hypomania. Higher sustained attention at age 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (β = -0.05; P < .001) and of depression at ages 17 to 18 years (β = -0.03; P = .04), and better performance in inhibition at age 10 years was associated with decreased risk of psychotic experiences at ages 17 to 18 years (β = -0.03; P = .04). These findings suggest that specific cognitive deficits in childhood are distinctively associated with different psychopathological symptoms in young people. Furthermore, these results suggest the potential of early cognitive interventions in childhood as a way of modifying or attenuating risk for subsequent psychopathological symptoms.

Early life factors of schizotypal personality disorder in adolescents: A systematic review.

INTRODUCTION: Schizotypal personality disorder (SPD) affects 4% of the general population in the United States. The identification of early life factors (ELFs) that confer risk to SPD in adolescents (ages 10-24years old) has become a major focus of clinical research on schizophrenia-spectrum disorders. This systematic review aims to determine what ELFs contribute to the onset of SPD in the adolescent population. A systematic search of PubMed, PsycINFO, Psychiatry online, Scopus, Web of Science, EMBASE and CINAHL databases was conducted using relevant keywords. Data were extracted using a standardized form following PRISMA guidelines. Twenty-four studies met the criteria for inclusion. ELFs in the development of SPD were grouped into two important clusters: (a) prenatal and early postnatal factors; (b) childhood trauma and parental factors. Mental health nurses, especially nurses in primary care, should be aware of potentially modifiable ELF. Longitudinal research is needed to determine the causative roles of these ELF play in the occurrence of SPD by using rigorous measurements. These findings call for awareness of the modifiable ELF for SPD and also inform possible future interventions to reduce these risks, such as parent-training or environmental enrichment programmes.