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Clinical and psychosocial outcomes of borderline personality disorder in childhood and adolescence: a systematic review

Published online by Cambridge University Press:  24 March 2015

C. Winsper ,
S. Marwaha ,
S. T. Lereya ,
A. Thompson ,
J. Eyden  and
S. P. Singh
C. Winsper*
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
S. Marwaha
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
S. T. Lereya
Affiliation:
Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
A. Thompson
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
J. Eyden
Affiliation:
Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
S. P. Singh
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
*
* Address for correspondence: C. Winsper, Ph.D., Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK (Email: [email protected])
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Abstract

Background

While there is a growing body of research on borderline personality disorder (BPD) in children and adolescents, controversy remains regarding the validity and diagnosis of the disorder prior to adulthood.

Method

MEDLINE, EMBASE, Psych INFO and PubMed databases were systematically searched for articles pertaining to the clinical and psychosocial outcomes (i.e. predictive validity) of BPD first diagnosed in childhood or adolescence (i.e. prior to 19 years of age). All primary empirical studies were included in the review. A narrative synthesis of the data was completed.

Results

A total of 8200 abstracts were screened. Out of 214 full-text articles, 18 satisfied the predetermined inclusion criteria. Quality assessment indicated that most studies had high risk of bias in at least one study domain. Consistent with the adult literature, the diagnostic stability of BPD prior to the age of 19 years was low to moderate, and mean-level and rank-order stability, moderate to high. Individuals with BPD symptoms in childhood or adolescence had significant social, educational, work and financial impairment in later life.

Conclusions

Studies indicate that borderline pathology prior to the age of 19 years is predictive of long-term deficits in functioning, and that a considerable proportion of individuals continue to manifest borderline symptoms up to 20 years later. These findings provide some support for the clinical utility of the BPD phenotype in younger populations, and suggest that an early intervention approach may be warranted. Further prospective studies are needed to delineate risk (and protective) factors pertinent to the chronicity of BPD across the lifespan.

Keywords

Adolescenceborderline personality disorderchildhoodpredictive validitysystematic reviewsyouth
Type
Review Article
Information
Psychological Medicine , Volume 45 , Issue 11 , August 2015 , pp. 2237 - 2251
Copyright
Copyright © Cambridge University Press 2015 

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References

Allott, K, Chanen, A, Yuen, HP (2006). Attrition bias in longitudinal research involving adolescent psychiatric outpatients. Journal of Nervous and Mental Disease 194, 958–961.CrossRefGoogle ScholarPubMed
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.Google Scholar
Barasch, A, Frances, A, Hurt, S, Clarkin, J, Cohen, S (1985). Stability and distinctness of borderline personality disorder. American Journal of Psychiatry 142, 1484–1486.Google ScholarPubMed
Bemporad, JR, Smith, HF, Hanson, G, Cicchetti, D (1982). Borderline syndromes in childhood: criteria for diagnosis. American Journal of Psychiatry 139, 596–602.Google ScholarPubMed
Bender, DS, Dolan, RT, Skodol, AE, Sanislow, CA, Dyck, IR, McGlashan, TH, Shea, MT, Zanarini, MC, Oldham, JM, Gunderson, JG (2001). Treatment utilization by patients with personality disorders. American Journal of Psychiatry 158, 295–302.CrossRefGoogle ScholarPubMed
Bernstein, DP, Cohen, P, Velez, CN, Schwab-Stone, M, Siever, LJ, Shinsato, L (1993). Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents. American Journal of Psychiatry 150, 1237–1243.Google Scholar
Biskin, RS, Paris, J, Renaud, J, Raz, A, Zelkowitz, P (2011). Outcomes in women diagnosed with borderline personality disorder in adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry 20, 168–174.Google ScholarPubMed
Black, DW, Blum, N, Pfohl, B, Hale, N (2004). Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders 18, 226–239.CrossRefGoogle ScholarPubMed
Black, DW, Gunter, T, Allen, J, Blum, N, Arndt, S, Wenman, G, Sieleni, B (2007). Borderline personality disorder in male and female offenders newly committed to prison. Comprehensive Psychiatry 48, 400–405.CrossRefGoogle ScholarPubMed
Bondurant, H, Greenfield, B, Tse, SM (2004). Construct validity of the adolescent borderline personality disorder: a review. Canadian Child and Adolescent Psychiatry Review 13, 53–57.Google ScholarPubMed
Bornovalova, MA, Hicks, BM, Iacono, WG, McGue, M (2009). Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: a longitudinal twin study. Development and Psychopathology 21, 1335–1353.CrossRefGoogle ScholarPubMed
Bornovalova, MA, Hicks, BM, Iacono, WG, McGue, M (2013). Longitudinal twin study of borderline personality disorder traits and substance use in adolescence: developmental change, reciprocal effects, and genetic and environmental influences. Personality Disorders: Theory, Research, and Treatment 4, 23–32.CrossRefGoogle ScholarPubMed
Chanen, AM, Jackson, HJ, McCutcheon, LK, Jovev, M, Dudgeon, P, Yuen, HP, Germano, D, Nistico, H, McDougall, E, Weinstein, C (2008 a). Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. British Journal of Psychiatry 193, 477–484.CrossRefGoogle ScholarPubMed
Chanen, AM, Jackson, HJ, McGorry, PD, Allot, KA, Clarkson, V, Yuen, HP (2004). Two-year stability of personality disorder in older adolescent outpatients. Journal of Personality Disorders 18, 526–541.CrossRefGoogle ScholarPubMed
Chanen, AM, Jovev, M, McCutcheon, LK, Jackson, HJ, McGorry, PD (2008 b). Borderline personality disorder in young people and the prospects for prevention and early intervention. Current Psychiatry Reviews 4, 48–57.CrossRefGoogle Scholar
Chanen, AM, Kaess, M (2012). Developmental pathways to borderline personality disorder. Current Psychiatry Reports 14, 45–53.CrossRefGoogle ScholarPubMed
Chanen, AM, McCutcheon, LK (2008). Personality disorder in adolescence: the diagnosis that dare not speak its name. Personality and Mental Health 2, 35–41.CrossRefGoogle Scholar
Chanen, AM, Thompson, K (2014). Preventive strategies for borderline personality disorder in adolescents. Current Treatment Options in Psychiatry 1, 358–368.CrossRefGoogle Scholar
Chen, H, Cohen, P, Johnson, JG, Kasen, S, Sneed, JR, Crawford, TN (2004). Adolescent personality disorders and conflict with romantic partners during the transition to adulthood. Journal of Personality Disorders 18, 507–525.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum: Hillsdale, NJ.Google Scholar
Cohen, P, Chen, H, Crawford, TN, Brook, JS, Gordon, K (2007). Personality disorders in early adolescence and the development of later substance use disorders in the general population. Drug and Alcohol Dependence 88, S71–S84.CrossRefGoogle ScholarPubMed
Crick, NR, Murray-Close, D, Woods, K (2005). Borderline personality features in childhood: a short-term longitudinal study. Development and Psychopathology 17, 1051–1070.CrossRefGoogle ScholarPubMed
Crowell, SE, Beauchaine, TP, Linehan, MM (2009). A biosocial developmental model of borderline personality: elaborating and extending Linehan's theory. Psychological Bulletin 135, 495–510.CrossRefGoogle ScholarPubMed
Daley, SE, Burge, D, Hammen, C (2000). Borderline personality disorder symptoms as predictors of 4-year romantic relationship dysfunction in young women: addressing issues of specificity. Journal of Abnormal Psychology 109, 451–460.CrossRefGoogle ScholarPubMed
Ferro, T, Klein, DN, Schwartz, JE, Kasch, KL, Leader, JB (1998). 30-Month stability of personality disorder diagnoses in depressed outpatients. American Journal of Psychiatry 155, 653–659.CrossRefGoogle ScholarPubMed
Fossati, A, Gratz, KL, Maffei, C, Borroni, S (2013). Emotion dysregulation and impulsivity additively predict borderline personality disorder features in Italian nonclinical adolescents. Personality and Mental Health 7, 320–333.CrossRefGoogle ScholarPubMed
Garnet, KE, Levy, KN, Mattanah, JJ, Edell, WS, McGlashan, TH (1994). Borderline personality disorder in adolescents: ubiquitous or specific? American Journal of Psychiatry 151, 1380–1382.Google ScholarPubMed
Griffiths, M (2011). Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists. Psychiatrist 35, 19–22.CrossRefGoogle Scholar
Grilo, CM, Becker, DF, Edell, WS, McGlashan, TH (2001). Stability and change of DSM-III-R personality disorder dimensions in adolescents followed up 2 years after psychiatric hospitalization. Comprehensive Psychiatry 42, 364–368.CrossRefGoogle ScholarPubMed
Hammersley, M (2001). On ‘systematic’ reviews of research literatures: a ‘narrative’ response to Evans & Benefield. British Educational Research Journal 27, 543–554.CrossRefGoogle Scholar
Higgins, JPT, Altman, DG (2008). Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series (ed. Higgins, J. P. T. and Green, S.), pp. 187–241. John Wiley & Sons Ltd: Chichester.CrossRefGoogle Scholar
Johnson, JG, Cohen, P, Kasen, S, Skodol, AE, Hamagami, F, Brook, JS (2000). Age-related change in personality disorder trait levels between early adolescence and adulthood: a community-based longitudinal investigation. Acta Psychiatrica Scandinavica 102, 265–275.CrossRefGoogle ScholarPubMed
Johnson, JG, Williams, JB, Goetz, RR, Rabkin, JG, Lipsitz, JD, Remien, RH (1997). Stability and change in personality disorder symptomatology: findings from a longitudinal study of HIV+ and HIV– men. Journal of Abnormal Psychology 106, 154–158.CrossRefGoogle ScholarPubMed
Jovev, M, Whittle, S, Yücel, M, Simmons, JG, Allen, NB, Chanen, AM (2014). The relationship between hippocampal asymmetry and temperament in adolescent borderline and antisocial personality pathology. Development and Psychopathology 26, 275–285.CrossRefGoogle ScholarPubMed
Kullgren, G, Renberg, E, Jacobsson, L (1986). An empirical study of borderline personality disorder and psychiatric suicides. Journal of Nervous and Mental Disease 174, 328–331.CrossRefGoogle ScholarPubMed
Laurenssen, EMP, Hutsebaut, J, Feenstra, DJ, Van Busschbach, JJ, Luyten, P (2013). Diagnosis of personality disorders in adolescents: a study among psychologists. Child and Adolescent Psychiatry and Mental Health 7, 3.CrossRefGoogle ScholarPubMed
Leichsenring, F, Leibing, E, Kruse, J, New, AS, Leweke, F (2011). Borderline personality disorder. Lancet 377, 74–84.CrossRefGoogle ScholarPubMed
Lenzenweger, MF (1999). Stability and change in personality disorder features: The Longitudinal Study of Personality Disorders. Archives of General Psychiatry 56, 1009–1015.CrossRefGoogle ScholarPubMed
Lofgren, DP, Bemporad, J, King, J, Lindem, K, O'Driscoll, G (1991). A prospective follow-up study of so-called borderline children. American Journal of Psychiatry 148, 1541–1547.Google ScholarPubMed
Loranger, AW, Sartorius, N, Andreoli, A, Berger, P, Buchheim, P, Channabasavanna, S, Coid, B, Dahl, A, Diekstra, RF, Ferguson, B (1994). The International Personality Disorder Examination: The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders. Archives of General Psychiatry 51, 215–224.CrossRefGoogle ScholarPubMed
Mattanah, JJ, Becker, DF, Levy, KN, Edell, WS, McGlashan, TH (1995). Diagnostic stability in adolescents followed up 2 years after hospitalization. American Journal of Psychiatry 152, 889–894.Google ScholarPubMed
Meijer, M, Goedhart, AW, Treffers, PD (1998). The persistence of borderline personality disorder in adolescence. Journal of Personality Disorders 12, 13–22.CrossRefGoogle ScholarPubMed
Miller, AL, Muehlenkamp, JJ, Jacobson, CM (2008). Fact or fiction: diagnosing borderline personality disorder in adolescents. Clinical Psychology Review 28, 969–981.CrossRefGoogle ScholarPubMed
Moffitt, TE, Caspi, A (2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Development and Psychopathology 13, 355–375.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine 151, 264–269.CrossRefGoogle ScholarPubMed
Paris, J (1997). Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology? Comprehensive Psychiatry 38, 237–242.CrossRefGoogle ScholarPubMed
Paris, J (2013). Personality disorders begin in adolescence. Journal of the Canadian Academy of Child and Adolescent Psychiatry 22, 195–196.Google ScholarPubMed
Paris, J, Brown, R, Nowlis, D (1987). Long-term follow-up of borderline patients in a general hospital. Comprehensive Psychiatry 28, 530–535.CrossRefGoogle ScholarPubMed
Pope, HG, Jonas, JM, Hudson, JI, Cohen, BM, Gunderson, JG (1983). The validity of DSM-III borderline personality disorder: a phenomenologic, family history, treatment response, and long-term follow-up study. Archives of General Psychiatry 40, 23–30.CrossRefGoogle ScholarPubMed
Reed, GM, Lux, JB, Bufka, LF, Trask, C, Peterson, DB, Stark, S, Threats, TT, Jacobson, JW, Hawley, JA (2005). Operationalizing the international classification of functioning, disability and health in clinical settings. Rehabilitation Psychology 50, 122–131.CrossRefGoogle Scholar
Roberts, BW, DelVecchio, WF (2000). The rank-order consistency of personality traits from childhood to old age: a quantitative review of longitudinal studies. Psychological Bulletin 126, 3–25.CrossRefGoogle ScholarPubMed
Rossouw, TI, Fonagy, P (2012). Mentalization-based treatment for self-harm in adolescents: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry 51, 1304–1313.e3.CrossRefGoogle ScholarPubMed
Sayers, A (2007). Tips and tricks in performing a systematic review. British Journal of General Practice 57, 425.CrossRefGoogle ScholarPubMed
Schuppert, HM, Timmerman, ME, Bloo, J, van Gemert, TG, Wiersema, HM, Minderaa, RB, Emmelkamp, PM, Nauta, MH (2012). Emotion regulation training for adolescents with borderline personality disorder traits: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry 51, 1314–1323.e2.CrossRefGoogle ScholarPubMed
Skodol, AE, Bender, DS (2003). Why are women diagnosed borderline more than men? Psychiatric Quarterly 74, 349–360.CrossRefGoogle ScholarPubMed
Skodol, AE, Gunderson, JG, McGlashan, TH, Dyck, IR, Stout, RL, Bender, DS, Grilo, CM, Shea, MT, Zanarini, MC, Morey, LC (2002). Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive–compulsive personality disorder. American Journal of Psychiatry 159, 276–283.CrossRefGoogle ScholarPubMed
Stepp, SD, Whalen, DJ, Scott, LN, Zalewski, M, Loeber, R, Hipwell, AE (2014). Reciprocal effects of parenting and borderline personality disorder symptoms in adolescent girls. Development and Psychopathology 26, 361–378.CrossRefGoogle ScholarPubMed
Van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine 39, 179–195.CrossRefGoogle ScholarPubMed
Vela, R, Gottlieb, E, Gottlieb, H (1983). Borderline syndromes in childhood: a critical review. In The Borderline Child: Approaches to Etiology, Diagnosis, and Treatment (ed. Robson, K. S.), pp. 31–48. McGraw-Hill: New York.Google Scholar
Wenning, K (1990). Borderline children: a closer look at diagnosis and treatment. American Journal of Orthopsychiatry 60, 225–232.CrossRefGoogle Scholar
Winograd, G, Cohen, P, Chen, H (2008). Adolescent borderline symptoms in the community: prognosis for functioning over 20 years. Journal of Child Psychology and Psychiatry 49, 933–941.CrossRefGoogle ScholarPubMed
Winsper, C, Zanarini, M, Wolke, D (2012). Prospective study of family adversity and maladaptive parenting in childhood and borderline personality disorder symptoms in a non-clinical population at 11 years. Psychological Medicine 42, 2405–2420.CrossRefGoogle Scholar
Wolke, D, Schreier, A, Zanarini, MC, Winsper, C (2012). Bullied by peers in childhood and borderline personality symptoms at 11 years of age: a prospective study. Journal of Child Psychology and Psychiatry 53, 846–855.CrossRefGoogle ScholarPubMed
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. WHO: Geneva.Google Scholar
Zanarini, MC, Frankenburg, F, Hennen, J, Reich, D, Silk, K (2006). Prediction of the 10-year course of borderline personality disorder. American Journal of Psychiatry 163, 827–832.CrossRefGoogle ScholarPubMed
Zelkowitz, P, Paris, J, Guzder, J, Feldman, R, Roy, C, Rosval, L (2007). A five-year follow-up of patients with borderline pathology of childhood. Journal of Personality Disorders 21, 664–674.CrossRefGoogle ScholarPubMed