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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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