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ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice

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Abstract

Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.

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Acknowledgments

Peter Fonagy is in receipt of funding from the UK National Institute of Health Research (Senior Investigator Award NF-SI-0514-10157). Mario Speranza wishes to thank all the colleagues from the European French Speaking Research Network on Borderline Personality Disorders in Adolescence (EURNET BPD), and in particular Maurice Corcos and Alexandra Pham-Scottez, for their valuable support. Patrick Luyten wishes to thank the MBT team at the Viersprong Institute (The Netherlands) for their support throughout the years. Michael Kaess would like to thank Andrew Chanen from the HYPE programme as well as Romuald Brunner and Franz Resch from his department in Heidelberg (Germany) for their mentoring in the field of adolescent self-harm and BPD. Christel Hessels would like to thank Marcel van Aken from Utrecht University as well as colleagues in the BPD expert group of the Center of Expertise of Child and Adolescent Psychiatry (The Netherlands). The work of Martin Bohus is mainly supported by the German Research Foundation Center Grant ‘Mechanisms of disturbed emotion processing in borderline personality disorder’ (KFO 256).

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Authors and Affiliations

  1. Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK

    Peter Fonagy & Patrick Luyten

  2. Department of Child and Adolescent Psychiatry, Versailles General Hospital, Faculty of Health Sciences, Research Unit EA4047, University of Versailles Saint-Quentin-en-Yvelines, 177 rue de Versailles, 78157, Le Chesnay, France

    Mario Speranza

  3. Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, Box 3722, 3000, Leuven, Belgium

    Patrick Luyten

  4. Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Blumenstrasse 8, 69115, Heidelberg, Germany

    Michael Kaess

  5. Expertise Centre for Personality Disorders, GGz Centraal, PO Box 3051, 3800 DB, Amersfoort, The Netherlands

    Christel Hessels

  6. Department of Psychosomatics and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany

    Martin Bohus

  7. Faculty of Health, University of Antwerp, Antwerp, Belgium

    Martin Bohus

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  1. Peter Fonagy
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Fonagy, P., Speranza, M., Luyten, P. et al. ESCAP Expert Article: Borderline personality disorder in adolescence: An expert research review with implications for clinical practice. Eur Child Adolesc Psychiatry 24, 1307–1320 (2015). https://doi.org/10.1007/s00787-015-0751-z

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