Tuesday, July 23, 2019

Borderline Symptoms at Age 12 Predict a Variety of Negative Outcomes at Age 18

Twelve-year-old children who exhibit symptoms associated with borderline personality disorder—such as experiencing extremes of rage, despair, or excitement—are at higher risk of having poor mental health by age 18, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry. The study also found these youth are more likely than their peers to be victims of violence and experience poor educational and employment outcomes.

Some mental health professionals are reluctant to diagnose borderline symptoms in young teenagers because it is regarded by some as a stigmatizing diagnosis, noted Jasmin Wertz, Ph.D., of the Department of Psychology and Neurosciences at Duke University and colleagues. “[O]ur findings argue in favor of early access to treatment for adolescents with borderline symptoms and against a ‘wait-and-see’ approach.”

A total of 2,232 British children in the Environmental Risk Longitudinal Twin Study (representing 1,116 families with same sex twins) were assessed during home visits at age 5, 7, 10, and 12; during these visits their mothers were also interviewed. At age 18, the participants were interviewed alone.

When the participants were 12, the researchers asked their mothers to rate how well a list of attributes described their children; the list included such statements as “easily jealous,” “emotions spiral out of control, has extremes of rage, despair, or excitement,” “angry and hostile,” and “engages in self-harm behavior.” Six years later, the researchers evaluated the participants for a variety of mental health disorders (including alcohol use disorder, conduct disorder, and depression) and asked them about history of suicide attempts and self-harm, academic and employment achievement, and experiences of victimization. This information was corroborated using reports by co-informants nominated by each twin (typically their co-twin and a parent) and official records.

Participants with more borderline symptoms at age 12 experienced worse mental health at age 18 compared with their peers with fewer symptoms: They were more likely to meet diagnostic criteria for a mental disorder, to have attempted suicide or engaged in self-harm, and to have used clinical and support services to cope with emotional and behavioral problems. They were also more likely to report experiencing of victimization during adolescence, performing poorly in school, and unemployment, the authors reported.

“Our findings show that adolescents’ borderline symptoms signal a longer-term need for care,” the researchers wrote. “Adolescents should be monitored and supported accordingly, particularly during the transition to adulthood when they face discharge from child and adolescent mental health services.”

For related information, see the Psychiatric News article “Experts Offer Guidance for Treating Patients With Borderline Personality Disorder” and the Psychiatric Services article “Treatment of Borderline Personality Disorder: Is Supply Adequate to Meet Public Health Needs?

(Image: iStock/kali9)


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.