Orygen, Melbourne, Australia.
Centre for Youth Mental Health, The University of Melbourne, Australia.
Can J Psychiatry. 2022 Jan;67(1):26-38. doi: 10.1177/0706743721992677. Epub 2021 Feb 12.
The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group.
One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; = 64) and older (aged 18 to 25 years; = 75) participants were compared on these same variables using -tests, chi-square tests, and logistic regression.
Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age.
Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.
对青少年人格障碍的日益关注往往忽视了从青春期到成年早期这一阶段发展连续性的证据。本研究旨在：(1)描述一组无先前基于证据的治疗人格障碍病史的边缘型人格障碍（BPD）年轻人的特征；(2)按参与者年龄组比较其特征。
139 名新入组监测青少年 BPD 结局的随机对照试验（Monitoring Outcomes of BPD in Youth，MOBY）的年轻 BPD 患者（15 至 25 岁）完成了半结构化访谈和自我报告量表，评估人口统计学、临床和功能特征。使用 t 检验、卡方检验和逻辑回归比较年轻（15 至 17 岁；n=64）和年长（18 至 25 岁；n=75）患者在这些相同变量上的差异。
患有 BPD 的年轻门诊患者具有广泛而严重的精神病理学，功能较差。BPD 青少年和年轻成年人在他们表现的 20 个关键方面存在显著相似性。在家庭构成、治疗史、反社会人格障碍、情绪调节障碍、物质使用、自残起始年龄和程度以及达到适当年龄的教育里程碑方面，两组之间存在显著差异。青少年 BPD 组的成员资格由家庭组成和自残预测，而年轻的 BPD 组的成员资格由未达到适当年龄的里程碑、职业脱离和情绪调节障碍预测。最终模型解释了 54%的方差，正确分类了 80.2%的样本。
处于早期阶段的 BPD 青少年和年轻成年人彼此之间存在严重且通常相似的问题，这支持了这一年龄段的发展连续性。然而，在表现上也存在有意义的差异，这表明治疗途径可能因年龄和/或发育阶段而异。人格障碍的检测和干预不应推迟到 18 岁以后。
