Bourvis Nadège, Cohen David, Benarous Xavier
Centre Hospitalier Intercommunal Toulon la Seyne (CHITS), 83000 Toulon, France.
Maison des Adolescents du Var, 83000 Toulon, France.
J Clin Med. 2023 Oct 21;12(20):6668. doi: 10.3390/jcm12206668.
Borderline personality disorder (BPD) has long suffered from overshadowing in adolescents and hopelessness from the psychiatrists themselves. Comprehensive guidelines for this age group are lacking.
This narrative review aims to describe current recommendations for BPD and recent empirical evidence on effective treatments (both pharmacological and non-pharmacological) and preventive approaches. Innovative approaches, based on recent and original research on BPD adolescents, are also discussed.
Very low-certainty evidence has supported that medication has a positive effect on core BPD symptoms in adolescents. Medication prescribed for suicidal crises or associated disorders should be included in a global therapeutic plan, including efficacy reassessment, treatment duration, and a security plan. The overall benefit of structured psychotherapy for adolescents with BPD (cognitive behavioral therapy, mentalization-based therapy, dialectic behavioral therapy, and group therapy) is more important for self-harm behaviors than other BPD symptoms. Their specific efficacy, although difficult to distinguish from the overall non-specific effect of integrative care.
structured care of young BPD individuals should be based on the following principles: (1) setting the frame of care, including recognition of the diagnosis, and sharing information with patients and families about symptoms, prognosis, and putative psychological mechanisms involved; and (2) promoting comprehensive approaches, including both specific and non specific therapy, ecological interventions, community care, and preventive interventions in at-risk groups.
边缘型人格障碍（BPD）长期以来在青少年群体中被忽视，甚至连精神科医生自身也对此感到绝望。目前缺乏针对该年龄组的综合指南。
本叙述性综述旨在描述当前针对BPD的建议以及关于有效治疗方法（包括药物治疗和非药物治疗）和预防措施的最新实证证据。同时也将讨论基于对BPD青少年的最新原创研究的创新方法。
极低确定性证据支持药物治疗对青少年BPD的核心症状有积极作用。用于自杀危机或相关疾病的药物应纳入整体治疗计划，包括疗效重新评估、治疗持续时间和安全计划。结构化心理治疗（认知行为疗法、基于心理化的疗法、辩证行为疗法和团体疗法）对BPD青少年的自我伤害行为的总体益处比对其他BPD症状更为重要。尽管难以将其特定疗效与综合护理的总体非特异性效果区分开来。
对年轻BPD患者的结构化护理应基于以下原则：（1）设定护理框架，包括诊断的识别，并与患者及家属分享有关症状、预后和涉及的假定心理机制的信息；（2）推广综合方法，包括特异性和非特异性治疗、生态干预、社区护理以及对高危群体的预防性干预。
