University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
Psychol Med. 2024 Jul;54(9):2033-2041. doi: 10.1017/S0033291724000126. Epub 2024 Feb 12.
Psychological treatments for young people with sub-threshold or full-syndrome borderline personality disorder (BPD) are found to be effective. However, little is known about the age at which adolescents benefit from early intervention. This study investigated whether age affects the effectiveness of early intervention for BPD.
= 626 participants ( age = 15 years, 82.7% female) were consecutively recruited from a specialized outpatient service for early intervention in BPD in adolescents aged 12- to 17-years old. DSM-IV BPD criteria were assessed at baseline, one-year ( = 339) and two-year ( = 279) follow-up.
Older adolescents presented with more BPD criteria (χ = 58.23, < 0.001) and showed a steeper decline of BPD criteria over the 2-year follow-up period compared with younger adolescents (χ = 13.53, = 0.001). In an attempt to disentangle effects of early intervention from the natural course of BPD, a parametrized regression model was used. An exponential decrease ( = 0.10, < 0.001) in BPD criteria was found when starting therapy over the 2-year follow-up. This deviation from the natural course was impacted by age at therapy commencement ( = 0.06, < 0.001), although significant across all ages: older adolescents showed a clear decrease in BPD criteria, and young adolescents a smaller decrease.
Early intervention appears effective across adolescence, but manifests differently: preventing the normative increase of BPD pathology expected in younger adolescents, and significantly decreasing BPD pathology in older adolescents. The question as to whether developmentally adapted therapeutic interventions could lead to an even increased benefit for younger adolescents, should be explored in future studies.
针对阈下或全综合征边缘型人格障碍（BPD）的年轻人的心理治疗被证明是有效的。然而，对于青少年从早期干预中获益的年龄知之甚少。本研究调查了年龄是否会影响 BPD 的早期干预效果。
从专门的青少年边缘型人格障碍早期干预门诊连续招募了 626 名参与者（年龄 15 岁，82.7%为女性），年龄在 12 至 17 岁之间。在基线、一年（n=339）和两年（n=279）随访时评估 DSM-IV BPD 标准。
较年长的青少年表现出更多的 BPD 标准（χ=58.23，<0.001），并且与较年轻的青少年相比，在两年的随访期间 BPD 标准下降更为陡峭（χ=13.53，=0.001）。为了将早期干预的效果与 BPD 的自然病程分开，我们使用了参数回归模型。在两年的随访期间，当开始治疗时，BPD 标准呈指数下降（=0.10，<0.001）。这种偏离自然病程的情况受到治疗开始时年龄的影响（=0.06，<0.001），尽管在所有年龄段都有显著差异：较年长的青少年 BPD 标准明显下降，而较年轻的青少年则下降较小。
早期干预在整个青春期似乎都是有效的，但表现方式不同：预防年轻青少年中预期的 BPD 病理的正常增加，并显著降低年长青少年的 BPD 病理。未来的研究应探讨是否针对青少年发展阶段的治疗干预可以为年轻青少年带来更大的益处。
