An 11-item measure to assess borderline traits in adolescents: refinement of the BPFSC using IRT

Diagnosis and Treatment of Borderline Personality Disorder in Young People

PURPOSE OF REVIEW

We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment.

RECENT FINDINGS

Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.

Psychometric Properties of the French Version of the Borderline Personality Features Scale for Children and Adolescents

Background:

The Borderline Personality Feature Scale for Children (BPFS-C) is currently the only dimensional measure of child and adolescent borderline features and the English version has been shown to have good psychometric properties. To extend the use of this measure with French speaking adolescents, it is essential to examine the reliability and validity of the French BPFS-C.

Objective:

The present study sought to assess the psychometric properties of the French BPFS-C.

Methods:

A community sample of 394 adolescents and young adults completed the Borderline Personality Features Scale for Children (BPFS-C), as well as the Million Adolescent Clinical Inventory (MACI) borderline tendency subscale, the Child Behavior Checklist- Youth Self-Report (CBCL-YSR) and the Beck Youth Inventories (BYI).

Results:

The findings show that both the long and short French BPFS-C have good internal consistency and convergent validity. Affect regulation, identity, relationship difficulties and self-harm were found to be closely inter-connected rather than distinct factors.

Conclusion:

The findings indicate that both long and short versions of French BPFS-C have good psychometric properties and provide preliminary evidence that the total scores are reliable and valid indicators of borderline personality features in adolescents and young adults.

Evaluating the Psychometric Properties of the Short Dark Triad (SD3) in Italian Adults and Adolescents

Abstract. The term Dark Triad refers to three socially aversive personality dimensions (i.e., Machiavellianism, narcissism, and psychopathy) that are evident in the normal range of personality. Jones and Paulhus (2014) developed the Short Dark Triad (SD3) as a 27-item measure of the three constructs. To assess the psychometric properties of the Italian translation, 678 adult university students and 442 adolescent high school students were sampled. Cronbach’s α values for the subscales were acceptable in both samples. Subscale intercorrelations ranged from .29 to .55 in adults and .29 to .53 in adolescents. Although subscale means were higher in the adolescent sample, the two item correlation matrices did not differ significantly. A confirmatory factor analysis using multidimensional full-information item response theory showed that a three-correlated-factor model provided the best fit in both adults and adolescents. When controlled for overlap, SD3 subscales showed adequate convergent and discriminant validity coefficients in both samples. The current research contributes to the literature on dark personalities in two ways: (a) It provides detailed psychometric support for the Italian translation of SD3 and (b) it directly compares SD3 performance in younger and older students.

Is mentalization-based therapy effective in treating the symptoms of borderline personality disorder? A systematic review

OBJECTIVE

This review sought to systematically review evidence on the efficacy of mentalization-based therapy (MBT) for the treatment of borderline personality disorder (BPD), in particular, in decreasing psychiatric symptoms associated with BPD and its comorbid disorders.

METHOD

Fourteen papers were included in the review which examined the effectiveness of MBT in the context of BPD; these included 11 original studies and three follow-up papers.

RESULTS

Mentalization-based therapy was found to achieve either superior or equal reductions in psychiatric symptoms when compared with other treatments (supportive group therapy, treatment as usual/standard psychiatric care, structured clinical management, and specialized clinical management).

DISCUSSION

Mentalization-based therapy can achieve significant reductions in BPD symptom severity and the severity of comorbid disorders as well as increase quality of life. However, caution is required, as the need for better quality research such as randomized controlled trials is pressing. Research is also needed on the proposed mediators of MBT.

PRACTITIONER POINTS

Mentalization-based therapy (MBT) is increasingly being considered as a treatment for people with borderline personality disorder (BPD), and a systematic review was required to investigate its effectiveness. MBT was found to be equally as effective or superior to well-established comparison treatments of BPD, however, the majority of studies was of unsatisfying quality. Little is known about the mechanisms of MBT. Further, better quality trials are needed to investigate its efficacy in treating BPD.

Assessment of Personality Functioning in Adolescents With the LoPF-Q 12-18 Self-Report Questionnaire

The classification of personality disorders (PDs) is in transition. The shortcomings of the categorical PD diagnoses led to the development of the Alternative Model for Personality Disorders (AMPD) in Section III of the DSM-5 regarding a dimensional differentiation of severity of personality pathology. Impairments in personality functioning are defined as a general Criterion A for PD. Inspired by the AMPD, the LoPF-Q 12-18 was developed to assess Levels of Personality Functioning (LoPF) dimensionally in adolescents from 12 to 18 years old in self-report. The questionnaire shows good scale reliabilities, good construct validity by demonstrating a systematic variation with pathology in line with theory, and a valuable clinical utility. The results suggest that the LoPF-Q 12-18 questionnaire is a clinically useful instrument to assess personality pathology in young people and that the concept of personality functioning is useful in detecting and describing central impairments of PD pathology at an early stage of development.

Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial

BACKGROUND

Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents.

METHODS

The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables.

RESULTS

Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm.

CONCLUSIONS

It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population.

TRIAL REGISTRATION

NCT02771691 ; Trial Registration Date: 25/04/2016.

Der OPD-KJ2-SF – Ein Instrument zur Erfassung der Achse Struktur der OPD-KJ-2 bei Jugendlichen im Selbsturteil

Zusammenfassung. Die Erfassung der Strukturdimensionen nach OPD-KJ-2 ist neben ihrer therapeutischen Relevanz vor dem Hintergrund ihrer inhaltlichen Nähe zu gegenwärtig diskutierten dimensionalen Herangehensweisen in der Diagnostik von Persönlichkeitsstörungen im DSM-5 und in der ICD-11 von hoher Aktualität. Im Rahmen dieser Studie erfolgte eine Evaluation der psychometrischen Gütekriterien des neu entwickelten Fragenbogens OPD-KJ-2-SF zur Erfassung der Strukturdimensionen im Jugendalter. Die Untersuchung wurde anhand einer gemischten klinischen und nichtklinischen Stichprobe (N = 589) durchgeführt. Der OPD-KJ2-SF zeigte sehr gute psychometrische Kennwerte mit guten Skalenreliabilitäten von .87 bis .98 Cronbachs Alpha auf Gesamt- und Hauptskalenebene. Alle Hauptskalen diskriminierten hoch signifikant mit Effektstärken (d) von 1.4 bis 1.6 zwischen den Schüler_innen und Patient_innen mit Persönlichkeitsstörungen. Der OPD-KJ2-SF erscheint als ein reliables und valides Instrument zur Erfassung von strukturellen Beeinträchtigungen im Jugendalter.

Borderline Personality Features Scale for Children-11: Measurement invariance over time and across gender in a community sample of adolescents

The Borderline Personality Features Scale for Children (BPFS-C) was recently shortened using item response theory to an 11-item version that is optimal for use in epidemiological studies and repeated assessment over time. Only 1 study has examined invariance of the BPFS-C-11 items across gender and no study has done so over time. The present study employed a longitudinal design to address this gap by evaluating measurement invariance across gender and over time during the transition into adulthood in a diverse community-based sample of 755 adolescents (56% female). Results indicated measurement variance for items measuring personal relationships and impulsivity/recklessness, with females having a greater probability of endorsing items regarding relationship instability and males more likely to endorse impulsivity, despite an equal position on the latent trait. Overall, there was partial measurement invariance of a single dimension of borderline features between males and females and full longitudinal invariance of this factor through the transition into young adulthood. The current findings provide empirical evidence supporting the reliability of BPFS-C-11 scores as a measure of borderline pathology (BP) during late adolescence and early adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Psychometric Properties of the Borderline Personality Features Scale for Children-11 (BPFSC-11) in a Sample of Community Dwelling Italian Adolescents

Abstract. The aims of the current study were to assess the psychometric properties of the Borderline Personality Features Scale for Children-11 (BPFSC-11) in adolescence. In particular, we aim at evaluating: the internal consistency and six-month test-retest reliability of the Italian translation of the BPFSC-11, its factor structure, and its convergent validity. Eight hundred five community dwelling adolescents were administered the Italian translations of the BPFSC-11 and Personality Diagnostic Questionnaire-4+(PDQ-4+) Borderline Personality Disorder (BPD) scale. The BPFSC-11 showed adequate internal consistency (Cronbach’s α = .78) and moderate six-month test-retest stability. Although confirmatory factor analysis did not support a one-factor model of the BPFSC-11 items, a bi-factor model (RMSEA = .04) showed that all BPFSC-11 items loaded significantly onto a general common factor, with two specific factors capturing largely residual variance due to distribution artifacts. In this study, the bivariate correlation between the BPFSC-11 and the PDQ-4+BPD scale was .64 ( p < .001). Finally, the BPFSC-11 showed gender invariance across items. In summary, our findings support the reliability and validity of the BPFSC-11 as a measure of self-reported borderline personality features in community dwelling adolescents.

Adolescence as a Sensitive Period for the Development of Personality Disorder

Over the last 15 years, controversy over the construct of adolescent personality disorder has largely been laid to rest because of accumulating empirical evidence in support of its construct validity. In this article, four conclusions that can be drawn from recent literature on borderline disorder in adolescents are discussed, with the ultimate goal of building an argument to support the idea that adolescence is a sensitive period for the development of personality disorder.

Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies

Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-V) criteria as in adults, borderline personality disorder (BPD) in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least five of the following domains: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation. BPD can be reliably diagnosed in adolescents as young as 11 years. The available epidemiological studies suggest that the prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% in adolescents consulting at an outpatient clinic to 78% in suicidal adolescents attending an emergency department. The diagnostic procedure is based on a clinical assessment with respect to developmental milestones and the interpersonal context. The key diagnostic criterion is the 1-year duration of symptoms. Standardized, clinician-rated instruments are available for guiding this assessment (eg, the Diagnostic Interview for Borderlines-Revised and the Childhood Interview for DSM-IV-TR BPD). The assessment should include an evaluation of the suicidal risk. Differential diagnosis is a particular challenge, given the high frequency of mixed presentations and comorbidities. With respect to clinical and epidemiological studies, externalizing disorders in childhood constitute a risk factor for developing BPD in early adolescence, whereas adolescent depressive disorders are predictive of BPD in adulthood. The treatment of adolescents with BPD requires commitment from the parents, a cohesive medical team, and a coherent treatment schedule. With regard to evidence-based medicine, psychopharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Supportive psychotherapy is the most commonly available first-line treatment. Randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy).

Validation of a Symptoms Distress Scale in a Cirrhotic Population Using Item Response Theory

BACKGROUND

The assessment of symptoms distress is an important strategy for symptoms management and treatment of patients with liver cirrhosis (LC); however, appropriate instruments are limited.

OBJECTIVE

The objective of this study was to validate a symptoms distress scale (SDS) by confirming the appropriateness of each item using item response theory.

METHODS

A cross-sectional and convenience sampling was conducted to recruit eligible cirrhotic outpatients from the gastroenterology outpatient department of a single medical university hospital. In total, 163 patients with LC completed the 21-item SDS. A graded response model with two-parameter (discrimination and difficulty) estimation was used for data analysis.

RESULTS

The item response theory model identified the validity of the SDS and found that most of the items in the SDS represented a high level of symptoms distress; moreover, three items of bruising, drowsiness, and dark urine were reported in cirrhotic patients with severe symptom distress. Four items comprising bodily pain, right upper quadrant pain, muscle cramps, and change in appearance can be appropriately represented in cirrhotic patients with mild symptoms distress. Moreover, the amount of test information in the SDS was >0.70, indicating acceptable reliability.

DISCUSSION

Items of the SDS can be useful for assessing different levels of symptoms distress; however, using the scale to assess mild symptoms distress in populations with LC should be done with great caution.

Item Response Theory Analyses, Factor Structure, and External Correlates of the Italian Translation of the Personality Inventory for DSM-5 Short Form in Community-Dwelling Adults and Clinical Adults

To assess the psychometric properties of the Italian translation of the 100-item short form of the Personality Inventory for DSM-5 (PID-5-SF), 2,143 community-dwelling adults (59.6% female), and 706 adult clinical participants (52.4% female) were administered the Italian translation of the PID-5. Clinical participants were also administered the Structured Clinical Interview for DSM-IV (SCID-II), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Item response theory analysis showed that all proposed PID-5-SF items showed adequate item discrimination parameters in both community-dwelling adults and clinical adults. All PID-5-SF trait scales showed satisfactory internal consistency estimates. PID-5-SF five-factor structure closely matched the factor structure of the PID-5 in both community-dwelling participants and clinical participants and was invariant across the two samples that participated in this study. Moreover, the factor structure of the PID-5-SF closely replicated the factor of the PID-5-SF that was originally reported in Maples et al.'s study. In our clinical sample, dominance analysis results showed that PID-5-SF scales explained a nonnegligible and significant amount of variance in both SCID-II and PDQ-4+ ratings of selected DSM-5 Section II personality disorder, and the use of the PID-5-SF did not result in a substantial loss of information as compared with the original PID-5.

Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: a feasibility study

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious health risk behavior that forms the basis of a tentative diagnosis in DSM-5, NSSI Disorder (NSSID). To date, established treatments specific to NSSI or NSSID are scarce. As a first step in evaluating the feasibility, acceptability, and utility of a novel treatment for adolescents with NSSID, we conducted an open trial of emotion regulation individual therapy for adolescents (ERITA): a 12-week, behavioral treatment aimed at directly targeting both NSSI and its proposed underlying mechanism of emotion regulation difficulties.

METHODS

Seventeen girls (aged 13-17; mean = 15.31) with NSSID were enrolled in a study adopting an uncontrolled open trial design with self-report and clinician-rated assessments of NSSI and other self-destructive behaviors, emotion regulation difficulties, borderline personality features, and global functioning administered at pre-treatment, post-treatment, and 6-month follow-up. Measures of NSSI and emotion regulation difficulties were also administered weekly during treatment.

RESULTS

Ratings of treatment credibility and expectancy and the treatment completion rate (88%) were satisfactory, and both therapeutic alliance and treatment attendance were strong. Intent-to-treat analyses revealed significant improvements associated with large effect sizes in past-month NSSI frequency, emotion regulation difficulties, self-destructive behaviors, and global functioning, as well as a medium effect size in past-month NSSI versatility, from pre- to post-treatment. Further, all of these improvements were either maintained or further improved upon at 6-month follow-up. Finally, change in emotion regulation difficulties mediated improvements in NSSI over the course of treatment.

CONCLUSIONS

Results suggest the acceptability, feasibility, and utility of this treatment for adolescents with NSSID.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02326012, December 22, 2014, retrospectively registered).

The local reliability of the 15-item version of the Geriatric Depression Scale: An item response theory (IRT) study

The 15-item version of the Geriatric Depression Scale (GDS-15) is a self-report screening instrument widely used. The current study aimed at providing evidence of the measurement precision of the GDS-15 applying Item Response Theory (IRT). The relative contribution of each item and the reliability of the whole scale in measuring the trait level around the cutoffs were investigated employing data collected from a sample consisting of 1344 old people (M=76.44years, SD=5.13; 58.7% women) involved in a large gerontological research project. The unidimensional two-parameter (2PL) logistic model was employed to item estimate location and slope parameters as well as the Test Information Function (TIF). Nine out of fifteen items were located around the cutoffs and the slopes showed that the majority of the items had substantial discrimination ability. The TIF peaked in correspondence of the cutoffs attesting the good local reliability of the scale. These findings support to the utility of the GDS-15 in detecting depression among older people.

Borderline personality disorder features, emotion dysregulation and non-suicidal self-injury: Preliminary findings in a sample of community-dwelling Italian adolescents

In order to assess the relationships among borderline personality disorder features, non-suicidal self-injury (NSSI) and emotion dysregulation, 122 community-dwelling Italian adolescents were administered by the Italian translations of the Borderline Personality Features Scale for Children-11, the Deliberate Self-Harm Inventory and the Difficulties in Emotion Regulation Scale (DERS). Regression models showed that both Deliberate Self-Harm Inventory (DSHI) and DERS scores significantly predicted Borderline Personality Features Scale for Children-11 total score; moreover, the DSHI total score significantly predicted the DERS total score. Our findings suggest that borderline personality features in adolescence are moderately, albeit significantly related to NSSI, and that emotion dysregulation does not completely account for the association between borderline personality features and NSSI, although it seems to explain a non-trivial proportion of this relationship. Copyright © 2016 John Wiley & Sons, Ltd.

Bridging the gap: the assessment and treatment of adolescent personality disorder in routine clinical care

Despite a marked increase in research supporting the assessment, diagnosis and treatment of personality disorder (PD) in adolescence, clinicians continue to be reluctant to apply treatment guidelines and psychiatric nomenclature in routine clinical care. This gap arises from several beliefs: (1) psychiatric nomenclature does not allow the diagnosis of PD in adolescence; (2) certain features of PD are normative and not particularly symptomatic of personality disturbance; (3) the symptoms of PD are better explained by other psychiatric syndromes; (4) adolescents' personalities are still developing and therefore too unstable to warrant a PD diagnosis; and (5) because PD is long-lasting, treatment-resistant and unpopular to treat, it would be stigmatising to label an adolescent with borderline personality disorder (BPD). In this paper, the empirical evidence challenging each of these beliefs is evaluated in the hope of providing a balanced review of the validity of adolescent PD with a specific focus on BPD. The paper concludes with recommendations on how routine clinical care can integrate a PD focus.

Mentalization-based treatment in groups for adolescents with borderline personality disorder (BPD) or subthreshold BPD versus treatment as usual (M-GAB): study protocol for a randomized controlled trial

Background

Evidence-based outpatient psychotherapeutic programs are first-line treatment of borderline personality disorder (BPD). Early and effective treatment of BPD is crucial to the prevention of its individual, psychosocial, and economic consequences. However, in spite of recent advantages in diagnosing adolescent BPD, there is a lack of cost-effective evidence-based treatment programs for adolescents. Mentalization-based treatment is an evidence-based program for BPD, originally developed for adults.

Methods/Design

Aims/hypotheses: We will investigate whether a specifically designed mentalization-based treatment in groups is an efficacious treatment for adolescents with BPD or subthreshold BPD compared to treatment as usual. The trial is a four-center, two-armed, parallel-group, assessor-blinded randomized clinical superiority trial. One hundred twelve patients aged 14 to 17 referred to Child and Adolescent Psychiatric Clinics in Region Zealand are randomized to 1 year of either mentalization-based treatment in groups or treatment as usual. Patients will be included if they meet at least four DSM-5 criteria for BPD. The primary outcome is self-reported borderline features at discharge. Secondary outcomes will include self-harm, depression, BPD criteria, externalizing and internalizing symptoms, and social functioning, together with parental reports on borderline features, externalizing and internalizing symptoms. Measures of attachment and mentalization will be included as mediational variables. Follow-up assessment will take place at 3 and 12 months after end of treatment.

Discussion

This is the first randomized controlled trial to test the efficacy of a group-based mentalization-based treatment for adolescents with BPD or subthreshold BPD. If the results confirm our hypothesis, this trial will add to the treatment options of cost-effective treatment of adolescent BPD.

Trial registration

Clinicaltrials.gov NCT02068326, February 19, 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1431-0) contains supplementary material, which is available to authorized users.

L’enfant borderline en devenir II : validation préliminaire de l’Échelle de traits de personnalité limite pour enfants

Le trouble de personnalité limite (TPL) est une psychopathologie sévère qui engendre une grande détresse personnelle et familiale et dont l’étiologie remonte à l’enfance. Les données empiriques appuyant une certaine stabilité temporelle des traits de personnalité de l’enfance à l’adolescence et à l’âge adulte, plusieurs auteurs soutiennent qu’il est possible d’observer chez des enfants et des adolescents des traits de personnalité pouvant être associés aux caractéristiques du TPL à l’âge adulte. Peu d’instruments permettent toutefois d’identifier chez les enfants et les adolescents des traits associés au TPL, d’où l’intérêt du Borderline Personality Features Scale for Children (BPFS-C). Basé sur une perspective développementale, cet instrument mesure les traits de personnalité limite chez les enfants de neuf ans et plus par un questionnaire autorapporté. Une première étude de validation de la version française de l’instrument démontre une cohérence interne très satisfaisante. Les corrélations entre les deux versions de l’instrument (en anglais et en français) sont significatives. L’analyse en composantes principales révèle un modèle en quatre composantes qui présente des similarités avec les quatre sous-échelles de la version anglaise, mais diffère quant à la répartition des énoncés appartenant initialement à la sous-échelle « problèmes d’identité » du BPFS-C. La poursuite de la validation de cet instrument permettrait d’identifier des traits de personnalité et des comportements associés au développement du TPL dans l’enfance et favoriserait la réalisation d’études prospectives afin d’augmenter les connaissances sur l’étiologie du TPL, ses manifestations et sa trajectoire au cours du développement.

Item Response Theory Modeling and Categorical Regression Analyses of the Five-Factor Model Rating Form: A Study on Italian Community-Dwelling Adolescent Participants and Adult Participants

To extend the evidence on the reliability and construct validity of the Five-Factor Model Rating Form (FFMRF) in its self-report version, two independent samples of Italian participants, which were composed of 510 adolescent high school students and 457 community-dwelling adults, respectively, were administered the FFMRF in its Italian translation. Adolescent participants were also administered the Italian translation of the Borderline Personality Features Scale for Children-11 (BPFSC-11), whereas adult participants were administered the Italian translation of the Triarchic Psychopathy Measure (TriPM). Cronbach α values were consistent with previous findings; in both samples, average interitem r values indicated acceptable internal consistency for all FFMRF scales. A multidimensional graded item response theory model indicated that the majority of FFMRF items had adequate discrimination parameters; information indices supported the reliability of the FFMRF scales. Both categorical (i.e., item-level) and scale-level regression analyses suggested that the FFMRF scores may predict a nonnegligible amount of variance in the BPFSC-11 total score in adolescent participants, and in the TriPM scale scores in adult participants.

Practitioner Review: Borderline personality disorder in adolescence--recent conceptualization, intervention, and implications for clinical practice

BACKGROUND

The past decade has seen an unprecedented increase in research activity on personality disorders (PDs) in adolescents. The increase in research activity, in addition to major nosological systems legitimizing the diagnosis of borderline personality disorder (BPD) in adolescents, highlights the need to communicate new research on adolescent personality problems to practitioners.

SCOPE

In this review, we provide up-to-date information on the phenomenology, prevalence, associated clinical problems, etiology, and intervention for BPD in adolescents. Our aim was to provide a clinically useful practitioner review and to dispel long-held myths about the validity, diagnostic utility, and treatability of PDs in adolescents.

FINDINGS AND CONCLUSION

Alongside providing up-to-date information on the phenomenology, prevalence, and etiology, we also report on associated clinical problems and interventions for adolescent BPD. It is only through early active assessment and identification of youngsters with these problems that a lifetime of personal suffering and health system burden can be reduced or altogether avoided. A variety of evidence-based approaches are now available to treat BPD and related clinical problems in young people. Future research should focus on establishing optimal precision in the diagnostic processes in different treatment settings.

Higher- and lower-order factor analyses of the Children's Behavior Questionnaire in early and middle childhood

The Children's Behavior Questionnaire (CBQ; Rothbart, Ahadi, & Hershey, 1994), a 195-item parent-report questionnaire, is one of the most widely used measures of child temperament, with previous analyses of its scales suggesting that 3 broad factors account for the overarching structure of child temperament (Rothbart, Ahadi, Hershey, & Fisher, 2001). However, there are no published item-level factor analyses of the CBQ, meaning that it is currently unclear whether items clearly load onto CBQ scales as proposed by its developers. Additionally, although the CBQ is intended to cover a broad window of development (i.e., ages 3-7), little is known about whether the structure of the CBQ differs depending on child age. The present study used a bottom-up approach to examine the lower- and higher-order structure of the CBQ in a large community sample of children at ages 3 (N = 944) and 5/6 (N = 853). Item-level exploratory factor analyses (EFAs) identified 88 items at age 3 and 87 items at age 5/6 suitable (i.e., with loadings ≥.40) for constructing lower-order factors. Of the lower-order factors derived at ages 3 and 5/6, fewer than half resembled original CBQ scales (Rothbart et al., 1994, 2001). Higher-order EFAs of the lower-order factors suggested that a 4-factor structure was the best fit at both ages 3 and 5/6. Thus, results indicate that a substantial number of CBQ items do not load well on a lower-order factor and that more than 3 factors are needed to account for its higher-order structure.

Diagnosing Borderline Personality Disorder During Adolescence: A Review of the Published Literature

Borderline personality disorder (BPD) is a debilitating disorder that occurs in approximately 1% to 3% of the general population. BPD is not only relatively prevalent; it is also associated with significant public health and security concerns. The clinical and social burden of adult BPD diagnosis has resulted in the desire for early diagnosis and the implementation of early intervention programs. A qualitative review of the scientific literature suggested that adolescence is a critical point for the early identification and therapeutic treatment of BPD. Although findings are far from conclusive, the inter-rater reliability and internal consistency of the Diagnostic and Statistical Manual of Mental Disorders symptom criteria for BPD during adolescence seem adequate. Recent studies based on a rigorous methodology of BPD assessment and large community samples reported prevalence rates for BPD diagnosis during adolescence that were less suspect than previous findings. A number of research studies addressed the construct validity of BPD in adolescents (i.e., whether a BPD diagnosis during adolescence actually measures what is intending to measure) and reported consistent relationships between BPD and associated areas of dysfunction and distress as evidence of the validity of the BPD diagnosis. Research evidence indicates that there is no single symptom that is predictive of later BPD diagnosis during adolescence; rather, a pattern of two to three selected BPD symptoms that are evident during adolescence seemed to be highly predictive of later BPD diagnosis, particularly when measures that were specifically designed to assess for BPD during adolescence were used as part of the assessment process.

If It Looks Like a Duck and Quacks Like a Duck: Evaluating the Validity of Borderline Personality Disorder in Adolescents

Background:

The validity of borderline personality disorder (BPD) has been a topic of much controversy in psychiatry. Over the last two decades, a wealth of empirical work has challenged long-held concerns regarding the validity of adolescent BPD. However, this research has been conducted within a traditional approach to psychiatric nosology.

Objective:

In this article, we aim to evaluate the validity of adolescent BPD as guided by both the Robins and Guze criteria for the validity of psychiatric constructs and the new National Institute of Mental Health Research Domain Criteria (NIMH RDoC).

Method:

We used the five principles of the Robins and Guze approach to evaluate selected research from our own and other groups regarding the validity of adolescent BPD. These principles include clinical description studies, laboratory studies, studies that delimitate the disorder from other related syndromes, follow-up studies, and family studies.

Results:

Within the Robins and Guze criteria framework, evidence to date supports the validity of adolescent BPD to some extent. However, limitations of the research about the construct validity of adolescent BPD have also been identified, most notably regarding the delimitation of adolescent BPD from other disorders as well as a lack of longitudinal and family studies.

Conclusions:

Given these limitations and the limitations of the Robins and Guze approach to psychiatric nosology, we recommend exploring the potential of the National Institute of Mental Health Research Domain Criteria as a complement to previous work.