Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships

Does self-compassion protect adolescents with non-suicidal self-injury from developing borderline features? A two-wave longitudinal study

Background: Adolescence is a vulnerable developmental stage for the onset of non-suicidal self-injury (NSSI) and borderline features, which are related psychological phenomena. Self-compassion reflects a sensitivity to own suffering and a motivation to relieve it, consisting of a more positive and beneficial self-to-self relationship. The aim of the present study was to test the effect of self-compassion between borderline features at baseline and six months with a sample of adolescents with a history of NSSI.Methods: At assessment wave one, participants were 139 Portuguese adolescents with an NSSI history (mean age = 15.52 years, SD = 0.87). Of these, 87 were re-assessed six months later (mean age = 15.46 years, SD = 0.86). Data were analysed through SPSS and PROCESS Macro.Results: The moderation model explained 56% of borderline features six months later, and the interaction between initial borderline features and the low and medium levels of self-compassion was significant. Youth with lower initial borderline features presented higher borderline features six months later if they had low self-compassion.Conclusions: These findings suggest that among adolescents with a history of NSSI, those with lower levels of self-compassion tend to exhibit higher borderline features in six-month when compared to their peers with higher levels of self-compassion. This observation emphasises the potential beneficial effect of self-compassion within this population.

Integrating Psychosocial Risks With Emerging Evidence for Borderline Personality Disorders in Adolescence: An Update for Clinicians

Borderline personality disorder (BPD) has seen significant advances in the knowledge of its developmental phenomenology during late childhood and adolescence. Various genetic, neurobiological, psychological, and social factors are implicated in the etiology of BPD. With emerging evidence on BPD development in adolescence, the review focused on recent literature to understand the role of psychosocial risk factors. The effects of adverse familial environment, physical, emotional, verbal, and sexual abuse, intergenerational transmission of psychopathological traits, maternal neglect and rejection, low socioeconomic status, bullying victimization, and dating violence were reviewed to understand their role in the development of BPD. BPD is a highly complex, serious, and enduring mental illness that has now been widely accepted to have symptoms that onset in early adolescence and could be diagnosed as early as age 12. BPD symptoms are stable, phenomenologically distinct from externalizing and internalizing disorders, and often present with co-occurring disorders, which during assessment could not explain impairments associated with BPD. New measures like the Difficulties in Emotion Regulation Scale (DERS), detailed developmental histories, understanding of psychosocial risks, shared decision-making, and psychoeducation could assist in early diagnosis and improvement of long-term outcomes. The implementation of evidence-based treatments is a challenge given higher costs and access to services; therefore, modifications in the treatment based on the core principles of these strategies should be considered. It is imperative to screen for psychosocial factors early in higher-risk groups. The assessment of familial factors, parental histories of psychopathologies, and histories of childhood abuse is important in context with impairing symptoms of clinical presentation and dimensional aspects of self-functioning. The role of family therapies, parental psychoeducation, and the integration of trauma-informed care approaches are important for clinical outcomes. Also, coordinated efforts with multiple stakeholders like school awareness programs, anti-bullying policies, legislation, and enforcement of existing laws might be instrumental in addressing issues related to victimization by peers.

Zusammenhang zwischen unterschiedlichen Mobbingerfahrungen und der Ausprägung von Borderline-Persönlichkeitsstörungsmerkmalen bei Jugendlichen in der Kinder- und Jugendpsychiatrie

Zusammenfassung: Theroretischer Hintergrund: Die vorliegende Studie untersucht den Zusammenhang zwischen Mobbing‍(–Arten) und der Ausprägung der Borderline-Persönlichkeitsstörung (BPS) bei Jugendlichen. Methode: 513 konsekutiv rekrutierte, jugendliche Patient_innen nahmen an einer umfassenden Diagnostik teil. Der Zusammenhang zwischen der Häufigkeit von Mobbingerfahrungen und der Anzahl der BPS-Kriterien wurde mit Hilfe von ordinalen logistischen Regressionen untersucht. Ergebnisse: Jugendliche Patient_innen, die in den vergangenen drei Monaten mehrmals pro Woche gemobbt wurden, wiesen eine stärkere BPS-Symptomatik auf als Jugendliche ohne Mobbingerfahrung (OR = 3.47, CI = 2.32 – 5.18, p < 0.001). Soziales Mobbing und Bedrohen erwiesen sich als wichtigste Prädiktoren für den Schweregrad der BPS-Symptomatik. Diskussion und Schlussfolgerung: Häufigere Mobbingerfahrungen, insbesondere sozialer und bedrohender Art, waren mit mehr Symptomen der BPS assoziiert. Programme zur Prävention von Mobbing an Schulen sollten gefördert sowie in der Behandlung von Patienten thematisiert werden.

Parental Reports of Physically Self-Destructive Behavior in the Offspring of Patients With Borderline Personality Disorder and Other Personality Disorders

The main aim of this article is to compare the prevalence of four forms of physically self-destructive behavior in the offspring of parents with borderline personality disorder (BPD) and compare them to the offspring of parents with other personality disorders (OPD). At the 4- and 6-year waves in a prospective study of the long-term course of BPD, participants were asked to report on the self-destructive behaviors of their children using the Childhood Self-Destructiveness Scale. A total of 68 parents were interviewed regarding 131 children, 104 of whom were offspring of parents with BPD (n = 55) and 27 were offspring of parents with OPD (n = 13). BPD parents reported significantly more self-injury and substance abuse in their children than OPD parents. The results from this study suggest that both direct and indirect forms of self-destructive behavior are both more common and quite specific for the children of parents with BPD.

Adverse Childhood Experiences and Neurocognition in Borderline Personality Disorder: A Call-to-Action Perspective Review

Adverse childhood experiences (ACEs) contribute to the development of personality traits leading to adult borderline personality disorder (BPD). Neurocognitive changes could partly mediate the association between ACEs and BPD. We discuss how exposure to ACEs could induce alterations in neurocognition, which, in turn, would contribute to the development of BPD. We conducted a review of MEDLINE articles through 2021, documenting a link between ACEs, neurocognitive impairments, and BPD, and also focusing on the pairwise associations. ACEs appear to have a strong impact on neurocognition and are a predictive factor for BPD. Maltreated, abused, and emotionally invalidated children are more likely to present BPD traits. Neurocognitive impairments in adults exposed to ACEs and in patients with BPD arise from similar brain alterations in the amygdala, hippocampus, and prefrontal cortex. These impairments seem to be linked with clinical dimensions of BPD: increased impulsivity to altered inhibitory control; dissociative experiences to nonspecific autobiographical memory; and emotionally biased facial recognition to unstable interpersonal relationships. This perspective review highlights the contributory role of neurocognition in the association between ACEs and BPD. Additional research is needed, however, on the interconnections among ACEs, neurocognition, and BPD. Future studies could also focus on developing tools to assess early adversity in BPD specifically and on psychotherapeutic approaches to promptly remedy neurocognitive impairments.

Borderline personality disorder in young people: associations with support and negative interactions in relationships with mothers and a best friend

BACKGROUND

Impaired interpersonal functioning has been highlighted as a core feature of borderline personality disorder (BPD). Adolescence and young adulthood form important developmental stages within both the emergence of BPD and the development of interpersonal functioning, which takes place mostly in relationships with parents and friends. This study aimed to: (i) investigate relations between BPD symptoms and both supportive and negative interactions with mothers and best friends; (ii) investigate whether the relations were moderated by age; (iii) test the robustness of our findings by comparing the results based on self-reports with results from a subsample in which supportive and negative interactions with mothers were rated by the mother.

METHODS

312 young people referred to mental healthcare completed self-report measures on BPD and supportive and negative interactions. Multiple regression analyses were conducted to examine the relations between BPD features and perceived supportive and negative interactions with mothers and a best friend, and to investigate whether these relations were moderated by age. Robustness of our findings was studied in a subsample (n = 104), by using a multi-informant design in maternal report on supportive and negative interactions with mothers.

RESULTS

Multiple regression analyses demonstrated that negative interactions with mothers as well as with a best friend were related to more BPD symptoms in young people. Supportive interactions were not related to BPD symptoms. Both BPD and quality of relations were not related to age. In a subsample in which supportive and negative interactions with mothers were rated by the mother, the maternal report showed slightly different results. In this model, both supportive and negative interactions with a best friend were positively related, whereas interactions with mothers were not related to BPD symptoms in young people.

CONCLUSIONS

Results highlight the importance of relationships with mothers and a best friend during adolescence and young adulthood. Given that BPD often emerges during this developmental phase, future research is needed to clarify how quality of relationships could alter pathways toward BPD in young people.

TRIAL REGISTRATION

Not applicable.

Adverse Childhood Experiences and Mental Health in an Adolescent Partial Hospital Program

Childhood adversity has been associated with myriad physical, emotional, and mental health symptoms across the lifespan, including higher risk for substance abuse, depression, suicidal ideation, and premature mortality. The current study evaluates the association between cumulative adverse childhood experiences and mental health distress at admission and discharge in an adolescent partial hospital program. Data were collected from 157 adolescents through clinical assessments administered during admission and discharge procedures (Youth Outcomes Questionnaire Self-Report (YOQ-SR), Treatment Support Measure (TSM), and Center for Youth Wellness Adverse Childhood Experiences Questionnaire Teen (CYW ACE-Q Teen)). Regression analyses were conducted to assess how cumulative ACEs predict admission mental health distress (Intrapersonal Distress, Critical Items, and Total Score) as well as mental health distress at discharge, above and beyond other clinically relevant factors. While ACEs significantly predicted overall distress at admission (p = .026), there were no other significant associations between ACEs and outcomes at admission, nor ACEs and any outcomes at discharge. This suggests experiences of adversity may not hinder or influence outcomes over the course of treatment in this setting. Experiences of adversity were highly endorsed in this sample; thus, further understanding of experiences of trauma and resilience in acute treatment settings is a critical area for future research to improve interventions for adolescents.

Psychosocial functioning in adolescents with non-suicidal self-injury: the roles of childhood maltreatment, borderline personality disorder and depression

BACKGROUND

There is a lack of studies examining psychosocial functioning in patients with non-suicidal self-injury (NSSI), especially in adolescents, and rates of impaired functioning in existing literature vary considerably. These variations may be attributable to further risk factors that influence psychosocial functioning. Thus, the aim of the study was to examine whether adolescent NSSI patients with childhood maltreatment (CM), a known risk factor for lower psychosocial functioning, may differ from adolescent NSSI patients without CM, and whether these differences may be explained by the severity of comorbid disorders. Specifically, we examined whether severity of borderline personality disorder (BPD), depression and posttraumatic stress disorder may explain differences in psychosocial functioning in NSSI patients with and without CM.

METHODS

Data of 368 adolescents with NSSI disorder from an outpatient clinic were analyzed using structural equation modeling. Clinicans' rating of the Global Assessment of Functioning Scale (GAF) was collected, in addition to clinical interviews.

RESULTS

Results indicate that GAF scores were lower among NSSI patients with CM and that the difference in psychosocial functioning between these groups was explained by BPD and depression severity.

CONCLUSIONS

Psychosocial functioning in NSSI patients varies depending on whether they have experienced CM or not. Specifically, these differences seem to be attributable to higher BPD and depression severity in adolescent NSSI patients with CM. Clinicians should ensure to assess CM and focus on BPD and depression severity in this population. Treatment of BPD and depression may notably reduce psychosocial impairment in NSSI patients with CM.

A Qualitative Evaluation of Young People's, Parents' and Carers' Experiences of a National and Specialist CAMHS Dialectical Behaviour Therapy Outpatient Service

(1) Background: Dialectical Behaviour Therapy (DBT) is the recommended treatment for Borderline Personality Disorder (BPD) symptoms in adults, however, research investigating the effectiveness of DBT for adolescents is limited. The present study explores the experiences of young people and their parents/carers of a DBT service using qualitative methodology. (2) Methods: Young people and their parents/carers, who completed DBT within the National and Specialist Child and Adolescent Mental Health DBT Service based at the Maudsley Hospital in London, were asked questions regarding their experience of the service. Data was collected from young people who completed treatment between July 2019 and July 2020 (n = 18) and their parents and carers (n = 7). (3) Results: Amongst young people, the themes identified were: a new way of living, better understanding of self, new skills, person-centred approach, and relationships with others. Parent and carer interviews revealed themes of improved relationships, feeling supported, improved quality of life, and time/timing. (4) Conclusions: Young people reported improvements in emerging BPD symptomology after completing DBT. Parents and carers reported improvements in their young person and families since starting DBT. A longer DBT programme, earlier DBT intervention, and the time-consuming nature of DBT were highlighted as areas for improvement.

Comorbidity Between Non-suicidal Self-Injury Disorder and Borderline Personality Disorder in Adolescents: A Graphical Network Approach

In 2013, DSM-5 urged for further research on non-suicidal self-injury (NSSI) and defined NSSI disorder (NSSI-D) for the first time separate from borderline personality disorder (BPD). However, research on the comorbidity between NSSI-D and BPD symptoms is still scarce, especially in adolescent populations. The current study selected 347 adolescents who engaged at least once in NSSI (78.4% girls, M age = 15.05) and investigated prevalence, comorbidity, gender differences, and bridge symptoms of NSSI-D and BPD. Network analysis allowed us to visualize the comorbidity structure of NSSI-D and BPD on a symptom-level and revealed which bridge symptoms connected both disorders. Our results supported NSSI-D as significantly distinct from, yet closely related to, BPD in adolescents. Even though girls were more likely to meet the NSSI-D criteria, our findings suggested that the manner in which NSSI-D and BPD symptoms were interconnected, did not differ between girls and boys. Furthermore, loneliness, impulsivity, separation anxiety, frequent thinking about NSSI, and negative affect prior to NSSI were detected as prominent bridge symptoms between NSSI-D and BPD. These bridge symptoms could provide useful targets for early intervention in and prevention of the development of comorbidity between NSSI-D and BPD. Although the current study was limited by a small male sample, these findings do provide novel insights in the complex comorbidity between NSSI-D and BPD symptoms in adolescence.

Non-Suicidal Self-Injury and Its Relationship with Family Psychological Function and Perceived Social Support among Iranian High School Students

BACKGROUND

Non-suicidal self-injury (NSSI) has become one of the serious public health concerns among adolescents. Factors like family and social environment of adolescents may be important determinants of the NSSI. This study aimed to investigate the relationship between family psychological function and perceived social support with the NSSI experience among adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

Overall, 4216 high school students (15-18 yr old) of Tabriz City, northwestern Iran were selected using multi-stage cluster random sampling method in October and November 2017. Participants completed survey including demographic characteristics, NSSI status, Iranian family psychological function, and perceived social support. After six months, NSSI status was reassessed. The data were analyzed using logistic regression model.

RESULTS

8.5% of the students had NSSI experience. In addition, the weak family psychological function increased the odds of experiencing the NSSI by 13 times compared to the strong psychological function (OR = 13.15, 95% CI: 7.19, 23.80). Besides, the low level of perceived social support increased the odds of experiencing the NSSI by about 7 times compared to the high perception of social support (OR= 6.67, 95% CI: 4.01, 11.11).

CONCLUSION

Low levels of psychological functioning of the families and perception of social support significantly can increase the odds of experiencing the NSSI among adolescents. Therefore, special attention should be paid to these factors in the development of relevant preventive programs in adolescence period.