ORCID Profile
0000-0003-4468-622X
Current Organisation
Technische Universität München
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Psychiatry | Sociological Methodology and Research Methods | Mental Health | Biological Psychology (Neuropsychology, Psychopharmacology, | Psychology | Public Health and Health Services | Health, Clinical And Counselling Psychology | Sociology and Social Studies of Science and Technology
ANZSRC Socio-Economic Objective (SEO)
Social Structure and Health | Mental health | Mental Health |
Related Links
Publications
Prevention and early intervention for borderline personality disorder: current status and recent evidence
Publisher: Royal College of Psychiatrists
Date: 2013
DOI: 10.1192/BJP.BP.112.119180
Abstract: Borderline personality disorder (BPD) is a leading candidate for developing empirically based prevention and early intervention programmes because it is common in clinical practice, it is among the most functionally disabling of all mental disorders, it is often associated with help-seeking, and it has been shown to respond to intervention, even in those with established disorder. Moreover, it can be reliably diagnosed in its early stages and it demarcates a group with high levels of current and future morbidity and mortality. Data also suggest considerable flexibility and malleability of BPD traits in youth, making this a key developmental period during which to intervene. Novel indicated prevention and early intervention programmes have shown that BPD in young people responds to intervention. Further work is required to develop appropriate universal and selective preventive interventions.
An ecological momentary assessment investigation of complex and conflicting emotions in youth with borderline personality disorder
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.PSYCHRES.2017.01.100
Abstract: Non-suicidal self-injury (NSSI) is a prevalent behaviour among people with borderline personality disorder (BPD) but many aspects of the emotional changes that trigger and maintain this behaviour are unknown. This study examines the relationships between NSSI and the number of negative ('negative complex') and opposing valence ('conflicting') emotions. One hundred and seven youth (aged 15-25 years) with first-presentation BPD were assessed using a combination of self-report and ecological momentary assessment to investigate trait levels of emotional acceptance and in vivo changes in the number of negative complex and conflicting emotions before and after self-injurious thoughts and behaviours. Multilevel modelling revealed that changes in the number of negative complex emotions mirrored distress levels before and after self-injurious thoughts and behaviours, approximating a quadratic curve. Increases in the number of negative complex emotions reported prior to self-injurious thoughts and behaviours were associated with lower acceptance of negative emotions. These findings indicate that the number of negative emotions experienced contributes to distress prior to engagement in NSSI. The relationship between non-acceptance of negative emotions and negative complex emotions prior to NSSI suggests that improved emotional awareness and acceptance should be a focus for early interventions aimed at reducing self-injury.
Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial
Publisher: Wiley
Date: 28-01-2019
DOI: 10.1111/EIP.12774
Abstract: Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. The results will inform treatment decisions for in iduals with borderline personality disorder who present with auditory verbal hallucinations.
Patterns of Non-Suicidal Self-Injury and Their Relationship with Suicide Attempts in Youth with Borderline Personality Disorder
Publisher: Informa UK Limited
Date: 07-09-2017
DOI: 10.1080/13811118.2017.1358226
Abstract: The study aimed to identify the relationships between patterns of non-suicidal self-injury (NSSI), their severity, and suicide attempts among 107 youth (aged 15-25 years) with borderline personality disorder (BPD). Two principal patterns were identified via a graphical representation of retrospectively reported 12-month histories of NSSI. These were habitual (NSSI occurring at regular intervals) and random patterns (NSSI inconsistently spaced). Habitual patterns of NSSI were associated with lower severity and fewer suicide attempts than random patterns. Within-person comparisons revealed a reduction in NSSI engaged within a habitual pattern and an increase in NSSI engaged within a random pattern in the month prior to a suicide attempt. Findings suggest that the accuracy of risk assessments among youth with BPD might be improved by identifying an in idual's historical pattern of NSSI, as well as any relative increase in NSSI engaged within a random pattern or relative reduction in NSSI engaged within a habitual pattern.
The value of early intervention in creating the new mental health system: Response to Allison et al
Publisher: SAGE Publications
Date: 28-05-2020
Effect of 3 Forms of Early Intervention for Young People With Borderline Personality Disorder
Publisher: American Medical Association (AMA)
Date: 02-2022
Review: Urgent need for RCT evidence on effectiveness of crisis interventions for borderline personality disorder
Publisher: BMJ
Date: 06-09-2012
Trajectories of change in depression symptoms and suicidal ideation over the course of evidence-based treatment for depression: Secondary analysis of a randomised controlled trial of cognitive behavioural therapy plus fluoxetine in young people
Publisher: SAGE Publications
Date: 15-03-2021
Abstract: Effective treatment of depression is a key target for suicide prevention strategies. However, only around one-third of young people with suicide risk respond to evidence-based treatments. Understanding the trajectory of suicidal ideation, as a marker of suicide risk, over the course of evidence-based treatment for depression might provide insight into more targeted and effective treatments. This is a secondary analysis of data from the multicentre Youth Depression Alleviation–Combined Treatment trial. A total of 153 young people aged 15–25 years diagnosed with major depressive disorder were randomly assigned in this double-blind, placebo-controlled trial to either cognitive behavioural therapy plus fluoxetine or cognitive behavioural therapy plus placebo. Participants were assessed for depression and suicidal ideation at baseline and at weeks 4, 8 and 12. Using group-based trajectory modelling, we identified two distinct depression trajectories. The first (Improving 54.9% n = 83) comprised those who experienced a consistent decline in depression symptoms. The second (Persisting 45.1% n = 70) comprised those who, despite treatment, still had clinically significant levels of depression by the end of treatment. For suicidal ideation, we identified four distinct trajectories: Non-clinical (15.5% n = 20), Low Improving (47.1% n = 75), High Improving (24.8% n = 38) and High Persisting (12.7% n = 20). Treatment allocation was not significantly associated with trajectory membership for either depression or suicidal ideation. Understanding the course of depression and suicidal ideation during treatment has important implications for managing suicide risk. The findings suggest that there is an identifiable group of young people for whom enhanced psychological and/or pharmacological intervention might be required to ensure a better treatment response. Specific interventions for those with suicidal ideation may also be prudent from the outset. The Youth Depression Alleviation–Combined Treatment trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12612001281886).
Personality disorder increases risk of low quality of life among women with mental state disorders
Publisher: Elsevier BV
Date: 10-2020
Attachment style and schema as predictors of social functioning in youth with borderline features
Publisher: Wiley
Date: 02-06-2011
DOI: 10.1002/PMH.169
A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.JAD.2010.06.016
Abstract: We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults. This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania. The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the s le was 265.5days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n=5) than in the non-BAR group (0.7%, n=1) who met conversion criteria (p<.001). These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.
Borderline Personality Disorder Diagnosis and Symptoms in Outpatient Youth as Risk Factors for Criminal Offenses and Interpersonal Violence
Publisher: Guilford Publications
Date: 11-2021
Abstract: The aim of the current study was to examine the risk for offending among outpatient youth with borderline pathology. Demographic and diagnostic data from 492 outpatients who attended a public mental health service for 15-to 25-year-olds between January 1998 and March 2008 were linked with information regarding criminal offenses and intervention orders collected from a statewide police database between March 1993 and June 2017. BPD diagnosis and number of BPD criteria were both associated with an elevated risk for violent and nonviolent offenses and family violence intervention orders. Moderation analyses revealed that the number of BPD criteria might affect males and females differently in terms of offending. Both impulsivity and anger independently predicted the risk for violent and nonviolent offenses and family violence intervention orders. Early detection of increased risk of offending among youth with BPD features is essential to develop targeted treatments for criminal or violent behavior.
Is basic self‐disturbance in ultra‐high risk for psychosis (‘prodromal’) patients associated with borderline personality pathology?
Publisher: Wiley
Date: 24-01-2013
DOI: 10.1111/EIP.12011
Abstract: Research in the phenomenological tradition suggests that the schizophrenia spectrum is characterized by disturbance of the 'basic' self, whereas borderline personality disorder involves disturbance of the 'narrative' self. The current study investigated this proposal in an ultra-high risk for psychosis s le. The s le consisted of 42 ultra-high-risk participants with a mean age of 19.22 years. Basic self-disturbance was measured using the Examination of Anomalous Self-Experience. Borderline personality pathology was measured using the borderline personality disorder items from the structured clinical interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) Axis II Personality Questionnaire. No correlation was found between the measures of basic self-disturbance and borderline personality pathology. The finding is consistent with the proposal that different (although not mutually exclusive) types of self-disturbance characterize the schizophrenia spectrum and borderline personality disorder. Further research should further examine the question of basic self-disturbance in patients with established borderline personality disorder.
Commentary: Commentary on the Twitter comments evoked by the May 2022 debate on diagnosing personality disorders in adolescents
Publisher: Wiley
Date: 07-12-2022
DOI: 10.1111/CAMH.12618
Abstract: The debate about the value and utility of personality disorder (PD) diagnosis in adolescence published in the May 2022 issue of CAMH generated fervent Twitter discussion. This commentary addresses some points raised in the Twitter discussion that represent important social and/or cultural beliefs that are often presented in day‐to‐day practice but are rarely tested in the context of scientific evidence. This includes, in particular, the assertion that symptoms used to diagnose personality disorder are better described as sequelae of trauma, and the assertion that effective treatment for PD is possible without a diagnosis. The call for a fundamental transformation of mental health services that currently do not meet the needs of people with PD and for the involvement of people with lived experience as equal partner in this process is supported by evidence and might represent common ground among those clinician‐scientist advocating for early intervention for PD and those expressing their concerns about this issue.
Young People With Borderline Personality Disorder Have an Increased Lifetime Risk of Being the Victim of Interpersonal Violence
Publisher: SAGE Publications
Date: 18-01-2021
Abstract: This study aimed to examine the lifetime risk of being the victim of criminal or violent offenses among young people with borderline personality disorder (BPD) features (1-9 DSM-IV criteria). Demographic and diagnostic data from 492 outpatients who attended a specialist public mental health service for 15- to 25-year-olds between January 1998 and March 2008 were linked with offending data from a state-wide police database, collected between March 1993 and June 2017, in order to establish victimization history. This included information on criminal offenses perpetrated against these young people and intervention orders implemented to protect them from being victimized by another person’s violent behavior. Logistic regression analyses, adjusted for sex and co-occurring mental state disorders, were conducted on n = 378 who had complete data (76.5% females). As hypothesized, BPD diagnosis and number of BPD criteria were both significantly associated with an increased risk of being the victim of a violent offense and the complainant of a family violence intervention order. Anger and impulsivity independently predicted a higher risk of being the victim of a violent offense, while unstable relationships, impulsivity, and affective instability independently predicted a higher risk of being the complainant of a family violence intervention order. No significant association was found between BPD and the risk of being the victim of a nonviolent offense. These findings indicate that young people with any BPD features (even below the DSM diagnostic threshold) are at increased risk for victimization by interpersonal violence. Moreover, this risk increases according to the number of BPD criteria. This issue needs to be addressed by prevention and early intervention programs (e.g., by working on self-assertion and interpersonal skills, taking into account the possible influence of previous traumatizing relationship experiences).
Rationale and First Results of Developing At-Risk (Prodromal) Criteria for Bipolar Disorder
Publisher: Bentham Science Publishers Ltd.
Date: 02-2012
DOI: 10.2174/138161212799316226
Abstract: Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for in iduals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
Two-year stability of personality disorder in older adolescent outpatients
Publisher: Guilford Publications
Date: 12-2004
DOI: 10.1521/PEDI.18.6.526.54798
Abstract: The 2-year stability of categorical and dimensional personality disorder (PD) in an older adolescent psychiatric outpatient s le was examined. One hundred and one 15-18-year-old participants were assessed using the Structured Clinical Interview for DSM Axis II Disorders (SCID-II) at baseline and 97 were re-interviewed, face-to-face, at 2 years. Of those with a categorical PD diagnosis at baseline, 74% still met criteria for a PD at follow-up, with marked gender differences (83% of females and 56% of males). Kappa for specific PDs was low for all except antisocial. Rank order and mean level dimensional stability ranged from high (antisocial, schizoid) to moderate (borderline, histrionic, schizotypal) to low (other PDs), with no decline in PD scores over the 2 years. There was no substantial influence upon stability of dimensional PD from the presence of Axis I disorder at baseline or from outpatient or inpatient treatment. However, categorical PD endured in 100% of those receiving inpatient care. The study supports that, in late teenage outpatients, the 2-year stability of the global category of PD is high and the stability of dimensionally rated PD appears to be similar to that found in young adults in a variety of settings, especially for some cluster A and B PDs. Diagnosis and early intervention appears to be justified in this age group.
HYPE: A Cognitive Analytic Therapy-Based Prevention and Early Intervention Programme for Borderline Personality Disorder
Publisher: Springer New York
Date: 2014
The Interaction of Childhood Maltreatment, Sex, and Borderline Personality Features in the Prediction of the Cortisol Awakening Response in Adolescents
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000456549
Abstract: b i Aims: /i /b The study aimed to investigate childhood maltreatment, sex, and borderline personality disorder (BPD) symptoms as prospective predictors of adolescent hypothalamic-pituitary-adrenal (HPA) axis reactivity. b i Method: /i /b A s le of 69 adolescents (30 female and 39 male) were selected from a larger longitudinal study of adolescent development and assessed at 3 time points. BPD symptoms were assessed at T1 (approx. 12.5 years), childhood maltreatment was assessed at T2 (approx. 14.9 years), and multiple assessments of salivary cortisol (cortisol awakening response CAR) were undertaken at T3 (approx. 15.5 years). b i Results: /i /b Multivariate linear regression analysis revealed a significant main effect for childhood maltreatment but not for early BPD symptoms as a predictor of lower CAR in adolescence ( i /i = 0.047). The association between childhood maltreatment and attenuated CAR was moderated by both early BPD symptoms ( i /i = 0.024 no childhood maltreatment-dependent attenuation of CAR in the presence of BPD symptoms) and sex ( i /i = 0.012 childhood maltreatment-dependent attenuation of CAR in females only). Furthermore, a 3-way BPD × childhood maltreatment × sex interaction ( i /i = 0.041) indicated that the moderating effect of BPD symptoms was present in females only. b i Conclusion: /i /b These findings indicate that attenuation of the HPA axis occurs as a response to early maltreatment rather than being related to the early occurrence of BPD pathology. Traumatized female in iduals with BPD symptoms might bypass adaptive HPA axis attenuation.
What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients
Publisher: SAGE Publications
Date: 29-10-2022
Abstract: Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity. A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored. One hundred and seven young people (18–25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used hetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients. High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.
Early intervention for adolescents with borderline personality disorder: Quasi-experimental comparison with treatment as usual
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670902817711
Abstract: Objective: The aim of the present study was to compare the effectiveness of specialized team-based early intervention for borderline personality disorder (BPD) with treatment as usual. Method: In a quasi-experimental design, 32 outpatients who received historical treatment as usual (H-TAU) were compared with 78 participants from a recently published randomized controlled trial of cognitive analytic therapy (CAT n = 41) versus manualized good clinical care (GCC n = 37), conducted in a specialized early intervention service for BPD (the Helping Young People Early (HYPE) programme). All participants were 15–18-year-old outpatients who fulfilled 2–9 DSM-IV BPD criteria. It was predicted that, compared with H-TAU, HYPE + GCC and HYPE + CAT would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24months. Results: At 24month follow up: (i) HYPE + CAT had lower standardized levels of, and a significantly faster standardized rate of improvement in, internalizing and externalizing psychopathology, compared with H-TAU and (ii) HYPE + GCC had lower standardized levels of internalizing psychopathology and a faster rate of improvement in global functioning than H-TAU. HYPE + CAT yielded the greatest median improvement on the four continuous outcome measures over 24months. No adverse effects were shown with any of the treatments. Conclusions: Specialized early intervention for subsyndromal or full-syndrome BPD is more effective than TAU, with HYPE + CAT being the most effective intervention. Reform of existing services using the HYPE model might yield substantial improvements in patient outcomes.
Sex-specific prediction of hypothalamic-pituitary-adrenal axis activity by pituitary volume during adolescence: A longitudinal study from 12 to 17 years of age
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.PSYNEUEN.2013.06.028
Abstract: To investigate the longitudinal relationship between pituitary gland volume (PGV) and parameters of hypothalamic-pituitary-adrenal axis (HPAA) functioning during adolescence. Participants were 49 adolescents (19 girls and 30 boys) selected from a larger longitudinal, population-based study of adolescent development. Assessments were conducted at three time points (S1, S2 and S3). MRI sessions were at S1 (age: M=12.62, SD=0.45 years) and S3 (M=16.48, SD=0.53 years) and multiple assessments of salivary cortisol were undertaken at S2 (M=15.51, SD=0.35 years). PGV was measured via previously validated manual tracing methods, and the cortisol awakening response (CAR) and diurnal slope (DSL) were used as indices of HPAA functioning. A significant sex-linked interaction was found for PGV at S1 predicting both CAR (p=0.025) and DSL (p=0.009) at S2. Specifically, PGV at S1 significantly predicted CAR (p=0.033) and DSL (p=0.010) in boys only, with no significant results found for girls. Neither CAR nor DSL at S2 predicted growth of PGV from S1 to S3. PGV in early adolescence predicted HPAA functioning in mid-adolescent boys but not in girls. The results suggest a significant influence of sex-specific development on the relationship between PGV and HPAA activity and reactivity. The findings have potential implications for understanding and interpreting sex-linked and stress related clinical disorders that emerge during mid-to-late adolescence.
Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder
Publisher: Wiley
Date: 28-11-2018
DOI: 10.1111/EIP.12763
Abstract: This study explored phenomenological aspects of auditory verbal hallucinations (AVH) and other psychotic symptoms among youth with borderline personality disorder (BPD). Sixty-eight outpatients, aged 15 to 25 years, were categorized into three groups according to their primary Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis and AVH symptom profile BPD + AVH (n = 23), schizophrenia spectrum disorder (SZ) + AVH (n = 22) and BPD with no AVH (n = 23). No differences in AVH were found between BPD + AVH and SZ + AVH. Compared with SZ + AVH, BPD + AVH scored lower on delusions and difficulty in abstract thinking and higher on hostility. BPD + AVH reported more severe self-harm, paranoid ideation, dissociation, anxiety and stress than BPD no AVH. This study replicates, in a s le of youth, the finding from studies of adults that AVH in BPD are indistinguishable from those in SZ, when assessed with the Psychotic Symptom Rating Scales (PSYRATS). Clinicians should specifically enquire about AVH among youth with BPD. When present, AVH appear to be an indicator of a more severe form of BPD.
Emotional sensitivity in youth with borderline personality pathology
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.PSYCHRES.2010.12.019
Abstract: If Borderline Personality Disorder (BPD) is characterized by an underlying emotional sensitivity, in iduals with this disorder would be expected to demonstrate accurate identification of emotional expressions at earlier stages of expression (i.e., lower thresholds of facial expressivity across all emotional valences). Twenty-one outpatient youth (aged 15-24 years) meeting 3 or more DSM-IV BPD criteria and 20 community-derived participants (aged 15-24 years) with no history of psychiatric problems were tested on a measure of emotional sensitivity, the Face Morph Task. In this test faces morph from neutral to each of the six basic emotional expressions. The BPD group showed no evidence of heightened sensitivity to emotional facial expressions compared to the community control group (all P>0.05 and effect sizes ranging from 0 to 0.6). They require comparable levels of emotional expressivity in order to correctly identify emotions. Therefore, emotional sensitivity might not be apparent early in the course of BPD. Rather, it might develop later in the course of the disorder or be present only in severe BPD.
Superior temporal gyrus volume in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.PSCYCHRESNS.2009.10.014
Abstract: This magnetic resonance imaging study investigated the superior temporal gyrus (STG) subregion volumes in 20 teenagers with first-presentation borderline personality disorder (BPD) and 20 healthy controls. While the STG volume early in the course of BPD did not differ from that of healthy controls, the BPD participants with violent episodes had a smaller left caudal STG volume compared with those without such episodes during the previous 6 months. Our preliminary findings might reflect the neurobiological heterogeneity of the disorder.
Midline brain structures in teenagers with first-presentation borderline personality disorder.
Publisher: Elsevier BV
Date: 08-2009
DOI: 10.1016/J.PNPBP.2009.03.035
Abstract: Brain morphologic changes have been reported in borderline personality disorder (BPD), but it remains largely unknown whether BPD is associated with midline brain abnormalities. We used magnetic resonance imaging to investigate the length of the adhesio interthalamica (AI) and cavum septum pellucidum (CSP) as well as third ventricular volume in 20 teenagers with first-presentation BPD and 20 healthy controls. While the CSP length did not differ between the groups, the AI was significantly shorter in BPD patients than in controls. Furthermore, the BPD patients had a significantly larger third ventricle than controls. These preliminary findings suggest that ongoing neuroimaging studies should further evaluate a potential involvement of midline brain structures in the pathogenesis of BPD.
Psychotic symptoms in adolescents with borderline personality disorder features
Publisher: Springer Science and Business Media LLC
Date: 03-12-2018
DOI: 10.1007/S00787-018-1257-2
Abstract: Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first to examine the prevalence of psychotic symptoms in 15-18-year olds with BPD features. It was hypothesised that adolescents with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15-18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01). Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.
Further Considerations on Early Intervention for Borderline Personality Disorder—Reply
Publisher: American Medical Association (AMA)
Date: 06-2022
Ecological momentary assessment of nonsuicidal self-injury in youth with borderline personality disorder.
Publisher: American Psychological Association (APA)
Date: 10-2017
DOI: 10.1037/PER0000205
Abstract: Nonsuicidal self-injury (NSSI) is highly prevalent among in iduals with borderline personality disorder (BPD). The aim of this study was to investigate the cognitive, emotional, and contextual experience of NSSI in 107 youth (aged 15-25 years) with BPD who had minimal prior exposure to treatment. Using ecological momentary assessment, participants completed a randomly prompted questionnaire about their affect, self-injurious thoughts, and behaviors six times per day for 6 days. Twenty-four youth with BPD engaged in 52 counts of NSSI, with 56 motives identified. Open-ended questions revealed that on occasions of NSSI, a large minority of participants could identify neither their motives (27%, n = 15) nor the environmental precipitants (46%, n = 24) for NSSI. Changes in affect revealed a pattern of increasing negative and decreasing positive affect prior to NSSI, with a reduction in negative and an increase in positive affect following NSSI. These changes were absent for those who did not engage in NSSI. Initial self-injurious thoughts and changes in negative and positive affect occurred a median of 35, 15, and 10 hr prior to NSSI, respectively. These findings suggest that youth with BPD have limited capacity to reflect on their motives and environment preceding NSSI. The patterns of affect change indicate that NSSI is maintained by reward incentives as well as negative reinforcement. The time between initial self-injurious thoughts and engagement in NSSI reveals a window of opportunity for intervention. (PsycINFO Database Record
Alliance rupture and repair processes in borderline personality disorder: A case study using dialogical sequence analysis
Publisher: Informa UK Limited
Date: 05-06-2017
Broad clinical high‐risk mental state (CHARMS): Methodology of a cohort study validating criteria for pluripotent risk
Publisher: Wiley
Date: 05-10-2017
DOI: 10.1111/EIP.12483
Abstract: The development of the ultra-high risk (UHR) criteria for psychosis created a new paradigm for the prevention research in psychiatry. Since (1) prevention research faces the challenge of achieving adequate statistical power when focusing on single low-incidence syndromes and (2) early clinical phenotypes are overlapping and non-specific, this study broadens the UHR state beyond psychosis as an outcome. The CHARMS (clinical high at-risk mental state) study aims to prospectively validate a set of trans-diagnostic criteria to identify help-seeking young people at risk of developing a range of serious mental illnesses. This paper describes the methodology of the CHARMS study, which involves applying the CHARMS criteria to a cohort of help-seeking young people aged 12 to 25 attending youth mental health services in Melbourne. New referrals meeting the CHARMS criteria are allocated to the CHARMS+ group referrals not meeting CHARMS threshold are allocated to CHARMS- group (control group) referrals meeting criteria for a full-threshold disorder are excluded. Transition status and clinical and functional outcomes are re-assessed at 6 and 12 months. This study will be the first to introduce and validate clinical criteria to identify a broader at-risk patient population, which may facilitate young people's access to clinical services and early treatment by reducing the reliance on "caseness" defined according to current diagnostic categories being required for service entry. These criteria may introduce a new, trans-diagnostic approach for understanding risk factors and pathogenic mechanisms that drive the onset of severe mental illness and the next generation of preventive intervention trials.
Prospective progression from high-prevalence disorders to bipolar disorder: Exploring characteristics of pre-illness stages
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.JAD.2015.04.025
Abstract: Identification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated. We examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests. The s le was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ(2)=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ(2)=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance. The small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.
Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder
Publisher: S. Karger AG
Date: 2020
DOI: 10.1159/000505194
Abstract: This is the first study to explore interpersonal schemata in outpatient youths (age 15–25 years) with early-stage borderline personality disorder (BPD) and auditory verbal hallucinations (AVH). It also aimed to replicate, in a transdiagnostic youth s le, the finding from studies of adults with AVH that negative beliefs about the self and others lead to negative appraisals of voices, which in turn elicits depression. The following 3 groups were compared: youth with BPD+AVH ( i n /i = 23), youth with schizophrenia spectrum disorder (SZ) with AVH (SZ+AVH, i n /i = 20), and youths with BPD who did not experience AVH (BPD no AVH, i n /i = 23). The BPD+AVH group reported more negative and fewer positive self schemata than the SZ+AVH group. They also saw themselves as being more socially inferior to others than did the SZ+AVH group, but they did not differ in appraisals of self or others, compared with the BPD no AVH group. In youths with AVH (BPD+AVH, SZ+AVH combined), the indirect effect of beliefs about self or others, via negative appraisals of voices on depression, was not significant. Instead, a significant indirect effect of negative appraisals of voices on depression, via negative beliefs about self, was found. The experience of AVH during adolescence and young adulthood, when the identity is still being formed, might have a more profound effect on the developing self than during later adulthood, when the self is more stable and resilient. Negative self-appraisals might constitute a treatment target for early intervention for youths with distressing voices, including those with BPD.
A psychoeducational group intervention for family and friends of youth with borderline personality disorder features: protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 25-07-2018
The clinical significance of subthreshold borderline personality disorder features in outpatient youth
Publisher: Guilford Publications
Date: 02-2019
Abstract: Studies among adult patients have found that subthreshold borderline personality disorder (BPD) features are associated with elevated psychosocial morbidity compared with patients with no BPD features. However, the clinical significance of subthreshold features of BPD has not been investigated among real-world patients during the clinical emergence of the disorder, which is usually between puberty and emerging adulthood. This study aimed to replicate and extend previous research by comparing outpatient youth aged 15–25 years with subthreshold BPD features with youth with no BPD features. The s le included 499 potential participants, of whom 111 had no DSM-IV BPD features at all, and 155 had between one and four features. Results indicated that the group with subthreshold BPD features had more severe mental illness and poorer social and occupational functioning. These findings suggest that subthreshold BPD features are clinically important and should be a focus of clinical intervention to reduce continuing disability and improve outcome.
Sexuality and sexual health among female youth with borderline personality disorder pathology
Publisher: Wiley
Date: 27-10-2017
DOI: 10.1111/EIP.12510
Abstract: Borderline personality disorder (BPD) is a severe mental disorder that is characterized by unstable relationships, impulsive behaviours and identity disturbance. BPD usually has its onset between puberty and young adulthood and presents disproportionately among females in clinical settings. Taken together, this makes young women with BPD a particularly vulnerable group with regard to healthy psychosexual development. It was hypothesized that female youth with BPD pathology would be more likely to score worse on measures of sexual health and safety, and to show greater uncertainty in sexual identity formation. Fifty 15 to 24 yr-old females with 3 or more Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV) BPD criteria were compared with 204 females from a nationally representative s le. Both groups were interviewed using a comprehensive interview for sexual health and relationships. The patient group completed a structured diagnostic interview. Young women with borderline personality pathology engaged in sexual relationships at a younger age, with more sexual partners in the previous year, in more casual relationships. They were more likely to practice unsafe sex for their first sexual experience, to be coerced into unwanted sexual activity, to be unclear about their sexual identity or their sexual attraction, and to report worse overall health status. BPD pathology in youth is associated with poor sexual health and safety, and uncertainty in sexual identity formation. These findings support the need for assessment of the sexuality and sexual health of youth with BPD, along with the need for routine screening in sexual health services for BPD features among high-risk youth.
Affective startle modulation in young people with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.PSYCHRES.2018.02.049
Abstract: This study investigated psychophysiological and subjective emotional responses to an affective startle modulation paradigm in first-presentation borderline personality disorder (BPD). Twenty BPD and 20 healthy control participants, aged 15-24 years, viewed a set of standardized pictures with pleasant, neutral, or unpleasant valence, and were instructed to either "maintain" or "suppress" their emotional response to the stimuli. Despite showing markedly higher levels of baseline distress on self-report questionnaires, BPD participants had significantly lower skin conductance responses and showed an absence of the fear potentiated startle response during early picture processing. Both groups showed similar startle responses later in picture processing, and when instructed to "maintain" or "suppress" their emotions. BPD participants were hypo-responsive to aversive stimuli during early processing, and did not react with more intense emotional responses to affective stimuli or show a diminished ability to regulate their responses. These results might be consistent with the finding that hypersensitivity of emotional response in BPD is specific to stimuli with themes of particular relevance to this disorder, such as rejection and abandonment.
The 'Self' and Borderline Personality Disorder: Conceptual and Clinical Considerations
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000438827
Abstract: Some concept of self has been used by many, although not all, researchers and clinicians as an ‘organising construct' for borderline personality disorder (BPD). There is considerable variation in this usage and how clearly researchers have defined the self. Given this ersity, and that ‘self' is often used interchangeably with parallel concepts (e.g. psyche, brain-mind, ‘person') or with features of self (e.g. self-awareness, identity), unqualified use of the term is problematic. This is further complicated by the heterogeneity and ‘comorbidity' of BPD and the limitations of syndromally based psychiatric nosology. Still, BPD remains in current classification systems and can be reliably diagnosed. A considerable body of research on self and BPD has accrued, including a recent profusion and confluence of neuroscientific and sociopsychological findings. These have generated supporting evidence for a supra-ordinate, functionally constituted entity of the self ranging over multiple, interacting levels from an unconscious, ‘core' self, through to a reflective, phenotypic, ‘idiographic' and relational self constituted by interpersonal and sociocultural experience. Important insights have been generated regarding emotional and social-cognitive dysregulation, disorder of self-awareness, relationality, identity, and coherence and continuity of the self. Many of these are shared by various trauma-related, dissociative disorders. A construct of the self could be useful as an explanatory principle in BPD, which could be construed as a ‘self-state' (and relational) disorder, as opposed to a less severe disorder of aspects of the self (e.g. mood or memory). We offer a tentative description of ‘Self' in this context, noting that any such construct will require a clear definition and to be evaluable.
Social perspective coordination in youth with borderline personality pathology
Publisher: Guilford Publications
Date: 02-2012
DOI: 10.1521/PEDI.2012.26.1.126
Abstract: This study investigated social perspective coordination (SPC) in youth (15-24-year-olds) with first-presentation borderline personality disorder (BPD). SPC is defined as the capacity to differentiate and integrate the perspective of the self with the perspectives of others (Selman, Beardslee, Schultz, Krupa, & Podorefsky, 1986). Two groups: patients with full or sub-syndromal BPD (n = 30) and patients with major depressive disorder (MDD n = 30) completed measures of SPC derived from the interpersonal negotiation strategies (INS) model (Selman et al., 1986). Compared with the MDD group, the BPD group responded to all vignettes with significantly lower SPC scores and SPC was a significant predictor of BPD status over and above self-reported, personality factors (Neuroticism and Agreeableness), attachment disturbance and functional impairment. These findings suggest that disturbances in social cognition are an important characteristic of in iduals with BPD pathology. These difficulties extended beyond attachment contexts and were not limited to situations involving BPD-related themes of abandonment, deprivations or mistrust/abuse.
Number of borderline personality disorder criteria and depression predict poor functioning and quality of life in outpatient youth
Publisher: Guilford Publications
Date: 12-2020
Abstract: This study aimed to investigate which factors contribute to poor functioning and poor quality of life in youth (aged 15–25 years) with borderline personality disorder (BPD), and whether the number of BPD criteria might be an independent predictor of these outcomes. A s le of 499 help-seeking outpatient youth, aged 15–25 years, was assessed. Stepwise multiple regression analyses showed that the number of BPD criteria was the best predictor of poor functioning, followed by number of mental health visits in the past month, female sex, and a current diagnosis of depression. Current depression was the best predictor of Assessment of Quality of Life utility score, followed by the number of BPD criteria. These findings underscore the clinical significance of DSM-IV BPD features (even when subthreshold for a categorical diagnosis) in youth and their effects upon social and occupational functioning and quality of life early in the course of BPD.
The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: A prospective study
Publisher: Wiley
Date: 05-05-2014
DOI: 10.1111/BDI.12205
Abstract: There are no established tools to identify in iduals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive in iduals and a matched group of in iduals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania. A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder. These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
Borderline Personality Disorder in Young People and the Prospects for Prevention and Early Intervention
Publisher: Bentham Science Publishers Ltd.
Date: 02-2008
Sleep in Young People with Features of Borderline Personality Disorder: A Scoping Review
Publisher: Guilford Publications
Date: 02-2021
Abstract: Sleep disturbance is commonly reported in young people with features of borderline personality disorder (BPD). Examining sleep quality and sleep-wake patterns in young people with features of BPD is essential to inform the development of sleep-improvement interventions. A scoping review was conducted according to the Joanna Briggs Institute methodology. The objectives were to map the literature regarding sleep in young people with features of BPD, highlight areas for further investigation, and provide methodological recommendations for future research. Seven data sets were included in the review. Young people with features of BPD had poorer objective and subjective sleep quality, disturbed sleep architecture (particularly rapid-eye-movement sleep), an increased vulnerability to delayed sleep phase syndrome, and more nightmares and dream anxiety, compared with healthy in iduals. Future research should use both objective and subjective sleep measures, include clinical comparison groups, and focus specifically on young people with BPD.
INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 26-06-2020
DOI: 10.1186/S13063-020-04471-3
Abstract: The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12–25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. In idual Placement and Support (IPS) is a client-driven model that assists in iduals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the IN idual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes. INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or ‘usual vocational services’ (UVS). Participants will comprise 108 help-seeking young people (aged 15–25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity. Current treatments for BPD have little impact on vocational outcomes and enduring functional impairment is prevalent among this patient group. IPS is a targeted functional intervention, which has proven effective in improving vocational outcomes for adults and young people with psychotic disorders. This trial will investigate whether IPS is effective for improving vocational (employment and educational) outcomes among young people with subthreshold or full-syndrome BPD. Australian New Zealand Clinical Trials Registry, ID: ACTRN12619001220156 . 13 September 2019.
Anterior cingulate volume in adolescents with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.PSCYCHRESNS.2008.12.004
Abstract: Reports of volumetric abnormalities in the anterior cingulate cortex (ACC) in adults with established borderline personality disorder (BPD) are inconsistent, and it is not known whether such abnormalities are present early in the disorder. We aimed to investigate ACC volume in a first-presentation teenage BPD s le with minimal exposure to treatment. Fifteen female BPD patients and 15 healthy female control participants underwent magnetic resonance imaging (MRI) scanning. ACC volumes were estimated using a reliable method that accounts for inter-in idual variation in sulcal morphology, and measurements were compared between the two groups. Analysis of variance revealed a decrease in volume of the left ACC in BPD patients compared with control participants. This volumetric change was correlated with parasuicidal behavior and impulsivity. A measure of ACC volume asymmetry was also correlated with fear of abandonment symptoms. Our results suggest that ACC volumetric abnormalities early in the course of BPD might be related to clinical correlates of the disorder. Longitudinal studies are needed to examine the nature of this abnormality over the course of the disorder.
Predictors of suicidal ideation severity among treatment-seeking young people with major depressive disorder: The role of state and trait anxiety
Publisher: SAGE Publications
Date: 11-01-2023
DOI: 10.1177/00048674221144262
Abstract: Depression and suicidal ideation are closely intertwined. Yet, among young people with depression, the specific factors that contribute to changes in suicidal ideation over time are uncertain. Factors other than depressive symptom severity, such as comorbid psychopathology and personality traits, might be important contributors. Our aim was to identify contributors to fluctuations in suicidal ideation severity over a 12-week period in young people with major depressive disorder receiving cognitive behavioural therapy. Data were drawn from two 12-week randomised, placebo-controlled treatment trials. Participants ( N = 283) were 15–25 years old, with moderate to severe major depressive disorder. The primary outcome measure was the Suicidal Ideation Questionnaire, administered at baseline and weeks 4, 8 and 12. A series of linear mixed models was conducted to examine the relationship between Suicidal Ideation Questionnaire score and demographic characteristics, comorbid psychopathology, personality traits and alcohol use. Depression and anxiety symptom severity, and trait anxiety, independently predicted higher suicidal ideation, after adjusting for the effects of time, demographics, affective instability, non-suicidal self-injury and alcohol use. Both state and trait anxiety are important longitudinal correlates of suicidal ideation in depressed young people receiving cognitive behavioural therapy, independent of depression severity. Reducing acute psychological distress, through reducing depression and anxiety symptom severity, is important, but interventions aimed at treating trait anxiety could also potentially be an effective intervention approach for suicidal ideation in young people with depression.
Towards a youth mental health paradigm: a perspective and roadmap
Publisher: Springer Science and Business Media LLC
Date: 14-08-2023
DOI: 10.1038/S41380-023-02202-Z
Abstract: Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.
Tobacco smoking in young people seeking treatment for mental ill-health: What are their attitudes, knowledge and behaviours towards quitting?
Publisher: Cambridge University Press (CUP)
Date: 22-04-2021
DOI: 10.1017/IPM.2020.18
Abstract: Tobacco smoking is a leading cause of preventable death and disease worldwide. Adults with mental ill-health smoke tobacco at substantially higher rates than other adults, with public health approaches effective in the population overall having less impact on those with mental ill-health. However, less is known about the tobacco smoking behaviours, attitudes and knowledge of young people with mental ill-health, despite this being the peak period of onset for both mental illness and cigarette smoking. Young people attending a youth mental health centre (providing both primary and specialist care) in Melbourne, Australia were approached by youth peer researchers and asked to complete a survey about smoking behaviours, attitudes and knowledge. We examined smoking and associated attitudes in the s le overall, and as a function of the services accessed. In total, 114 young people completed the survey, with 56.3% reporting lifetime cigarette smoking, 42.0% smoking in the last 12 months and 28.6% in the past week. Of current regular smokers, 75.0% acknowledged they should quit in the future however, only 23.5% planned to do so in the next month, with 44.4% confident that they could quit. Participants lacked knowledge about interactions between tobacco smoking, mental and physical health. Youth presenting for mental ill-health had high rates of cigarette smoking relative to population rates. Presentation at youth mental health services may represent a critical window for early intervention to reduce the lifetime impacts of cigarette smoking in mental ill-health. Interventions to support smoking cessation in this group are urgently needed.
Affective and cognitive theory of mind abilities in youth with borderline personality disorder or major depressive disorder
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.PSYCHRES.2017.06.016
Abstract: Theory of mind (ToM) is an important social cognitive ability that has been investigated in BPD, with inconsistent findings indicating impaired, comparable, and enhanced ToM in BPD. This study aimed to clarify and extend previous findings by investigating affective and cognitive ToM abilities in youth early in the course of BPD, by including a clinical comparison group of youth with major depressive disorder (MDD). Female participants aged 15-24 years diagnosed with BPD (n = 41) or MDD (n = 37) completed the Reading the Mind in the Eyes Test (RMET) and Happé's Cartoon Task, measures of affective and cognitive dimensions of ToM, respectively. The BPD group performed significantly worse than the MDD group on the affective ToM task, even after controlling for age, intelligence and depressive symptoms. Results for cognitive ToM were not significantly different. Finding of poorer performance on a measure of affective ToM, in BPD youth, relative to youth with MDD early in the course of BPD suggest a developmental failure of sociocognitive abilities needed for mentalising and which are theorised as giving rise to core features of BPD. Future research should employ more naturalistic paradigms to study social cognition and should assess in iduals even earlier in the course of BPD.
The addition of fluoxetine to cognitive behavioural therapy for youth depression (YoDA-C): a randomised, double-blind, placebo-controlled, multicentre clinical trial
Publisher: Elsevier BV
Date: 09-2019
Cognitive Reappraisal Impairs Negative Affect Regulation in the Context of Social Rejection for Youth With Early-Stage Borderline Personality Disorder
Publisher: Guilford Publications
Date: 04-2023
DOI: 10.1521/PEDI.2023.37.2.156
Abstract: Application of emotion regulation strategies might be susceptible to the context of social rejection for in iduals with borderline personality disorder (BPD). This study compared the ability of 27 outpatient youths (15-25 years old) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, with social rejection acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies because they might be contraindicated.
Infusion of donor feces affects the gut–brain axis in humans with metabolic syndrome
Publisher: Elsevier BV
Date: 12-2020
Early Intervention for Borderline Personality Disorder
Publisher: Wiley
Date: 03-10-2014
Microbiome and metabolic disorders related to obesity: Which lessons to learn from experimental models?
Publisher: Elsevier BV
Date: 11-2016
Differences between first episode schizophrenia and schizoaffective disorder
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.SCHRES.2013.02.036
Abstract: The diagnostic and clinical overlap between schizophrenia and schizoaffective disorder is an important nosological issue in psychiatry that is yet to be resolved. The aim of this study was to compare the clinical and functional characteristics of an epidemiological treated cohort of first episode patients with an 18-month discharge diagnosis of schizophrenia (FES) or schizoaffective disorder (FESA). This study was part of the larger First Episode Psychosis Outcome Study (FEPOS) which involved a medical file audit study of all 786 patients treated at the Early Psychosis Prevention and Intervention Centre between 1998 and 2000. Of this cohort, 283 patients had an 18-month discharge diagnosis of FES and 64 had a diagnosis of FESA. DSM-IV diagnoses and clinical and functional ratings were derived and validated by two consultant psychiatrists. Compared to FES patients, those with FESA were significantly more likely to have a later age of onset (p=.004), longer prodrome (p=.020), and a longer duration of untreated psychosis (p<.001). At service entry, FESA patients presented with a higher illness severity (p=.020), largely due to the presence of more severe manic symptoms (p<.001). FESA patients also had a greater number of subsequent inpatient admissions (p=.017), had more severe depressive symptoms (p=.011), and higher levels of functioning at discharge. The findings support the notion that these might be considered two discernable disorders however, further research is required to ascertain the ways and extent to which these disorders are discriminable at presentation and over time.
Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach
Publisher: Frontiers Media SA
Date: 08-01-2021
DOI: 10.3389/FPSYT.2020.553578
Abstract: Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a “pluripotent” approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study ( N = 114) show that 34% of young people who completed the 12-month follow-up assessment ( N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
A study comparing the experiences of family and friends of young people with borderline personality disorder features with family and friends of young people with other serious illnesses and general p
Publisher: Springer Science and Business Media LLC
Date: 22-07-2020
DOI: 10.1186/S40479-020-00128-4
Abstract: Family and friends (‘carers’) of adults with borderline personality disorder (BPD) and carers of young people with other serious illnesses experience significant adversity but research on the experiences of caring for a young person with BPD features is sparse. This study aimed to: (i) describe the experiences of carers of young people with BPD features (ii) compare them with published data assessing carers of young people with other serious illnesses and with adults from the general population. Eighty-two carers (M age = 44.74, SD = 12.86) of 54 outpatient young people (M age = 18.76, SD = 3.02) who met 3 to 9 DSM-IV BPD criteria completed self-report measures on distress, experiences of caregiving, coping, and expressed emotion. Independent-s les t-tests were employed to compare scores with those reported by convenience comparison groups of general population adults or carers of young people with eating disorders, cancer, or psychosis. Carers of young people with BPD features reported significantly elevated levels of distress, negative caregiving experiences, and expressed emotion, as well as maladaptive coping strategies, compared with general population adults or carers of young people with other serious illnesses. Carers of young people with BPD features experience elevated levels of adversity compared with their peers in the general adult population. This adversity is similar to, or greater than, that reported by carers of young people with other severe illnesses. Research is needed to clarify factors underlying adverse caregiving experiences and to develop and evaluate interventions to support carers of young people with BPD features. Prospectively registered with the Australian New Zealand Clinical Trial Registry ACTRN12616000304437 on 08 March 2016, anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369867 .
Relationships between the frequency and severity of non‐suicidal self‐injury and suicide attempts in youth with borderline personality disorder
Publisher: Wiley
Date: 18-07-2017
DOI: 10.1111/EIP.12461
Abstract: Non-suicidal self-injury (NSSI) is a recognized indicator of suicide risk. Yet, the ubiquity of this behaviour in borderline personality disorder (BPD) limits its utility as a predictor of risk. Consequently, this study aimed to elucidate the relationship between other features of NSSI, including frequency and severity, and suicide attempts. Participants included 107 youth (15 to 25 year olds) with BPD who were assessed for BPD severity, depressive symptoms, 12-month frequency of NSSI and suicide attempts, as well as the levels of treatment sought following each self-harm event. Three-quarters (75.7%) of youth with BPD reported NSSI and two-thirds (66.4%) reported a suicide attempt over the previous 12 months. The frequency of NSSI over the previous 12 months did not show a linear or quadratic relationship with the number of suicide attempts when adjusting for severity of depression, impulsivity and interpersonal problems. NSSI severity was not associated with more frequent suicide attempts. Only impulsivity and depression were uniquely predictive of suicide attempt frequency. A relative increase in the frequency and severity of NSSI occurred in the months prior to a suicide attempt. The prevalence of NSSI and suicide attempts among youth presenting for their first treatment of BPD appear to be perilously high, considerably higher than rates reported by adults with BPD. Findings suggest that clinicians should give more weight to average levels of impulsivity and depression, rather than the absolute frequency and severity of NSSI, when assessing for risk of suicide attempts. Notwithstanding this, a relative increase in the frequency and severity of NSSI appears to be predictive of a forthcoming suicide attempt.
Corpus callosum morphology and relationship to orbitofrontal and lateral ventricular volume in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.PSCYCHRESNS.2010.04.001
Abstract: Previous studies have demonstrated alterations to fronto-limbic circuitry and callosal structure in borderline personality disorder (BPD). We predicted that a first-presentation BPD cohort who demonstrated orbitofrontal cortex (OFC) reductions would show regional reductions in the anterior corpus callosum. Twenty teenage first-presentation BPD patients and twenty matched healthy controls underwent Magnetic resonance imaging (MRI) was performed in 20 teenaged first-presentation BPD patients and 20 matched healthy controls. Corpus callosum size and shape and ventricular volume were estimated using established methods and compared between the two groups. The relationship between illness variables and callosal morphology was also examined. OFC volume was correlated with callosal and ventricular variables. BPD participants and controls did not differ on measures of callosal size or shape, or ventricular size. BPD participants showed an alteration to the pattern of age-related expansions seen in the callosum. BPD participants with a history of trauma did not demonstrate significant neuroanatomical differences from those without. OFC volumes did not correlate with the thickness of the anterior corpus callosum. Gross neuroanatomical changes are not present at the level of the callosum in teenagers with first-presentation BPD. Changes seen in other studies might reflect factors associated with the duration of BPD, such as recurrent comorbidity with axis I disorders, or treatment.
Olfactory sulcus morphology in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.PSCYCHRESNS.2019.08.006
Abstract: Gray matter reduction of the orbitofrontal cortex (OFC) has been reported in borderline personality disorder (BPD), but it remains unknown whether the BPD patients exhibit morphologic changes of the olfactory sulcus, a potential marker of forebrain development located on the OFC. We used magnetic resonance imaging to investigate the length and depth of the olfactory sulcus in 20 teenagers (15 females and 5 males) with first-presentation BPD and 20 healthy controls (15 females and 5 males). While there was no group difference in the length of the sulcus, the BPD patients (especially those with a history of trauma) had a significantly shallower right olfactory sulcus compared with controls. In addition, sulcus depth was negatively correlated with the severity of impulsivity and affective instability in the BPD patients. These preliminary findings may suggest a significant role of environmental risk factors (i.e., trauma exposure) during childhood to adolescence in the neurobiology of BPD.
The addition of fluoxetine to cognitive behavioural therapy for youth depression (YoDA-C): study protocol for a randomised control trial
Publisher: Springer Science and Business Media LLC
Date: 04-11-2014
Attentional processes and responding to affective faces in youth with borderline personality features
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.PSYCHRES.2012.03.027
Abstract: This study examined attentional biases for emotional faces in borderline personality disorder (BPD). Twenty-one outpatient youth (aged 15-24 years) meeting three or more DSM-IV BPD criteria and 20 community-derived participants (aged 15-24 years) with no history of psychiatric problems and not meeting any BPD criteria completed a modified dot-probe task that tested automatic (30 ms) and controlled (500 ms) stages of information processing. The findings indicate that, compared with healthy controls, youth with borderline features were faster to respond to congruent rather than incongruent fear stimuli. This effect was independent of state anxiety and was observed during the 30 ms presentation of fearful faces. There was no significant effect for happy or angry faces. Youth with borderline features were also slower to respond to incongruent rather than paired neutral trials, indicating difficulties in disengaging attention from the perceived threat. Such differences were not found for the healthy controls. Thus, youth with borderline features had an attentional bias for fearful faces that reflected difficulty in disengaging attention from threatening information during pre-conscious stages of attention. This finding extends previous research highlighting the diminished capacity for affect regulation and subsequent engagement in behavioural strategies to avoid distress in BPD. Future research should explore the relationship between information processing, emotion regulation in adult BPD s les.
Personality disorder is an excess risk factor for physical multimorbidity among women with mental state disorders
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.PSYCHRES.2017.08.010
Abstract: We examined whether mental state disorders (lifetime mood, anxiety, eating, substance misuse) with comorbid personality disorder are associated with physical multimorbidity in a population-based s le of women. Mental state and personality disorders were assessed using semi-structured diagnostic interviews. Clinical measures were performed and medical conditions, medication use and lifestyle factors were documented by questionnaire. Mental state disorders were associated with higher odds of physical multimorbidity risk was especially high for those with comorbid personality disorder. These findings suggest that mental state and physical comorbidity might be worsened by the additional comorbidity of personality disorder.
A Comparison of Adolescent versus Young Adult Outpatients with First-Presentation Borderline Personality Disorder: Findings from the MOBY Randomized Controlled Trial
Publisher: SAGE Publications
Date: 12-02-2021
Abstract: 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 s le 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 n = 64) and older (aged 18 to 25 years n = 75) participants were compared on these same variables using t-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 s le 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 in iduals reach 18 years of age.
A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features
Publisher: SAGE Publications
Date: 12-05-2023
DOI: 10.1177/00048674231172108
Abstract: Preliminary evidence indicates that interventions designed to support family and friends (‘carers’) of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial. This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15–25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person’s sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was ‘negative experiences of care’, measured with the Experience of Caregiving Inventory, at the 7-week endpoint. A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], M age = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary ( d = −0.32 95% confidence interval = [−17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge. Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers’ preferences for support and barriers to care.
Omega-3 Fatty Acid Supplementation in Adolescents with Borderline Personality Disorder and Ultra-High Risk Criteria for Psychosis: A Post Hoc Subgroup Analysis of a Double—Blind, Randomized Controlled
Publisher: SAGE Publications
Date: 07-2013
DOI: 10.1177/070674371305800705
Abstract: To investigate whether long-chain omega-3 (n-3) polyunsaturated fatty acids (PUFAs) improve functioning and psychiatric symptoms in young people with borderline personality disorder (BPD) who also meet ultra-high risk criteria for psychosis. We conducted a post hoc subgroup analysis of a double-blind, randomized controlled trial. Fifteen adolescents with BPD (mean age 16.2 years, [SD 2.1]) were randomized to either 1.2 g/day n-3 PUFAs or placebo. The intervention period was 12 weeks. Study measures included the Positive and Negative Syndrome Scale, the Montgomery–Åsberg Depression Rating Scale, and the Global Assessment of Functioning. Side effects were documented with the Udvalg for Kliniske Undersøgelser. Fatty acids in erythrocytes were analyzed using capillary gas chromatography. At baseline, erythrocyte n-3 PUFA levels correlated positively with psychosocial functioning and negatively with psychopathology. By the end of the intervention, n-3 PUFAs significantly improved functioning and reduced psychiatric symptoms, compared with placebo. Side effects did not differ between the treatment groups. Long-chain n-3 PUFAs should be further explored as a viable treatment strategy with minimal associated risk in young people with BPD.
The relationship between impulsivity and vocational outcome in outpatient youth with borderline personality features
Publisher: Wiley
Date: 26-04-2011
DOI: 10.1111/J.1751-7893.2011.00271.X
Abstract: This study aims to examine the relationship between each Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) borderline personality feature and vocational outcome (i.e. employment and education) in a s le of young people diagnosed with borderline personality pathology. The s le comprised 60 young people registered with a specialist early intervention programme for borderline personality disorder (BPD). Diagnostic data and vocational information were obtained from a standardized semistructured assessment and medical record review for a period of 12 months from entry into the treatment programme. DSM-IV criterion 4 'impulsivity' upon entry to the treatment programme was associated with poor vocational outcome 12 months after index assessment. Although the results of the present study suggest that impulsivity is an important feature predictive of vocational functioning in BPD, and that specific intervention in impulsivity might be a critical goal for early intervention of BPD to maximize functional recovery for such patients, further studies are required to test the reliability and validity of the role of impulsivity in relation to vocational outcome of these patients.
Predictors of substance use in youth with borderline personality disorder.
Publisher: American Psychological Association (APA)
Date: 07-2018
DOI: 10.1037/PER0000257
Abstract: Concomitant substance misuse in adults with borderline personality disorder (BPD) is associated with a more severe course of illness and poorer outcomes. Previous research has found an association between the number of borderline personality features and substance misuse in community s les. This study examined the relationship between substance use and severity of BPD in youth presenting for the first time for treatment (first presentation) of BPD. Participants were 117 help-seeking youth aged 15-25 years (93 females M
Depressive symptoms in first episode schizophrenia spectrum disorder
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.SCHRES.2011.08.018
Abstract: Depressive symptoms in 'non-affective' first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score >3) in a large representative s le of FES patients (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms. Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia. 26.2% (n=106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n=15) continued to have moderate to severe depressive symptoms at discharge. Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.
Rapid facial mimicry responses are preserved in youth with first presentation borderline personality disorder
Publisher: Elsevier BV
Date: 04-2020
The prevalence, age distribution and comorbidity of personality disorders in Australian women
Publisher: SAGE Publications
Date: 11-07-2017
Abstract: We aimed to describe the prevalence and age distribution of personality disorders and their comorbidity with other psychiatric disorders in an age-stratified s le of Australian women aged ⩾25 years. In idual personality disorders (paranoid, schizoid, schizotypal, histrionic, narcissistic, borderline, antisocial, avoidant, dependent, obsessive-compulsive), lifetime mood, anxiety, eating and substance misuse disorders were diagnosed utilising validated semi-structured clinical interviews (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition and Structured Clinical Interview for DSM-IV Axis II Personality Disorders). The prevalence of personality disorders and Clusters were determined from the study population ( n = 768), and standardised to the Australian population using the 2011 Australian Bureau of Statistics census data. Prevalence by age and the association with mood, anxiety, eating and substance misuse disorders was also examined. The overall prevalence of personality disorders in women was 21.8% (95% confidence interval [CI]: 18.7, 24.9). Cluster C personality disorders (17.5%, 95% CI: 16.0, 18.9) were more common than Cluster A (5.3%, 95% CI: 3.5, 7.0) and Cluster B personality disorders (3.2%, 95% CI: 1.8, 4.6). Of the in idual personality disorders, obsessive-compulsive (10.3%, 95% CI: 8.0, 12.6), avoidant (9.3%, 95% CI: 7.1, 11.5), paranoid (3.9%, 95% CI: 3.1, 4.7) and borderline (2.7%, 95% CI: 1.4, 4.0) were among the most prevalent. The prevalence of other personality disorders was low (⩽1.7%). Being younger (25–34 years) was predictive of having any personality disorder (odds ratio: 2.36, 95% CI: 1.18, 4.74), as was being middle-aged (odds ratio: 2.41, 95% CI: 1.23, 4.72). Among the strongest predictors of having any personality disorder was having a lifetime history of psychiatric disorders (odds ratio: 4.29, 95% CI: 2.90, 6.33). Mood and anxiety disorders were the most common comorbid lifetime psychiatric disorders. Approximately one in five women was identified with a personality disorder, emphasising that personality disorders are relatively common in the population. A more thorough understanding of the distribution of personality disorders and psychiatric comorbidity in the general population is crucial to assist allocation of health care resources to in iduals living with these disorders.
Comprehensive Lifestyle-Modification in Patients with Ulcerative Colitis–A Randomized Controlled Trial
Publisher: MDPI AG
Date: 24-09-2020
DOI: 10.3390/JCM9103087
Abstract: Patients with ulcerative colitis suffer from impaired health-related quality of life (HrQoL). Comprehensive lifestyle-modification might increase HrQoL and decrease disease activity. Ninety-seven patients in clinical remission with impaired HrQoL were randomly assigned to a 10 week comprehensive lifestyle-modification program (LSM n = 47 50.28 ± 11.90 years) or control (n = 50 45.54 ± 12.49 years) that received a single workshop of intense training in naturopathic self-help strategies. Primary outcome was HrQoL (Inflammatory Bowel Disease Questionnaire IBDQ) at week 12. Secondary outcomes included IBDQ subscales generic HrQoL disease activity and microbiome. Both groups showed improvement in HrQoL from baseline to post-treatment at week 12. The IBDQ sum score showed no significant group difference (p = 0.251). If patients attended more than 50% of the training sessions, a significant group effect (p = 0.034) was evident in favor of LSM. In addition, the SF-36 mental component summary (p = 0.002) was significantly different between the groups in favor of LSM. Disease activity microbiome and adverse events did not differ. Both a single workshop and a 10-week comprehensive lifestyle-modification program can improve HrQoL in patients with ulcerative colitis in remission with no apparent effects on clinical disease activity. A treatment difference was observed when examining a subs le of patients who attended ≥ 50% of sessions.
An MRI study of pituitary volume and parasuicidal behavior in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.PSCYCHRESNS.2007.12.003
Abstract: This structural magnetic resonance imaging study examined the relationship between pituitary gland volume (PGV) and lifetime number of parasuicidal behaviors in a first-presentation, teenage borderline personality disorder (BPD) s le with minimal exposure to treatment. Hierarchical regression analysis revealed that age and number of parasuicidal behaviors were significant predictors of PGV. These findings indicate that parasuicidal behavior in BPD might be associated with greater activation of the hypothalamic-pituitary-adrenal (HPA) axis. Further studies are required using direct neuroendocrine measures and exploring other parameters of self-injurious behavior, such as recency of self-injurious behavior, intent to die and medical threat.
High-risk sexual behaviour in young people with mental health disorders
Publisher: Wiley
Date: 19-06-2019
DOI: 10.1111/EIP.12688
Abstract: This study aimed to determine the prevalence of high-risk sexual behaviours, sequelae and associated factors in young people attending a youth mental health service. The study design was a cross-sectional survey of 103 young people aged between 15-25 years carried out across four specialist mental health clinics. A questionnaire on the sexual health of secondary level students was adapted for this study. Mental health symptomatology was assessed through the Brief Psychiatric Rating Scale (BPRS). The mean age was 20.9 (SD ±2.8) years, with 50.5% being female, 41.7% male and 7.7% transgender. A total of 52.4% (N = 54) attended the psychosis [EPPIC] clinic 15.6% (N = 16) attended the ultra-high risk for psychosis [PACE] clinic 19.4% (N = 20) attended the personality disorders [HYPE] clinic and 12.6% (N = 13) attended the mood clinic [YMC]. The mean BPRS score was 47.7 (SD ±12.2). A total of 77.7% of young people had previously been sexually active and of these, 37.5% did not use consistent contraception 26.3% had been pregnant, of which 95.2% were unplanned. A total of 68.8% reported having been tested for sexually transmitted infections and 25.5% tested positive. The severity of symptoms or clinical characteristics were not associated with engagement in high-risk sexual behaviours. These results indicate that young people with mental health disorders have high needs in regard to their sexual health, which could be addressed by incorporating sexual health referral pathways into early intervention services.
A Comparison of Self-Reported Emotional Regulation Skills in Adults With Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder
Publisher: SAGE Publications
Date: 02-04-2017
Abstract: Objective: Emotion dysregulation has been described as a central feature of both borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD). The current study aims to compare emotion regulation among ADHD, BPD, and healthy controls (HC). Method: Eighty adults with ADHD, 55 with BPD, and 55 HC completed self-report assessments of ADHD and BPD symptoms, psychosocial functioning, and emotion regulation skills. Principal components analysis (PCA) was conducted on the emotion regulation items, followed by multivariate analyses of group differences in emotion regulation. Results: PCA yielded four components: “Being Aware of Emotions,” “Making Sense of Emotions,” “Modifying and Accepting Emotions,” and “Confronting Emotions With Self-Encouragement.” The last component best distinguished the two patient groups from the HC. No differences were found between adults with ADHD and BPD. Conclusion: Adults with ADHD and BPD report comparable difficulties in encouraging oneself to attend inner aversive experiences, without engaging in impulsive behavior.
Screening for borderline personality disorder in outpatient youth
Publisher: Guilford Publications
Date: 08-2008
DOI: 10.1521/PEDI.2008.22.4.353
Abstract: Young people with borderline personality disorder (BPD) commonly seek help but often go unrecognized. Screening offers a means of identifying in iduals for more detailed assessment for early intervention and for research. This study compared the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), Borderline Personality Questionnaire (BPQ), the BPD items from the International Personality Disorder Examination Screening Questionnaire and the BPD items from the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II) Personality Questionnaire. 101 outpatient youth (aged 15-25 years) completed the screening measures and were interviewed, blind to screening status, with the SCID-II BPD module. The screening measures were readministered two weeks later to assess test-retest reliability. All four instruments performed similarly but the BPQ had the best mix of characteristics, with moderate sensitivity (0.68), the highest specificity (0.90), high negative predictive value (0.91) and moderate positive predictive value (0.65). Compared to the other three instruments, the BPQ had the highest overall diagnostic accuracy (0.85), a substantially higher kappa (0.57) with the criterion diagnosis, the highest test-retest reliability (ICC = 0.92) and the highest internal consistency (alpha = 0.92). The only clear difference to emerge in the Receiver Operator Curve (ROC) analysis was that the BPQ significantly outperformed the MSI (p = 0.05). Screening for BPD in out-patient youth is feasible but is not a replacement for clinical diagnosis.
Insular cortex volume and impulsivity in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.PNPBP.2009.07.017
Abstract: Fronto-limbic neural dysfunction has been implicated in the emotional dysregulation and impulsivity seen in borderline personality disorder (BPD). However, it remains unclear whether affected in iduals exhibit morphologic changes of the insular cortex, a fronto-limbic integration cortex engaged in emotional regulation and impulse control. This magnetic resonance imaging study examined the insular cortex volume and its relationship to clinical characteristics in a first-presentation teenage BPD s le. No significant difference was found in the insular volume between 20 BPD participants (5 males) and 20 healthy control participants (5 males). There was no association between the insular volume and parasuicidal episodes, trauma exposure, or comorbid Axis I disorders, but the BPD participants with violent episodes during the previous 6 months had a smaller insular volume bilaterally compared with those without such episodes. Furthermore, right anterior insular volume in the BPD participants was negatively correlated with impulsivity score. These preliminary findings suggest that insular cortex volume does not significantly differ in early BPD, but that there might be a relationship with violent and impulsive behavior that is often seen in the disorder. Further studies are needed to clarify whether the potential relationship between the insular cortex volume and impulsivity is specific to BPD.
Borderline Personality Features And Development Of Psychosis In An 'ultra High Risk' (Uhr) Population: A Case Control Study
Publisher: Wiley
Date: 05-06-2012
DOI: 10.1111/J.1751-7893.2012.00365.X
Abstract: There is clinical uncertainty as to whether borderline personality disorder (BPD) traits in those with an 'at risk mental state' have an effect on the risk of 'transition' to psychosis. We aimed to investigate the relationship between baseline BPD features, risk of transition and type of psychotic disorder experienced. This is a case-control study of 'ultra high risk' (UHR) for psychosis patients treated at the clinic, between 2004 and 2007. 'Cases' were UHR in iduals who made the 'transition' to full threshold psychotic disorder within 24 months 'control' group was a matched UHR s le who had not developed a psychotic disorder at 24 months. In iduals were matched on time of entry to the clinic, age and gender. Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) BPD features were assessed from clinical assessments using a structured instrument (Structured Clinical Interview for DSM-IV Axis II Disorder for BPD (SCID-II BPD)). Psychosis diagnosis following transition was rated from the clinical files using the operational criteria in studies of psychotic illness (OPCRIT) computer algorithm. The number of BPD traits and number with full threshold BPD were compared in those who developed psychosis and those who did not. We analysed data from 48 cases and 48 controls. There was no statistically significant difference in the rate of transition to psychosis for those with baseline full-threshold BPD, compared with those without BPD. The number of BPD traits or number with full threshold BPD did not differ by psychosis diagnosis grouping. Co-occurring BPD or BPD features does not appear to strongly influence the risk of short-term transition to psychosis or the risk of developing a non-affective psychotic disorder in this population.
Youth Depression Alleviation‐Augmentation with an anti‐inflammatory agent (YoDA‐A ): protocol and rationale for a placebo‐controlled randomized trial of rosuvastatin and aspirin
Publisher: Wiley
Date: 05-11-2015
DOI: 10.1111/EIP.12280
Abstract: There is growing support for the role of inflammation and oxidative stress in the pathophysiology of major depressive disorder (MDD). This has led to the development of novel strategies targeting inflammation in the treatment of depression. Rosuvastatin and aspirin have well-documented, anti-inflammatory and antioxidant properties. The aim of the Youth Depression Alleviation: Augmentation with an anti-inflammatory agent (YoDA-A) study is to determine whether in iduals receiving adjunctive anti-inflammatory agents, aspirin and rosuvastatin experience a reduction in the severity of MDD compared with in iduals receiving placebo. YoDA-A is a 12-week triple-blind, randomized controlled trial funded by the National Health and Medical Research Council, Australia. Participants aged 15-25, with moderate-to-severe MDD, are allocated to receive either 10 mg/day rosuvastatin, 100 mg/day aspirin, or placebo, in addition to treatment as usual. Participants are assessed at baseline and at weeks 4, 8, 12 and 26. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. The study is planned to be completed in 2017. At date of publication, 85 participants have been recruited. Timely and targeted intervention for youth MDD is crucial. Given the paucity of new agents to treat youth MDD, adjunctive trials are not only pragmatic and 'real-world', but additionally aim to target shortfalls in conventional medications. This study has the potential to first provide two new adjunctive treatment options for youth MDD aspirin and rosuvastatin. Second, this study will serve as proof of principle of the role of inflammation in MDD.
Childhood sexual abuse and abnormal personality: A population-based study
Publisher: Cambridge University Press (CUP)
Date: 27-09-2011
DOI: 10.1017/S0033291710001789
Abstract: Childhood sexual abuse (CSA) has been shown to be a risk factor for personality disorder (PD). However, no previous studies have examined whether associations exist between sexual abuse and abnormal personality as measured both categorically and dimensionally. Such enquiry would more fully illuminate the impact of CSA on adult personality. Using a large nationally representative s le, we set out to examine associations between CSA and categorically defined PD. We also examined associations between CSA and the five dimensions of personality (openness to experience, conscientiousness, extraversion, agreeableness and neuroticism). A total of 1520 young adults were interviewed to determine the prevalence of sexual abuse occurring before age 16 years. A dimensional measure of personality was completed by 1469 participants, and 1145 had an informant-based PD assessment. PD was independently associated with repeated CSA [fully adjusted odds ratio (OR) 1.9, 95% confidence interval (CI) 1.1–3.4]. Repeated sexual abuse was also associated with higher neuroticism and lower agreeableness ( p values for both .001). Adjusting for the effects of potential confounders and mediators, including earlier symptoms of anxiety and depression, had little impact on the strength of associations. We conclude that repeated CSA is independently associated with categorically defined PD, and also with higher neuroticism and lower agreeableness. Our findings suggest that if a dimensional classification of PDs is adopted in future classification systems, there might be meaningful continuity with previous aetiological research conducted using the current categorical system.
Attrition bias in longitudinal research involving adolescent psychiatric outpatients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2006
Substance Use in Youth With Borderline Personality Disorder
Publisher: Guilford Publications
Date: 09-11-2017
Abstract: Co-occurring substance misuse and borderline personality disorder (BPD) in adults is associated with more severe dysfunction and poorer prognosis than BPD alone. However, it is unknown to what extent substance use in youth with BPD is normative for this age group or pathological. This study compared substance use in 117 help-seeking youth (aged 15-25 years) with their first presentation for treatment of BPD, with an epidemiological general population s le and with healthy age- and gender-matched controls. Established instruments were used to diagnose BPD and assess substance use. Alcohol dependence, daily tobacco use, and use of illicit substances in the past month were between four and nine times more prevalent in the BPD group than in the general population. Similarly, the prevalence of substance use was disproportionately higher in youth with BPD than in matched controls. The findings indicate a non-normative, alarmingly high rate of substance use among youth with BPD.
Emotional and personality dysfunctions in early psychosis
Publisher: Cambridge University Press
Date: 19-02-2009
Sexual functioning and experiences in young people affected by mental health disorders
Publisher: Elsevier BV
Date: 07-2017
Orbitofrontal, amygdala and hippocampal volumes in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.PSCYCHRESNS.2007.08.007
Abstract: It is not known whether the fronto-limbic volume reductions found in adults with established borderline personality disorder (BPD) are present early in the disorder. The aim of the study was to investigate orbitofrontal cortex (OFC), hippoc al and amygdala volumes in a first-presentation teenage BPD s le with minimal exposure to treatment. Groups of 20 BPD patients and 20 healthy control participants underwent magnetic resonance imaging. Hippoc al, amygdala, OFC and whole brain volumes were estimated and compared between the two groups. Analysis of variance revealed reversal of the normal (right>left) asymmetry of OFC grey matter volume in the BPD group, reflecting right-sided OFC grey matter loss in the BPD group compared with control participants. No significant differences were found for amygdala or hippoc al volumes comparing BPD with control participants. We identified OFC but not hippoc al or amygdala volumetric differences early in the course of BPD. Hippoc al and amygdala volume reductions observed in adult BPD s les might develop during the course of the disorder, although longitudinal studies are needed to examine this.
Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder
Publisher: Guilford Publications
Date: 02-2022
Abstract: This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The s le comprised 112 outpatients with a BPD diagnosis, aged 15–25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
A pilot trial of moderated online social therapy for family and friends of young people with borderline personality disorder features
Publisher: Wiley
Date: 12-2020
DOI: 10.1111/EIP.13094
Abstract: We evaluated the acceptability, usability and safety of Kindred, a novel online intervention for carers of young people with borderline personality disorder (BPD) using a pre–post pilot trial design. The secondary aim explored whether Kindred use was associated with clinical improvements for caregivers on measures of burden of caregiving, stress, expressed emotion, family communication, disability, coping and knowledge of BPD and for patients on measures of severity of BPD symptoms and level of functional impairment. The trial site was the Helping Young People Early program for young people with BPD at Orygen in Melbourne, Australia. Informed consent was obtained from 20 adult carers (i.e., relatives or friends) and 10 young people aged 15–25 with BPD. Kindred, which was available for 3 months, incorporated online psychoeducation, carer‐to‐carer social networking and guidance from expert and peer moderators. Assessments were completed at baseline and 3 months follow‐up. Multiple indicators of acceptability, usability and safety were utilized. Seventeen carers were enrolled in Kindred and eight young people completed baseline measures. A priori acceptability, usability and safety criteria were met. Carer burden, stress, expressed emotion, family communication, quality of life, functioning, coping and perceived knowledge of BPD improved at follow‐up. Sixty‐six percent of the young people (4/6) reported that they believed Kindred had improved their carers' understanding of BPD. Kindred was shown to be acceptable, usable and safe, with encouraging improvements in both carer and young person outcomes. Kindred warrants evaluation of its efficacy via an randomized controlled trial.
Posttraumatic stress disorder following recent-onset psychosis: An unrecognized postpsychotic syndrome
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-1991
DOI: 10.1097/00005053-199105000-00002
Abstract: Clinical experience with psychotic patients early in the course of their illness suggested that symptoms of posttraumatic stress disorder (PTSD) may not be uncommon after recovery from an acute psychotic episode. Thirty-six patients recovering from an acute psychotic episode within 2 to 3 years of onset of their illness were assessed as inpatients and followed up on two occasions during the year after discharge. The prevalence of PTSD was found to be 46% at 4 months and 35% at 11 months, measured by a questionnaire linked to DSM-III criteria. The relationships between negative symptomatology and PTSD symptoms and between depressive symptomatology and PTSD symptoms were also examined a significant correlation was found only for the latter. The psychopathological, preventive, and therapeutic implications of these findings are discussed, and future research strategies are proposed.
Vocational engagement among young people entering mental health treatment compared with their general population peers.
Publisher: Wiley
Date: 03-07-2019
DOI: 10.1111/EIP.12712
Abstract: To compare rates of vocational engagement for youth entering specialist mental health treatment with the general population. A file audit retrieved vocational data for 145 youth aged 15 to 25 entering treatment. Clinical and population data were stratified by age and sex and compared between cohorts. Compared to the population, young people entering mental health treatment were less likely to have completed at least Year 11 in school (77% vs 42%, P < 0.001) and demonstrated higher rates of "Not in Education, Employment or Training" (9% vs 33%, P < 0.001). In iduals aged 15 to 18 years entering treatment experienced greater rates of educational disengagement than the population (30% vs 11%, P < 0.001), whereas people aged 19 to 25 years showed higher unemployment rates (52% vs 35%, P = 0.003). Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.
Improving functional outcomes in early‐stage bipolar disorder: The protocol for the REsearch into COgnitive and behavioural VERsatility trial
Publisher: Wiley
Date: 10-02-2019
DOI: 10.1111/EIP.12797
Abstract: Young people with bipolar disorder (BD) commonly experience reduced quality of life, persistent symptoms and impaired functional recovery despite often superior school performance. Compromised long-term functioning can ensue. There is evidence that psychological therapies alongside pharmacology may be more efficacious earlier in the course of the disorder. Intervention in the early stages may thus reduce the burden and risk associated with BD and mitigate the impact of the disorder on normal developmental trajectories. To date, however, the availability of evidence-based psychological therapies for young people with early BD is limited. Furthermore, there are no large-scale randomized controlled trials (RCTs) of such interventions. The study is a prospective, single-blind, RCT examining the effectiveness of an adjunctive in idualized and manualized psychological intervention, compared with treatment as usual within youth-specific early intervention services. The REsearch into COgnitive and behavioural VERsatility (RECOVER) intervention is delivered over a 6-month period. About 122 young people in the early stages of BD-I (at least one manic episode in the previous 2 years, with no more than five lifetime treated/untreated manic or hypomanic episodes) will be recruited. The assessments will occur at baseline, 3, 6 (primary endpoint, end of treatment), 9, 12, 15 and 18 months. Recruitment will commence in January 2019 and is anticipated to occur over a 3.5-year period. To date, there are no evidence-based psychological therapies tailored to young people with early BD. We will test whether early psychological intervention in the course of BD can reduce the symptomatic, psychological, vocational and social impacts that are seen in entrenched disorder.
Factors associated with vocational disengagement among young people entering mental health treatment
Publisher: Wiley
Date: 18-07-2018
DOI: 10.1111/EIP.12718
Abstract: Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). In idual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022 OR = 0.05, P = 0.002 respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
Subjective and objective sleep in young people with borderline personality disorder features
Publisher: Wiley
Date: 19-08-2021
DOI: 10.1111/JSR.13463
Abstract: Characterising sleep in young people (aged 15–25 years) with borderline personality disorder (BPD) features is crucial given the association between BPD features and sleep disturbance, negative consequences of poor sleep, and normative developmental sleep changes that occur in this age group. The present study aimed to characterise the sleep profile of young people with BPD to determine whether this profile is non‐normative and specific to BPD. Participants were 96 young people (40 with BPD features, 38 healthy in iduals, and 18 young people seeking help for mental health difficulties without BPD). Sleep was measured subjectively (self‐report questionnaires) and objectively (10 days of actigraphy). Young people with BPD features reported poorer subjective sleep quality, greater insomnia symptoms and later chronotype than same‐age healthy and clinical comparison groups. Young people with BPD features also displayed irregular sleep timing, later rise times, greater time in bed and longer sleep durations than healthy young people. Those with BPD features had superior sleep quality (greater sleep efficiency, less wake after sleep onset) and longer sleep durations than the clinical comparison group. Sleep profiles were similar across young people with BPD features with and without co‐occurring depression. Overall, the findings revealed a subjective–objective sleep discrepancy and suggest that sleep‐improvement interventions might be beneficial to improve subjective sleep in young people with BPD features.
Diagnosis and Treatment of Borderline Personality Disorder in Young People
Publisher: Springer Science and Business Media LLC
Date: 25-04-2020
Unmet mental health and criminogenic needs among justice-involved young people: a role for clinicians in the community
Publisher: Informa UK Limited
Date: 04-05-2023
Comparing three forms of early intervention for youth with borderline personality disorder (the MOBY study): study protocol for a randomised controlled trial
Publisher: Springer Science and Business Media LLC
Date: 21-10-2015
Evaluation of a psychoeducational group intervention for family and friends of youth with borderline personality disorder
Publisher: Springer Science and Business Media LLC
Date: 24-03-2017
A comparison of experiences of care and expressed emotion among caregivers of young people with first-episode psychosis or borderline personality disorder features
Publisher: SAGE Publications
Date: 11-10-2021
DOI: 10.1177/00048674211050299
Abstract: Caregivers of in iduals with severe mental illness often experience significant negative experiences of care, which can be associated with higher levels of expressed emotion. Expressed emotion is potentially a modifiable target early in the course of illness, which might improve outcomes for caregivers and patients. However, expressed emotion and caregiver experiences in the early stages of disorders might be moderated by the type of severe mental illness. The aim was to determine whether experiences of the caregiver role and expressed emotion differ in caregivers of young people with first-episode psychosis versus young people with ‘first-presentation’ borderline personality disorder features. Secondary analysis of baseline (pre-treatment) data from three clinical trials focused on improving caregiver outcomes for young people with first-episode psychosis and young people with borderline personality disorder features was conducted (ACTRN12616000968471, ACTRN12616000304437, ACTRN12618000616279). Caregivers completed self-report measures of experiences of the caregiver role and expressed emotion. Multivariate generalised linear models and moderation analyses were used to determine group differences. Data were available for 265 caregivers. Higher levels of negative experiences and expressed emotion, and stronger correlations between negative experiences and expressed emotion domains, were found in caregivers of young people with borderline personality disorder than first-episode psychosis. Caregiver group (borderline personality disorder, first-episode psychosis) moderated the relationship between expressed emotion and caregiver experiences in the domains of need to provide backup and positive personal experiences. Caregivers of young people with borderline personality disorder experience higher levels of negative experiences related to their role and expressed emotion compared with caregivers of young people with first-episode psychosis. The mechanisms underpinning associations between caregiver experiences and expressed emotion differ between these two caregiver groups, indicating that different supports are needed. For borderline personality disorder caregivers, emotional over-involvement is associated with both negative and positive experiences, so a more detailed understanding of the nature of emotional over-involvement for each relationship is required to guide action.
Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: Randomised controlled trial
Publisher: Royal College of Psychiatrists
Date: 12-2008
DOI: 10.1192/BJP.BP.107.048934
Abstract: No accepted intervention exists for borderline personality disorder presenting in adolescence. To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care. In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months. Eighty-six patients were randomised and 78 (CAT n =41 GCC n =37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment. Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.
Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders
Publisher: Elsevier BV
Date: 2021
Targeting mental health care attributes by diagnosis and clinical stage: the views of youth mental health clinicians
Publisher: AMPCo
Date: 11-2017
DOI: 10.5694/MJA17.00692
Abstract: To explore the potential utility of clinical stage and mental disorder categories as a basis for determining which attributes of youth mental health care should be offered to which groups of young people. In June 2017, we conducted an online survey of youth mental health clinicians that collected information on the participants' background and areas of expertise, then presented vignettes describing young people with different stages of six mental disorders (disorder-based vignettes were matched to participants' area of expertise). For each vignette, participants were asked to give a quantitative estimate of the proportion of young people with similar mental health problems they thought would clinically benefit from each of twelve attributes of mental health care (other than pharmacological or in idual psychological therapies). Survey results were analysed as independent, disorder-based s les, using standard statistical tests of significance, and as a stratified s le using mixed-effects models. A total of 412 clinicians working in 32 countries participated in both parts of the survey. Respondents represented a broad range of clinical disciplines, settings and areas of expertise. Their estimated proportions of young people who would benefit from the mental health care attributes varied by clinical stage and disorder (eg, a mean of 93% [interquartile range (IQR), 90%-100%] of young people with Stage 2 psychosis were estimated to benefit from case management with a multidisciplinary team while only 15% [IQR, 1%-25%] of young people with Stage 1b generalised anxiety disorder were estimated to benefit from collection and processing of biological s les). Neither the background of the respondents nor the sex of the characters in the vignettes significantly influenced the results. A combination of clinical stage and disorder information might be an appropriate basis for ensuring that the right attributes of early intervention mental health care are provided to the right young people at the right time. Policy and research priorities include trialling novel services, preferences research among young people, strengthening service responses to subthreshold disorders and promoting high-fidelity collection of clinical stage data in youth mental health settings.
ENACT: a protocol for a randomised placebo-controlled trial investigating the efficacy and mechanisms of action of adjunctive N-acetylcysteine for first-episode psychosis
Publisher: Springer Science and Business Media LLC
Date: 28-11-2019
DOI: 10.1186/S13063-019-3786-5
Abstract: First-episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown that the antioxidant amino acid N -acetylcysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2 g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-ups. ENACT is a 26-week, randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15–25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of: inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry. Australian New Zealand Clinical Trials Registry, ID: ACTR N12618000413224 . Registered on 21 March 2018.
The relationship between hippocampal asymmetry and temperament in adolescent borderline and antisocial personality pathology
Publisher: Cambridge University Press (CUP)
Date: 25-11-2014
DOI: 10.1017/S0954579413000886
Abstract: Investigating etiological processes early in the life span represents an important step toward a better understanding of the development of personality pathology. The current study evaluated the interaction between an in idual difference risk factor (i.e., temperament) and a biological risk factor for aggressive behavior (i.e., atypical [larger] rightward hippoc al asymmetry) in predicting the emergence of borderline personality disorder (BPD) and antisocial personality disorder symptoms during early adolescence. The s le consisted of 153 healthy adolescents ( M = 12.6 years, SD = 0.4, range = 11.4–13.7) who were selected from a larger s le to maximize variation in temperament. Interactions between four temperament factors (effortful control, negative affectivity, surgency, and affiliativeness), based on the Early Adolescent Temperament Questionnaire—Revised, and volumetric measures of hippoc al asymmetry were examined as cross-sectional predictors of BPD and antisocial personality disorder symptoms. Boys were more likely to have elevated BPD symptoms if they were high on affiliation and had larger rightward hippoc al asymmetry. In boys, low affiliation was a significant predictor of BPD symptoms in the presence of low rightward hippoc al asymmetry. For girls, low effortful control was associated with elevated BPD symptoms in the presence of atypical rightward hippoc al asymmetry. This study builds on previous work reporting significant associations between atypical hippoc al asymmetry and poor behavioral regulation.
A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology
Publisher: Springer Science and Business Media LLC
Date: 20-11-2018
DOI: 10.1007/S10597-017-0197-5
Abstract: Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
The youth model in mental health services
Publisher: SAGE Publications
Date: 2008
eNACT: A protocol for a randomised placebo-controlled trial investigating the efficacy and mechanisms of action of adjunctive N-acetylcysteine for first episode psychosis
Publisher: Research Square Platform LLC
Date: 11-10-2019
Abstract: Background First episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown the antioxidant amino acid N-acetyl cysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-up. Methods ENACT is a 26-week randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15-25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Discussion Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry.
Identifying attributes of care that may improve cost-effectiveness in the youth mental health service system
Publisher: AMPCo
Date: 11-2017
DOI: 10.5694/MJA17.00972
Abstract: To identify attributes of youth mental health care for which there is evidence of potential cost-effectiveness. We performed a literature review of economic evaluations that examined both costs and outcomes for attributes of youth mental health care other than pharmacological or in idual psychological therapies for full-threshold disorders. We searched the United Kingdom National Health Service Economic Evaluations Database for evaluations published to the end of 2014 and MEDLINE, Google Scholar and the citation lists of relevant publications for peer-reviewed studies published in English since 1997. Forty economic evaluations met inclusion criteria. Psychosis was the mental disorder with the most developed economic evidence base, with good evidence of cost-effectiveness for first-episode psychosis services. There was a developing cost-effectiveness evidence base for other disorders. The most common attributes of the interventions examined in the included studies were the location of services, engagement and support of families, assessment, prevention, early intervention, group delivery format and information provision. We used our findings to formulate a list of attributes of youth mental health care that may be acceptable to young people and potentially cost-effective. There is at least suggestive cost-effectiveness evidence for a range of attributes of youth mental health care. Further economic research is needed to substantiate most cost-effectiveness findings and to improve targeting of care among young people. Future economic evaluations should examine costs from both societal and health care perspectives and incorporate evidence regarding young people's preferences.
Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people
Publisher: SAGE Publications
Date: 02-03-2023
DOI: 10.1177/00048674231157274
Abstract: The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. This study included young people, aged 15–24 years, who attended Orygen’s Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000–1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. The study included 282 young people, of these 78.0% ( n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% ( n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% ( n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed. DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.
Treating co‐occurring first‐episode psychosis and borderline personality: a pilot randomized controlled trial
Publisher: Wiley
Date: 16-11-2011
DOI: 10.1111/J.1751-7893.2011.00306.X
Abstract: First-episode psychosis and borderline personality disorder are severe mental disorders that have their onset in youth. Their co-occurrence is clinically well recognized, is associated with significant risks and is complex to treat. Yet, there is no published specific intervention for this problem. This study reports a pilot randomized controlled trial comparing combined specialist first-episode treatment plus specialist early intervention for borderline personality, entitled Helping Young People Early, with specialist first-episode treatment alone. We aimed to evaluate the safety and feasibility of adding early intervention for borderline personality. The study investigated the safety of specialist first-episode treatment plus specialist early intervention for borderline personality in relation to deterioration in psychosis, aggression, self-harm and suicidality, and feasibility in relation to the completion of therapy phases. Sixteen patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) criteria for first-episode psychosis and borderline personality (four or more DSM-IV criteria) were randomized either to specialist first-episode treatment alone or specialist first-episode treatment plus specialist early intervention for borderline personality and were followed up at the end of treatment and 6 months later. The results showed that it was feasible to recruit and assess a high risk and complex group of patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality was an acceptable and safe treatment. A larger-scale randomized controlled trial of early intervention for borderline personality for young first-episode psychosis patients with co-occurring full or subsyndromal borderline personality is warranted.
Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review.
Publisher: American Psychological Association (APA)
Date: 2016
DOI: 10.1037/PER0000148
Abstract: Personality disorder (PD), outcomes of erse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required.
Pituitary volume in teenagers with first-presentation borderline personality disorder
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1016/J.PSCYCHRESNS.2007.05.001
Abstract: This study used magnetic resonance imaging to examine pituitary gland volume (PGV) in teenage patients with a first presentation of borderline personality disorder (BPD). No difference in PGV was observed between healthy controls (n=20) and the total BPD cohort (n=20). However, within the BPD cohort, those exposed to childhood trauma (n=9) tended to have smaller pituitaries (-18%) than those with no history of childhood trauma (n=10). These preliminary findings suggest that exposure to childhood trauma, rather than BPD, per se, might be associated with reduced PGV, possibly reflecting hypothalamic-pituitary-adrenal axis dysfunction.
Co‐occurring first‐episode psychosis and borderline personality pathology in an early intervention for psychosis cohort
Publisher: Wiley
Date: 26-09-2023
DOI: 10.1111/EIP.13352
Abstract: Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under‐recognized and under‐researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP) (ii) demographic and clinical factors associated with FEP + BPP (iii) the symptomatic and functional outcomes. This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30‐month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM‐IV Axis II Personality Questionnaire BPD criteria. In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian‐born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self‐harm throughout the follow‐up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care. BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self‐harm. Specific interventions need to be developed.
The influence of personality disorder on the future mental health and social adjustment of young adults: a population-based, longitudinal cohort study
Publisher: Elsevier BV
Date: 07-2016
Preliminary evidence for the cognitive model of auditory verbal hallucinations in youth with borderline personality disorder
Publisher: Frontiers Media SA
Date: 16-05-2019
Youth Depression Alleviation with Anti-inflammatory Agents (YoDA-A): a randomised clinical trial of rosuvastatin and aspirin
Publisher: Springer Science and Business Media LLC
Date: 17-01-2020
DOI: 10.1186/S12916-019-1475-6
Abstract: Inflammation contributes to the pathophysiology of major depressive disorder (MDD), and anti-inflammatory strategies might therefore have therapeutic potential. This trial aimed to determine whether adjunctive aspirin or rosuvastatin, compared with placebo, reduced depressive symptoms in young people (15–25 years). YoDA-A, Youth Depression Alleviation with Anti-inflammatory Agents, was a 12-week triple-blind, randomised, controlled trial. Participants were young people (aged 15–25 years) with moderate to severe MDD (MADRS mean at baseline 32.5 ± 6.0 N = 130 age 20.2 ± 2.6 60% female), recruited between June 2013 and June 2017 across six sites in Victoria, Australia. In addition to treatment as usual, participants were randomised to receive aspirin ( n = 40), rosuvastatin ( n = 48), or placebo ( n = 42), with assessments at baseline and weeks 4, 8, 12, and 26. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to week 12. At the a priori primary endpoint of MADRS differential change from baseline at week 12, there was no significant difference between aspirin and placebo (1.9, 95% CI (− 2.8, 6.6), p = 0.433), or rosuvastatin and placebo (− 4.2, 95% CI (− 9.1, 0.6), p = 0.089). For rosuvastatin, secondary outcomes on self-rated depression and global impression, quality of life, functioning, and mania were not significantly different from placebo. Aspirin was inferior to placebo on the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) at week 12. Statins were superior to aspirin on the MADRS, the Clinical Global Impressions Severity Scale (CGI-S), and the Negative Problem Orientation Questionnaire scale (NPOQ) at week 12. The addition of either aspirin or rosuvastatin did not to confer any beneficial effect over and above routine treatment for depression in young people. Exploratory comparisons of secondary outcomes provide limited support for a potential therapeutic role for adjunctive rosuvastatin, but not for aspirin, in youth depression. Australian New Zealand Clinical Trials Registry, ACTRN12613000112763 . Registered on 30/01/2013.
The HYPE Clinic: An Early Intervention Service for Borderline Personality Disorder
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Substance Use in Youth With Borderline Personality Disorder
Publisher: Guilford Publications
Date: 10-2018
Abstract: Co-occurring substance misuse and borderline personality disorder (BPD) in adults is associated with more severe dysfunction and poorer prognosis than BPD alone. However, it is unknown to what extent substance use in youth with BPD is normative for this age group or pathological. This study compared substance use in 117 help-seeking youth (aged 15–25 years) with their first presentation for treatment of BPD, with an epidemiological general population s le and with healthy, age- and gender-matched controls. Established instruments were used to diagnose BPD and assess substance use. Alcohol dependence, daily tobacco use, and use of illicit substances in the past month were between four and nine times more prevalent in the BPD group than in the general population. Similarly, the prevalence of substance use was disproportionately higher in youth with BPD than in matched controls. The findings indicate a non-normative, alarmingly high rate of substance use among youth with BPD.
Related Organisations
University Of North Carolina At Chapel Hill
Location: United States of America
Related Funding Activities
Discovery Projects - Grant ID: DP1092637
Start Date: 2010
End Date: 12-2013
Amount: $379,400.00
Funder: Australian Research Council
View Funded ActivityLinkage Projects - Grant ID: LP190100247
Start Date: 01-2021
End Date: 06-2024
Amount: $567,500.00
Funder: Australian Research Council
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