Early detection and intervention for adolescents with borderline personality disorder
BORIS DOI
Abstract
Borderline personality disorder (BPD) is a severe mental disorder characterized by instability in personal relationships, self-image and affective experiences as well as high impulsivity. Its prevention and early intervention have been declared a public health priority. Although research has made progress in early detection and early intervention in adolescents, which is the period when the disorder most often emerges, gaps in knowledge remain. This work contributes to closing these gaps by advancing the early detection of and intervention for BPD in adolescents.
Study 1 examined risk and self-harm behaviors as markers of BPD in adolescents and determined that the combination of risk and self-harm behaviors tends to be a specific marker of BPD, whereas self-harm alone is transdiagnostic in nature. Study 2 evaluated the stepped care approach used in AtR!Sk, a specialized outpatient clinic for adolescents with risk-taking and self-harm behaviors. The evaluation revealed that stage 1 of the approach was effective in improving psychosocial functioning and reducing overall psychopathology and non-suicidal self-injury, and that the decision criterion for identifying those in need of further treatment was well chosen. However, stage 2 of the stepped care approach did not demonstrate any incremental therapeutic benefit. Study 3 delved deeper into psychotherapy process research in adolescents treated for full or subthreshold BPD. The aim was to examine the integration of physiological data into self-report-based assessment of the psychotherapy process to address bias and validity issues associated with self-reports of patients with BPD. The results indicated that the integration of physiological data into session evaluation does not replace self-reports but opens up new perspectives and could thus provide a more multifaceted view of psychotherapeutic processes in the treatment of adolescents with BPD.
Overall, the results provide important insights for improving early detection and intervention in adolescents. As an overall framework that integrates all pieces of the puzzle of BPD – from disorder-specific characteristics such as symptom trajectories and comorbidities through early identification and intervention options – and that is able to guide future research in a systematic way is still lacking, a transdiagnostic clinical staging model that addresses this gap is described in the further course of this work. The results of the three studies presented are subsequently embedded into this model and possibilities for future research are considered.
Study 1 examined risk and self-harm behaviors as markers of BPD in adolescents and determined that the combination of risk and self-harm behaviors tends to be a specific marker of BPD, whereas self-harm alone is transdiagnostic in nature. Study 2 evaluated the stepped care approach used in AtR!Sk, a specialized outpatient clinic for adolescents with risk-taking and self-harm behaviors. The evaluation revealed that stage 1 of the approach was effective in improving psychosocial functioning and reducing overall psychopathology and non-suicidal self-injury, and that the decision criterion for identifying those in need of further treatment was well chosen. However, stage 2 of the stepped care approach did not demonstrate any incremental therapeutic benefit. Study 3 delved deeper into psychotherapy process research in adolescents treated for full or subthreshold BPD. The aim was to examine the integration of physiological data into self-report-based assessment of the psychotherapy process to address bias and validity issues associated with self-reports of patients with BPD. The results indicated that the integration of physiological data into session evaluation does not replace self-reports but opens up new perspectives and could thus provide a more multifaceted view of psychotherapeutic processes in the treatment of adolescents with BPD.
Overall, the results provide important insights for improving early detection and intervention in adolescents. As an overall framework that integrates all pieces of the puzzle of BPD – from disorder-specific characteristics such as symptom trajectories and comorbidities through early identification and intervention options – and that is able to guide future research in a systematic way is still lacking, a transdiagnostic clinical staging model that addresses this gap is described in the further course of this work. The results of the three studies presented are subsequently embedded into this model and possibilities for future research are considered.
Date of Publication
2024
Year of graduation
2024
Theses Type
dissertation
Subject(s)
Language(s)
en
Author(s)
Faculty/Graduate School
Institute
Access(Rights)
open.access
Primary OA Publication
true