Borderline personality disorder in adolescents: Evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients

University of Houston, Houston, TX 77004, USA.
Comprehensive psychiatry (Impact Factor: 2.25). 01/2012; 53(6):765-74. DOI: 10.1016/j.comppsych.2011.12.003
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Empirical evidence is increasing in support of the validity of the construct of borderline personality disorder (BPD) in adolescence. There is growing consensus that the early identification and treatment of emerging borderline traits may be an important focus. However, few diagnostic (questionnaire- or interview-based) measures specifically developed or adapted for adolescents and children exist. The Childhood Interview for DSM-IV Borderline Personality Disorder (CI-BPD) [Zanarini, 2003] is a promising interview-based measure of adolescent BPD. Currently, no studies have explicitly been designed to examine the psychometric properties of the CI-BPD. The aim of the current study was to examine various psychometric properties of the CI-BPD in an inpatient sample of adolescents (n = 245). A confirmatory factor analytic approach was used to examine the internal factor structure of the 9 CI-BPD items. In addition, internal consistency, interrater reliability, convergent validity (with clinician diagnosis and 2 questionnaire-based measures of BPD), and concurrent validity (with Axis I psychopathology and deliberate self-harm) were examined. Similar to several adult studies, the confirmatory factor analytic results supported a unidimensional factor structure for the CI-BPD, indicating that the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria on which the CI-BPD is based constitute a coherent combination of traits and symptoms even in adolescents. In addition, other validity criteria were excellent. Taken together, the current study provides strong evidence for the validity of the CI-BPD for use in adolescents.

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Available from: Carolyn Ha, Aug 14, 2014
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    • "Evidence in support of the diagnosis in adolescence includes longitudinal continuity, a genetic basis, overlap between adolescent and adult BPD in terms of the latent variables underlying symptoms and the risk factors associated with BPD, and evidence for marked separation of course and outcome of adolescent BPD and other psychiatric disorders [4]. In adolescence, BPD affects 11% of psychiatric outpatients [5] and 30%–49% of inpatients [2] [6]. Populations diagnosed with BPD have increased rates of hospitalization [7], have poor clinical and psychosocial functioning [8], and remain a challenging group to treat [9]. "
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    ABSTRACT: Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage=15.42, SD=1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD. Copyright © 2015. Published by Elsevier Inc.
    Comprehensive psychiatry 07/2015; DOI:10.1016/j.comppsych.2015.07.008 · 2.25 Impact Factor
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    • "Instead, when items with low slope and LD were removed to form the BPFSC-11, support for a unidimensional factor structure for the BPFSC-11 was found. This is consistent with several studies that have demonstrated a unidimensional factor structure for BPD assessment tools in adults (e.g.Aggen, Neale, Roysamb, Reichborn-Kjennerud, & Kendler, 2009; Feske, Kirisci, Tarter, & Pilkonis, 2007; Sanislow et al., 2002), children (for example, Michonski et al., 2013), and adolescents (for example, Sharp et al., 2012). Evidence of dimensionality depends on the pattern of covariation among the items; theoretically, it is possible that multiple factors might be found with items specifically written to measure indicators of the more narrowly defined constructs. "
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    ABSTRACT: Despite historical concerns about the validity of the construct of borderline personality disorder (BPD) in adolescence, there is now general consensus that BPD in adolescence constitutes a valid and reliable diagnosis. Yet the development and refinement of measures to assess borderline traits in adolescents is in its infancy. Moreover, brief and easy-to-administer measures of borderline traits for use in large-scale studies do not exist. The aim of the current study was to evaluate the Borderline Personality Features Scale for Children (BPFSC; Crick, Murray-Close, & Woods, 2005) and develop a short version of the BPFSC through the use of item response theory (IRT) methods. BPFSC data from a community sample of 964 adolescents (mean age = 15.1 years, SD = .79; 55.9% female) were used to examine the factor structure of the BPFSC. The hypothesized 4-factor structure was not supported. The unidimensional IRT analysis showed instances of local dependence among item pairs and item responses that were not strongly related to the underlying construct. As a consequence, items were eliminated, creating a unidimensional 11-item brief BPFSC (the BPFSC-11). Next, evidence of construct validity of scores based on the shortened version was evaluated using a different sample of 371 inpatient adolescents. We demonstrated similar indices of construct validity as observed for the BPFSC total score with the BPFSC-11 scores and found evidence for good criterion validity. Use of the BPFSC-11 in clinical settings will reduce the burden on respondents without loss of information. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Personality Disorders: Theory, Research, and Treatment 03/2014; 5(1):70-8. DOI:10.1037/per0000057 · 3.54 Impact Factor
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    • "However, some empirical studies have affirmed the construct validity of the BPD diagnosis in adolescents, albeit with lower diagnostic stability (e.g. Bondurant et al. 2004; Sharp et al. 2012). "
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    ABSTRACT: Background: The aim of this study was to examine prospective predictors of suicide events, defined as suicide attempts or emergency interventions to reduce suicide risk, in 119 adolescents admitted to an in-patient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months. Method Structured diagnostic interviews and self-report instruments were administered to adolescent participants and their parent(s) to assess demographic variables, history of suicidal behavior, psychiatric disorders, family environment and personality/temperament. Results: Baseline variables that significantly predicted time to a suicide event during follow-up were Black race, high suicidal ideation in the past month, post-traumatic stress disorder (PTSD), childhood sexual abuse (CSA), borderline personality disorder (BPD), low scores on positive affectivity, and high scores on aggression. In a multivariate Cox regression analysis, only Black race, CSA, positive affect intensity and high aggression scores remained significant. Conclusions: Our findings suggest the following for adolescent populations: (1) in a very high-risk population, risk factors for future attempts may be more difficult to ascertain and some established risk factors (e.g. past suicide attempt) may not distinguish as well; and (2) cross-cutting constructs (e.g. affective and behavioral dysregulation) that underlie multiple psychiatric disorders may be stronger predictors of recurrent suicide events than psychiatric diagnoses. Our finding with respect to positive affect intensity is novel and may have practical implications for the assessment and treatment of adolescent suicide attempters.
    Psychological Medicine 08/2012; 43(05):1-11. DOI:10.1017/S0033291712001912 · 5.94 Impact Factor
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