title: Correlates, stability and predictors of borderline personality disorder among previously suicidal youth.
abstract: This article examines a large cohort of previously suicidal adolescents, identifying those that surpassed threshold criteria for borderline personality disorder (BPD), according to the Abbreviated Diagnostic Interview of Borderlines (Ab-DIB), and determining the stability, correlates and predictors of BPD from early-to-late adolescence. Two hundred and eighty-six youth (mean baseline age 14.6 years; SD 1.5), presenting consecutively to a metropolitan pediatric hospital emergency department for evaluation of suicidality, were assessed at initial consultation for Axis I and II disorders and demographic and clinical variables. Two hundred and twenty-nine (80%) were re-assessed for those variables 4 years later and 204 (70.3%) had complete data sets at recruitment and follow-up. Previously suicidal youths who met BPD threshold on the Ab-DIB at recruitment were distinguishable at baseline from those who did not in conduct disorder symptoms (p < 0.003), lower levels of functioning (p < 0.001), drug use (p < 0.001), stressful life events (p < 0.003) and family relations (p < 0.001). The BPD diagnosis was consistent, according to this measure, at baseline and follow-up for 76% of participants. Four groups with respect to borderline pathology (persisting, remitting, emerging and never) were identified (ICC = 0.603, 95% CI = 0.40-0.78). Persistent BPD status was predictable by older age at presentation (p < 0.01) and level of functioning (p < 0.05). Eight percent were also suicidal at the 4-year follow-up. Using a self-report measure of BPD, we suggest that suicidal youth can indeed be diagnosed with the disorder at 14 years old, supporting the shift from DSM-IV to DSM-5, given what appears to be its temporal stability, differentiation of those suffering with considerable symptomatology or not, and predictors of its status in late adolescence. The low suicidality rate at follow-up indicates a good short-term prognosis.
authors.affiliation: Faculty of Medicine, Montreal Children's Hospital (MCH), McGill University Health Centre (MUHC), Room D-572, 2300 Tupper St, Montreal, QC, H3H 1P3, Canada, brian.greenfield@muhc.mcgill.ca.
authors.forename: Brian
authors.initials: B
authors.lastname: Greenfield
authors.forename: Melissa
authors.initials: M
authors.lastname: Henry
authors.forename: Eric
authors.initials: E
authors.lastname: Lis
authors.forename: Josh
authors.initials: J
authors.lastname: Slatkoff
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Guilé
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dougherty
authors.forename: Xun
authors.initials: X
authors.lastname: Zhang
authors.forename: Amir
authors.initials: A
authors.lastname: Raz
authors.forename: L
authors.initials: L
authors.lastname: Eugene Arnold
authors.forename: Londa
authors.initials: L
authors.lastname: Daniel
authors.forename: Brian L
authors.initials: BL
authors.lastname: Mishara
authors.forename: Robert K
authors.initials: RK
authors.lastname: Koenekoop
authors.forename: Filipa
authors.initials: F
authors.lastname: de Castro
mesh_terms: D000293:Adolescent; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D019966:Substance-Related Disorders; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*
references.citation: Clin Psychol Rev. 2008 Jul;28(6):969-81
references.pmid: 18358579
references.citation: J Pers Disord. 1998 Spring;12(1):13-22
references.pmid: 9573516
references.citation: Psychiatr Serv. 2002 Jun;53(6):738-42
references.pmid: 12045312
references.citation: Dev Psychopathol. 2009 Fall;21(4):1335-53
references.pmid: 19825271
references.citation: J Am Acad Child Psychiatry. 1979 Autumn;18(4):679-92
references.pmid: 541473
references.citation: Am J Psychiatry. 2007 Jun;164(6):929-35
references.pmid: 17541053
references.citation: Am J Psychiatry. 1999 Oct;156(10):1529-35
references.pmid: 10518162
references.citation: Am J Psychiatry. 2004 Nov;161(11):2108-14
references.pmid: 15514413
references.citation: Am J Psychiatry. 1990 Apr;147(4):470-6
references.pmid: 2316734
references.citation: J Child Psychol Psychiatry. 2008 Sep;49(9):933-41
references.pmid: 18665882
references.citation: Psychiatr Serv. 2002 Dec;53(12):1574-9
references.pmid: 12461218
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8
references.pmid: 9204677
references.citation: Am J Psychiatry. 1999 Oct;156(10):1522-8
references.pmid: 10518161
references.citation: Eur Child Adolesc Psychiatry. 2009 Sep;18(9):575-81
references.pmid: 19390770
references.citation: J Pers Disord. 2004 Dec;18(6):507-25
references.pmid: 15615664
references.citation: Am J Psychiatry. 1995 Jun;152(6):889-94
references.pmid: 7755119
references.citation: J Clin Psychiatry. 2008 Apr;69(4):533-45
references.pmid: 18426259
references.citation: J Psychosom Res. 1972 Jun;16(3):205-13
references.pmid: 5072914
references.citation: J Can Acad Child Adolesc Psychiatry. 2008 Nov;17(4):197-201
references.pmid: 19018322
references.citation: Compr Psychiatry. 2001 Nov-Dec;42(6):482-7
references.pmid: 11704940
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Jul;35(7):878-88
references.pmid: 8768347
references.citation: Am J Psychiatry. 1993 Aug;150(8):1237-43
references.pmid: 8328570
references.citation: Personal Ment Health. 2013 May;7(2):89-101
references.pmid: 24343935
references.citation: J Pers Disord. 2000 Summer;14(2):109-26
references.pmid: 10897462
references.citation: Arch Gen Psychiatry. 1983 Nov;40(11):1228-31
references.pmid: 6639293
references.citation: J Pers Disord. 2008 Aug;22(4):353-64
references.pmid: 18684049
references.citation: J Am Acad Child Adolesc Psychiatry. 1991 Jul;30(4):609-16
references.pmid: 1890095
references.citation: Arch Gen Psychiatry. 2011 Aug;68(8):827-37
references.pmid: 21464343