title: Developmental trajectories of self-injurious behavior, suicidal behavior and substance misuse and their association with adolescent borderline personality pathology.
abstract: OBJECTIVE
  Adolescent risk-taking and self-harm behaviors are associated with affect dysregulation and impulsivity, both core features of borderline personality disorder (BPD). We hypothesized that the developmental courses of these behaviors i) tend to cluster rather than appear individually, and ii) might indicate adolescent BPD pathology. Therefore, we explored the developmental trajectories of self-injurious behavior (SIB), suicidal behavior (SB) and substance misuse (SM) in a community sample of adolescents; and we investigated the trajectories' overlap and its associations with BPD traits.
  
  
  METHODS
  513 adolescents, aged 15-17 years, were followed for two years as part of the Saving and Empowering Young Lives in Europe study and its subsequent follow-up. Distinct developmental trajectories were explored using general growth mixture modeling.
  
  
  RESULTS
  Three distinct classes were identified within each of the harmful behaviors SIB, SB and SM. Both the high-risk SIB trajectory and the high-risk SB trajectory demonstrated elevated initial degree of engagement, followed by a gradual decrease. The SM high-risk trajectory had a medium initial degree of engagement, which increased over time. There was a high degree of overlap (80-90%) among the high-risk trajectories for the three behaviors (SIB, SB and SM), and this overlap was significantly associated with elevated levels of BPD pathology.
  
  
  CONCLUSIONS
  The data collection was based on participants' self-report.
  
  
  CONCLUSIONS
  The findings indicate a similar pattern of reduction over time between SIB and SB for the high-risk trajectories, whereas the high-risk trajectories for SM show a pattern of increase over time. The observed symptom shift is associated with borderline personality pathology in adolescents. Therefore these behaviors might represent early indicators of risk supporting potential early detection.
authors.affiliation: Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Orit
authors.initials: O
authors.lastname: Nakar
authors.affiliation: Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Romuald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: German Centre for Research on Aging at the University of Heidelberg, Heidelberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schilling
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia & Centre for Youth Mental Health, The University of Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chanen
authors.affiliation: Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gloria
authors.initials: G
authors.lastname: Fischer
authors.affiliation: Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Parzer
authors.affiliation: National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Karolinska Institute, Stockholm, Sweden; Department of Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Carli
authors.affiliation: National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Karolinska Institute, Stockholm, Sweden.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
authors.affiliation: Department of Health Sciences, University of Molise, Campobasso, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sarchiapone
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, NY, USA.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wasserman
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, NY, USA.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Hoven
authors.affiliation: Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Resch
authors.affiliation: Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. Electronic address: michael.kaess@med.uni-heidelberg.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Kaess
mesh_terms: D000293:Adolescent; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D010551:Personality; D012309:Risk-Taking; D057566:Self Report; D016728:Self-Injurious Behavior / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D055815:Young Adult; D000092864:Suicide Prevention
keywords: Borderline personality disorder; Growth mixture modeling; Self-injury; Substance misuse; Suicidal behavior