What works for adolescents with borderline personality disorder: towards a developmentally informed understanding and structured treatment model
Introduction
What works for adolescents with borderline personality disorder (BPD)? And, how do we best understand the mechanisms (theory of change) and design treatment that works for young people diagnosed with BPD? In this paper, we try to answer these questions. We do so by first selectively reviewing the current data for evidence-based treatment programs for BPD in adolescents. Next, we focus on the specific developmental issues in adolescence that might challenge the psychotherapeutic context as well as how to integrate those challenges in BPD treatment. Further, we will report and comment on a recent Danish randomized controlled trial (RCT) we conducted that compared the effectiveness of a mentalisation-based group-treatment program adolescents with BPD (MGAB) with treatment as usual (TAU) [1•], and reflect on these findings in terms of implications for treatment of adolescent BPD. We conclude with a few thoughts regarding future research and directions.
Section snippets
Evidence-based treatment for adolescent BPD: what is the evidence?
Research over the last decade has shown that BPD in adolescence (a) is a valid and reliable diagnosis [2], (b) displays the same or even higher prevalence rates as in adults populations [3], (c) is associated with a marked decrease in social functioning [4], (d) is linked to individual suffering [5], (e) demonstrates high levels of comorbidity [6], and (f) represents a substantial financial burden to both the educational and the general mental health system [7]. Notwithstanding the
BPD in adolescence: normative development in comparison to adult functioning
Of crucial relevance for designing treatment for adolescent BPD, is thorough knowledge about the normative adolescent development as well as awareness about the key developmental challenges pertinent to adolescence. BPD is a psychiatric condition, typically emerging and perhaps peaking in adolescence (14–17 years) [18•,19]. Adolescence itself is a period characterized by ‘BPD traits’ of high affect instability, enhanced anger, impulsivity and identity challenges [20], and a normative increase
Mentalization-based group treatment for adolescents with BPD - is it a feasible approach?
Based on the relatively limited effectiveness reported in the research literature as well as the lack of evidence-based guidelines for treatment of BPD in adolescence, a Danish research team recently decided to test a treatment program focused on a group intervention for adolescents with BPD. This RCT-study compared MGAB with TAU for adolescents with BPD (for details see Ref. [30]). The design of the MGAB program was inspired by research suggesting that group psychotherapy generally is as
Where do we go from here: future research and the role of the social context
How do we interpret these results [1•] and what implications do these findings have for the understanding of treatment of adolescent BPD? First of all, one tempting straightforward conclusion would be that the MGAB program is not suitable for adolescents with BPD or, at the very least, that it is not superior to standard treatment. The latter seems evident and confirms what is often found in psychotherapy research, namely that specialised treatment modalities are not superior to standard
CRediT author statement
All authors contributed equally to all of the CRediT topics.
Conflict of interest statement
Nothing declared.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
References (58)
- et al.
Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial
JAMA Psychiatry
(2018) - et al.
Treading a fine line: is diagnosing depression in young people just medicalising moodiness?
Br J Gen Pract
(2009) - et al.
Ongoing neural development of affective theory of mind in adolescence
Soc Cogn Affect Neurosci
(2013) - et al.
Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study
Dev Psychol
(2005) - et al.
Girls’ and boys’ problem talk: implications for emotional closeness in friendships
Dev Psychol
(2016) - et al.
The mentalizing approach to psychopathology: state of the art and future directions
Annu Rev Clin Psychol
(2020) - et al.
Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial
J Child Psychol Psychiatry
(2020) - et al.
Personality disorders in adolescence
The Encyclopedia of Child and Adolescent Development
(2020) Borderline personality disorder in young people: are we there yet?
J Clin Psychol
(2015)- et al.
A life span perspective on borderline personality disorder
Curr Psychiatry Rep
(2019)