The Borderline Diagnosis for Children (original) (raw)
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DEVELOPMENTAL PSYCHOPATHOLOGY: THE APPROACH TO THE BORDERLINE CASE
The emergence of developmental psychopathology as a independent discipline has provided various interesting ways of dealing with mental disease, particularly in children. This new approach promises to overcome some of the limitations of previous views of deviance based either on the mental psychiatric model or on different theoretical orientations in clinical psychology. From a developmental view, psychological and medical sciences have undergone a sort of hierarchical integration in dealing with deviant behaviour. In the present work, the specific contributions of two subdisciplines, Child Psychiatry and Developmental Psychology, will be considered through the analysis of their origins, evolution and theoretical background, in an attempt to provide an integrative view of the issue. Some of the theoretical principles claiming to support developmental psychopathology as an independent science are discussed with specific reference to their clinical implications. The advantages and limitations of a developmental approach to deviance are considered, and some controversial issues highlighted. A particularly emphasis is placed on the approach to borderline cases where one cannot establish a well-defined psychopathological entity and therefore neither the medical psychiatric model nor the normal expectations of developmental psychology seem to be appropriate in dealing with such cases. A chapter on the definitional problem related to borderline cases is included, and their importance within the school context discussed Some traditional systems of diagnosis and classification in child psychiatry are reviewed. In an attempt to overcome some limitations on their use in psychopathology, a modified version of a multi-axial psychiatric scheme of diagnosis and classification is proposed for use within the framework of developmental psychopathology. A case study is included aiming to illustrate a borderline case and to provide a wider discussion about the model of classification and some clinical issues.
Borderline pathology in children and adolescents
International Journal of Mental Health Nursing, 2004
Mental health nurses have historically been pessimistic about and often unsympathetic towards clients diagnosed with borderline personality disorder. By the time these clients reach adult mental health services their behaviours are often difficult to manage and they often suffer significant re-victimization by health services. Questions need to be raised about how best to avert the consolidation of the problems associated with the disorder. This paper explores the concept of 'borderline pathology' in children and adolescents and examines the best available evidence for utilizing an early identification and intervention model for children and adolescents who exhibit this constellation of symptoms.
Diagnosing Borderline Disorders
Issues in Religion and Psychotherapy, 1981
The physician's dictum is "primum non nocere" first, do no harm. Dr. Allen Bergin is noted for his research showing that psychotherapy in some instances harms the patient or worsens his condition. Dr. Bergin's concern in assigning me this presentation is that we as therapists need to know something of how to recognize and understand the prime candidates for getting worse in improper therapy. Little about the therapy of these patients will be discussed since it can't be learned from a lecture. Those not familiar with it should refer to the most experienced therapist they know. Even he will be challenged. Let us clarify which patients we are talking about. Most therapists have been baffled by certain patients who ;eem to show symptoms of several neuroses, sometimes all at once, and at times psychosis as well. For patients hovering on these borders between categories, various diagnostic terms have been used, the most enduring of which has been, not surprisingly, &...
Borderline Disorders of Childhood: An Overview
Journal of the American Academy of Child & Adolescent Psychiatry, 1990
This selected review considers children classified as "borderline" and focuses on two broad categories: Borderline personality disorder/borderline spectrum and schizotypal personality disordcr/autism/schivophrcnia spectrum classifications. Clinical descriptions, biological correlates, delimitation from other disorders, outcome, family studies, hypothesized etiologies, therapeutic considerations, and response to treatment arc presented for each. Data support the subclassification of the heterogeneous groupings of borderline children into at least the two categories, and their differentiation from each other and from other clinical disorders in the population. Overlap across the borderline categories exists for individual children. The nature and shortcomings of relevant studies arc described, the need for scientifically based research championed, and a differential approach to directive treatment of borderline children advocated. Further subclassification of borderline disorders should result in more cost-effective diagnosis and treatment. 1.
The effects of including a callous-unemotional specifier for the diagnosis of conduct disorder
Journal of Child Psychology and Psychiatry, 2011
Background: 'With Significant Callous-Unemotional Traits' has been proposed as a specifier for conduct disorder (CD) in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The impact of this specifier on children diagnosed with CD should be considered. Methods: A multi-site cross-sectional design with volunteers (n = 1136) in the third-seventh grades and 566 consecutive referrals (ages 5-18) to a community mental health center were used to estimate the prevalence rates of CD with and without the proposed specifier. In addition, the degree of emotional and behavioral (especially physical aggression) disturbance and level of impairment in youth with and without CD and with and without the specifier was evaluated. Results: In the community sample, 10%-32% of those with CD and 2%-7% of those without CD met the callous-unemotional (CU) specifier threshold depending on informant. In the clinic-referred sample, 21%-50% of those with CD and 14%-32% without CD met the CU specifier threshold depending on informant. Those with CD and the specifier showed higher rates of aggression in both samples and higher rates of cruelty in the clinicreferred sample. Conclusions: Results indicate between 10% and 50% of youth with CD would be designated with the proposed CU specifier. Those with CD and the specifier appear to be more severe on a number of indices, including aggression and cruelty.
Etiological features of borderline personality related characteristics
Development and Psychopathology, 2012
It has been reported that borderline personality related characteristics can be observed in children, and that these characteristics are associated with increased risk for the development of borderline personality disorder. It is not clear whether borderline personality related characteristics in children share etiological features with adult borderline personality disorder. We investigated the etiology of borderline personality related characteristics in a longitudinal cohort study of 1,116 pairs of same-sex twins followed from birth through age 12 years. Borderline personality related characteristics measured at age 12 years were highly heritable, were more common in children who had exhibited poor cognitive function, impulsivity, and more behavioral and emotional problems at age 5 years, and co-occurred with symptoms of conduct disorder, depression, anxiety, and psychosis. Exposure to harsh treatment in the family environment through age 10 years predicted borderline personality related characteristics at age 12 years. This association showed evidence of environmental mediation and was stronger among children with a family history of psychiatric illness, consistent with diathesis-stress models of borderline etiology. Results indicate that borderline personality related characteristics in children share etiological features with borderline personality disorder in adults and suggest that inherited and environmental risk factors make independent and interactive contributions to borderline etiology.
Parent-Adolescent Concordance in Borderline Pathology and why it Matters
Journal of Abnormal Child Psychology, 2018
The aims of the current study were to: 1) identify patterns of agreement between parent-adolescent dyads on reports of adolescent borderline personality features utilizing latent class analysis (LCA) and 2) examine the clinical implications of class membership for indices of psychiatric severity and internal psychological resources. The sample included 643 adolescent inpatients. Borderline personality features were assessed by both adolescents and parents using the Borderline Personality Features Scale-Child (BPFS-C; Crick et al. 2005) and Borderline Personality Features Scale-Parent (BPFS-P; Sharp et al. 2010), respectively. Following recommended statistical approaches for evaluating rater concordance, LCA was utilized to identify distinct classes of parent-adolescent dyads based on concordance/discrepancy in BPFS reports. The subsequent classes were then related to outcome measures of psychiatric severity and internal psychological resources (emotion regulation and experiential acceptance). LCA identified 3 classes of parent-adolescent dyads: 2 convergent classes demonstrating BPFS-P and BPFS-C agreement at a moderate and high level and a divergent class consisting of dyads reporting clinically significant scores on the BPFS-P but clinically negligible BPFS-C scores. Both convergent classes evidenced higher rates of psychiatric severity and lower access to internal resources. The current study is the first to use LCA to examine the relation between informant concordance on reports of DSM-based adolescent borderline pathology in a clinical sample. The significance of the discrepancies within and between classes is discussed with relation to psychosocial outcomes, the diagnosis of borderline personality disorder and implications for what it means when parents and adolescents disagree.
Journal of Personality Disorders, 2021
The aim of the current study was to examine the risk for offending among outpatient youth with borderline pathology. Demographic and diagnostic data from 492 outpatients who attended a public mental health service for 15- to 25-year-olds between January 1998 and March 2008 were linked with information regarding criminal offenses and intervention orders collected from a statewide police database between March 1993 and June 2017. BPD diagnosis and number of BPD criteria were both associated with an elevated risk for violent and nonviolent offenses and family violence intervention orders. Moderation analyses revealed that the number of BPD criteria might affect males and females differently in terms of offending. Both impulsivity and anger independently predicted the risk for violent and nonviolent offenses and family violence intervention orders. Early detection of increased risk of offending among youth with BPD features is essential to develop targeted treatments for criminal or violent behavior.