Many clinicians are reluctant to diagnose BPD in young people due to a variety of reasons including the fact that their personalities and their brains themselves are still developing (the human brain is not fully developed until about the age of 25 years) and, sadly, the stigma that is still attached to a diagnosis of BPD (although, with increasing public awareness and education in relation to mental illness, the situation regarding stigma is slowly but surely improving).
However, despite the fact that such clinicians do not like to make a formal diagnosis of this very serious and debilitating illness, it by no means follows that young people are not afflicted with BPD-related symptoms. On the contrary, very many are.
Early-onset BPD refers to the development of BPD in persons below the age of 19 years. (My own disturbed behaviour began very early, I was dissociating at school – the teachers thought I’d gone deaf – every time families were mentioned in class. By eleven I was crying almost every day (at home rather than at school), shutting myself in cupboards (cocooning) and flying into angry rages in a desperate attempt, I now understand, to protect myself from her psychological abuse (this backfired when she threw me out of the house when I was thirteen)).
BPD is a very serious psychiatric condition irrespective of the age at which an individual develops it but early-onset BPD is particularly undesirable as research suggests when the disorder strikes during adolescence research suggest that a higher percentage, and significant proportion, of such patients, continue to present some BPD related symptoms up to 20 years later.
WHAT RISK FACTORS ARE CONNECTED TO THE EARLY ONSET OF BPD?
FAMILY-RELATED ENVIRONMENTAL FACTORS:
- low socioeconomic status
- economic crisis
- maladaptive parental behaviours
(All three of above are described by Bozzatello et al. (2019) as ‘robust independent prospective risk factors for early BPD [the term ‘prospective risk factors’ refers to risk factors identified by prospective studies which are studies of individuals over time are run to collect data about these individuals as their characteristics or circumstances change).
- maternal psychopathology. For example, being brought up by a mother with BPD greatly increases the child’s risk of developing early-onset BPD (Reinelt et al., 2014).
- discord between mother and child
- significant role confusion
- poor parent/child boundaries
- psychologically controlling parents
TRAUMA-RELATED ENVIRONMENTAL FACTORS:
- verbal abuse
- emotional/physical/sexual abuse
- emotional/physical neglect
- peer victimization
- genetic predisposition/gene-environment interaction
- aggressive temperament and, in particular, relational aggression (the anger I started to display towards my mother contributed to her throwing me out of the house and when I went to live with my father and step-father I was frequently told I ‘gave off waves of hostility’ – whatever that may mean).
- emotional instability
- unusually prone to negative emotions (after my mother threw me out and I went to live with my father and step-mother I was constantly accused of being ‘morose. My almost daily crying sessions carried on unabated into my late teens and beyond).
- both internalizing disorders (anxiety, depression, self-harm) and externalizing disorders (alcohol abuse drug abuse, ADHD, conduct disorder, and opposite defiant disorder displayed in childhood/adolescence also predict early-onset BPD.
Because early-onset BPD may precipitate particularly devastating long-term adverse effects on many important areas of life it is imperative that young people showing signs of developing the condition receive appropriate professional help as a matter of urgency. For more information about the treatment of BPD in young people, you may wish to visit: What Is Borderline Personality Disorder? | Child Mind Institute.
David Hosier BSc Hons; MSc; PGDE(FAHE).
Citation: C. Winsper, M. Zanarini and D. Wolke Prospective study of
family adversity and maladaptive parenting in childhood and borderline
personality disorder symptoms in a non-clinical population at 11 years.
Psychological Medicine, Available on CJO 2012
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