Study Distinguishes Adolescent- vs. Adult-Onset Borderline Personality Disorder

While adolescent-onset Borderline Personality Disorder (BPD) is symptomatically similar to adult-onset BPD, it differs in other ways that may have prognostic significance, according to a recent study.

The study, conducted by Mary Zanarini, Ed.D., professor of psychology at Harvard Medical School, and Marianne Goodman, MD, of Mount Sinai School of Medicine, found only four clinically meaningful differences in prevalence rates of the 24 Borderline Personality Disorder symptoms studied.

The following four BPD symptoms were significantly more common among people with adult-onset BPD:

• Quasi-psychotic thought
• Undue dependency/masochism
• Devaluation/manipulation/sadism
• Countertransference problems

According to the study’s researchers, this may be because Borderline Personality Disorder symptoms have not yet developed in some adolescents who will exhibit them when they are older. Also, those with adolescent-onset BPD may not recognize the presence of some BPD symptoms.

“There’s no doubt you can have full-blown Borderline Personality Disorder at the age of 13,” Zanarini said.

Adolescent- vs. Adult-Onset BPD

People with adolescent-onset BPD (meaning they were first hospitalized before the age of 18), reported higher rates of major depression, panic disorder, social phobia, and eating disorder not otherwise specified (EDNOS). Rates of substance abuse and Post Traumatic Stress Disorder (PTSD) were similar for both groups.

Both adults and adolescents reported the same lifetime rate of individual therapy, at about 95 percent. However, adolescents were much more likely to have a history of taking medications (93 percent vs. 84 percent) and to have had prior psychiatric hospitalizations (98 percent vs. 72 percent).

The study also found that people with adolescent-onset BPD were less likely to report a childhood history of sexual abuse. They also reported less severe abuse of other types, as well as less severe neglect, according to the study.

Other findings from the study include the following:

• Those with adolescent-onset BPD reported better social and vocational functioning than those with adult-onset BPD. This may be the result of adolescents receiving more support from their families and the community.
• People with adolescent-onset BPD were less likely to have been treated in residential or day BPD treatment.
• Those with adolescent-onset BPD reported lower levels of neuroticism, agreeableness, and conscientiousness, but higher levels of extraversion.

The study involved 111 people with adolescent-onset Borderline Personality Disorder and 224 with adult-onset BPD. Zanarini presented the study’s findings during the National Education Alliance for Borderline Personality Disorder’s (NEA-BPD’s) conference on treating adolescents with BPD in March.