Although borderline symptoms show a normative decline throughout adulthood, severe psychosocial impairment often remains. Identifying personality pathology in college‐age students may help prevent “adaptive failure” that can occur during the critical period of development from puberty through the late 20s and thus reduce impairment later in life. The aims of the current study were to estimate the prevalence of borderline personality disorder (BPD) in a diverse college sample, determine which symptoms confer the greatest relative risk of screening positive for BPD and examine the utility of the Personality Inventory for DSM‐5 brief form (PID‐5‐BF) in identifying BPD. Participants were 1456 undergraduate students, and 312 individuals (21.4% of the sample) screened positive for BPD. Chronic feelings of emptiness conferred the greatest relative risk of any symptom; students who endorsed this symptom were 15 times more likely to screen positive for BPD than those who did not. Scales and composite scores of the PID‐5‐BF demonstrated diagnostic accuracy ranging from sufficient to excellent. The current study contributes to literature concerning best practices in screening for personality pathology in young adults. Results suggest that chronic feelings of emptiness are significant for detecting at‐risk students and implications for the use of the PID‐5‐BF are discussed.

The Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18) is the only self-report measure informed by the Level of Personality Functioning ( Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-5; American Psychiatric Association, 2013]) Alternative Model of Personality Disorders developed for adolescents. The present investigation includes two studies evaluating the English LoPF-Q 12-18. In Study 1, single-factor and bifactor structures (unidimensional severity criterion and four specific factors: identity, self-direction, empathy, intimacy) were evaluated in an ethnically diverse community sample ( N = 453; age 10–18; 57% female). Study 2 used a community control ( n = 298; age 10–18; 54.4% female) and clinical sample ( n = 94; age 11–18; 58.5% female) to examine reliability, validity, and clinical utility. Study 1 results supported the bifactor model, with a robust general factor and little multidimensionality caused by the group factors, suggesting an essentially unidimensional structure. Study 2 revealed good internal consistency and construct validity and provided clinical cut-offs, supporting the use of the LoPF-Q 12-18 total score in research and clinical applications.

Although providers and patients may largely agree on what is essential to clinically useful assessment and diagnosis, patients have a unique voice and contribute additional information to our conceptualization of clinical utility. The current study evaluated the clinical utility of three diagnostic models (Section II categorial, Section III hybrid, and the original ICD-11 dimensional) from the consumer/user perspective. Participants included 703 undergraduate students and 154 family members or individuals with borderline personality disorder. Participants rated mock diagnostic reports on six indices of clinical utility. Results indicated that undergraduates favored categorical reports over the original ICD-11 dimensional reports on three of six indices but rated categorical and hybrid reports as essentially equivalent. In the patient/family sample, participants favored the hybrid or categorical model on all indices. Our findings speak to the value of a clear diagnostic label and suggest that future iterations of the DSM adopting a hybrid or dimensional model should have a continued focus on simplicity in communication.

Background. Borderline personality disorder (BPD) is a severe mental illness that typically onsets during adolescence. Emotion dysregulation is a key feature of BPD, and several interventions have been developed to target these difficulties. However, many barriers to care exist for adolescents with BPD, such as difficult-to-find and time-consuming treatment. Considering these limitations, the evidence-based group treatment Systems Training for Emotional Predictability and Problem Solving (STEPPS) was previously adapted for adolescents with BPD or symptoms of BPD and has shown promise in a preliminary study, but more work is needed examining STEPPS for use in adolescents. Methods. This paper uses a case study approach to evaluate STEPPS in two adolescents and their parents who completed 18 weeks of STEPPS intervention. Adolescents and their parents completed the STEPPS assessment of borderline personality features weekly during treatment to track changes over time. Moreover, participants completed assessments of emotion regulation, interpersonal difficulties, and general psychopathology before treatment, after program completion, and at 6- and 12-month follow-ups. Results. Results showed that both adolescents reported a decline in BPD features following STEPPS, albeit with unique patterns in decline. Parent reports of youth BPD features were less straightforward but suggested improvement in BPD features during treatment, but stability or small increases in symptoms at post-treatment and follow-up assessments. Results also illustrated improvements in emotion regulation, reduced stress in the parent-adolescent relationship, improvement in inadequate parent-adolescent boundaries, and a decline in functional impairment. Conclusions. Overall, STEPPS may offer a brief and cost-effective treatment for BPD, although more research is needed to fully establish its efficacy in adolescents.

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