An evaluation of clinical practice guidelines for self-harm in adolescents: The role of borderline personality pathology.

Abstract

Borderline personality disorder (BPD) is associated with high rates of self-harm, suicide attempts, and death by suicide in adults and adolescents. Screening and assessment of BPD in self-harming adolescents could be an important clinical intervention. The aim of this article was to identify whether existing clinical practice guidelines (CPGs) for the care of self-harm in adolescents considered the screening, diagnosis, and/or treatment of BPD. Previous work by Courtney, Duda, Szatmari, Henderson, and Bennett (2018) used Preferred Reporting Items for Systematic Reviews and Meta-Analyses methods to identify 10 CPGs relevant to self-harm in children and adolescents. In this study, the 10 CPGs were reviewed for content about screening, assessment, and/or treatment recommendations for adolescents with BPD. Out of the 10 CPGs, 4 acknowledged the association between BPD and self-harm in adolescents. There was minimal to no guidance provided in the CPGs regarding specific screening, assessment, or treatment strategies for BPD. This may be due to the lack of evidence for efficacy and effectiveness of screening for BPD, thereby limiting the development of guideline recommendations. Studies that examine the impact of screening for BPD in clinical settings are needed. In the interim, CPGs should cite the prevalence of BPD in adolescents who self-harm and reference research showing the benefit of treatment with dialectical behavioral therapy for self-harm and suicide attempts in youth with BPD.

Ideal standards for policy on student self-harm: What research and practice tells us

“…Given self-harm is a common symptom in several mental health disorders that may emerge during adolescence, such as borderline personality disorder (BPD) and major depressive disorder (MDD) (American Psychiatric Association, 2013), it may be that policies should address or make reference to mental illness in adolescents, if only briefly. Indeed, Boylan et al (2019) recommend that all clinical practice guidelines for self-harm in adolescence should provide some information on comorbidity with BPD and found in a review of guidelines that this was lacking. Similarly, our review of policies did not find comorbid disorders such as BPD to be a common theme and this may be an area for further research and development.…”