Borderline personality disorder in children and adolescents: discriminant validity in relation to major depressive disorder

Abstract

Clinical discernment of the diagnosis of borderline personality disorder (BPD) in adolescents is difficult, due in part to very high rates of comorbidity with major depressive disorder (MDD) or depressive symptoms. This paper reviews published research on studies about risk factors, neurobiological and neuropsychological correlates and treatment in both disorders for persons less than 25 years of age. The aim is to focus on differences identified between the disorders to substantiate their discriminative validity, although similarities are included. Very few studies were found which directly compared youth with both disorders -or both disorders -in the same sample. These studies found strong covariation between BPD and MDD symptoms across adolescence and conjoint response to dialectical behavioural therapy. Youth with BPD may have greater impairments in social processing than youth with MDD. Indirect comparisons supported poor evidence for discriminative validity and no findings were replicated. To date, the limited research base does not support that BPD and MDD are distinct disorders in adolescence, however the absence of observed differences is not the same as evidence of no difference. Given the importance of improving psychiatric and psychological care for youth, it is strongly recommended that studies about adolescent mood and mood disorder include concurrent and repeated measurement of BPD and MDD.