Recruiting and exploring vulnerabilities among young people at risk, or in the early stages of serious mental illness (borderline personality disorder and first episode psychosis)

Abstract

IntroductionMany gaps exist in our understanding of the developmental pathways to severe mental illness (SMI), including borderline personality disorder (BPD) and psychosis. However, those who have experienced adverse childhood experiences (ACEs) are at an increased risk and there is evidence to suggest that one of the earliest markers is emotional dysregulation. An area which has received relatively less research attention is the role neurodevelopmental disorders (NDDs) play. The aim of this feasibility study was therefore to explore the clinical profiles of young people early in the course of SMI, including their profiles of ACEs, emotional regulation difficulties, borderline personality traits and NDDs.MethodsA cross-sectional study of young people (aged 15–25) at risk of SMI, currently being seen within NHS mental health services, was conducted. This included those with early symptoms of psychosis and/or BPD as assessed by diagnostic interview. Eligible participants self-completed a battery of sociodemographic, clinical, and psychological measures in the company of a researcher. This included assessments of: symptoms of NDDs; borderline pathology traits; ACEs; and difficulties in emotional regulation. Statistical analyses included Mann–Whitney U tests and multiple regression.ResultsOf the 118 potentially eligible participants who were referred, 48 were ultimately included in the study. Young people early in the course of SMI reported a high prevalence of ACEs and deficits in emotional regulation. In total, 79% met criteria for attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Emotional dysregulation was found to significantly mediate the association between both ACEs and the frequency of NDDs and borderline personality traits, however given the small sample size these results are preliminary in nature.ConclusionYoung people early in the course of SMI are at an increased risk of experiencing multiple childhood adversities and our results indicate a high prevalence of NDDs amongst them. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity. We suggest that the clinical implications of our findings include routine screening for NDDs and ACEs and an increased recognition of the significance of emotional dysregulation. However, larger scale longitudinal studies are needed to investigate these preliminary findings further.

Harmonizing early intervention strategies: scoping review of clinical high risk for psychosis and borderline personality disorder

“…7 studies ( Koutsouleris et al, 2014 ; McMillan et al, 2017 ; Sanchez et al, 2019 ; Seiler et al, 2020 ; Burke et al, 2022 ; Gajwani et al, 2022 ; Gruber et al, 2023 ) included patients at CHR-P and patients with BPD, with or without additional samples of patients with FEP or major depressive disorder/mood disorders and healthy controls. In this theme, CHR-P and BPD represented different clinical populations (even though some CHR-P youth also displayed a comorbid BPD).…”

“…Clinical recommendations included assessing sub-threshold positive symptoms in help-seeking youth even though their major complaint is non-psychotic ( Seiler et al, 2020 ), screening for neurodevelopmental disorders and adverse childhood experiences ( Gajwani et al, 2022 ), integrating sexual health screening into initial assessment ( Sanchez et al, 2019 ), and implementing a range of strategies to address sexual health and sexual dysfunction ( McMillan et al, 2017 ). Gruber et al emphasized the clinical implications of comprehensive assessment measures to evaluate identity- and self-disturbances ( Gruber et al, 2023 ).…”

“…Research recommendations included employing longitudinal study designs ( Gajwani et al, 2022 ; Gruber et al, 2023 ), investigating more specific neuroanatomical biomarkers ( Koutsouleris et al, 2014 ), and replicating relevant study findings. For example, Burke et al (2022) showed fewer voluntary and involuntary hospital admissions in youth who had transitioned to psychosis from PACE, HYPE, or primary care compared to cases presenting directly with FEP.…”

The Impact of Psychological Interventions on Functioning in the Context of Borderline Personality Disorder Features for Adolescents and Young Adults; a Systematic Review and Meta Analysis

“…For example, Juurlink et al (2021) found that identity instability and chronic emptiness predicted vocational di culties, while perceived social support has been shown to act as a protective factor against functional impairment (Thadani et al, 2022). As such, it is important to be open to all forms of trials and interventions for BPD in adolescents and young adults as the work is still in its nascent stages in clinical and community settings(Gajwani et al, 2022). The awaited ODDESSI trial, an RCT exploring Open Dialogue Therapy's effects, a social network model of crisis and continuing mental healthcare, could offer valuable insights into the impact on functioning and recovery(Pilling et al, 2022).Findings indicated a slight increase in ES at the nal follow-up for longer-term outcomes in specialist BPD interventions.…”