Differentiating adolescents with borderline personality disorder from normal adolescents and adolescents with other disorders

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Middleton, Anna Elisabeth

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This research investigates whether adolescents with Borderline Personality Disorder (BPD) can be reliably differentiated from normal and other-disordered adolescents. Psychoanalytic theory describes borderline psychopathology as deriving from difficulties in the separation/individuation phase of early development. Mahler (1946) portrays the rapprochement subphase of this period as a time when the child is vulnerable to the nascent of personality disorders. Blos (1967) elaborated this theory positing adolescence as a “second individuation” where earlier separation/individuation difficulties reemerge. Difficulties in the rapprochement stage make the second individuation problematic, leaving the adolescent at risk for borderline pathology. Westen (2003) states that research on BPD in adolescence remains in its infancy. Studies conducted in the 1990’s revealed BPD can be reliably diagnosed in adolescents (Block et al., 1991; Westen et al., 1990). The validity of the concept in this age group remains to be shown, however. “The overlap with other disorders, the difficulty with diagnosing or differentiating borderline symptoms in the setting of continuing adolescent development, and the lack, as yet, of outcome data add to the conceptual confusion” (James et al., 1996). The most recognized theory on BPD, developed by Kernberg (1977), suggests individuals with BPD can be distinguished by their 1) object relations, 2) primitive defensive operations, and 3) reality testing. This study hypothesized that Kernberg’s characteristics, and individuation difficulties highlighted by Blos, are more problematic in adolescent girls who meet the criteria for BPD than normal or other-disordered adolescent girls. The measures in this study—DIB-R, Splitting Index, Separation Individuation Questionnaire, BORRTI--measure BPD, splitting, separation/individuation, and object relations and reality testing, respectively. Participants were drawn from a clinical setting, foster care, or the normal population. The presence of borderline psychopathology was ascertained by the DIB-R (Zanarini, et al., 1989), thus establishing three groups composed of 21 borderline, 17 other-disordered, and 33 non-clinical adolescents. Each participant was asked to complete the three aforementioned measures. As predicted, significantly more borderline participants demonstrated more severe difficulties than the other groups. These results allow for greater diagnostic clarity and outline specific areas of focus for researchers and practitioners such that earlier recovery might be achieved.