Citation

Pham-Scottez A. Inf. Psychiatr. 2016; 92(1): 29-37.

Copyright

(Copyright © 2016, John Libbey Eurotext)

DOI

10.1684/ipe.2015.1431

PMID

unavailable

Abstract

Eurnet-BPD is multicenter research organization, in various European Francophone countries (France, Switzerland, and Belgium) with a longitudinal prospective, and whose objectives are to explore the validity of the diagnosis of borderline personality disorder (BPD) in adolescence, as well as its stability during the transition to adulthood. Its objective is also to describe the specifics of TPB in adolescence (comorbidity with other personality disorders and psychiatric disorders, suicide attempts and self-mutilation, life events during childhood, traumatic history, terms of attachment, emotional regulation, alexithymia, depression, depressiveness, educational paths, use of care etc.). Eighty-five adolescents from 15 to 19 years of age, boys and girls, hospitalized or outpatients, with BPD (diagnosis based on SIDP-IV) and 84 control subjects matched for sex and age were included in the study. All evaluations were performed using standardized instruments, self-questionnaires and semi-structured interviews. Factor analysis is a two-factor solution, a factor facing inwards, reflecting the lack of internal coherence and instability of identity, and a factor facing outwards, resulting in impulsive behavior and self-aggressiveness. The most frequently found comorbidities were mood disorders, eating disorders, disruptive behavior disorders and substance abuse. TPB also appears frequently associated with other personality disorders such as obsessive personality disorders, antisocial behaviour and avoidance. Suicide attempts were also studied, and the main conclusions are that repeated suicide attempts appear structured, self-reinforcing, self-supporting TPB in these adolescents. Eurnet-BPD also attempted to understand the self-mutilation of these borderline adolescents who embody a dysfunctional adaptation strategy in order to regulate their emotions and feelings. The diagnostic stability of TPB, three years later during the transition to adulthood, although moderate in a categorical perspective, was the best dimensional point of view. The childhood of these borderline adolescents experience multiple splitting with parental figures, a lower quality of parentchild relationship, family dysfunction with a lack of intrafamilial coherence, and a 25 % history of attempted suicide by one of the two parents. The attachment modalities of these borderline teenagers are that in the majority they are insecure, above all a fearful and worried type of individual. The acts of abuse are numerous, emotional abuse, physical abuse, physical neglect, especially sexual abuse (16 %). In fact, 36 % of adolescents who are sexually abused continue to see their attacker, and the judicial authorities are only informed in less than half of the cases, which "adds trauma to trauma", to the environment of those teenagers who have suffered sexual abuse show themselves to be unprotected. Multivariate analyses have demonstrated four factors as being intensely predictive of the onset of BPD in adolescence: emotional abuse, lack of family cohesion, strict control by the father and a fearful kind of insecure attachment. In summary, Eurnet-BPD, the first prospective longitudinal study of a cohort of adolescents with BPD, shows the validity of the diagnosis of BPD in adolescence and highlights the factors of childhood history that appear decisive in the emergence of TPB in adolescence. All these data argue for multimodal intensive care, as early in life as possible, to improve the long-term prognosis of these patients.

Language: fr

Keywords

Adolescent; Family; Comorbidity; Self-harm; Longitudinal study; Diagnosis; Factor analysis; Attempted suicide; Borderline; Mental trauma; Predictive; Semi-structured interview; SIDP-IV