Correlates, stability and predictors
of borderline personality disorder
among previously suicidal youth
Brian Greenfield A...
Acknowledgments
Thanks to Hogg Family Foundation
Thanks to NHRDP
Brian Greenfield, MD
Fifty Shades of Borderline Personali...
Borderline Personality Disorder (BPD)
Somewhat recognized during adolescence :
DSM-5 (< 18 years old)
(Yen S, Gagnon K, Sp...
How to distinguish adolescent BPD
from Hall’s “storm and stress”
o Distress
o Fleeting Identity Confusion
Brian Greenfield...
How to distinguish adolescent BPD
from Hall’s “storm and stress”
When does “storm and stress” exceed a
threshold into an e...
Gunderson et al. (2011)
Ten year follow-up adult BPD:
o 85% remission
o 12% relapse
o Severe persistent impairment
(Gunder...
Prevalence
o 5.9% non-clinical adult samples
o Community adolescents
(15% male; 17.2% female)
o 22% adolescent outpatients...
Measurement
o Adult-based criteria
o Variable measures
o Inclusions of “storm and stress”
Brian Greenfield, MD
Fifty Shade...
Distress
o Many BPD sufferers attempt suicide
o 10% commit suicide
(Paris J, 2002)
o Attempt during adolescence
o Suicide ...
American/Canadian suicide rates
(2009/2010) ages 15-19 years old:
7.5 / 1000 and 9.0 / 100, 000
(Statistics Canada, 2009; ...
What we did
o Large cohort
o Vulnerable early adolescent patients
o Followed to late adolescence
o Correlates of BPD
o Sta...
Goals
o Early identification
o Distinguish BPD from the ‘condition’
Brian Greenfield, MD
Fifty Shades of Borderline Person...
Hypothesis I
Group differences are apparent between
previously suicidal adolescents with and
without BPD at ages 14 and 18...
Hypothesis II
o BPD among suicidal adolescents is
heterogeneous
• Persisting
• Emerging
• Remitting
o BPD demonstrates tem...
Hypothesis III
Persisting BPD driven by:
• Drug use
• Prior hospitalization
• Mood disorders
Brian Greenfield, MD
Fifty Sh...
Procedure
Brian Greenfield, MD
Fifty Shades of Borderline Personality Disorder in Adolescence
ISSPD XIV October 14, 2015
Sample
286 T1
263 (92%) T3
at 6 months
229 (80%) T4
219 (77%)
Completed measure
204 (71%)
Completed data (T1 & T4)
Brian G...
Dropouts similar to participants
o Age (14.6 years)
o Female (70.7%)
o % BPD
o ↓ Depression (34 vs. 53%)
o ↓ ETOH (37 vs. ...
Measures
o DISC MOOD
CD
o Spectrum of Suicide Behavior
o CGAS
o Substance abuse
o Coddingtom
o IFR
o Ab-DIB
Brian Greenfie...
Results Hypothesis I
Significant Differences between BPD & Non BPD
Recruitment
o Depression ↑
o Conduct disorder ↑
o CGAS ...
Results Hypothesis II
T1 T4
YES
NO
Brian Greenfield, MD
Fifty Shades of Borderline Personality Disorder in Adolescence
ISS...
Results Hypothesis III
BPD at follow-up predicted by:
 Older age at first presentation
 Lower level of functioning
Brian...
Results
o 17 (7.8%) of 219 patients remained
suicidal at T4, 16 (94.1%) meeting BPD
criteria
o No sex differences with res...
Discussion
Suicidal adolescents with BPD:
o Drug use
o Stressful life events
o Family Dysfunction
o Major Depression
o CD
...
Discussion
Like adults with BPD, adolescents
CGAS=59
( ↑ of 20 from T1 but impaired functioning)
Brian Greenfield, MD
Fift...
Discussion
o BPD stable = 76% (155/204) of suicidal
youth over 4 year follow-up
o Compatible with BPD traits in the
commun...
Discussion
o BPD baseline, 8x > non-BPD baseline
→ BPD follow-up
o BPD can be diagnosed by age 14
o BPD persistent and BPD...
Discussion
o 16.7% BPD only once =
o Predictors may distinguish BPD from
condition
o ↓ Function + ↑ Age = Predictors
Brian...
Discussion
No gender differences
• Does bifurcation occur > 18 years?
• Are measures not discerning adult male
BPD?
Brian ...
Discussion
o Suicide occurs more commonly > 30
o Most adolescent suicidality associated
with BPD – persisting
o Help adole...
Limitations
o Only reporting on 71% of original cohort
o Subtract 29% from stability = 48% (still
very stable)
o Our subje...
Take home points
o Adolescent BPD may likely be
diagnosable by age 14
o Adolescent BPD is highly stable
o Adolescents rema...
Take home points
o Most suicidal adolescents are no longer
suicidal 4 years later
o Adolescent BPD has no gender bias
Bria...
Prochain SlideShare
Chargement dans…5
×

Correlates, stability and predictors of borderline personality disorder among previously suicidal youth

196 vues

Publié le

Brian Greenfield
Institut d'été 2016

Publié dans : Santé & Médecine
0 commentaire
2 j’aime
Statistiques
Remarques
  • Soyez le premier à commenter

Aucun téléchargement
Vues
Nombre de vues
196
Sur SlideShare
0
Issues des intégrations
0
Intégrations
2
Actions
Partages
0
Téléchargements
3
Commentaires
0
J’aime
2
Intégrations 0
Aucune incorporation

Aucune remarque pour cette diapositive

Correlates, stability and predictors of borderline personality disorder among previously suicidal youth

  1. 1. Correlates, stability and predictors of borderline personality disorder among previously suicidal youth Brian Greenfield Amir Raz Melissa Henry L. Eugene Arnold Eric Lis Londa Daniel Josh Slatkoff Brian L. Mishara Jean-Marc Guile Robert K. Koenekoop Geoffrey Dougherty Filipa de Castro Xun Zhang Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  2. 2. Acknowledgments Thanks to Hogg Family Foundation Thanks to NHRDP Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  3. 3. Borderline Personality Disorder (BPD) Somewhat recognized during adolescence : DSM-5 (< 18 years old) (Yen S, Gagnon K, Spirito A, 2013; Miller AL, Muehlenkamp JJ, Jacobson CM, 2008) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  4. 4. How to distinguish adolescent BPD from Hall’s “storm and stress” o Distress o Fleeting Identity Confusion Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015 G. Stanley Hall 1846-1924
  5. 5. How to distinguish adolescent BPD from Hall’s “storm and stress” When does “storm and stress” exceed a threshold into an enduring personality disorder? Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  6. 6. Gunderson et al. (2011) Ten year follow-up adult BPD: o 85% remission o 12% relapse o Severe persistent impairment (Gunderson JG, Stout RL, McGlashan TH, Shea MT, Morey LC, Grilo CM, Zanarini MC, Yen S, Markowitz JC, Sanislow C, Ansell E, Pinto A, Skodol AE, 2011) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  7. 7. Prevalence o 5.9% non-clinical adult samples o Community adolescents (15% male; 17.2% female) o 22% adolescent outpatients Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  8. 8. Measurement o Adult-based criteria o Variable measures o Inclusions of “storm and stress” Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  9. 9. Distress o Many BPD sufferers attempt suicide o 10% commit suicide (Paris J, 2002) o Attempt during adolescence o Suicide > 30 years old Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  10. 10. American/Canadian suicide rates (2009/2010) ages 15-19 years old: 7.5 / 1000 and 9.0 / 100, 000 (Statistics Canada, 2009; Centre for Disease Control and Prevention, 2012) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  11. 11. What we did o Large cohort o Vulnerable early adolescent patients o Followed to late adolescence o Correlates of BPD o Stability to late adolescence o Predictors of outcome Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  12. 12. Goals o Early identification o Distinguish BPD from the ‘condition’ Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  13. 13. Hypothesis I Group differences are apparent between previously suicidal adolescents with and without BPD at ages 14 and 18 years with respect to clinical and demographic variables at baseline and follow-up Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  14. 14. Hypothesis II o BPD among suicidal adolescents is heterogeneous • Persisting • Emerging • Remitting o BPD demonstrates temporal stability Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  15. 15. Hypothesis III Persisting BPD driven by: • Drug use • Prior hospitalization • Mood disorders Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence
  16. 16. Procedure Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  17. 17. Sample 286 T1 263 (92%) T3 at 6 months 229 (80%) T4 219 (77%) Completed measure 204 (71%) Completed data (T1 & T4) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  18. 18. Dropouts similar to participants o Age (14.6 years) o Female (70.7%) o % BPD o ↓ Depression (34 vs. 53%) o ↓ ETOH (37 vs. 55%) o ↓ IFR o ↑ Suicide (2.7 vs. 2.25) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  19. 19. Measures o DISC MOOD CD o Spectrum of Suicide Behavior o CGAS o Substance abuse o Coddingtom o IFR o Ab-DIB Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence
  20. 20. Results Hypothesis I Significant Differences between BPD & Non BPD Recruitment o Depression ↑ o Conduct disorder ↑ o CGAS ↓ o Drug use ↑ o Coddington ↑ o IFR ↑ o Prior hospitalizations ↑ o Previous visits to ER ↑ Follow-Up o Depression ↑ o Conduct disorder ↑ o CGAS ↓ o Suicide ↑ Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  21. 21. Results Hypothesis II T1 T4 YES NO Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015 Persisting 76% (155/204) Never 7.4% (15/204)
  22. 22. Results Hypothesis III BPD at follow-up predicted by:  Older age at first presentation  Lower level of functioning Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  23. 23. Results o 17 (7.8%) of 219 patients remained suicidal at T4, 16 (94.1%) meeting BPD criteria o No sex differences with respect to BPD diagnosis Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  24. 24. Discussion Suicidal adolescents with BPD: o Drug use o Stressful life events o Family Dysfunction o Major Depression o CD o ↓ functioning Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence
  25. 25. Discussion Like adults with BPD, adolescents CGAS=59 ( ↑ of 20 from T1 but impaired functioning) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence
  26. 26. Discussion o BPD stable = 76% (155/204) of suicidal youth over 4 year follow-up o Compatible with BPD traits in the community (46-73%) (Wingrad G, Cohen P, Chen H, 2008; Bornovalova MA, Hicks BM, Lacono WG, McGue M, 2009) o Higher than reports of BPD threshold (14-23%) (Mattanah JJ, Becker DF, Levy KN, Edell WS, McGlashen TH, 1995; Meijer M, Goedhart AW, Treffers, 1998) Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  27. 27. Discussion o BPD baseline, 8x > non-BPD baseline → BPD follow-up o BPD can be diagnosed by age 14 o BPD persistent and BPD emerging may → BPD adulthood Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  28. 28. Discussion o 16.7% BPD only once = o Predictors may distinguish BPD from condition o ↓ Function + ↑ Age = Predictors Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015 “storm and stress”
  29. 29. Discussion No gender differences • Does bifurcation occur > 18 years? • Are measures not discerning adult male BPD? Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  30. 30. Discussion o Suicide occurs more commonly > 30 o Most adolescent suicidality associated with BPD – persisting o Help adolescents with suicidality may ↓ adult BPD suicidality o Only 7.8% adolescent BPD remain suicidal but 76% of our sample remain BPD hence, BPD not synonymous with suicide Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  31. 31. Limitations o Only reporting on 71% of original cohort o Subtract 29% from stability = 48% (still very stable) o Our subjects did not suicide! o Excluded medically and surgically unstable suicidal adolescents o Evaluation = therapy o Used the Ab-DIB Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  32. 32. Take home points o Adolescent BPD may likely be diagnosable by age 14 o Adolescent BPD is highly stable o Adolescents remaining suicidal are likely to suffer from BPD o Persisting BPD can be predicted by later age (>14) and by poorer functioning at the time of presentation to emergency Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015
  33. 33. Take home points o Most suicidal adolescents are no longer suicidal 4 years later o Adolescent BPD has no gender bias Brian Greenfield, MD Fifty Shades of Borderline Personality Disorder in Adolescence ISSPD XIV October 14, 2015

×