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Adaptive Functioning and Psychiatric Symptoms in Adolescents With Borderline Personality Disorder

Andrew M. Chanen, M.B.B.S., M.P.M., F.R.A.N.Z.C.P.; Martina Jovev, Ph.D.; and Henry J. Jackson, Ph.D., F.A.P.S.

Objective: To examine adaptive functioning and psychopathology in adolescents with DSM-IV borderline personality disorder.

Method: 177 psychiatric outpatients (derived from 2 samples collected between March 1998 and July 1999 and between November 2000 and September 2002) aged 15 to 18 years were assessed using a structured interview for personality disorder diagnoses. Three groups, namely (1) those with a borderline personality disorder, (2) those with a personality disorder other than borderline personality disorder ("other personality disorder"), and (3) those without any personality disorder ("no personality disorder"), were compared on measures of psychiatric symptoms and psychosocial functioning. Primary outcome measures were Axis I diagnoses, Youth Self-Report, Young Adult Self-Report, Health of the Nation Outcome Scales for Children and Adolescents, Social and Occupational Functioning Assessment Scale, and sociodemographic variables.

Results: The borderline personality disorder group (N = 46) had the most severe psychiatric symptoms and functional impairment across a broad range of domains, followed by the other personality disorder (N = 88) and no personality disorder (N = 43) groups, respectively. Borderline personality disorder was a significant predictor over and above Axis I disorders and other personality disorder diagnoses for psychopathology, general functioning, peer relationships, self-care, and family and relationship functioning.

Conclusions: The borderline personality disorder diagnosis should not be ignored or substituted by Axis I diagnoses in adolescent clinical practice, and early intervention strategies need to be developed for this disorder.

(J Clin Psychiatry 2007;68:297-306)

Received April 27, 2006; accepted July 18, 2006. From the ORYGEN Research Centre, Department of Psychiatry (Drs. Chanen, Jovev, and Jackson), and the Department of Psychology (Dr. Jackson), the University of Melbourne, Melbourne, Australia.

Supported by grants 97-0230 and 98-0198 from the Victorian Health Promotion Foundation, Melbourne, Australia, and grant 990748 from the National Health and Medical Research Council, Canberra, Australia.

Drs. Chanen, Jovev, and Jackson report no other financial relationships relevant to the subject of this article.

The authors thank all participants in this study and the staff of ORYGEN Youth Health. Particular thanks go to Verity Clarkson, B.Sc. (Hons), Kelly Allott, B.App.Sci. (Hons), and Caroline Weinstein, B.A., for their assistance with data collection; to Mr. Hok Pan Yuen, M.Sc., for statistical advice; and to Rosemary Purcell, Ph.D., for comments on an earlier version of this article.

Corresponding author and reprints: Andrew M. Chanen, F.R.A.N.Z.C.P., ORYGEN Research Centre, Locked Bag 10, Parkville, Victoria, Australia 3052 (e-mail: