Breakdown or Personality Disorder? Psychiatric Characterization and Developmental Pathways Towards Young Adulthood in...

Background/Objectives: Research is lacking about the development of personality disorders (PDs) from adolescence to early adulthood. This study aimed to characterize the profile of high-risk adolescents compared to adolescents with full-blown PDs and adolescents with other psychiatric disorders and to identify clinical markers that constitute a risk profile. Methods: We evaluated 99 adolescents (12-17 years old) through DSM-5-based semi-structured interviews, questionnaires, cognitive tasks, and scales regarding functioning and disorder severity. We divided patients into three groups: 22 adolescents with full-blown personality disorder (FBPD), 57 adolescents at high risk for personality disorders (HPD), and 20 adolescents with other DSM-5 psychiatric disorders (OTH). At follow-up, 56 patients completed the assessment. Possible developmental trajectories of FBPD and HPD patients were remission (total or partial) of PD-related symptoms, stability of symptoms, or transition from HPD to FBPD. Results: FBPD adolescents had more impaired family backgrounds. At baseline, the HPD group was mainly composed of female patients, younger than the FBPD ones. Externalizing symptoms may represent prodromal symptoms of FBPD. High-risk patients who made the transition were younger than those who did not, and their mothers reported higher internalizing symptoms at baseline. None of the FBPD patients remitted. Conclusions: These findings support the hypothesis of a PD "at-risk mental state" and the importance of the implementation of PD early detection and treatment in adolescents, regardless of patient age.