Borderline personality disorder in adolescents: An underrecognized diagnosis

Borderline Personality Disorder (BPD) in adolescents is a complex, often under-recognized psychiatric condition characterized by the emotional dysregulation, impulsivity, unstable self-image, and difficulties in relationships.

To explore the clinical and sociodemographic characteristics of BPD in adolescents, as well as associated factors and management strategies.

A cross-sectional study was conducted at the outpatient department of a tertiary care Institute of Mental Health and Neurosciences from November 2024 to January 2025. A total of 71 adolescents aged 9 to 18 years were assessed using the Borderline Personality Features Scale for Children-11 Self-Report (BPFSC) and the DSM-5 criteria for BPD.

Results revealed a predominance of female participants (95.77%), with an average age of symptom onset at 14.97 years and an average age of presentation at 16.87 years. The most common presenting symptoms, included impulsivity (90.14%), affective instability (80.28%), and intense anger (78.87%), while identity disturbance was the less frequently observed (8.45%). Familial conflict was the most common predisposing factor (36.61%), with Major Depressive Disorder (MDD) as the most frequent comorbidity (11.26%). Psychotherapy was universally prescribed, with low-dose quetiapine (28.16%) and sertraline (26.76%) being the most used pharmacotherapies.

The findings highlight the importance of recognizing the early manifestation of BPD traits, particularly in those at high risk for developing the full disorder. Recognizing BPD as a significant, but often overlooked condition in adolescents is essential to mitigate its impact and improving the quality of life for affected individuals making early identification and intervention a necessity.