Childhood Mental Health Characteristics of Adults Diagnosed With Borderline Personality Disorder: A Descriptive Study

Borderline personality disorder (BPD) is a burdensome and diagnostically challenging condition. There is a need to identify its risk factors, yet prior studies are scarce and small-scale. We aimed to describe the prevalence of psychiatric comorbidities and the level of mental health resource utilization during adolescence in patients with BPD.

We conducted a retrospective descriptive study of 938 participants (aged 18-26 years) with BPD at a large, multi-site, integrated health maintenance organization (HMO) system in Southern California. Data were collected from January 2010 to September 2020. Comorbidities of interest were other psychiatric conditions diagnosed before age 18. Healthcare utilization data included age of first psychiatry encounter, age at first psychiatric hospitalization, number of psychiatric hospitalizations per year, number of sessions of intensive outpatient group therapy and partial hospitalization, number of visits with a psychiatrist, number of crisis calls, and number of psychotherapy sessions.

The analytic cohort included 816 (87.0%) female patients with a mean age of 22 years. BPD prevalence in the overall population was 0.1% (n=2,287). Comorbidities with the highest prevalence included depressive and anxiety disorders at 83.5% (n=783) and 69.6% (n=653), respectively. Suicidal ideation and suicide attempts were prevalent at 38.6% (n=362) and 0.5% (n=5). Before the age of 18 years, 70.7% (n=663) had a psychiatric visit, 86.7% (n=813) had psychotherapy, and 34.8% (n=326) had a psychiatric hospitalization.

The findings of this study suggest high psychiatric comorbidity and healthcare utilization in patients with BPD. Given lower rates of adolescent suicidality, early intervention may decrease BPD-associated mortality. Psychiatric comorbidities may predict the risk of developing BPD. Future comparative analyses should validate the statistical significance of these predictors and whether screening improves BPD outcomes.