Borderline personality traits in early adolescence: the role of attachment and reflective functioning

Borderline personality disorder (BPD) is a severe mental health condition typically identified in adolescence. Insecure attachment has been linked to BPD, with adult studies suggesting that reflective functioning might represent a mechanism linking attachment patterns to BPD. However, this interplay remains insufficiently explored in early adolescence-a developmental phase associated with reorganization of attachment and social cognitive function. The aim of this study is to explore the association between attachment styles and borderline personality traits (BPTs) in early adolescence and to test whether reflective functioning explains the association between attachment and borderline traits.

A total of 112 adolescents aged 11-14 years attending a community outpatient child and adolescent mental health service completed the Attachment Questionnaire for Children (AQC), the Reflective Functioning Questionnaire (RFQ) and the Greek modified Borderline Personality Features Scale - Children (BPFS-C). Mediation analysis was conducted using secure attachment as the reference category.

Insecure attachment styles were significantly associated with higher odds of elevated BPTs. Reflective functioning significantly explained a significant amount of variance in the association between ambivalent attachment and high BPTs [OR = 2.92, 95% BCa CI (1.14, 10.17)], whereas avoidant attachment demonstrated a smaller but marginally statistically significant indirect effect through reflective functioning [OR = 1.77, 95% BCa CI (1.00, 3.95)] alongside a strong direct effect [OR = 4.34, 95% BCa CI (1.36, 12.53)].

Avoidant and ambivalent attachment appear to be strongly linked to BPTs in early adolescence through partially distinct pathways, highlighting the need for early targeted interventions.