Diagnosing adolescent borderline personality disorder in the inpatient setting

Borderline personality disorder (BPD) is a serious mental illness that despite evidence and research showing validity in adolescents, is often not diagnosed or misdiagnosed in this population. Reasons for this include misinformation about the age requirement in the diagnostic criteria, myths about treatability and adolescent development, and stigma surrounding the diagnosis. Adolescents with BPD symptomology frequently present to inpatient psychiatric and medical settings due to recurrent suicide attempts and self-harm. A substantial body of research supports the reliable and accurate diagnosis of BPD in adolescents, with findings comparable to those in adults. Importantly, both subthreshold adolescents and adolescents who meet full BPD criteria can respond to evidence-based treatment, including dialectical-behavioral-therapy for adolescents (DBT-A). It is recommended to evaluate adolescents who present with multiple suicide attempts or recurrent self-harm for BPD in order to support early intervention. Two screening instruments that have been validated and studied in adolescent inpatients include the McLean Screening Instrument (MSI) and the Borderline Personality Features Scale for Children (BPFS-C). Psychoeducation should be given to patients and families, using simple non-judgemental and non-blaming language. This strategy provides understanding, validation, and direction to the young person and family and helps to connect them to appropriate long term treatment. The inpatient setting can be used to provide acute safety, re-evaluate the diagnosis and treatment, provide education to patients and their families, reinforce evidence-based psychotherapeutic interventions, refer to evidence-based psychotherapeutic and social resources, and consider deprescribing ineffective psychotropic medications.