Diagnostic assessment and therapeutic approaches to borderline disorders in adolescents

Not all young people who present with a borderline syndrome are equally vulnerable. Clinical manifestations appear along a spectrum that varies from an apparently less severely disturbed psychoneurotic to those who appear with almost total ego fragmentation (Giovacchini, 1964). When the syndrome appears as a result of social system trauma in early adolescence, adequate diagnosis and appropriate intervention can make for speedy recovery. A typical scenario is the absence of a peer group that is developmentally needed, along with the family tension and social system turbulence produced by a change of location, school, or cultural environment. When executives move with their families, for example, their adolescent children are likely to react with at least depression, with at worst a borderline syndrome. The therapy of disturbed borderline young people is likely to be successful only in an environment that optimally meets developmental needs with skilled intervention in biological, psychological, and social fields. The latter should include work with the family in which the individual psychopathology of the parents, their marital relationships, and the strengths and weaknesses of the family system are all assessed.