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Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists

  • Mark Griffiths (a1)
Aims and method

To establish the views of child and adolescent psychiatrists (n = 52) regarding the conceptual and empirical validity, clinical utility and acceptability of the diagnosis of borderline personality disorder in child and adolescent populations. A questionnaire survey was carried out.


The child and adolescent psychiatrists' perception of the validity of borderline personality disorder for adult populations was relatively high (82% felt it to be valid). Significantly fewer of those considered borderline personality disorder to be valid for adolescent populations (37%). Strikingly different results were obtained when the questions related to child (<12 years) populations (2%).

Clinical implications

Given the views expressed by these consultant child and adolescent psychiatrists, it would seem appropriate to approach with caution suggestions that the borderline personality disorder category should have extended use with adolescent and child populations.

Corresponding author
Mark Griffiths (
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1 Aronson, T. Historical perspectives on the borderline concept: a review and critique. Psychiatry 1985; 48: 209–22.
2 Bleiberg, E. Borderline disorders in children and adolescents: the concept, the diagnoses and the controversies. Bull Menninger Clin 1994; 58: 169–96.
3 Wright, K, Haigh, K, McKeown, M. Reclaiming the humanity in personality disorder. Int J Ment Health Nurs 2007; 16: 236–46.
4 Miller, A, Muehlenkamp, JJ, Jacobson, C. Fact or fiction? Diagnosing borderline personality disorder in adolescents. Clin Psychol Rev 2008; 28: 969–81.
5 Chanen, A, Jovev, M, Djaja, D, McDougall, E, Rawlings, D. Screening for borderline personality disorder in outpatient youth. J Pers Disord 2008; 22: 353–64.
6 Shapiro, T. Debate forum: resolved – borderline personality disorder exists in children under 12. J Am Acad Child Adolesc Psychiatry 1990; 29: 478–83.
7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association, 1994.
8 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization, 1992.
9 Wiggins, O, Schwartz, M. The limits of psychiatric knowledge and the problem of classification. In Philosophical Perspectives on Psychiatric Classification (ed Sadler, J, Wiggins, O, Schwartz, M): 89103. Johns Hopkins University Press,, 1994.
10 Kupfer, D, First, M, Regier, D. A Research Agenda for DSM-V. American Psychiatric Association, 2002.
11 Fulford, B, Thornton, T, Graham, G. Oxford Textbook of Philosophy and Psychiatry. Oxford University Press, 2006.
12 Sadler, J. Values and Psychiatric Diagnosis. Oxford University Press, 2005.
13 Kendler, KS. Toward a scientific psychiatric nosology: strengths and limitations. Arch Gen Psychiatry 1990; 47: 969–73.
14 Bolton, D. What is Mental Disorder? An Essay in Philosophy, Science and Values. Oxford University Press, 2008.
15 Kendall, R, Jablensky, A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 2003; 160: 412.
16 Bernstein, D, Cohen, P, Skodol, A, Bezirganian, S, Brook, J. Childhood antecedents of adolescent personality disorders. Am J Psychiatry 1996; 153: 907–13.
17 Bondurant, H, Greenfield, B, Tse, SM. Construct validity of the adolescent borderline personality disorder: a review. Can Child Adolesc Psychiatr Rev 2004; 13: 53–7.
18 Meijer, M, Goedhart, A, Treffers, P. The persistence of borderline personality disorder in adolescence. J Pers Disord 1998; 12: 1322.
19 Mattanah, J, Becker, D, Levy, K, Edell, W, McGlashan, T. Diagnostic stability in adolescents followed up 2 years after hospitalization. Am J Psychiatry 1995; 152: 889–94.
20 Garnet, K, Levy, K, Mattanah, J, Edell, W, McGlashen, T. Borderline personality disorder in adolescents: ubiquitous or specific? Am J Psychiatry 1994; 151: 1380–82.
21 Westen, D, Shedler, J, Durrett, C, Glass, S, Martens, A. Personality disorder diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative. Am J Psychiatry 2003; 160: 952–66.
22 Bemporad, J, Cicchetti, D. Borderline syndromes in childhood: criteria for diagnosis. Am J Psychiatry 1982; 139: 596601.
23 Hoffman, P, Buteau, E, Hooley, J, Fruzetti, A, Bruce, M. Family members' knowledge about borderline personality disorder: correspondence with their levels of depression, burden, distress and expressed emotion. Fam Process 2003; 42: 469–78.
24 Castillo, HA. Dangerous diagnosis: a user-led survey of people with a personality disorder diagnosis finds a group more sinned against than sinning. Mental Health Today 2003; 3 (February): 2730.
25 Nehls, N. Borderline personality disorder, gender stereotypes, stigma, and limited system of care. Issues Ment Health Nurs 1998; 19: 97112.
26 Bateman, A, Fonagy, P. Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment. Oxford University Press, 2004.
27 Garcia, JA, Weisz, JR. When youth mental health care stops: therapeutic relationship problems and other reasons for ending youth outpatient treatment. J Consult Clin Psychol 2002; 70: 439–43.
28 Dubow, E, Lovko, K, Kauasch, D. Demographic differences in adolescents' health concerns and perceptions of helping agents. J Clin Child Psychol 1990; 19: 4454.
29 Wilson, C, Deane, F, Biro, V, Ciarrochi, J. Youth Barriers to Help-Seeking and Referral from General Practitioners. Illawarra Division of General Practice and University of Wollongong, Illawarra Institute for Mental Health, 2003.
30 Rickwood, D, Deane, F, Wilson, C, Ciarrochi, J. Young people's help-seeking for mental health problems. Aust e-J Adv Ment Health 2005; 4: 134.
31 Thompson, SJ, Bender, K, Lantry, J, Flynn, PM. Treatment engagement: building therapeutic alliance in home-based treatment with adolescents and their families. Contemp Fam Ther 2007; 29: 3955.
32 Everall, R, Paulson, B. The therapeutic alliance: adolescent perspectives. Counselling and Psychotherapy Research 2002; 2: 7887.
33 Street, C, Svanberg, J. Where Next? New Directions in In-patient Mental Health Services for Young People. Young Minds, 2003.
34 Linehan, M. Dialectical behavioural therapy: a cognitive behavioural approach to parasuicide. J Pers Disord 1987; 1: 328–33.
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Validity, utility and acceptability of borderline personality disorder diagnosis in childhood and adolescence: survey of psychiatrists

  • Mark Griffiths (a1)
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