Borderline Symptoms at Age 12 Signal Risk for Poor Outcomes During the Transition to Adulthood: Findings From a Genetically Sensitive Longitudinal Cohort Study
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OBJECTIVE: Borderline personality disorder in adolescence remains a controversial construct. We addressed concerns about the prognostic significance of adolescent borderline pathology by testing whether borderline symptoms at age 12 years predict functioning during the transition to adulthood, at age 18 years, in areas critical to life-course development. METHOD: We studied members of the Environmental Risk (E-Risk) Longitudinal Twin Study, which tracks the development of a birth cohort of 2,232 British twin children. At age 12, study members' borderline symptoms were measured using mothers' reports. At age 18, study members' personality, psychopathology, functional outcomes, and experiences of victimization were measured using self-reports, coinformant reports, and official records. RESULTS: At age 18, study members who had more borderline symptoms at age 12 were more likely to have difficult personalities, to struggle with poor mental health, to experience poor functional outcomes, and to have become victims of violence. Reports of poor outcomes were corroborated by coinformants and official records. Borderline symptoms in study members at 12 years old predicted poor outcomes over and above other behavioral and emotional problems during adolescence. Twin analyses showed that borderline symptoms in 12-year-olds were influenced by familial risk, particularly genetic risk, which accounted for associations with most poor outcomes at age 18. CONCLUSION: Borderline symptoms in 12-year-olds signal risk for pervasive poor functioning during the transition to adulthood. This association is driven by genetic influences, suggesting that borderline symptoms and poor outcomes are manifestations of shared genetic risk.
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Negative outcomes such as educational challenges, unemployment, and increased health care utilization and costs are already prevalent during the transition from adolescence to young adulthood in persons with BPD.
“evidence consistently suggests that negative outcomes, such as educational challenges, unemployment, and increased health care utilization and costs, are already prevalent during the transition from adolescence to young adulthood in persons with BPD [11, 12].”
From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [12]
The Discussion reports that borderline symptoms at age 12 predicted poor educational and vocational outcomes at age 18. The Results report greater use of clinical and support services. The study examined adolescents with borderline symptoms, not specifically people diagnosed with BPD, and the passages do not report health care costs. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDelaying appropriate diagnoses carries clinical risk, as evidence is accumulating that many of the harms associated with PDs occur early in the course of the disorder, and delay tends to lead toward greater impairments and poorer outcomes.
“Delaying appropriate diagnoses, in turn, carries clinical risk, as evidence is accumulating that many of the harms associated with PDs occur early in the course of the disorder (61), and delay tends to lead toward greater impairments and poorer outcomes (62).”
From Prevalence and 10-year stability of personality disorders from adolescence to young adulthood in a high-risk sample (2022) · cites this paper as [62]
Short-term correlates of PD in adolescents include increased suicidality, school dropout, risk of substance abuse, and increased use of health care services.
“For examples, short-term correlates of PD in adolescents include increased suicidality, school dropout, risk of substance abuse, and increased use of health care services (31).”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [31]
These poor outcomes are already established in the transition from adolescence to young adulthood in young persons with BPD.
“Evidence clearly suggests that these poor outcomes are already established in the transition from adolescence to young adulthood in young persons with BPD (31, 48).”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [31]
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“Evidence clearly suggests that these poor outcomes are already established in the transition from adolescence to young adulthood in young persons with BPD (31, 48).”
BackgroundRemeeus, M. G. A., Clarke, S. L., Feenstra, D. J., Van Eeren, H., Smits, M. L., Debruyne, S., Kouijzer, M. E. J., Luyten, P., Scholte, R. H. J., & Hutsebaut, J. (2024) · Trials · doi:10.1186/s13063-024-08095-9 · Cited by 3 · see citing works
“…emerge in adolescence [10], and evidence consistently suggests that negative outcomes, such as educational challenges, unemployment, and increased health care utilization and costs, are already prevalent during the transition from adolescence to young adulthood in persons with BPD [11, 12].”
Background
- Authors
- Wertz, J., Caspi, A., Ambler, A., Arseneault, L., Belsky, D. W., Danese, A., Fisher, H. L., Matthews, T., Richmond-Rakerd, L. S., & Moffitt, T. E.
- Affiliations
- Duke University (US)
- King's College London (GB)
- Columbia University (US)
- Corresponding author
- Wertz, Jasmin
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 59
- Issue
- 10
- Pages
- 1165-1177.e2
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6980181
- OpenAlex
- W2957115773
- Cited by
- 95
- References
- 52
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 9 · 2023: 13 · 2022: 23 · 2021: 10 · 2020: 7 · 2019: 2
- FWCI
- 12.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Keywords
- borderline symptoms, borderline personality disorder, adolescence, coming of age, functional outcome, mental health, victimization, violence, genetic risk, familial risk, twin studies, Environmental Risk Longitudinal Twin Study, life course development
- MeSH terms
- Adolescent, Borderline Personality Disorder, Child, Female, Humans, Longitudinal Studies, Male, Cohort Studies, Crime Victims, Young Adult, Bullying
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