Diagnosis of personality disorders in adolescents: a study among psychologists
Open accessAbstract
BACKGROUND: Recent guidelines concerning the treatment of personality disorders (PDs) recommend diagnosing PDs in adolescents. However, it remains unclear whether these guidelines influence the current opinions and practices of mental health care professionals. METHODS: Five hundred sixty-six psychologists completed an online survey concerning PDs in adolescents, of whom 367 professionals reported working with adolescents. The survey contained demographical questions (age, gender, profession, work setting) and specific questions related to PD in adolescence. RESULTS: Although a majority of psychologists working with adolescents acknowledged the existence of PDs in adolescents (57.8%), only a small minority diagnoses PDs in adolescence (8.7%) and offers a treatment specifically aimed at targeting PD pathology (6.5%). Reasons for not diagnosing PDs in adolescence mainly concerned the belief that adolescent personality problems are transient (41.2%) and that the DSM-IV-TR does not allow diagnosing PDs in adolescence (25.9%). CONCLUSIONS: Although practice guidelines might have influenced clinicians' opinions about PDs in adolescence, they have had little impact so far on routine clinical practice.
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Young persons with BPD remain largely undetected in primary services, are not referred to appropriate treatment, and are rarely provided appropriate, evidence-based treatments.
“Data from the Netherlands [14] as well as Australia [15] show that young persons with BPD remain largely undetected in primary services, are not referred to appropriate treatment, and are rarely provided appropriate, evidence-based treatments.”
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 [14]
The Results and Discussion report that few surveyed psychologists in the Netherlands and Belgium diagnosed adolescent personality disorders (8.7%) or offered specialized treatment (6.5%). The Discussion says underdiagnosis might prevent referral, but the study did not measure referrals. It addresses personality disorders generally rather than BPD specifically, and does not establish what happens in primary services or whether treatments provided were evidence-based. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHesitation to make the diagnosis was mainly informed by the beliefs that features of PD are transient in adolescence (41.2%) and/or that PD diagnoses were not allowed by DSM-IV-TR (25.9%).
“Hesitation (or even reluctance) to make the diagnosis was mainly informed by the beliefs that features of PD are transient in adolescence (41.2%) and/or that PD diagnoses were not allowed by DSM-IV-TR (25.9%).”
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 [2]
Psychologists working in primary and secondary care avoided the diagnosis more than those working in more specialized settings.
“Psychologists working in primary and secondary care avoided the diagnosis more than those working in more specialized settings.”
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 [2]
Only 8.7% of 566 psychologists surveyed actually made the diagnosis of a PD in adolescents, even though 57.8% indicated that they recognized this disorder among the adolescents they treated.
“showing that only 8.7% of 566 psychologists surveyed actually made the diagnosis of a PD in adolescents, even though 57.8% indicated that they recognized this disorder among the adolescents they treated.”
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 [2]
Only 6.5% of Dutch psychologists provide PD-oriented treatment, with none of these clinicians working in front-line services.
“While there is some regional variation, Laurenssen et al. (2) found that only 6.5% of Dutch psychologists provide PD-oriented treatment, with none of these clinicians working in front-line services.”
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 [2]
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References 18 · Cited by 135
- Authors
- Laurenssen, E. M. P., Hutsebaut, J., Feenstra, D. J., Van Busschbach, J. J., & Luyten, P.
- Affiliations
- De Viersprong (NL)
- Erasmus MC (NL)
- University College London (GB)
- Corresponding author
- Laurenssen, Elisabeth Martina Petronella
- Venue
- Child and Adolescent Psychiatry and Mental Health
- Published
- 2013
- Volume
- 7
- Issue
- 1
- Pages
- 3
- ISSN
- 1753-2000 (ISSN-L)
- PMC
- PMC3583803
- OpenAlex
- W2096594304
- Cited by
- 135
- References
- 18
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 13 · 2021: 15 · 2020: 15 · 2019: 6 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 11 · 2014: 6 · 2013: 3
- FWCI
- 11.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Child and Adolescent Psychiatry and Mental Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- personality disorders, adolescents, diagnosis, psychologists, clinical practice, clinical guidelines, DSM-IV-TR, personality disorder treatment, clinician beliefs
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