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Borderline personality disorder (BPD) emerges during adolescence and young adulthood and has profound effects throughout this vulnerable developmental phase and beyond. Hitherto, clinical interventions for BPD have focused on individuals with established andor chronic forms of the disorder. However, over the past 15 years, a body of evidence has developed supporting the reliability, validity, and clinical importance of the diagnosis of BPD in adolescence, underscoring the need for prevention and early intervention for BPD. This paper describes the work of the Helping Young People Early (HYPE) Clinic in Melbourne, Australia. HYPE is a novel indicated prevention and early intervention service for BPD in youth (15 to 25 y of age). It uses an integrated, team-based intervention model comprising time-limited cognitive analytic therapy as developed by Ryle, case management, and general psychiatric care. The HYPE intervention is supported by effectiveness data.

Borderline personality disorder (BPD) is associated with substantial psychosocial impairment, morbidity, mortality and high health resource utilization. These data make a compelling case for developing prevention and early intervention strategies for BPD. This review examines the BPD diagnosis in young people, along with prospective risk factors for and precursors to the development of BPD. It then considers the prospects for and potential risks and benefits associated with prevention and early intervention for BPD. It concludes that the BPD diagnosis in young people has similar reliability, validity and prevalence to BPD in adults and that BPD in young people almost certainly has serious and pervasive negative repercussions over subsequent decades. Current data are inadequate to inform specific universal or selective prevention programs for BPD. However, they do support including BPD prevention as an outcome when evaluating universal and/or selective interventions for a variety of mental health problems and adverse psychosocial outcomes. The data are stronger for developing indicated preventive interventions but the strongest data support early intervention for the emerging BPD phenotype. Early intervention programs will need to be realistic in their aims, require change in clinician attitudes and service systems and must be mindful of the risk of iatrogenic harm.

Objective: The increasing focus on adolescent personality disorder has tended to ignore evidence of the developmental continuity of the period from puberty to young adulthood. This study aims to: (1) describe the characteristics of a sample of young people with borderline personality disorder (BPD) who had no previous history of evidence-based treatment for the disorder and (2) compare their characteristics by participant age group.Methods: One hundred and thirty-nine young people (15 to 25 years) with BPD, newly enrolled in the Monitoring Outcomes of BPD in Youth randomized controlled trial, completed semi-structured interview and self-report measures assessing demographic, clinical, and functional characteristics. Younger (aged 15 to 17 years; n= 64) and older (aged 18 to 25 years; n= 75) participants were compared on these same variables using t-tests, chi-square tests, and logistic regression.Results: Young outpatients with BPD had extensive and severe psychopathology and were functioning poorly. Adolescents and young adults with BPD showed substantial similarities on 20 key aspects of their presentation. Significant between-groups differences were observed in household makeup, treatment history, antisocial personality disorder, emotion dysregulation, substance use, age of commencement and extent of self-harm, and achievement of age-appropriate educational milestones. Adolescent BPD group membership was predicted by family composition and self-harm, whereas young adult BPD group membership was predicted by not achieving age-appropriate milestones, vocational disengagement, and emotion dysregulation. The final model explained 54% of the variance and correctly classified 80.2% of the sample by age.Conclusions: Both adolescents and young adults with early stage BPD present with severe and often similar problems to one another, supporting developmental continuity across this age range. However, there are also meaningful differences in presentation, suggesting that pathways to care might differ by age and/or developmental stage. Detection and intervention for personality disorder should not be delayed until individuals reach 18 years of age.