week 9: Wertz et al (2020) borderline symptoms at 12 signal risk for poor outcomes during transition to adulthood: findings from a longitudinal cohort study

What was the primary objective of the Wertz et al study?

The primary objective was to test whether borderline symptoms in 12-year olds predict functions during the transition to adulthood at age 18, addressing concerns about the prognostic significance of adolescent borderline pathology.

What type of study design was used in the Environmental Risk (E-Risk) Longitudinal Twin Study?

The Environmental Risk (E-Risk) Longitudinal Twin study is a birth cohort study of British two children, following their development over time.

How were borderline symptoms measured at age 12 in the study participants?

Borderline symptoms at age 12 were measured using mothers’ reports based on selected items from the Shedler-Westen Assessment Procedure 200-item Q-Sort for Adolescents (SWAP-200-A) and the Achenbach System of Empirically Based Assessment.

According to the study results, how did participants with more borderline symptoms at age 12 generally fare during the transition to adulthood (age 18)?

Participants with more borderline symptoms at age 12 were more likely to have difficult personalities, struggle with poor mental health, experience poor functional outcomes, and have become victims of violence before age 18.

Did the study find that adolescent borderline symptoms predicted poor outcomes independently of other behavioural and emotional problems experienced in adolescence?

Yes, the study found that borderline symptoms continued to predict most outcomes independently of other behavioural and emotional problems, although some associations with mental disorder diagnoses were explained away.

What role did familial risk, specifically genetic risk, play in the association between age 12 and borderline symptoms and age 18 outcomes?

The study found that familial risk, particularly genetic risk, accounted for most of the associations between age 1 borderline symptoms and age 18 poor outcomes, suggesting they are manifestation of shared genetic risk.

Why is the diagnosis of borderline personality disorder in adolescence considered controversial by some clinicians?

The diagnosis is controversial due to concerns that symptoms may be transient, the diagnosis could be stigmatising, personality is still developing, and some symptoms might be mistaken for normative adolescent “storm and stress”.

How did the study approximate clinically significant levels of borderline symptoms in 12-year olds?

Clinically significant levels of borderline symptoms were approximated by creating a dichotomous measure identifying study members scoring at or above the 95th percentile of the continuous borderline symptoms scale.

Were the findings regarding poor outcomes at age 18 solely based on self-report from the study participants?

No, reports of poor outcomes were corroborated by coinformants (individuals nominated by the participants, typically parents or co-twins) and officials records in addition to self-reports.

Based on the study’s conclusions, what is one implication for health professional working with adolescents who display borderline symptoms?

One implication is that health professionals should consider assessing adolescents’ borderline symptoms in addition to other emotional and behavioural disorders, as they provide independent prognostic information.