Research Review: What we have learned about early detection and intervention of borderline personality disorder

Background: Borderline personality disorder (BPD) typically emerges during adolescence and early adulthood and has severe personal, social and economic consequences. Despite significant research efforts on early intervention over the past two decades, delays in diagnosis and treatment are still common, and exclusion of individuals with BPD from mental health services is prevalent. Methods: In order to bridge the gap between research and clinical practice, this review qualitatively synthesises empirical evidence on early intervention for BPD, addressing four key questions: (1) Should BPD be diagnosed in adolescents? (2) How is BPD diagnosed in adolescents? (3) Is adolescent BPD treatable, and how effective are treatments? and (4) Can BPD development be prevented? Findings: Evidence supports diagnosing BPD in adolescents from the age of 12 years, with validated diagnostic measures available. While outpatient, disorder-specific psychotherapy has shown efficacy in reducing BPD symptoms and self-harm in youth, the evidence is limited by the small number of randomised controlled trials (RCTs), small sample sizes, heterogeneous inclusion criteria, varying control interventions and high risk of bias. Indicated prevention targeting subthreshold BPD symptoms shows promise, but further research is needed on selective and universal prevention strategies. Conclusions: Enhancing healthcare professionals' knowledge about early diagnosis and treatment for BPD appears necessary in order to reduce the reluctance to diagnose the disorder in adolescence, which is recommended by many national treatment guidelines today. Additionally, large-scale, rigorous RCTs are necessary to establish the superiority of disorder-specific treatments over standard care and explore novel service models that offer easily accessible and scalable evidence-based care for young people with BPD features.