The Willingness of Therapists to Diagnose and Treat Borderline Personality Disorder in Adolescents: Results from a Germany-Wide Online Survey

Theoretical Background: A limited willingness to diagnose borderline personality disorder (BPD) in adolescence may impede the early detection and treatment of the disorder. Objective: This study collected empirically based data on the willingness of therapists who work with children and adolescents to diagnose and treat BPD in adolescents. It also identified variables associated with the willingness both to diagnose and to treat BPD in adolescence. Method: We included a total of 207 participants (171 males, 36 females, median age: 35 - 39 years) from an online survey in the statistical analyses. Results: Overall, 32 % of the therapists reported assigning a diagnosis of BPD from the age of 14, 56 % from the age of 18, and 12 % would not assign a diagnosis at all. Logistic regression showed that the reservations "lack of stability of a still developing personality " and "concerns about pathologizing typical adolescent ways of thinking and behaving " were significantly associated with a lower willingness to diagnose BPD in adolescents. In total, 72 % of the therapists were willing to treat adolescents with BPD-specific symptoms. The variables "previous/current treatment experiences " and "nonsuicidal self-injury " increased the willingness to treat, whereas treatment in an inpatient setting lowered it. Notably, 62 % of the therapists used a disorder-specific method to treat BPD. Discussion and conclusion: Despite the high willingness of therapists to treat adolescents with BPD, the question remains whether this can be generalized to clinical care. To this end, surveys from the patients' perspective would be extremely helpful. Mixed-method approaches would be useful to understand why there is a difference between the willingness to diagnose and the willingness to treat.