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Table of Contents
LETTER TO THE EDITOR
Year : 2021  |  Volume : 35  |  Issue : 3  |  Page : 154-155

A comment on risk of teenage pregnancy among adolescents with borderline personality disorder: A nationwide longitudinal study


Department of Psychiatry, Chimei Medical Center, Tainan City, Taiwan

Date of Submission06-May-2021
Date of Decision25-May-2021
Date of Acceptance26-May-2021
Date of Web Publication24-Sep-2021

Correspondence Address:
Fong- Lin Jang
No. 442, Section 2, Shu-Lin Street, Tainan City 70246
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TPSY.TPSY_31_21

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How to cite this article:
Kao PH, Jang FL. A comment on risk of teenage pregnancy among adolescents with borderline personality disorder: A nationwide longitudinal study. Taiwan J Psychiatry 2021;35:154-5

How to cite this URL:
Kao PH, Jang FL. A comment on risk of teenage pregnancy among adolescents with borderline personality disorder: A nationwide longitudinal study. Taiwan J Psychiatry [serial online] 2021 [cited 2021 Oct 20];35:154-5. Available from: http://www.e-tjp.org/text.asp?2021/35/3/154/326581



The article about the risk of teenage pregnancy among adolescents with borderline personality disorder (BPD) written by Mu-Hong Chen and Shih-Jen Tsai published in the recent issue of the Taiwanese Journal of Psychiatry [1] is an impressive and important study. We have read this paper with great interest.

This paper leads us to reflect whether it is appropriate to diagnose a teenager with BPD. This issue has been debated for a long time. In Diagnostic and Statistical Mannual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR) the diagnostic criteria of BPD include instability of interpersonal relationship, self-identified disturbance, affective instability, and impulsivity, beginning by early adulthood and presenting itself in various contexts [2]. But the above features are common in developing adolescents. That is why many clinicians, for example, Kernberg [3], hesitated to diagnose adolescents with BPD. In literature, several longitudinal studies support the independent diagnosis of BPD from other mental disorders in adolescence, including the large-scale children in the community study following up 800 youth for 20 years [4]. The current conclusion from child and adolescent psychiatrists of BPD experts is that BPD in adolescence is independent from other DSM Axis I mental disorders which are the antecedents (but not a consequences) of BPD [5]. We must notice that the diagnosis of personality disorder (PD) in adolescence is not stable. In the children in community study [4], only 21% of patients have persistently shown their PD into adulthood. Up to date, the diagnosis of BPD in adolescence has been accepted [6], yet the diagnosis of PD in DSM-5 and DSM-V can be applied to children or adolescents under 18 years of age only “in those relatively unusual instances in which the individual's particular maladaptive personality traits appear to be pervasive, persistent and unlikely to be limited to a particular developmental stage or an episode of an Axis I disorder [2].” Besides, the above features must have been present for at least one year.

In Chen and Tsai's study [1], they used the Taiwan National Health Research Institute Database (NHRID) from 2001 to 2009 and enrolled 809 girl patients who were once diagnosed of BPD (International Classification of Diseases [ICD]-9-CM codes: 301.83) and early pregnancy. But we are concerned about the reliability of BPD diagnosis for adolescents in Taiwan with ICD-9 system then. Is it possible that we coded BPD in a “difficult” girl who actually did not match the BPD criteria in the DSM system? In addition, longitudinal follow-up of the enrolled patients for at least one year is necessary. Surely, it is rather feasible to trace these patients to early adulthood with NHRID. We can explore how many patients were still diagnosed of BPD after adolescence.

It is challenging for clinicians to manage a PD patient, no matter a child or an adult. We suggest that the Taiwanese Society of Psychiatry can develop or choose a dimensional self-report scale for PD. Such a tool can help the first-line clinicians to organize symptoms in diagnosis and follow-up progress in treatment. Through the assistance of the scale, we can give PD patients an early and comprehensive intervention.


  Financial Support and Sponsorship Top


The authors declare that they have no financial support or sponsorship in writing this paper.


  Conflicts of Interest Top


The authors declare that they have no conflict of interest in writing this paper.



 
  References Top

1.
Chen MH, Tsai SJ: Risk of teenage pregnancy among adolescents with borderline personality disorder: a nationwide longitudinal study. Taiwan J Psychiatry 2021; 35: 26-31.  Back to cited text no. 1
    
2.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Text Revision. Washington, DC: American Psychiatric Association, 2000.  Back to cited text no. 2
    
3.
Kernberg OF: What's next? a clinical overview. Psychiatr Clin North Am 2018; 41: 17-22.  Back to cited text no. 3
    
4.
Cohen P, Crawford TN, Johnson JG, et al.: The children in the community study of developmental course of personality disorder. J Pers Disord 2005; 19: 466-86.  Back to cited text no. 4
    
5.
Sharp C, Vanwoerden S, Wall K: Adolescence as a sensitive period for the development of personality disorder. Psychiatr Clin North Am 2018; 41: 669-83.  Back to cited text no. 5
    
6.
Kaess M, Brunner R, Chanen A: Borderline personality disorder in adolescence. Pediatrics 2014; 134: 782-93.  Back to cited text no. 6
    




 

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