Taiwanese Journal of Psychiatry

LETTER TO THE EDITOR
Year
: 2021  |  Volume : 35  |  Issue : 3  |  Page : 156-

Chen's reply on “A comment on risk of teenage pregnancy among adolescents with borderline personality disorder”


Mu- Hong Chen 
 Department of Psychiatry, Taipei Veterans General Hospital; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Correspondence Address:
Mu- Hong Chen
No. 201, Shih-Pai Road, Section 2, Taipei 112
Taiwan




How to cite this article:
Chen MH. Chen's reply on “A comment on risk of teenage pregnancy among adolescents with borderline personality disorder”.Taiwan J Psychiatry 2021;35:156-156


How to cite this URL:
Chen MH. Chen's reply on “A comment on risk of teenage pregnancy among adolescents with borderline personality disorder”. Taiwan J Psychiatry [serial online] 2021 [cited 2021 Dec 6 ];35:156-156
Available from: http://www.e-tjp.org/text.asp?2021/35/3/156/326582


Full Text



Thanks for Kao and Jang's comment [1] on “Risk of teenage pregnancy among adolescents with borderline personality disorder (BPD): a nationwide longitudinal study,” written by Shih-Jen Tsai and me [2]. Recognizing the good points made in their comment, I am offering the following clarification:

Evidence indicated that the estimated point prevalence of BPD is about 1% in the adolescent population despite nonsuicidal self-injury or deliberate self-harm, and one of the clinical indicators in BPD reaches a prevalence of over 20%, even up to 40%, in adolescents [3],[4],[5],[6]. Johnson et al. further suggested that cumulative prevalences of BPD in youths are 1.4% and 3.2% at 16 years and at 22 years of age, respectively [3]. Increasing evidence has supported the validity, reliability, and stability of BPD diagnosis in adolescents [3],[7], which may be indirectly reflected by such a prevalence gap between BPD diagnosis and BPD symptoms in previous epidemiological studies [3],[4],[5],[7].

Kao and Jang also expressed their concern whether clinicians may code BPD in a “difficult” adolescent patient who actually did not meet the BPD criteria [1]. This concern is not only a clinical issue but also a philosophical debate because some clinicians may be reluctant to diagnose BPD in younger individuals [8]. But, an exact diagnosis may indicate the comprehensive understanding in the psychopathology and further facilitates the prompt and optimal treatment [8],[9]. In a recent review, Chanen et al. have reported the importance of early identification of BPD symptoms and the prompt intervention programs for those young patients, which may reduce the subsequent adversities, such as early pregnancy in the current study [9]. Finally, when diagnosing and treating BPD in adolescents, I would like to remind that a clinical art of “too much water drowned the miller” should be carefully considered.

 Financial Support and Sponsorship



The study was supported by grant from Taipei Veterans General Hospital (V106B-020, V107B-010, V107C-181, and V108B-012), Yen Tjing Ling Medical Foundation (CI-109-21 and CI-109-22), and Ministry of Science and Technology, Taiwan (107-2314-B-075-063-MY3 and 108-2314-B-075-037).

 Conflicts of Interest



The author declares that he has no conflicts of interest in writing this reply.

References

1Kao 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. [In this issue]
2Chen MH, Tsai SJ: Risk of teenage pregnancy among adolescents with borderline personality disorder: a nationwide longitudinal study. Taiwan J Psychiatry 2021; 35: 26-31.
3Johnson JG, Cohen P, Kasen S, et al.: Cumulative prevalence of personality disorders between adolescence and adulthood. Acta Psychiatr Scand 2008; 118: 410-3.
4Brunner R, Kaess M, Parzer P, et al.: Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: a comparative study of findings in 11 European countries. J Child Psychol Psychiatry 2014; 55: 337-48.
5Lewinsohn PM, Rohde P, Seeley JR, et al.: Axis II psychopathology as a function of Axis I disorders in childhood and adolescence. J Am Acad Child Adolesc Psychiatry 1997; 36: 1752-9.
6Reichl C, Kaess M: Self-harm in the context of borderline personality disorder. Curr Opin Psychol 2021; 37: 139-44.
7Bondurant H, Greenfield B, Tse SM: Construct validity of the adolescent borderline personality disorder: a review. Can Child Adolesc Psychiatr Rev 2004; 13: 53-7.
8Bozzatello P, Bellino S, Bosia M, et al.: Early detection and outcome in borderline personality disorder. Front Psychiatry 2019; 10: 710.
9Chanen AM, Nicol K, Betts JK, et al.: Diagnosis and treatment of borderline personality disorder in young people. Curr Psychiatry Rep 2020; 22: 25.