Borderline personality disorder subtypes among hospitalized female adolescents

Borderline personality disorder (BPD) is a complex diagnosis due in part to the heterogeneity among individuals with the disorder. Attempts have been made to develop subtypes within the classification in order to guide treatment and research with this population. An earlier study by this author suggested that subtypes could be identified among hospitalized female adolescents with BPD. While this population has a reputation for having difficult hospitalizations, earlier findings suggested that a small behaviorally problematic subgroup may be responsible for this negative reputation. The current study sought first to replicate these earlier findings by identifying two behavioral subgroups in a larger sample. Second, it sought to examine and compare the demographic, historical, diagnostic, and personality characteristics in the two groups. It was hypothesized that the behaviorally problematic patients would only differ from their non-problematic peers in their degree of interpersonal difficulties. 48 female adolescent inpatients with BPD served as subjects in the study. As predicted, most of these patients (41) showed few problematic behaviors during their hospital stays. A small group of seven patients (the index group) did display such behaviors. Results indicated that in most ways the two groups were similar, and did not support the hypothesis that the two groups could be well differentiated on the basis of degree of interpersonal difficulties. However, the small sample size, particularly of the index group, is likely to have seriously hindered an adequate testing of the hypothesis. Results suggested that female adolescents with BPD who have problematic hospitalizations are more likely to be in state custody, have a less submissive interpersonal style, are perceived by staff members as experiencing less emptiness, receive higher staff frustration ratings, and may have more critical degree of suicidality than their peers. These findings should be considered in future research. While it may be difficult to predict which female adolescents with BPD are likely to have behaviorally problematic hospitalizations, this study provides more evidence that most of these patients will not have problematic hospitalizations. The hope is that this knowledge may help decrease staff anxiety and dissemble the negative stigma associated with these patients