Borderline Personality Disorder in Adolescents: Subtypes and Their Perceptions of Dialectical Behavior Therapy

Borderline Personality Disorder (BPD) continues to be a source of largely unmatched frustration and difficulty. A leading complaint from both clinicians and researchers involves the incredible heterogeneity in the symptomology associated with BPD. Although in two previous studies, researchers have identified subtypes of BPD in adolescents, this investigator marks the first attempt to replicate subtypes of BPD in adolescents based on data collected directly from adolescents and parents. As a secondary goal, this researcher also compared how perceptions of Dialectical Behavior Therapy (DBT) differ between internalizing and externalizing, subtypes. The analysis plan began with using two independent cluster analyses techniques on parent (N=48) and adolescent (N=48) data sets with the purposes of identifying adolescent BPD subtypes. Given the significant differences found between these two data sets, the decision was made to drop the parent data set from further analyses and focus on the convergent subtypes derived in the adolescent data set. Based on Q-factor and cluster analytic techniques, four meaningful subtypes emerged from the adolescent data set. The Mixed subtype was described as a non-anxious, depressed subtype of high sensation-seeking borderline adolescents. The Average subtype presented as a comparatively better-functioning, less symptomatic group of borderline adolescents, without prominent internalizing or externalizing symptoms. The Internalizing subtype was characterized as an anxious/depressive, low sensation-seeking subtype of borderline adolescents. Finally, the Externalizing subtype represented a non-depressed, non-anxious, primarily externalizing subtype of borderline adolescents. No statistically significant differences were found among subtypes on perceptions of DBT. However, given the exploratory nature of this new avenue of research, non-significant, but clinically noteworthy differences between the Internalizing and Externalizing subtypes were examined. Adolescents in the Internalizing subtype rated all aspects of the program, as well as overall satisfaction with the program, more highly than adolescents in the Externalizing subtype. Although differences were not statistically significant, the data show, the possibility that DBT targets Internalizing adolescents more effectively than it does Externalizing adolescents. Therefore, this researcher provides further evidence of meaningful subtypes of BPD in adolescents and presents preliminary data on related implications for treatment.