The following is a summary of the “Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD,” published in the February 2023 issue of Psychiatry by O’Grady, et al.

Among the many risk factors for developing borderline personality disorder (BPD) in childhood and adolescence, impulsivity and trauma stand out. Yet, there have been scant prospective longitudinal investigations of BPD’s causes and progression, much less those that took into account numerous risk factors simultaneously. An ethnically and racially diverse (47% non-white) group of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder were used to investigate the theory-informed predictors of young-adult BPD diagnosis and dimensional features from childhood and late adolescence (ADHD).

Low levels of objectively evaluated executive functioning in childhood and a cumulative history of childhood adverse experiences/trauma predicted the diagnostic status of BPD in young adults, even after controlling for significant factors. Moreover, both hyperactivity/impulsivity and unpleasant experiences/trauma in childhood predicted dimensional aspects of BPD in young adults. No significant indicators emerged for BPD diagnosis in late adolescence; however, both internalizing and externalizing symptoms were strong predictors of BPD dimensional features. 

Exploratory moderator studies showed that impaired executive functioning predicted BPD dimensional features more strongly when the individual was of low socioeconomic class.

The small size of their sample necessitates caution in concluding. Focusing on preventative interventions in populations at increased risk for BPD, such as those aimed at enhancing executive functioning skills and decreasing trauma risk, is 1 possible path forward (and its manifestations). Replication, sensitive measures of early emotional invalidation, and expansion to male samples are all needed.