Borderline personality disorder (BPD) features and their relationship with trauma and dissociation among Chinese adolescents: is BPD really a trauma-related disorder?

Background: Borderline personality disorder (BPD) is less understood in adolescents than in adults. The extent to which BPD can be conceptualised as a trauma-related disorder remains an ongoing debate. Most existing studies relied on Western adult samples. Objectives: This study examined BPD features and their relationship with trauma-related factors (i.e. adverse experiences and post-traumatic and dissociative symptoms) in a sample of Chinese adolescents. Methods: A total of 1,147 Chinese adolescents from two public schools (mean age = 16.4; 54.6% female) completed the Adverse Childhood Experiences Questionnaire, the Self-Report Dissociative Disorders Interview Schedule-Borderline Personality Disorder, the International Trauma Questionnaire, and the Dissociative Experiences Scale-Taxon. Results: In this sample, 9.9% endorsed ≥5 BPD features on a screening tool (sensitivity = 95.2%; specificity = 64.9%). Most (89%) participants with ≥5 BPD features reported childhood abuse/neglect, compared to 21.3% for those with <5 BPD features. Among participants with ≥5 BPD features, 64.9% screened positive for dissociative symptoms (52.6%) and/or ICD-11 PTSD/CPTSD (41.2%). Trauma-related factors explained 52.9% of the variance in BPD features, which were most strongly associated with disturbances in self-organisation (DSO) symptoms (β =.306, p <.001), emotional abuse (β =.145, p <.001), PTSD symptoms (β =.137, p <.001), and dissociative symptoms (β =.136, p <.001). Conclusion: BPD features are not rare among Chinese adolescents, warranting public health attention. Moreover, given the high rates of childhood abuse/neglect (89%) and dissociation/PTSD/CPTSD (64.9%) in adolescents with ≥5 BPD features, and considering the close relationship between trauma-related factors and BPD features, prevention and treatment of BPD features among young people should take trauma-related factors into consideration.