Nesse estudo, as histórias de tratamento relatadas por adolescentes hospitalizados com o diagnóstico de Transtorno de Personalidade Borderline (TPB) foram comparadas àquelas relatadas por uma amostra separada de adultos hospitalizados com TPB. Também, a gravidade e a fenomenologia das vivências dissociativas relatadas por adolescentes hospitalizados com TPB foram comparadas às relatas por adolescentes sem diagnósticos psiquiátricos e com as de uma amostra separada de adultos com TPB. Cento e quatro adolescentes entre 13-17 anos que preenchiam rigorosamente o diagnóstico de TPB foram entrevistados sobre suas histórias de tratamento psiquiátrico. A mesma entrevista semiestruturada foi administrada a 290 adultos com idade maior ou igual a 18 anos que também preenchiam critérios para TPB. A Escala de Experiências Dissociativas (DES) foi administrada a um total de 89 adolescentes hospitalizados entre 13-17 anos que preenchiam critérios para o TPB. A mesma medida de autorrelato de 28 itens foi administrada a 51 adolescentes da mesma faixa etária e a 290 adultos hospitalizados com o diagnóstico de TPB. Adolescentes e adultos com TPB apresentaram histórico semelhante de utilização de terapia individual (93% vs. 96%), medicamentos psicotrópicos de uso contínuo (93% vs. 84%), polifarmácia (68% vs. 66%), antidepressivos (72% vs. 80%) e de lítio (14% vs. 26%). No entanto, adolescentes foram significativamente mais propensos a apresentarem histórico de internações psiquiátricas prévias (96% vs. 79%), a terem participado de psicoterapia de grupo (54% vs. 36%), e relataram uso maior de antipsicóticos (55% vs. 39%) e estimulantes (19% vs. 7%) em comparação a adultos com TPB. Em contraste, em comparação com adultos com TPB, os adolescentes com TPB fizeram menor uso de terapia individual intensiva (0% vs. 36%), grupos de autoajuda (7% vs. 51%), tratamentos residenciais (13% vs. 36%), e de benzodiazepínicos (10% vs. 43%). Adolescentes com TPB apresentaram uma pontuação média na DES maior do que os adolescentes sem diagnósticos psiquiátricos (19 vs. 9), assim como em 2 dos 3 fatores derivados da DES: Absorção (27 vs. 15) e despersonalização (15 vs. 3). Adolescentes e adultos com TPB apresentam tanto a pontuação geral média quanto a dos 3 fatores derivados da DES semelhantes. Em relação a distribuição das pontuações médias da DES em adolescentes com TPB, 35% apresentaram pontuação de abaixo de 10 (baixa), 47% tinham pontuação entre 10 e 29.9 (comum em diagnósticos psiquiátricos não primariamente associados à trauma) e 18% tinham pontuação elevada, com DES maior ou igual a 30 (associada ao transtorno de estresse pós-traumático (TEPT) ou transtornos dissociativos); um padrão de distribuição semelhante aos adultos com TPB. Em relação a experiências de adversidade na infância e ao diagnóstico de TEPT, em adolescentes e adultos com TPB que apresentam elevados níveis de sintomas dissociativos (DES maior ou igual a 30 pontos), os relatos de negligência tem taxas semelhantes (81% vs. 91%), enquanto esse subgrupo de adolescentes com TPB apresentam menores taxas de relato de abuso sexual (25% vs. 85%), físico (25% vs. 73 %) e menor prevalência de TEPT (25% vs. 87%) do que adultos com TPB. Em conjunto, os resultados desse estudo sugerem que tanto adolescentes quanto adultos hospitalizados com TPB apresentam histórias de tratamento complexas, com altas taxas de uso de recursos ambulatoriais e tratamentos intensivos. Adicionalmente, os resultados desse estudo sugerem que adolescentes com TPB apresentam vivências dissociativas tão severas quanto a de adultos com TPB, e reforçam a necessidade de acessar clinicamente, de modo estruturado, a presença de sintomas dissociativos em adolescentes com TPB, mesmo sem histórico de trauma

In this study, we compared the psychiatric treatment histories reported by adolescent inpatients with borderline personality disorder (BPD) to those reported by a separate sample of adult inpatients with BPD. Also, the severity and quality of dissociative experiences reported by adolescent inpatients with BPD were compared to those reported by psychiatric healthy adolescents and to a separate sample of adult inpatients with BPD. One hundred and four hospitalized girls and boys aged 13-17 who met rigorous criteria for BPD were interviewed concerning their histories of psychiatric treatment. The same semi-structured interview, which has proven psychometric properties, was administered to 290 adults aged 18 or older who met the same criteria for BPD. The Dissociative Experiences Scale (DES) was administered to a total of 89 hospitalized girls and boys aged 13-17 who met rigorous criteria for BPD. The same 28 item self-report measure with demonstrated reliability and validity was administered to 51 age-matched psychiatrically healthy adolescents and 290 inpatient adults aged 18-35 who met criteria for BPD. Borderline adolescents and adults had similar lifetime rates of individual psychotherapy (93% vs. 96%), history of taking standing medications (93% vs. 84%), polypharmacy (68% vs. 66%), and reported use of antidepressants (72% vs. 80%), anticonvulsants (28% vs. 22%) and lithium (14% vs. 26%). However, adolescents were significantly more likely than adults with BPD to have a history of prior psychiatric hospitalizations (96% vs. 79%), to have been in group therapy (54% vs. 36%) and reported a higher use of antipsychotics (55% vs. 39%) and stimulants (19% vs. 7%). In contrast, they were significantly less likely than adults with BPD to have been in intensive individual therapy (0% vs. 36%), self-help groups (7% vs. 51%), and residential treatment (13% vs. 36%), and a smaller use of benzodiazepines (10% vs. 43%). Adolescents with BPD had significantly higher mean overall DES score in comparison with healthy adolescents (19 vs. 9), as well as higher scores on two factors derived from the DES: absorption (27 vs. 15), depersonalization (15 vs. 3), and similar scores on amnesia (10 vs 7). Borderline adolescents and adults had similar overall and three factor structure DES scores. Regarding the distribution of mean DES scores in adolescents with BPD, 35% had a score bellow 10 points (low score), 47% had a score between 10 and 29.9 (common in psychiatric diagnoses not primarily associated with trauma) and 18% had a score of 30 or more (associated with post-traumatic stress disorder (PTSD) and dissociative disorders); a distribution similar to adults with BPD. Regarding experiences of childhood adversity and the diagnosis of PTSD, in adolescents and adults with BPD presenting high levels of dissociative symptoms (DES score of 30 or more), they had reported similar rates of neglect (81% vs. 91%), but adolescents with BPD had lower rates of experiences of sexual abuse (25% vs 85%), physical abuse (25%% vs. 73 %) and lower prevalence of PTSD (25% vs. 87%) in comparison with adults with BPD. Taken together, the results of this study suggest that hospitalized adolescents and adults with BPD both have a complex treatment history, with high lifetime rates of outpatient and more intensive treatments. Additionally, the results of this study suggest that adolescents have dissociative experiences as severe as adults with BPD and reinforce the importance of routinely conducting clinical assessment of dissociative symptoms even in adolescents with BPD who do not report trauma