Objectives
The aim of the present study was to examine the relation between cyclothymic temperament and borderline personality disorder traits in adolescents and to identify a typology of adolescents based on temperamental traits (cyclothymic temperament and BPD traits).
Participants and methods
A sample of 312 adolescents completed several questionnaires assessing cyclothymic temperament, borderline personality disorder traits, depressive symptoms, suicidal ideation, antisocial behaviors and frequency of cannabis use.
Results
The Cyclothymic-Hypersensitive Temperament (CHT) questionnaire and the Borderline Personality Features Scale for Children (BPFS-C) were highly correlated which suggests that these scales may measure the same construct. Factor analyses of the pooled items of both scales yielded two factors, ‘anger–impulsivity’ and ‘affective instability’, both composed half of items from both scales. The relation between these traits and suicidal ideation was fully mediated by depressive symptomatology. Cluster analysis showed that these traits may occur independently and that adolescents with both traits had the highest levels of depressive symptoms, suicidal ideations and antisocial behaviors.
Discussion
The CHT questionnaire and the BPFS-C may measure the same construct which appeared relevant for defining a subgroup of adolescents with high levels of depressive symptoms, suicidal ideations and antisocial behaviors.
Cyclothymic temperament and borderline personality disorder (BPD) are connected constructs sharing emotional and behavioral dysregulation. Cyclothymic temperament is characterized by high mood-lability, emotional reactivity, irritability and impulsivity (Akiskal, Djenderedjian, Rosenthal, & Khani, 1977). BPD is mainly characterized by a pervasive pattern of instability of affects, identity, behavior and relationships (DSM-IV, 2000). Both constructs share emotional instability, heightened irritability, anger, and impulsivity. These two overlapping constructs have been developed from different approaches in psychopathology. Cyclothymic temperament has been developed as a mild form of and a precursor to bipolar disorder and has been mainly linked to biological and genetic influences (Akiskal et al., 1977). BPD is derived from the psychoanalytic approach and described a personality organization mainly reflecting early negative caregiving experiences (e.g., Kernberg, 1980). Both cyclothymic temperament (Kochman et al., 2001 and Kochman et al., 2005) and BPD (Masterson, 1971) have been extended to adolescents. Cyclothymic temperament has been reported to be common in clinical samples (Kochman et al., 2001 and Kochman et al., 2005), but, to our knowledge, has not been explored in non-clinical adolescents. BPD and borderline personality traits have been reported to be common in both clinical and community samples of adolescents (Chabrol et al., 2001, Chabrol and Leichsenring, 2006 and Tomko et al., 2013).
As in adults, significant overlap between the cyclothymic temperament and BPD has been reported in clinical samples of children and adolescents (Perugi et al., 2003, Perugi et al., 2011 and Zimmerman and Morgan, 2013). Some authors have suggested that cyclothymic disorder and bipolar disorders in adolescents may be misdiagnosed as BPD (e.g. Kochman et al., 2005 and Ruggero et al., 2010). Conversely, others suggest that BPD may be misdiagnosed as bipolar disorders (McClellan & Hamilton, 2006). Moreover, cyclothymic temperament and BPD are both associated to impulsive/risk taking behavior. Kochman et al. (2005) reported that a cyclothymic temperament at baseline predicted not only the bipolar outcome, but also suicidal behaviors in children and adolescents with an index diagnosis of major depressive episode. It has also been highlighted as a risk factor for substance use in adolescents (Unseld et al., 2012). BPD in adolescence increases the risk for suicidality (e.g., Glenn et al., 2013 and Wedig et al., 2012) and a high comorbidity between BPD and substance use disorders has also been found in adolescents (e.g., Chabrol et al., 2005, Distel et al., 2012 and Rizvi et al., 2011). Finally, cyclothymic temperament and BPD are associated to antisocial behaviors in adolescents (e.g., Chanen et al., 2007 and Kovacs and Pollock, 1995).
