TITLE:
Dynamics and Outcomes of Borderline Personality Disorder in Youth: Results of a Comparative Follow-Up Study
AUTHORS:
Aleksei Andreevich Kuleshov, Elena Sergeevna Krylova, Liubov Olegovna Volkova
KEYWORDS:
Borderline Personality Disorder, Youth, Bipolar Disorder, Schizotypal Disorder, Follow-Up Study, Social and Occupational Prognosis
JOURNAL NAME:
Open Journal of Social Sciences,
Vol.14 No.4,
April
30,
2026
ABSTRACT: Objective: The objective of the study is to determine the dynamics of borderline personality disorder (BPD) with onset in youth based on the study of two follow poly-addictiveup groups to assess further nosological trajectories and outcomes. Material and Methods: The study was conducted at the Mental Health Research Center (MHRC) in the Department of Youth Psychiatry. Clinical-psychopathological and psychometric methods were used to examine 143 patients with youth-onset BPD. Two follow-up groups were formed. Group 1 (2019-2022) consisted of 73 patients (67.1% males and 32.9% females; mean age at first presentation was 20 ± 4.2 years) who received inpatient or outpatient care at the clinical departments of the MHRC between 2019 and 2022 with a diagnosis of youth BPD. To assess further dynamics, Group 1 was re-examined in an outpatient setting between 2024 and 2026, with a follow-up duration of 4.5 ± 2.5 years. Group 2 (2006-2010) included 70 patients (61.0% males and 39.0% females; mean age at first presentation was 22 ± 5.5 years) who underwent initial examination between 2006 and 2010 and were re-evaluated between 2021 and 2022, with a follow-up duration of no less than 10 years. Results: BPD in youth represents a clinically heterogeneous pathological construct, within which three types are distinguished based on the dominant core psychopathological feature: “affective storm” (Type I), “addictive adrenalinomania” (Type II), and “cognitive dissociation” (Type III). In the 2019-2022 follow-up group, the stability of the BPD diagnosis was 58.9%, and for the 2006-2010 group, it was 61.43%. In the follow-up study for Type I BPD, a transformation of affective lability into distinct phases meeting the criteria for bipolar disorder (BD) was revealed in 36.4% (p = 0.001) of patients in the 2019-2022 group and 36.8% (p = 0.034) in the 2006-2010 group. The dynamics of Type I BPD were characterized by the compensation of behavioral patterns with the most favorable outcomes for social adaptation. Special attention is warranted for the nosological trajectories in Type III BPD (with a predominance of cognitive dissociation). In a significant portion of these patients across the two follow-up groups (38.5% and 20.8%, respectively), a trajectory toward a schizotypal disorder diagnosis (F21.X) was established (p = 0.002). The observed dynamics indicate a nosological trajectory for Type III BPD where profound identity disturbances and progressive autization act as predictors of the schizotypal continuum. For patients with Type II BPD, the critical factor worsening the prognosis and increasing mortality risk is the addition of poly-addictive disorders. This particular subgroup demonstrates the most severe profile of outcomes, dominated by social maladaptation. A comparative analysis of the two follow-up groups (2006-2010 and 2019-2022) revealed no statistically significant differences (p > 0.05) in the vectors of nosological transformation. Conclusion: The established diagnosis of BPD in youth is confirmed in adulthood in the majority of cases. The study results demonstrate the contemporary pathomorphosis of the disease, confirmed by two independent follow-up groups, showing nosological trajectories toward affective disorders and schizotypal spectrum disorders. The identified typological variants of BPD, with their specific dynamics and outcomes, have high prognostic significance for further research and can serve as a basis for developing personalized socio-rehabilitation measures.