As they tend to have insecure attachment—mainly unresolved, preoccupied, or fearful19—patients with BPD expect other people cannot be trusted and will not be available for support. In a study about diagnostic efficiency of BPD criteria in adolescents compared with adults, the abandonment fears were found to be the best inclusion criteria

for adolescents.24 In this study, patients had an 85% chance of Inhibitors,research,lifescience,medical meeting the full diagnostic criteria when they endorsed the abandonment fears. On a regular basis, we hear these patients tell us that the worst thing that could happen to them would be to be left alone. At its extreme, this symptom can lead young girls to do such things as undressing in front of a Web cam, or agreeing to prostitution in order not to lose their boyfriends. On the other hand, their fear of being abandoned is so great that in some circumstances, they break bonds or ruin their Inhibitors,research,lifescience,medical relationships in anticipation that they might be rejected. The second criterion describes the intense and unstable

relationships characterized by alternating between extremes of idealization and devaluation. Anyone likely to take care of an adolescent with BPD—like a teacher, schoolmate, or a therapist—is very soon of great importance and he or she is being idealized for his or her virtues and capacities. However when the patient unfortunately becomes disappointed, which happens Inhibitors,research,lifescience,medical at some point Inhibitors,research,lifescience,medical given the great

expectations and the extreme sensitivity to feeling of rejection, there is a rapid shift to a devalued position. The third criterion introduces the identity disturbance, a markedly and persistently unstable self-image or sense of self. Their perceptions of themselves, their values, their friends, and even their sexual identity can change dramatically. Questioning Inhibitors,research,lifescience,medical about one’s identity is of course normal in adolescence, but it is the marked and persistent character of the instability that distinguishes normal from pathological. In BPD, confusion and http://www.selleckchem.com/CDK.html changes are out of proportion. Westen et al assessed the potential manifestations of identity disturbance in adolescence, and they concluded that the items most distinctively associated with BPD describe feelings of emptiness, fluctuations in self-perception, and dependency on specific relationships to maintain a sense of identity.25 Criterion 4 concerns self -damaging impulsivity in at least two areas. We can often see these youngsters enough either abuse drugs, drive recklessly, engage in dangerous sexual practices, or have bulimic episodes, for example, but beyond the level of normal experimentation in adolescence. These patients recurrently demonstrate suicidal behavior, gestures, or threats, or self-mutilating behavior (criterion 5). This is often what first brings them to clinical attention, as they are taken to the emergency department for these threats or gestures.