The transient paranoia or dissociative symptoms of criterion 9 arise in highly stressful situations. The patient might describe feeling detached from his or her body or “like in a dream” (depersonalization, derealization). In the extreme, this can take the form of brief psychotic-like episodes. Even if absent from diagnostic criteria, splitting deserves to be mentioned, #selleck chemicals llc keyword# as it is widely used by BPD patients, especially teenagers, who tend not to tolerate ambiguity or grey zones. They-or their parents-often note that

they think and act in “all black or all white” way. Many patients (and their parents) also describe themselves as moody and sensitive children.33 A study demonstrated that the antecedents of adolescent personality disorder could be traced to 10 years earlier in the form

of childhood emotional and behavioral problems. Conduct problems were Inhibitors,research,lifescience,medical predictive of all three clusters, as depressive symptoms were associated with cluster B.34 The early temperament differences and early-onset mental state or behavioral problems are confirmed in a later review.22 Oppositional defiant disorder and attention Inhibitors,research,lifescience,medical deficit-hyperactivity disorder are also pointed out as possible predictive factors of BPD in adolescents.35 Management of BPD in adolescents First, one should establish the aims of the intervention, to avoid wearing it down with unrealistic expectations. An important goal should be to improve the psychosocial functioning, and decrease the BPD symptoms, suicide and self-harm being primary targets. Discussing the management of BPD in adolescents implies addressing psychotherapies, pharmacology, hospitalization, and family implication. Inhibitors,research,lifescience,medical Psychotherapy Dialectical behavior therapy (DBT) DBT18,36,37 is an adaptation of cognitive behavioral therapy by Marsha Linehan, who uses the dialectical philosophy in her therapeutic interventions, by flexibly balancing and synthesizing acceptance Inhibitors,research,lifescience,medical and change. It refers to the fact that opposite constructs can

both be true at the same time; “you are doing the best you can at the moment and you need to do better.” The core dialectic in DBT is accepting patients where they are in the moment and working to help them change. The therapy, CYTH4 as initially used with adults, includes weekly individual sessions, skills-training group sessions, phone consultation available at all times with the therapist, and team consultation meetings. The skills taught are mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. There is an important hierarchy of the treatment targets, with life-threatening behaviors being addressed in priority. They are followed by therapy-interfering behaviors and quality-of-life interfering behaviors. This constitutes the first stage of treatment; subsequent stages are described but have not yet been the focus of studies. Miller and colleagues first adapted DBT for use with suicidal adolescents.