Table 1 Staging model for BPD (adapted from [29])
Stage | Borderline features | Co-morbidity | Social and occupational functioning |
|---|---|---|---|
Stage 0 | No classic symptoms of BPD, but latent impairments in self and interpersonal functioning, expressed in problems in mood regulation, attention deficits, frustration and distress tolerance | Either no formal disorders or some areas of mental problems, including ADHD, conduct problems | No extensive problems, but areas of problems, including school functioning or peer contacts |
Stage I | Emerging symptoms of BPD, usually in the areas of affect dysregulation and impulse control | Usually ‘co-morbid’ disorders, including mood, anxiety and conduct disorders | Emerging significant problems in school, peer contacts or relationship between parents and child |
Stage II | First episode of full BPD | Usually co-morbid disorders, often in associated areas of emotion dysregulation (mood disorders, PTSD, substance abuse) | Significant and lasting problems in school, peer contacts and family |
Stage III | Relapse in full BPD or chronic patterns of full BPD | Usually chronic and multiple co-morbid disorders | Usually recurring significant problems in social and occupational functioning |
Stage IV | Full BPD without remission of main problem areas | Usually severe and chronic associated psychopathology | No social or occupational recovery |