Examining the predictive association of irritability with borderline personality disorder in a clinical sample of female adolescents

OBJECTIVES: Borderline personality disorder (BPD) is a disorder associated with emotion dysregulation and is common in clinical samples of adolescents. The identification and delineation of BPD from other disorders is important, yet methods for effectively screening for BPD are lacking. Here, we examine whether irritability can be used as a screening item for BPD in adolescents at risk for the disorder. METHODS: We assessed Diagnostic Interview for Borderline-Revised and Development of Well-Being Assessment scores in a clinical sample of female adolescents ages 12-17 (n = 78) to identify BPD and group cases into 'irritable' and 'non-irritable' mood types, respectively. We then examined the prevalence of irritability and its predictive association with BPD. RESULTS: The prevalence of BPD was 26% (n = 20). There was a significant association between irritable mood and BPD, specifically (χ² (1) = 17.740, p < 0.001). Irritability was endorsed in all (n = 20) BPD cases (sensitivity: 100%), while in non-BPD cases (n = 58), irritability was endorsed in 27 (specificity: 53%; positive predictive value: 0.33; and negative predictive value: 1.0). CONCLUSION: Irritability is a highly sensitive screening item for BPD in adolescents. The absence of irritability in an adolescent may be an important clinical tool to rule out BPD. © 2020 John Wiley & Sons, Ltd.