From Affective Dysregulation to Psychopathology: Neurodevelopmental Disorders and Trauma in Young People at Risk of Serious Mental Illness (SMI)

Abstract

Introduction: Many gaps exist in our understanding of the developmental pathways to SMI. Specifically, although it is now known that SMI’s differ in the timing of their presentation (for example, we know that Borderline Personality disorder (BPD) symptoms peak in late adolescence[i] and schizophrenia in early adulthood. The earliest clinical presentations of youth with mental illness are frequently characterized by a heterogeneous collection of symptoms and symptom patterns. The first presentation of potential SMI is therefore often a complex and undifferentiated clinical phenotype, marked by general psychopathology. These manifestations can be disabling, yet, due to the current focus on adult taxonomy, youth with early symptoms are often missed by services and left untreated[ii] . Even when young people receive “a diagnosis”, that diagnosis frequently changes, emphasizing the importance of studying the evolution of SMI comprehensively, and with attention to the unique needs of young people. Aim: Firstly, too examine the sociodemographic profile and psychiatric history of this group, including their exposure to Adverse Childhood Experiences (ACEs); (2) to explore their profiles of emotional regulation difficulties and borderline personality pathology; (3) to investigate the prevalence of common neurodevelopmental disorders (NDD) (ASD and ADHD); and (4) to determine whether affective dysregulation mediates the relationship between either frequency of ACEs or frequency of NDDs and the severity of borderline pathology among this group. Method: A cross-sectional study of young adults at risk of SMI, currently being seen within NHS mental health services in the UK, was conducted between 2016 and 2018. Young people aged between 15 and 25 years of age, who met criteria for early BPD or psychosis. Results: The majority of participants were female and between the ages of 15 and 20. Parental psychopathology was reported by 64% of participants and close to half (48%) had had a previous psychiatric admission. Nearly three quarters of participants (74%) reported having attempted suicide within their lifetime and 38% reported having deliberately self-harmed in the past 2 weeks. emotional dysregulation, the direct effect of the frequency of ACEs on borderline pathology remained significant, supporting partial atemporal mediation. Emotional dysregulation, the direct effect of the frequency of NDD’s on borderline pathology no longer significant, suggesting that the relationship between the NDD screening result and borderline pathology is fully mediated by emotional dysregulation in this sample. Conclusion: Identifying early features of potential SMI and understanding the common trajectories of adolescents and young adults at risk is a research imperative. Our results indicate this is a group marked by significant social and clinical complexity, with an increased risk of experiencing multiple childhood adversities and a high prevalence of Neurodevelopmental Disorders. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity