Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. C URRENT O PINION Childhood adversity and borderline personality disorder: a focus on adolescence Elizabeth A. Newnham a,b,c and Aleksandar Janca d Purpose of review This article explores recent research in the field of childhood exposure to trauma and the development of borderline personality disorder in adolescence. Recent findings Adolescence is a critical period of development. Exposure to trauma, specifically sexual abuse, prior to and during puberty has specific implications for personality development and heightens risk for borderline personality disorder. Elevated symptom levels in adolescence are likely to decline across adulthood, but social and vocational impairments remain. Impulsivity, difficulties in emotion regulation, and suicidality may characterize adolescent expression of borderline personality disorder, whereas negative affect and functional impairment are more stable features of the disorder. Summary Preliminary findings in treatment models for adults have potential for benefit among adolescence. Further research is required to examine treatment effectiveness and efficiency. Greater attention to low-income and middle-income nations, which are disproportionately affected by adversity, is needed to determine cross- cultural validity and the impact of trauma in adolescent populations. Keywords adolescence, borderline personality disorder, trauma INTRODUCTION A safe environment and healthy interactions in early childhood and adolescence enable not only optimal cognitive and physical development, but also the psychological skills vital to later social and vocational engagement [1]. Millions of children are exposed to trauma each year, and an emerging consensus suggests that childhood trauma and adversity are significant risk factors for the develop- ment of borderline personality disorder (BPD) and related personality traits [2 & ,3,4]. Little is known about the precise role of various exposure types, the timing of traumatic experiences, or the inter- active contributions of genetics and the environ- ment in the development of BPD. A renewed focus on research into BPD in adolescence has focused on life-course development, family environment, and the relative role of genes and neurobiology to pro- vide insights into the complex relationship between early exposure to trauma and maladaptive person- ality traits. This article focuses on recent studies and findings in this area so as to facilitate a more soph- isticated understanding of the relationship between childhood trauma and the emergence of borderline personality traits in adolescence, a period critical to later health outcomes. THE EARLY ENVIRONMENT Child development occurs within a social ecology of family, peers, and community. Secure attachment with a reliable and sensitive caregiver in childhood enables the development of appropriate social behaviors, affect regulation, cognitive flexibility and coherent self-perception [5]. Interruption to a Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, Massachusetts, USA, b Department of Psychiatry, University of Oxford, Oxford, UK, c School of Psychology and d School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Perth, Western Australia, Australia Correspondence to Aleksandar Janca, MD, MSc, FRCPsych, FRANZCP, Winthrop Professor and Head, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Medical Research Foundation Building, 50 Murray Street, Perth, WA 6000, Australia. Tel: +61 8 9224 0293; fax: +61 8 9224 0285; e-mail: aleksandar.janca@uwa.edu.au Curr Opin Psychiatry 2014, 27:68–72 DOI:10.1097/YCO.0000000000000028 www.co-psychiatry.com Volume 27  Number 1  January 2014 REVIEW