Childhood Sleep and Youth BPD Symptoms

The pursuit of early markers that may predict subsequent risk for borderline personality disorder (BPD) has been an important area for researchers. For example, an early history of loss or emotional or physical abuse has been frequently associated with later development of BPD.

Many BPD symptoms first emerge during adolescence; therefore, exploration of patterns in childhood that may be correlated with borderline symptoms emerging in adolescence may result in useful correlations. One area that has not been significantly examined is sleep cycles and how circadian rhythm irregularities may be associated with mental illness.

Patients with diagnosed BPD often complain of sleep disturbances, such as nightmares, insomnia, or unstable day-night sleep schedules. Such individuals often exhibit patterns of staying up late and sleeping during the day. I have seen patients who insist they have been unable to fall asleep and stay awake for several days at a time. Some have substantiated these claims under observation in an inpatient environment. Often, more severe borderline symptoms were correlated with more disrupted sleep schedules.

Little research has examined how sleep and BPD are associated. Does the development of BPD symptoms, such as anxiety or mood changes, precipitate sleep problems? Or does sleep dysfunction revealed early in life predict the potential for later onset of BPD? Disturbances in circadian rhythm cycles observed early in life may be related to later evolution of psychiatric illness.

A recent, large British study published this month on JAMA Psychiatry Online¹ examined the relationship between infant and childhood sleep patterns and later development of BPD symptoms in adolescence. Children were evaluated over a span of 13 years. The study also examined the relationship between sleep patterns and the expression of psychotic symptoms in adolescence. A total of over 13,000 youths were evaluated. Of these, 6,000 juveniles were evaluated for BPD symptoms.

Youths age 11-13 who reported BPD symptoms had consistently later bedtimes and experienced shorter total sleep duration at ages 3-4 than those without symptoms. (A different correlation was demonstrated for those adolescents, age 12-13, who developed psychotic symptoms; they displayed frequent night awakenings and irregular sleep routines measured at 6 months, 30 months, and 5.8 years.)

These findings may suggest that enforcement of consistent early evening bedtimes and monitoring that ensures adequate sleep in children may be protective against the later expression of BPD. However, if circadian rhythm disorganization is biologically determined, such recommendations may not be easily achievable. Parents may be unable to enforce adequate sleep in young children whose biologically or genetically determined biorhythms are abnormal. Nature and nurture issues must be considered in understanding how sleep patterns are related to mental functioning. Early recognition of irregular sleep patterns in children may presage the need for early, personalized observation or intervention.